bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of Vitamin D Supplementation in Disease Activity, Activity-Related Markers, Inflammatory Marker and Serum Calcium of Systemic Lupus Erythematosus Patiens: A Systematic Review and Meta-Analysis
Authors: Kambayana G , Sindhughosa Dwijo Anargha , Kurniari Pande Ketut , Gotera Wira , Kandarini Yenny 
Published: August 2021

Background: Effect of additional supplementation of vitamin D toward Systemic lupus erythematosus (SLE) disease activity still differ in results obtained between studies being conducted. The current meta-analysis systematically analyzed the effect of vitamin D supplementation on SLE disease activity with updated literature, also its effect toward other parameters.
Material and Methods: Relevant literatures were obtained from PubMed database and Google Scholar. The obtained studies were analyzed using fixed effect model or random effect model.
Results: Five eligible studies with a total of 318 participants were included. Vitamin D supplementation did not affect the total SLEDAI score in SLE patients with pooled mean difference of -0.96 (p =0.09; 95% CI: -2.06 to 0.14). Serum vitamin D level increased after administration of vitamin D with pooled mean difference of 12.67 (p =0.001; 95% CI: 5.04 to 20.29). vitamin D supplementation increase serum calcium levels, with pooled difference of 0.07 (p = 0.006; 95% CI: 0.02 to 0.12). Pooled results from two studies obtained vitamin D supplementation did not affect ESR, C3 and C4.
Conclusions: Current meta-analysis obtained no significant changes in SLEDAI scores due to vitamin D supplementation. In contrast, serum vitamin D and serum calcium levels were increased.
Fournier gangrene, use of negative pressure wound therapy
Authors: Mirón Fernández I , León Díaz FJ , Pérez Reyes M , Santoyo Santoyo J 
Published: August 2021

Resumen

Los sistemas de terapia con presión negativa (TPN) han demostrado su eficacia en el manejo del cierre temporal del abdomen en casos de trauma grave, síndrome compartimental y sepsis. En la práctica clínica también se aplica su uso en el proceso de curación de heridas con gran carga infecciosa para acelerar su curación disminuyendo el débito del exudado. La gangrena perineal se define como una fulminante y progresiva infección de la región perineal, y/o genital. Su importancia radica en la elevada mortalidad que alcanza entre un 3 a 67%. Exponemos un caso de uso de la TPN en un paciente con una gangrena de Fournier.

Varón 65 años, hipertenso, diabético. Consulta por dolor anal y fiebre. A la exploración defecto a las 11h en posición de litotomía con drenaje espontáneo de absceso, importante celulitis y empastamiento. Se explora bajo anestesia encontrando celulitis perianal con necrosis extendida por ambas fosas isquiorectales, se realiza necrosectomía de toda la circunferencia anal (Figura 1). Tras varias curas, se confecciona colostomía temporal dada la severa afectación esfinteriana y la colocación de sistema de TPN (Figura 2). Se realizan varias curas con TPN acelerando la resolución de la infección. Tras 44 días de ingreso, el paciente es dado de alta pendiente de reconstrucción del tránsito.
Value Co-Creation and Co-Destruction in Online Education during the Covid19 Pandemic: Special reference to Sri Lankan State Sector Universities
Authors: Karunathilake R. L. P. , Galdolage B. S. 
Published: August 2021

Covid-19 pandemic hit all aspects of individuals’ lives in the whole globe including Sri Lanka and made mega changes in every person’s day-to-day life. People had to limit travelling, thus services which used to provide at physical interfaces with direct face-to-face interactions had to search new options in delivering their services. Education sector, including higher education in Sri Lanka had to move from on-campus classroom-based teaching to new modes of delivering academic programs via remote basis. This new normal is challenging for both the academics and the students due to lack of experience and unequal distribution of facilities which inhibit equal value creation in education. Since this phenomenon is new, scholarly attention has not been received adequately. Therefore, this study aims to explore the value co-creation and co-destruction in online education in state sector universities in Sri Lanka. The primary data were collected via semi-structured interviews from fifty university undergraduates representing different universities and geographic locations in Sri Lanka. They were encouraged to freely talk about their experience in online education. The study found nine key factors and re-classified them into four main themes as ‘resources availability, commitment, interaction, and personal and domestic conditions’ which bring value co-creation to some respondents while the same would destroy the value for some other students in gaining education. The findings would be helpful to the government, policy makers, academics, and students to enhance the collaborative value creation in distance education.
Early experience with surgical strategies aimed at preserving the pulmonary valve and annulus during repair of tetralogy of Fallot
Authors: Dharmapuram Anil Kumar , Ramadoss Nagarajan , Goutami Vejendla , Verma Sudeep , Pande Shantanu , Devalaraja Sindhura 
Published: August 2021

