bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of the Efficacy of Intradermal Tranexamic Acid and Topical Triple Combination Modification in Decreasing the Severity Score of Melasma: A Meta-analysis
Authors: Indraswari Anindia , Indramaya Diah Mira , Sari Maylita , Utomo Budi , Ervianti Evy , Setyaningrum Trisniartami , Astindari Astindari , Umborowati Menul Ayu 
Published: December 2024

Abstract
Melasma is a symmetrical chronic hypermelanosis that affects the skin of the face, characterised by brownish patches with uneven margins, particularly in areas regularly exposed to sunlight. Although topical triple combination modifications are good first-line therapy for melasma, they have a wide range of negative effects. Consequently, new effective treatments with fewer side effects are required. It has been observed that intradermal tranexamic acid (TA) has low adverse effects and a good therapeutic response in treating melasma. This study aimed to assess the degree of the melasma area and severity index in patients treated with topical triple combination modifications and intradermal tranexamic acid therapy. Electronic databases were searched for relevant articles based on predetermined eligibility requirements. The statistical analysis was conducted using the Review Manager (RevMan) v5.4 software. Randomized controlled trials were used in designing three investigations with a total of 184 patients. After intervention, there was a significant difference in the MASI score between the intradermal tranexamic acid group and the modified topical triple combination group, with a mean difference (MD) of -0.81 (95% CI [-1.05, -0.57]), a combined result of 6.54 with P < 0.00001 and low heterogeneity (I2 = 0%). The intradermal tranexamic acid group also demonstrated a lower MASI score, and the funnel plot revealed no publication bias. This study found that intradermal tranexamic acid is more effective than topical triple combination modifications and has fewer side effects. Therefore, it can serve as an alternative primary therapy option for melasma.
Mesothelial/monocytic incidental cardiac excrescences: An unusual cause for constrictive pericarditis
Authors: Shanmugasundaram Sakthisankari , Sreenivasan Vidyalakshmi , Sukumar Murugan M. , Sivanandam Shanthakumari 
Published: December 2024

ABSTRACT
This case report explores an unusual cause of constrictive pericarditis discovered during histopathological examination. Mesothelial/monocytic incidental cardiac excrescences (MICE) have been reported in association with previous cardiac surgery and ruptures, and are typically found on heart valves or chambers. These excrescences are prone to being misdiagnosed as malignancies based on histopathological analysis. The present case provides a comprehensive examination of a rare instance of cardiac MICE, shedding light on this uncommon entity.
Conjunctival melanoma with conjunctival melanocytic intraepithelial neoplasia in a patient with neurofibromatosis type 1
Authors: Sreelakshmi S. , Divya V. , Goswami Moupia , Walvekar Priyanka V. , Kumar Rekha V. 
Published: December 2024

ABSTRACT
Conjunctival melanomas are rare but aggressive ocular neoplasms, often arising from conjunctival melanocytic intraepithelial neoplasia (C-MIN) or primary acquired melanosis (PAM) with atypia. We report a case of conjunctival melanoma in a 42-year-old man with neurofibromatosis Type 1 (NF1), who developed a pigmented lesion on his left eyelid. Examination revealed diffuse pigmentation of the bulbar conjunctiva and nodular lesions in the lower palpebral conjunctiva and lateral canthus. A biopsy confirmed melanoma and a left orbital exenteration was performed. Histopathology showed melanoma with extensive melanosis, C-MIN and melanoma in situ. Conjunctival melanoma is rare and uncommon in NF1 patients. Hence, awareness of this entity and detailed evaluation and follow-up of a case of PAM are essential, especially in a setting of NF1 to exclude atypia and progression to melanoma.
The pheochromocytoma odyssey: Lives entwined
Authors: Vani D , Shashidhar H.B. , Shameel Mohammed Azm , Nataraju G 
Published: December 2024

ABSTRACT

Background:
Pheochromocytoma is a rare catecholamine-secreting tumour of the adrenal medulla. We present two cases with contrasting outcomes.

