bluuebunny/crossref_metadata_2025_split huggingface dataset:
Splenic Calcifications in a Patient with Systemic Lupus Erythematosus: A Case Report
Authors: Al Arfaj Abdurhman Saud , Khalil Najma 
Published: February 2025

Abstract
Splenic calcifications are very rarely reported in systemic lupus erythematosus (SLE), a multisystem autoimmune disease. We report a 52-year-old woman having SLE, diagnosed in 1992, with lupus nephritis class IV/V treated with prednisolone, hydroxychloroquine, mycophenolate mofetil, and rituximab. A computed tomography scan of her abdomen and pelvis done in 2019, postdiagnosis of breast carcinoma showed incidental findings of innumerable tiny uniform benign calcifications in the spleen. Follow-up imaging tests of the abdomen and pelvis done until 2024 showed unchanged small scattered calcifications in the spleen. As in our case, splenic calcifications in SLE show a distinctive well-defined pattern of circular dense calcification, which excludes the capsular tissue unlike in other connective tissue diseases, are bigger than the punctate calcifications observed in granulomatous infections and are different in size and imaging appearance from splenic calcified metastases. Our case is one of the few case reports describing the rare feature of characteristic splenic calcifications in SLE.
Diagnostic Delay in Rheumatoid Arthritis Patients: A Multi-centric Study Conducted in Saudi Arabia
Authors: Alanazi Fehaid , Abdulaziz Sultana , Alghanim Khawla , Alhamzi Hanan , Alrayes Hanan 
Published: February 2025

Abstract

Background:
Early referral and treatment during the initial inflammatory stages of rheumatoid arthritis (RA) improve patient outcomes and quality of life. However, patients often delay seeking medical advice, leading to diagnostic delays. Limited data is available on diagnostic delays among RA patients in Saudi Arabia (SA).

Objectives:
This study evaluates the time lag between symptom onset, seeking medical advice, and diagnostic delay in RA patients registered in the Saudi Arthritis Registry (SAR).

Methods:
A retrospective multicenter study was conducted across five hospitals in Saudi Arabia, involving 668 RA patients aged 16 years and above who met the 2010 American College of Rheumatology/European League Against Rheumatism diagnostic criteria. Patients with other rheumatic diseases were excluded. Data on demographics, family history, symptom onset, healthcare visits, and diagnostic delays were extracted from the SAR. Analysis was performed using IBM SPSS version 28.

Results:
Among the 668 patients (569 women, 99 men; female-to-male ratio: 5.7:1), the median age was 43 years, and 59% were employed. Educational levels varied, with 20.36% illiterate, 24.9% with primary education, 25.7% high school, 27.1% bachelor’s, and 1.9% with advanced degrees. Delays in seeking medical advice were observed in 53% of patients (>6 months), 24.7% (3–5 months), and 22.3% (<3 months). Before rheumatology referral, 40.87% were seen by one healthcare provider, 35.48% by two, and 23.65% by three or more providers. General practitioners accounted for 27.1% of referrals. The median diagnostic delay was 16.42 weeks. Significant associations were observed between education, gender, and delays. Patients with higher education (Master’s/PhD) showed the highest prevalence of delay (72.6%, p < 0.001). Female patients tended to seek medical advice earlier (1–5 months, 49%) compared to males (3–11 months, 47.5%, p = 0.012). No significant associations were found between age, family history, and delays in seeking medical advice.

Conclusion:
Delays in seeking medical advice and diagnosis of RA were identified at multiple stages. Female patients sought care earlier than males, while higher educational attainment was paradoxically associated with greater delays. Early referral and timely treatment initiation by rheumatologists are essential to improve RA outcomes in Saudi Arabia.
Perioperative 5-fluorouracil, leucovorin, oxaliplatin, and docetaxel (FLOT) regimen in gastric cancer: Pathological regression grade and its relationship to clinical outcome
Authors: Atci Muhammed M. , Secmeler Saban , Sakin Abdullah , Arici Serdar , Can Orcun , Selvi Oguzhan , Cekin Ruhper , Yasar Nurgul , Geredeli Caglayan , Cihan Sener 
Published: February 2025

Abstract

Background:
We aimed to evaluate the data of perioperative 5-fluorouracil, leucovorin, oxaliplatin, and docetaxel (FLOT) chemotherapy regimen in locally advanced gastric cancer (LAGC) patients with real-life experience.