Background :
During repair of tetralogy of fallot (TOF) we modified surgical strategies to preserve the valve and annulus if the pulmonary valve leaflets are pliable and not significantly dysplastic.

Methods :
Initially, the repair was done from the main pulmonary artery (Group-1, 215 patients) and later through an additional incision in the infundibulum of the right ventricle (Group-2, 73 patients). Recently, we changed the approach to commissurotomy of the fused leaflets by releasing the supra valvar tethering and delamination of the cuspal apparatus till the base to improve the mobility of the cusps and do a controlled commissurotomy (Group-3, 14 patients). With delamination, we could extend the limit of the repair to a z-score of –3.5.

Results :
There was no hospital mortality; two patients died at home after discharge. A mean follow-up of 42.01 months ± 19.25 is available for 198 patients (92%) for group 1, 16.03 ± 7.45 for group 2, and 4.07 ± 2.09 for group 3. The re-intervention-free survival is 94.4% in group 1. The z value improved from -3 (-3–-2) to -1.2 (-3 – 0), P = 0.001 in Group 1, from -2.8 (-3–-2.4) to -1 (-1.1–-0.7), P = 0.001 in Group 2 and from –3 (-4–-3) to -1, P = 0.001 in Group 3. In all the groups, there was trivial or mild pulmonary regurgitation.

Conclusions :
During repair of TOF, adequate valve/annulus sparing is possible if the repair is done from both the main pulmonary artery and infundibular incisions using the delamination technique.
Hemodynamic rounds
Authors: Sivakumar Kothandam , Mohakud Ashish Ranjan 
Published: August 2021

ABSTRACT
Segmental pulmonary arterial hypertension occurs when the right and left pulmonary arteries are nonconfluent and receive blood supply from different sources. High blood pressure confined to limited lung segments may accelerate progression of pulmonary vascular resistance. Calculation of segmental vascular resistance and assessment of operability in such situations are done after integrating catheter hemodynamics, magnetic resonance imaging techniques, or perfusion scintigraphy. When an isolated pulmonary artery perfused by a restrictive ipsilateral arterial duct is associated with a large nonrestrictive contralateral arterial duct connected to the other pulmonary artery, leading to unilateral pulmonary arterial hypertension and features of high vascular resistance, it offers unique challenges to decision-making.
Prevalence of thyroid disorders in type 2 diabetic patients – A 1-year cross-sectional study
Authors: Mudhol Rikita Ramesh , Turamari Shivakumar Veeranna , Mudhol Rekha Ramesh , Srinivas B. 
Published: August 2021

BACKGROUND:
Diabetes is one of the commonest health problem and has become a major health challenge worldwide. There is evidence from the literature suggesting that the intricate bond between Thyroid disorder and diabetes mellitus deceivingly contributes to micro and macro-vascular complications.

OBJECTIVE:
This study is being undertaken to determine an association between prevalence of thyroid disorders in Type 2 diabetic patients.

MATERIAL AND METHODS:
A hospital based prospective cross sectional study was carried out in the department of Medicine, at a tertiary care hospital in Belgaum. The study included 100 Type 2 diabetic patients who were interviewed for demographic details, duration of diabetes and history of other comorbid conditions. The patients were subjected to clinical examination and were investigated for fasting blood sugars, post prandial blood sugars, glycosylated haemoglobin (HbA1C), free triiodothyronine (T3), free thyroxine (T4) and thyroid-stimulating hormone (TSH). Data was analysed using SPSS statistical software version 20.0.