Case Presentation:
Case 1: A 40-year-old female presented with acute abdominal pain. Imaging revealed a haemorrhagic cyst in the right suprarenal region. Laboratory tests showed normal plasma metanephrine and low cortisol levels. Histopathological diagnosis of pheochromocytoma was done. The patient made a full recovery following emergency surgery.

Case 2:
A 51-year-old male presented with acute abdomen and shock, elevated plasma metanephrine levels and normal cortisol. Contract computed tomography showed right suprarenal mass. Emergency adrenalectomy was done; the patient succumbed to complications. Histopathology identified the mass as pheochromocytoma.

Conclusion:
These cases highlight the diverse presentations and outcomes of pheochromocytoma, emphasising the need for early diagnosis and appropriate management and intervention to improve patient outcome.
Anaphylaxis Induced Refractory Bronchospasm in “Anticipated Difficult Airway” Situation: Combined Approach of Fibre Optic Laryngoscope Guided Endotracheal Tube Placement via the Nasal Route and Sevoflurane during Rapid Sequence Induction
Authors: Kumar Sanjay , Bhattacharya Amrita , Khuba Sandeep , Gupta Nupur , Kant Rama 
Published: December 2024

Abstract
We wish to report here how we tackled anaphylaxis-induced bronchospasm in an ‘anticipated difficult airway’ situation using a novel combination of established practices. Our patient was morbidly obese and had both predicted difficult mask ventilation as well as predicted difficult intubation in the immediate pre-induction period. He developed bronchospasm, which we attempted to treat as per the established protocols. All of these failed, and we then proceeded to insert a 7-mm endotracheal tube nasally, its tip lying just above the epiglottis (via fibre-optic guidance). Sevoflurane vapours and oxygen were delivered through it, and this gradually relieved the bronchospasm and improved the patient’s oxygenation.
Heavy Slow Resistance Training for Proximal Hamstring Tendinopathy: A Case Report
Authors: Shah Dhairav A. , Lakhani Nirati P. 
Published: December 2024

Abstract

Evidence suggests that not all tendinopathy patients respond solely to eccentric exercises. Systematic reviews on patellar and Achilles tendinopathies indicate positive outcomes with heavy slow resistance training (HSRT). This case report describes a 38-year-old active male with chronic left proximal hamstring tendinopathy (PHT), experiencing pain during squats, and prolonged sitting, running, and lifting objects. Familiar with loaded exercises, he followed an autoregulation progression method of training, using the rate of perceived exertion and repetitions-in-reserve to guide training. Within 3 weeks, his pain reduced from 8/10 to 0.5/10. Over 12 weeks, his performance surpassed pre-injury levels, achieving 100 kg back squats, 160 kg conventional deadlifts, 90 kg Romanian deadlifts, and 100 kg loaded barbell hip thrusts, and progressing from 60 kg back squats. At a 1-year follow-up, no recurrence was reported. Currently, no research exists on HSRT for PHT in India. Systematic reviews suggest that load intensity, rather than contraction type, maybe the key stimulus for muscle–tendon recruitment.
Is the Future Green? Assessing Environmental Health Confidence in Internal Medicine Residents
Authors: Chambers Jessica Y. , Rippon Jillian , Ahle Daniel , Le Xavier , Miller Beth , Moreno Alejandro 
Published: December 2024

Background Despite global awareness of the impacts of climate change on human health, assessment of resident physicians’ confidence in environmental health is limited. Lack of confidence in explaining environmental health topics can affect both patient education and advocacy efforts.
Objective To determine how confident resident physicians are in their environmental health training and their ability to explain climate health topics.
Methods An online survey was distributed to internal medicine residents at a large university-affiliated program in 2023. Self-perceived confidence levels in explaining various environmental health topics to a peer were measured using a Likert scale (from 1=not confident at all, to 5=completely confident) and a subsequent rank-order analysis of the response means.
Results The response rate was 56% (62 out of 110 residents). A mean confidence score of 2.22 was reported on all topics, with hazardous waste (m=1.73), endocrine disruptors (m=1.76), water quality (m=1.9), toxicology (m=2.02), and environmental justice (m=2.04) representing lowest scores. Highest mean scores were reported in food security (m=2.71) and emerging infectious disease (m=2.92). Twenty-seven of 62 (44%) residents reported no confidence at all in their ability to discuss environmental justice concepts, with 17 of 62 (27%) reporting slight confidence in doing so.
Conclusions Physician trainees report low confidence levels regarding their ability to explain multiple environmental topics to their peers. Forty-four of 62 (71%) residents report either no or slight confidence in their ability to explain environmental justice to a colleague.
A Graduate Medical Education Fellowship in Climate Change and Human Health: Experience and Outcomes From the First 5 Years
Authors: Dresser Caleb , Wiskel Tess , Giudice Catharina , Humphrey Kimberly , Storr Latoya , Balsari Satchit 
Published: December 2024