Methods:
In this retrospective study, LAGC patients who received perioperative FLOT chemotherapy regimen between 2017 and 2020 were included. The patients were grouped according to tumor regression grade (TRG): histopathological responders (complete/moderate response) and histopathological non-responders (minimal/poor response). The factors affecting TRG were evaluated and its relationship to clinical outcome was analyzed by disease-free survival (DFS) and overall survival (OS).

Results:
A total of 141 LAGC patients were included. Median age of patients was 62 (range: 35–75) years of whom 69.5% were men. According to TRG, 41 (29.1%) patients were histopathological responders (College of American Pathologists (CAP)-TRG 0/1). Grade, perineural and lymphovascular invasion, clinical stage, tumor markers (Carcinoembryonic antigen (CEA) and Carbohydrate antigen (CA)19-9), radiological response, and ypTNM stage were statistically significant in univariate analysis and lymphovascular invasion was detected as an independent factor in multivariate analysis for TRG. Grade 3-4 toxicities were observed in only 28 (19.9%) patients. Two years DFS and OS rates were higher in the histopathological responder group (100% and 100%) compared to the histopathological non-responder group (59% and 52.9%) (P = 0.01 and P = 0.02, respectively).

Conclusion:
In our study, it was found that the FLOT regimen had a favorable TRG and a safe toxicity profile in gastric cancer patients. In addition, while lymphovascular invasion could predict TRG, the survival and disease recurrence were positively affected by the favorable TRG response.
Chronic myeloid leukemia during pregnancy complicated by dengue infection and pulmonary embolism
Authors: Wickramasinghe Wasanthi , Weerawardena Anoma , Ranaweera Prabhodhana , Gooneratne Lallindra , Wijeyaratne Chandrika 
Published: February 2025

Abstract
Chronic myeloid leukemia (CML) is a myeloproliferative neoplasm characterized by the rearrangement of long arm of chromosomes 9 and 22, resulting in the Philadelphia chromosome, creating the fusion oncogene BCR–ABL1. Median age of onset of CML is 67 years. However, approximately a third of patients are of reproductive age at diagnosis. CML presenting during pregnancy is extremely rare, and there are no randomized controlled trials to address the optimal management of CML during pregnancy. We report a 38-year-old woman diagnosed with CML during her routine antenatal clinic booking visit, which was further complicated by dengue fever and pulmonary embolism during pregnancy. She was successfully managed by a multidisciplinary team, which resulted in the delivery of a healthy baby boy. This case adds to the literature on CML in pregnancy and reflects the importance of a multidisciplinary team approach when managing complicated patients who require timely rational interventions.
A retrospective analysis of 26 cases of duodenal neuroendocrine tumor treated by endoscopic submucosal dissection
Authors: Li Kehan , Chen Tao , Duan Bensong , Ji Yingjie , Li Jingze , Xu Meidong 
Published: February 2025

Abstract

Background:
Duodenal neuroendocrine tumors (D-NETs) are rare but clinically significant tumors that can occur in various parts of the duodenum, including the duodenal papilla. Endoscopic submucosal dissection (ESD) has emerged as a minimally invasive treatment option for D-NETs, offering potential advantages in terms of tumor removal and postoperative recovery. We aimed to retrospectively analyze the clinical characteristics and prognosis of ESD for D-NETs.

Methods:
A total of 26 cases of duodenal neuroendocrine tumors (27 lesions), including duodenal papillary neuroendocrine tumors, were studied retrospectively.