RESULTS:
The prevalence of thyroid disorder in type 2 diabetic patients was 35%. Of them 16% had subclinical hypothyroidism. The males outnumbered the females in the study and 22% of the males had thyroid disorder (P = 0.8390). Subjects in the age group of 61 to 70 years, prevalence was higher as compared to other groups (P = 0.0569). There was an increased risk of thyroid dysfunction in long standing type 2 diabetics (P = 0.0240). The prevalence was higher in patients with poor glycemic control, though the findings were not statistically significant (P = 0.1021).

CONCLUSION:
Thyroid Dysfunction is widely prevalent in patients with type 2 diabetes in our study. Hence it is prudent to screen routinely for Thyroid dysfunction in type 2 Diabetic patients, which will help in improving the quality of life and reduce the mortality rate.
Comparative Evaluation of Potassium Hydroxide Mount, Fungal Culture, and Histopathology of Nail Clipping with Periodic Acid–Schiff Stain in the Diagnosis of Onychomycosis
Authors: Gautam Manjyot , Shah Nidhi , Bhattar Prachi , Nadkarni Nitin , Patil Sharmila 
Published: August 2021

Context:
Onychomycosis (OM) is a commonly encountered problem in clinical practice, which needs to be differentiated from other causes of dystrophic nails as its treatment is long-term and may have potential side effects. Routinely used laboratory tests like direct microscopy with potassium hydroxide (KOH) and fungal culture (FC) show inconsistent sensitivity. Hence, newer methods of diagnosis are required.

Aim:
This study aims to compare the efficacy of KOH mount, fungal culture, and histopathology of nail clippings with periodic acid–Schiff stain for the diagnosis of onychomycosis.

Settings and Design:
This was a cross-sectional study conducted in the Dermatology Outpatient Department of a tertiary care center in Navi Mumbai from September 2013 to September 2014.

Subjects and Methods:
A total of 102 patients with clinically suspected OM were included in the study and evaluated for the following three methods: KOH mount, FC, and HP/PAS stain. To determine the efficacy and performance characteristics of each test, FC was chosen as the gold standard for statistical analysis.

Statistical Analysis Used:
Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for each test. Association among the study group was assessed with the help of Chi-square test.

Results:
Of the 102 patients, direct microscopy with KOH mount was positive in 47, FC in 30, and HP/PAS in 71 patients. Ninety-one out of the 102 patients had at least one of the three diagnostic tests positive. Using this as the denominator, KOH mount, culture, and HP/PAS had sensitivities of 51.64%, 32.96%, and 78.02%, respectively. Diagnostic sensitivity increased to 89.38% when both KOH and HP/PAS were combined. For calculation of specificity of KOH and HP/PAS, we used FC as the gold standard because it gives precise identification of the pathogen. Specificity for KOH and HP/PAS was 59.7% and 34.7%, respectively. It increased to 73.7% if both KOH and HP/PAS were positive.

Conclusion:
Using PAS on nail scraping can yield higher diagnostic sensitivity with no loss of specificity and hence can be considered as the method of choice for the diagnosis of OM. Accuracy of diagnosis can be increased by combining the two tests (KOH and HP/PAS) instead of one test (HP/PAS).
Minimally invasive techniques as a first line approach in the management of emphysematous pyelonephritis - A single centre experience
Authors: Gite VA , Shaw V , Agrawal M , Sankapal P , Maheshwari M 
Published: August 2021

Context:
Emphysematous pyelonephritis (EPN) is a dangerous necrotizing infection of the kidney involving the diabetics with a high case fatality rate. Recent medical literature has shown shifting of treatment strategy from conventional radical approach to minimally invasive approach.

Aims:
The aim of our study was to assess the role of minimally invasive stepwise decompression techniques in the management of EPN and preservation of the renal unit.

Settings and Design:
This was a retrospective observational study conducted from June 2017 to April 2020 at a tertiary care centre.

Material and Methods:
We reviewed the hospital online records of 18 patients diagnosed with EPN for patient demographics, clinical profiles, co-morbidities, laboratory and, radiological investigations, surgical interventions performed and the outcomes. The severity of EPN was graded as per the Huang classification. Patients underwent surgical interventions as per the treatment protocol and response was assessed.