Background Climate change is affecting health and health care, but most physicians lack formal training on climate change. There is a need for graduate medical education (GME) programs that prepare physician leaders to address its health impacts.
Objective To describe the development and iterative piloting of a GME fellowship in climate change and health and to assess fellows’ academic output and public engagement before and after fellowship matriculation.
Methods A GME training program was developed and implemented at an emergency medicine department in a US teaching hospital in collaboration with affiliated academic centers. Participants consisted of emergency physicians from the United States and abroad. Program duration and format were adjusted to meet individual career goals. Outcomes assessed include program completion, postgraduation professional roles, and academic outputs and public engagement before and after fellowship matriculation (2019-2023), compared via paired t tests.
Results Five fellows have matriculated; 2 have graduated, while 3 remain in training. Costs and in-kind support include salaries, faculty time, research support, travel to conferences, and tuition for a public health degree. Fellows averaged 0.26 outputs per month before matriculation (95% CI 0.01-0.51) and 2.13 outputs per month following matriculation (95% CI 0.77-3.50); this difference was significant via 2-tailed t test (alpha=.05, P=.01). Subanalyses of academic output and public engagement reveal similar increases. Following matriculation, 186 of 191 (97.4%) of outputs were related to climate change.
Conclusions For the 5 fellows that have enrolled in this GME climate change fellowship, academic and public engagement output rates increased following fellowship matriculation.
Teaching Climate and Health in Preventive Medicine Residency Programs: A Survey of Program Directors
Authors: Passannante Marian R. , Shahani Shaun , Gochfeld Michael , Purcell Wendy M. , Savul Sajjad A. , Thomas Pauline 
Published: December 2024

Background Climate change and related pollution and environmental damage are an urgent focus for public health physicians. Curricular content is increasing in medical schools, but to date, only pediatrics has published guidance for residency education.
Objective To survey program directors of Accreditation Council for Graduate Medical Education preventive medicine specialties (public health and preventive medicine [PHPM], occupational and environmental medicine [OEM], and aerospace medicine [AM]) for current teaching on climate and health issues.
Methods Links to an online 9-question confidential survey were sent to all program directors through Listservs January through March 2024. Questions were developed with guidance from a climate health expert. Responses were analyzed via summary statistics for continuous data, as well as Fisher’s Exact, Kruskal-Wallis, and Wilcoxon pairwise comparison tests for nominal data.
Results Thirty-five of 71 programs responded (49.3%), including 21 of 42 PHPM, 12 of 23 OEM, and 2 of 6 AM programs. Two (5.9%) reported having a formal curriculum for climate and health issues, and 2 (5.9%) reported not covering any included topics. Programs differed by topic emphasis with OEM and AM more likely to address fire, smoke, wind, and flooding effects. Lectures and local or state health department rotations were the most frequent teaching strategies. Of complete responders, 23 of 34 (67.6%) expressed interest in joining a workgroup to develop shared curricula.
Conclusions This survey of preventive medicine residency programs found that most include climate and health topics, but only 2 have a formal curriculum, and 2 reported no topics included in the survey.
“It’s Kind of a Rite of Passage”: An Exploration Into Residents’ Experience of Learning in a Critical Care Setting
Authors: Kopstick Avi J. , Sanders Benjamin W. , Felmet Kathryn , Yarris Lalena M. , Phromsivarak Kelly Serena 
Published: December 2024