Results:
A total of 26 patients with D-NETs (27 lesions) were pathologically diagnosed, and 27 lesions were found by chance during endoscopy. The lesions included duodenal bulbar, descending part, and duodenal papilla. Nineteen tumors were <1 cm (70.4%) in diameter, and eight tumors were 1–2 cm (29.6%) in diameter. There were five cases of duodenal papilla NETs. G1: 24 (88.8%) and G2: 3 (11.1%). Endoscopic ultrasonography showed that 27 lesions were confined to the submucosa. One case was a neuroendocrine tumor 2 mm inside a tubular adenoma at the papilla. All operations were performed by senior doctors in the department. The total resection rate was 100%, and the incidence of intraoperative bleeding and perforation was 0. Delayed bleeding and perforation were 0. The shortest operation time was 25 min, and the longest was 70 min. Burning tumor cells at the basal resection margin were noted in 11 lesions, necessitating careful pathological assessment. There were 24 cases of G1 type and 3 cases of G2 type. All 26 patients underwent abdominal CT before operation to confirm the absence of lymph node and distal metastasis. One patient with papillary lesion had positive lesion base resection and was treated with additional operation. Temporary biliary and pancreatic duct stents were placed before or after ESD in all five cases of duodenal papillary lesions, and no biliary and pancreatic complications occurred after surgery. Postoperative follow-up gastroscopy and abdominal CT confirmed no recurrence or metastasis during a follow-up period of 3 months to 4.5 years. There was no recurrence or metastasis during a follow-up period of 3 months to 4 ½ years.

Conclusion:
ESD may be an effective and safe intervention for D-NETs ≤20 mm confined to the mucosa or submucosa of the duodenum, including the papilla. Clinicians should remain vigilant about potential complications during and after surgery. Duodenal ESD treatment NET has high requirements in terms of treatment technology, and clinicians should pay attention to the potential complications of ESD during operation.
High-risk human papillomavirus infection among women with atypical squamous cells of undetermined significance in Pap smear: A seven-year follow-up study in South India
Authors: Kalavathy M.C. , Mathew Aleyamma , Krishna K.M. Jagathnath , Saritha V.N. , Sujathan K. 
Published: February 2025

Abstract

Background:
Well-defined pre-cancerous stages help early detection of uterine cervical cancer by Pap smear or human papillomavirus (HPV) analysis. HPV induces atypical squamous cells of undetermined significance (ASCUS) which can progress to higher grade lesions depending on persistence of infection with High-risk human papillomavirus (HrHPV). The HrHPV prevalence and persistence after 18–36 months, associated risk factors for persistence among women with ASCUS, and the effect of persisting HrHPV in the cytological progression upto a period of seven years are analyzed.

Methods:
In the routine Pap smear clinic of a Women and Children Hospital, women who had ASCUS in Pap smear in 2009–2011 were the sample for the study. A sample of 152 women with ASCUS in Pap smear, were subjected for HrHPV (16, 18, 31, 33 and 42) analysis. These women were invited for a repeat Pap smear and HrHPV analysis after 18 months. Women with HrHPV in both the rounds were advised to come for yearly routine follow-up Pap smear upto seven years.

Results:
The HrHPV prevalence was 46%, HrHPV persistence within 18–36 months was 60.8% and clearance was 39%. Among many risk factors for HrHPV persistence in univariate analysis, having more than two pregnancies and unhealthy appearing cervix were significant in multivariate analysis. 94% of the women with persistent ASCUS or higher lesion within seven years were initially persistent HrHPV positives.

Conclusion:
Since persistence of HrHPV in the cervix at least for 2 years helps in the persistence or progression of ASCUS even after seven years, routine HPV analysis should be done for women with ASCUS cytology, and who have high parity and unhealthy cervix. These women should be closely followed up to identify the progression to higher grade lesions.
Prospective assessment of quality of life in patients with brain metastasis receiving whole brain radiotherapy
Authors: Padhi Sanjukta , Meher Papuji , Pujari Lincoln , Mekap Himanshu Shekhar , Patro Kanhu C. 
Published: February 2025

Abstract

Background:
Palliative whole brain radiotherapy (WBRT) is an important cornerstone for the management of brain metastasis. WBRT alleviates symptoms, aiding in tapering of steroid dose. Thus, the assessment of quality of life (QoL) has become increasingly recognized as an important outcome in patients with brain metastasis. The primary objective of this study was to assess whether there was an improvement in QoL for patients with brain metastasis after radiation therapy and to evaluate the feasibility of application of shorter QoL assessment methods.

Methods:
This prospective observational study included 84 patients treated for brain metastasis. QoL assessments were conducted at baseline and three months after completion of WBRT. QoL assessment was done with EORTC QOL-C15-PAL, EORTC QOL-BN20 module and Barthel index for Activities of Daily Living. Statistical analysis was done using SPSS version 21, paired sample t-tests and Spearman’s correlation.