Statistical Analysis Used:
Descriptive statistics was applied.

Results:
Diabetes mellitus was present in 15 (83.3%) patients along with urinary tract obstruction in 8 (44.4%) patients. Flank pain (77.7%) was the most common presenting clinical feature while Escherichia coli (55.5%) were the most common causative organism. Most patients (50%) had Type- II EPN, all of which were managed successfully by minimally invasive procedures. In total seventeen patients (94.4%) responded well while one patient (5.5%) underwent nephrectomy with no mortality.

Conclusions:
Renal salvage in EPN requires multidisciplinary approach including the initial medical management followed by properly selected stepwise decompressive surgical techniques. Conservative management and decompression techniques have shown to improve patient's outcome, reducing the traditional morbidity associated with nephrectomy.
Magnetic resonance enterography and bowel ultrasonography in Saudi Arabian patients with Crohn's disease
Authors: Ahmad Rani , Abduljabbar Ahmed , Wazzan Mohammad , Thabit Rawan , Mosli Mahmoud , Saadah Omar I. 
Published: August 2021

Background:
Crohn's disease (CD) is a complex autoimmune disease that results in chronic inflammation of the gastrointestinal tract. CD activity is determined through clinical, laboratory, endoscopic, and radiological evaluations. Studies that examine the data of radiological modalities of evaluation are lacking, particularly in Saudi Arabia. This study compares magnetic resonance enterography (MRE) and ultrasonography (US) findings among patients diagnosed with CD, to uncover a possible correlation between these techniques.

Methods:
All patients were assessed for disease activity using MRE and US.

Results:
A total of 376 patients with CD were recruited. The mean age was 14.9 ± 4.3 years (range, 8–27 years), and males constituted 64% (n = 239) of the cohort. Overall, a strong positive correlation was found between US and MRE evaluations of disease activity (r = 0.83, P < 0.001). US activity correlated positively with MRE findings of enlarged lymph nodes (P < 0.001), bowel wall enhancement (P < 0.001), distal jejunal thickness (P < 0.001), and distal ileal thickness (P < 0.001). The mean difference in wall thickness was significant based on gender (P < 0.001), age in proximal jejunal thickness (P < 0.001), and distal ileal thickness (P = 0.011).

Conclusions:
MRE and US correlate significantly as imaging techniques for the assessment of CD activity.
Automated grating contrast-sensitivity
Authors: Mahayana Indra Tri , Sakti Dhimas Hari , Gani Tatang Talka 
Published: August 2021

PURPOSE:
Residual visual loss is an important predictor of optic neuritis relapse and progression. This study aimed to investigate the hidden residual visual loss in patients with optic neuritis using automated contrast-sensitivity (CS) function testing.

MATERIALS AND METHODS:
This cross-sectional study investigated 29 recovered optic neuritis patients (age: 27.69 ± 13.32 years, range: 13–51). Twenty age-matched controls with normal visual acuity (VA, in LogMAR) were recruited, for comparison with patients' VA and CS function after stable recovery from optic neuritis (6 months of follow-up). CS tests used a novel software that displays a single set of Gabor patches (2 cycles per degree at 10° ×10° of visual angle) with contrasts grating from 100% to 0.1%.

RESULTS:
There were 13 adolescent patients (63.6%: retrobulbar neuritis [RN]; 36.4%: papillitis), 14 adult patients (50%: RN; 42.9%: papillitis), and only 2 older patients (all with neuroretinitis). There was improvement of VA in the patient group at first diagnosis and follow-up (VA initial vs. final: 1.438 ± 1.134 vs. 0.235 ± 0.272, P < 0.001). This VA improvement was similar to control group (P = 0.052). In CS, there were significant differences in patient versus control groups (69.069% ± 70.235% vs. 27.215% ± 25.27%, P = 0.025). Linear regression showed that initial VA and CS function could not predict final VA (P = 0.183 and P = 0.138, respectively).