Background Many trainees complete rotations in intensive care units (ICUs), but little is known about how ICU rotations impact learners. Understanding residents’ experiences in ICU rotations is a crucial step toward improving resident education and understanding the consequences, intended and unintended, of critical care learning.
Objective We performed a qualitative study to understand how pediatric and emergency medicine residents experience a pediatric ICU (PICU) rotation.
Methods For this phenomenological study, we explored residents’ experiences with critical care learning by focusing on the high-stakes, emotionally charged PICU environment. Semistructured interviews were conducted with 12 residents after their first PICU rotation from July 2019 through March 2020. Data were analyzed through line-by-line coding, serial discussions, and consensus meetings. Finally, emergent themes and convergent narratives were constructed around the resident PICU experience.
Results Residents perceived the PICU as a challenging environment for independent, self-driven, and active learning. They suffered adverse psychological effects, leading some to “give up” and many to experience feelings consistent with acute traumatic stress. Despite these challenges, residents described their PICU rotation as a “rite of passage” and reported increased comfort with caring for “sick kids.”
Conclusions Residents describe their PICU rotations as intense experiences that result in increased physician comfort. However, they also endure psychologically traumatic experiences that may hinder them, and the independent practitioners they become, from caring for certain types of patients in the future.
Characteristics of ADHD in Struggling Residents and Fellows
Authors: Warburton Karen M. , Yost Joanna S. , Bajo Stephanie D. , Martindale James R. , Parsons Andrew S. , Ryan Michael S. 
Published: December 2024

Background Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental condition that often results in poor academic performance. Little is known about how ADHD manifests in residents and fellows.
Objective To describe the prevalence and phenotype of ADHD among residents and fellows referred to a centralized remediation program.
Methods We conducted a retrospective review of data obtained from referrals to a single-center centralized graduate medical education remediation program from 2017 to 2023. Data included demographic variables, ADHD and mental health history, and training performance characteristics. ADHD was determined by self-report, clinical diagnosis by mental health provider, or neuropsychological testing.
Results A total of 173 trainees were referred in the study period. The prevalence of ADHD was 20% (35 of 173). ADHD was most commonly diagnosed in childhood (57%, 20 of 35); however, 26% (9 of 35) were diagnosed during or after medical school. Only 37% (13 of 35) were on medication, and 69% (24 of 35) disclosed at least one concomitant mental health diagnosis. Performance deficits were common in professionalism (69%, 24 of 35), organization/efficiency (O/E; 63%, 22 of 35), and medical knowledge (46%, 16 of 35). Repeated errors in patient care were made by 34% (12 of 35); 29% (10 of 35) failed at least one board examination, and 20% (7 of 35) required extension of residency or fellowship training. When compared to referrals without ADHD, residents and fellows with ADHD were more likely to struggle with O/E, failure to engage, and repeated errors.
Conclusions One in 5 trainees referred to a GME remediation program had ADHD, and most were not being treated for ADHD when referred. The deficits identified suggest an ADHD phenotype in GME which may be considered for struggling residents and fellows.
Epidemiological Profile, Predominant Morbidity Among Veterans and Military Retirees: retrospective analysis of case series from 1969 to 2022
Authors: Muajima Jean Baptiste , Kapour Germain , Mukengeshay Twende Patrick , Ghoma Linguiss Laure Stella , Nkoko Bompangue Didier 
Published: December 2024