Results:
The median age was 59 years (range 37–81 years). Statistically significant improvement was seen in Barthel index at three months follow-up. For C-15-PAL and BN20 questionnaires, there was a statistically significant improvement seen in the majority of post therapy QoL scores. Baseline KPS was positively correlated with baseline Barthel index, C-15PAL physical functioning scale and baseline global QoL scale, but it negatively correlated with baseline QLQ-BN20 motor dysfunction scale. Baseline KPS was positively correlated with follow-up QLQ-C15-PAL physical functioning scale.

Conclusion:
Palliative therapy with WBRT for brain metastasis forms an integral support for improved quality of life. Among various assessment tools available, the shorter versions allow for better completion and compliance.
Pattern of distress among cancer patients assessed during new patient counseling: A cross-sectional study
Authors: Balasubramanian Satheesan , Abraham Jisha , Sobhith V K , Malodan Riyas 
Published: February 2025

Abstract

Background:
Distress is an unpleasant emotional feeling of uneasiness, sadness, worry, anger, helplessness, or guilt and is considered as the sixth vital sign of cancer. Understanding and managing distress at an early stage helps the patient to deal with cancer in a better way. The objective of the study is to estimate the pattern of distress among cancer patients assessed during new patient counseling and its association with demographic factors.

Methods:
This is a cross-sectional retrospective study conducted by reviewing the case record forms of patients for a period of 4 months. The study included cancer patients between the age of 18 and 75 who attended new patient counseling and reported a score on the NCCN distress thermometer. Those with incomplete information and history of known psychiatric or neurological disorders were excluded.

Results:
Among the 348 patients, 39.9% had a distress score of 4 or above, which is clinically significant distress. Nearly 75% of them reported that their distress has a psycho-social reason, and 25% reported that distress is due to physical reasons. Analysis of the association of gender and age with clinically significant distress revealed that women and younger age groups had higher distress. In our study, Christians had a higher association with clinically significant distress.

Conclusion:
More than one-third of the patients reported to have clinically significant distress. This emphasizes the key role of distress screening and new patient counseling in an oncology setting. This also stresses the need for a psychotherapeutic approach in managing psycho-social concerns of cancer patients.
Comparative Assessment of Stress and Anxiety among Medical and Nonmedical Undergraduate Students – A Cross-sectional Study
Authors: Mittal Nehal , Tyagi Niharika , Parvaiz Nida , Dhalla Nipun , Asthana Garima 
Published: February 2025

Abstract

Background:
In this increasing world of competition, the levels of stress, anxiety, and depression are increasing proportionately with the work pressures leaving a deep negative impact on the life of an individual. Therefore, this study aims to compare the stress and anxiety levels among medical and nonmedical students.

Methodology:
This cross-sectional study was conducted on 262 subjects aged between 19 and 25 years for a period of 6 months (January 2024 to June 2024). The recruited subjects constituted two groups: Group I of dental students (n = 131) and Group II of engineering students (n = 131). All the participants were made to fill out a Google Forms that consisted of the Work Stress Questionnaire (WSQ) and Hamilton Anxiety Rating Scale (HAM-A) to assess the stress levels. The obtained data were subjected to statistical analysis using SPSS version 24, and P < 0.05 was considered statistically significant with a power of 80%.

Results:
The results concluded that the prevalence of anxiety in medical students was relatively higher in Group I as compared to Group II on the basis of WSQ and HAM-A scales. On the basis of WSQ and HAM-A scales it was concluded that anxiety was relatively higher in Group I as compared to Group II, though the results were not statistically significant . Group 1 displayed mild anxiety in 24.4% of the participants, mild-to-moderate anxiety in 19.1% , moderate-to-severe anxiety in 24.4%, and severe anxiety in 35.9% individuals. These values were comparatively higher as compared to Group II where severe anxiety was found in 33.6% individuals.

Conclusion:
It was concluded that stress and anxiety were present in all the participants of both the groups, though slightly higher in medical students.
Cognitive Impairment amongst Older Adults with Chronic Medical Conditions and Its Association with Medication Adherence in a Nigerian Tertiary Hospital
Authors: Kareem Yesiru Adeyemi , Adesina Ismail Olaiitan , Olajide Abayomi O. , Shuaib Abdulhakeem , Ibrahim A.M. , Ogualili Placidus Nwakuba , Uwakwe Richard 
Published: February 2025

Abstract

Introduction:
Older adults constitute a rapidly growing population whose healthcare needs are unique, with a higher prevalence of physical and psychiatric morbidities. A knowledge gap exists on the association between cognitive impairment and medication adherence in older adults with chronic medical conditions. This study examined the association between cognitive impairment and medication adherence amongst older adults with hypertension, diabetes mellitus and arthritis.