CONCLUSIONS:
Patients with optic neuritis showed decreased CS compared to control group which indicated the residual visual loss. Automated CS testing is useful in detecting residual visual loss in patients who recovered from optic neuritis.
Pinning of interfaces in a random medium with zero mean
Authors: Dondl Patrick W. , Jesenko Martin , Scheutzow Michael 
Published: August 2021

We consider two related models for the propagation of a curvature sensitive interface in a time independent random medium. In both cases we suppose that the medium contains obstacles that act on the propagation of the interface with an inhibitory or an acceleratory force. We show that the interface remains bounded for all times even when a small constant external driving force is applied. This phenomenon has already been known when only inhibitory obstacles are present. In this work we extend this result to the case of – for example – a random medium of random zero mean forcing.
The first model we study is discrete with a random forcing on each lattice site. In this case we construct a supersolution employing a local path optimization procedure. In the second, continuous, model we consider a random heterogenous medium consisting of localized small obstacles of random sign. To construct a stationary supersolution here, we need to pass through sufficiently many blocking obstacles while avoiding any obstacles of the other sign. This is done by employing a custom percolation argument.
Perception of Risk for Lassa Fever among Residents of a Rural Community in Edo State, Nigeria
Authors: Alenoghena I , Omuemu V 
Published: August 2021

Background: The prevention and control of Lassa fever depends on the adoption of appropriate behavioural practices. The expected changes are best explained using the Health Belief Model. The study investigated respondents’ perception of their risk for Lassa fever infection and its associated factors in Akhalowa community of Edo State.
Methods: This cross-sectional study was conducted among eligible heads of households using a structured interviewer-administered questionnaire. Data were analyzed using descriptive and inferential statistics on IBM SPSS version 22.0. A p-value < 0.05 at 95% confidence interval was considered statistically significant.
Results: The participants included 220 respondents with mean age (SD) of 37.9 (13.2) years. There were 127 (57.7%) females and 143 (65.0%) respondents had at least secondary education. One hundred and ninety one (86.8%) of them were aware of Lassa fever, out of which 146 (76.4%) had overall good perception of their risk for the disease and 144 (75.4%) agreed that Lassa fever was a problem in the community. One hundred and seventy seven (92.7%) agreed that complying with preventive measures would protect them against Lassa fever. Respondents’ good knowledge of Lassa fever was the only significant predictor of good perception of risk for Lassa fever [Odds Ratio=3.806; 95 CI = 1.498-9.672, p=0.005].
Conclusion: The study revealed overall good perception of risk for Lassa fever among the respondents. It is therefore recommended that this is sustained through continuous risk communication messages on the prevention and control of Lassa fever to the people by the Edo State and local governments.
Knowledge and Practice of Malaria Control Measures among Women Attending Antenatal Clinics in Abakaliki, Nigeria
Authors: Azuogu V , Ndie C , Onah C , Akpa C , Eze N , Azuogu B 
Published: August 2021

Background: Pregnant women, children and immune-compromised persons are highly vulnerable to malaria morbidity and mortality. Malaria accounts for about 50% of all clinic attendance in Nigeria and contributes significantly to anaemia in pregnancy, low birth weight, preterm births, still births and perinatal mortality. It is therefore imperative that these highly susceptible groups of people are adequately informed and supported for prevention of malaria at all times. This study assessed the knowledge and practice of malaria control measures among Antenatal Care attendees in Abakaliki.
Methods: A descriptive cross-sectional study was conducted in the two biggest hospitals in Abakiliki, among 400 Antenatal Care attendees selected using systematic sampling technique. Data was collected using interviewer administered questionnaire and analyzed using Statistical Package for Social Sciences version 22. Chi-square was used to test for associations between independent and dependent variables. The significance level was set at p< 0.05.
Results: The mean age of respondents was 29.2 ± 4.1 years. Majority correctly identified methods of diagnosis of malaria in pregnancy. Although 375(93.7%) of the women constantly owned a long-lasting insecticide treated net, only 187(49.9%) of them always slept under it. While 363(90.7%) of the respondents cleared their surrounding bushes, only 130 (32.5) regularly used in-door insecticide spray and 153(38.3%) always used anti-malaria prophylaxis in the index pregnancy.
Conclusion: Knowledge about malarial control measures was high but use of Long-Lasting Insecticide Treated Net with drug prophylaxis was suboptimal. It is therefore recommended that health education on malaria prevention practice be intensified during Antenatal clinic visits.