Context and objective. Increasing morbidity among veterans is a major public health concern in low-income countries. This specific group often receives less attention. This study aimed to describe the distribution of the most common diseases among veterans and military retirees in Kinshasa and identify factors associated with the predominant pathology in this group. Methods. A cross-sectional analytical study was conducted on veterans and military retirees in Kinshasa. Data were collected through a documentary review and analyzed using RStudio software. Results. Five pathologies were predominant among veterans and military retirees: hypertension, heart disease, diabetes mellitus, stroke, and malaria. Related diseases were also identified, including hypertension associated with diabetes mellitus, stroke associated with diabetes mellitus, sepsis associated with Buruli ulcer, and heart disease associated with hypertension. The sole factor significantly associated with hypertension in these individuals was the military rank: Subaltern officer (aOR = 0.290, 95% CI [0.117-0.720], p = 0.008); Non-commissioned officers (aOR = 0.186, 95% CI [0.098-0.356], p < 0.001); Senior officers (aOR = 0.246, 95% CI [0.079-0.758], p = 0.015). Conclusion. The present study provides valuable information on the health status of veterans and military retirees, contributing to a better understanding of their healthcare needs.
Received: December 13th, 2023
Accepted: July 16th, 2024
https://dx.doi.org/10.4314/aamed.v17i4.10
Determinants of Intention to Use Buy Now Pay Later (BNPL)
Authors: Hoo Wong Chee , Khee Khor Hooi , Wolor Christian Wiradendi , Teck Tan Seng , Toh Jason See 
Published: December 2024

Objectives: Buy Now, Pay Later (BNPL) is categorized as a fintech service. It is a type of short-term installment plan, the fintech companies integrate the lending installment plan as one of the payment options in online shops. The payment scheme allows consumers to pay the total amount in installment mode without interest charge over a short period of time, usually within a few months. The main aim of this research is to examine the factors that influence the intention to use BNPL services in Malaysia.

Theoretical Framework: The study utilizing the Unified Theory of Acceptance and Use of Technology (UTAUT) theories as the underlying theoretical framework.

Method: A quantitative approach was used in this study. A statistical software tool, SPSS, is used to analyze the data that was collected from 384 respondents through the online survey questionnaires.

Results and Discussions: The finding of this study shows that materialism, social influence and user-friendliness significantly positively influence the intention to use BNPL. While trust is not significantly influencing the intention to use BNPL.

Research Implication: The research offers understanding in consumer behavior, informing regulatory frameworks and enhancing BNPL service offerings.

Originality/Value: This study's novelty lies in examining BNPL adoption determinants specifically within the Malaysian context where social influence played the most important part for the adoption of BNPL.
Beyond Chains: Re-examining Identity and Resilience in “12 Years A Slave” for SDGs in Education and Social Justice
Authors: Aprilia Fitria , Neisya  , Mutmainnah  
Published: December 2024

Objective: This study aims to examine the portrayal of power dynamics and social hierarchies in 12 Years a Slave, with a particular focus on the narrative’s representation of the superior-inferior dichotomy between Whites and Blacks within the context of slavery. By exploring the novel's fluid and multifaceted meanings, this research contributes to the Sustainable Development Goals (SDG), particularly in advancing justice, equality, and social education.

Theoretical Framework: This analysis is grounded in deconstruction, a critical approach that seeks to unpack and challenge inherent assumptions, hierarchies, and meanings within texts. By applying deconstruction to 12 Years a Slave, the study highlights shifting interpretations of characters' identities and roles, as well as the broader implications of slavery as a socio-political system.

Method: A qualitative deconstructive approach is used to analyze character roles, relationships, and social positioning in the novel. Through this lens, the study seeks to uncover how multiple interpretations and meanings emerge, challenging fixed readings of slavery's representation and its socio-cultural impact.

Results and Discussion: Findings reveal a prominent depiction of racial power dynamics, emphasizing a rigid division between superior Whites and subordinate Blacks. However, the novel’s narrative complexity allows for multiple interpretations, reflecting nuanced representations of power, identity, and resistance. This analysis underscores the novel’s challenge to definitive interpretations, revealing the evolving meanings of slavery and justice.

Research Implications: This study contributes to both literary and social education by highlighting the importance of deconstructive analysis in examining racial hierarchies and the legacy of slavery, aligning with SDG goals for social justice and equality. The findings emphasize the role of critical thinking and open-ended analysis in literary studies, offering insights valuable for educational contexts focused on history, race, and power dynamics.

Originality/Value: By applying deconstruction to 12 Years a Slave, this study provides original insights into the novel's portrayal of slavery, power, and identity, contributing to the ongoing discourse on racial justice and historical memory in literature. The research enhances understanding of the social implications of slavery, adding value to literature’s role in addressing SDG objectives related to educational social justice and equality.