Methods:
A cross-sectional study design was utilised. Three hundred and twenty-seven older adults aged 60 and above were recruited for six months. The socio-clinical pro forma, Community Screening Instrument for Dementia (CSID) and Morisky Medication Adherence Scale-8 were administered. A simple linear regression analysis was done to assess the relationship between medication adherence and cognitive impairment, whereas multiple linear regression was used to control for the effect of confounders on this association.

Results:
This study found a positive correlation between cognitive functioning and medication adherence, this, however, did not reach statistical significance (β =0.055, P = 0.318). The age of participants, number of medications, duration of illness and number of previous hospitalisations were identified as confounders in the effect of cognitive functioning on medication adherence. The model explained 6.3% of the variance in medication adherence. Using the general linear model, cognitive impairment and diagnosis of medical condition independently predicted medication adherence (P = 0.026 and P < 0.001, respectively). However, their interaction did not significantly influence medication adherence (P = 0.311).

Conclusion:
Cognitive impairment is associated with low medication adherence in older adults with chronic medical conditions. This association is affected by age, chronicity and admissions. This underscores the need for proactive screening of older adults in day-to-day geriatric practice.
Эллинистические истоки политической традиции самозванчества и его распространение в России в XVII–XVIII вв.
Authors: Митрофанов А.Ю. 
Published: February 2025

Статья посвящена исследованию феномена распространения самозванчества как серьезного политического явления в России в XVII–XVIII вв. (в преддверии эпохи Екатерины Великой). Автор обнаруживает истоки политической традиции самозванчества в политических традициях эллинистического мира (Лже-Филипп, Лже-Александр II), воспринятых римлянами (Лже-Нероны, фальсификация генеалогии Константина Великого) и повлиявших на византийскую политическую систему (Лже-Феодосий, Лже-Тиберий, Лже-Диогены и т. д.). Делаются выводы о динамике византийского самозванчества и о ее влиянии на развитие феномена в Европе Позднего Средневековья (XIV–XV вв.) (Лже-Иоанн Посмертный во Франции, Лже-Эдуард V в Англии), об интенсивности развития самозванчества в России в период Смутного Времени (Лже-Дмитрии, Лже-Петр) и в последующие десятилетия (Лже-Алексеи Алексеевичи, Лже-Алексеи Петровичи, Лже-Петр Петрович и т. д.), о ключевом значении истории конфликта Императора Петра III и Императрицы Екатерины II для эскалации социального конфликта и реанимирования самозванчества в правление Екатерины II (Пугачев, Лже-Иоанны Антоновичи, княжна Тараканова). Статья открывает собой серию публикаций, посвященных проблемам политической истории России XVIII столетия.
The article is devoted to the study of the phenomenon of the spread of imposture as a serious political phenomenon in Russia in the XVII–XVIII centuries. (on the eve of the era of Catherine the Great). The author discovers the origins of the political tradition of imposture in the political traditions of the Hellenistic world (False Philip, False Alexander II), perceived by the Romans (False Nerons, falsification of the genealogy of Constantine the Great) and influenced the Byzantine political system (False Theodosius, False Tiberius, False Diogenes, etc.). Conclusions are drawn about the dynamics of Byzantine imposture and its influence on the development of the phenomenon in Europe of the Late Middle Ages (XIV–XV centuries) (False John the Posthumous in France, False Edward V in England), on the intensity of the development of imposture in Russia during the Time of Troubles (False Dmitry, False Peter) and in subsequent decades (False Aleksey Alekseevich, False Aleksey Petrovich, False Peter Petrovich, etc.), about the key importance of the history of the conflict between Emperor Peter III and Empress Catherine II for the escalation of social conflict and reanimate imposture during the reign of Catherine II (Pugachev, False Ioanna Antonovich, Princess Tarakanova). The article opens a series of publications devoted to the problems of the political history of Russia in the XVIII century.