bluuebunny/crossref_metadata_2025_split huggingface dataset:
CHADS2 and CHA2DS2-VASc Scores Can Guide the Evaluation of Cryptogenic Ischemic Stroke
Authors: Ekizoglu Esme , Atmaca Murat M , Çinar-Balcıoglu Çagla , Yesilot Nilufer , Çoban Oguzhan 
Published: December 2021

Abstract

Background and Aims:
Cryptogenic ischemic strokes (CIS) are treated with antiplatelets for stroke prevention in routine clinical practice. The objective of this study was to investigate whether the CHADS2 and CHA2DS2-VASc scores may be used to identify the patients with CIS at higher risk of ischemic stroke despite antiplatelet therapy.

Material and Methods:
We calculated CHADS2 and CHA2DS2-VASc scores in patients with first ever CIS; those previously managed with antiplatelets (AP group) and in those without antiplatelets (non-AP group), using the prospectively recorded data of the Istanbul Medical School Stroke Registry from 1996-2014.

Results:
Of the 4466 IS patients, 886 patients with first ever IS had complete data for score calculation. Seventy-five (39 women) of them were diagnosed with CIS. CHADS2 and CHA2DS2-VASc scores were significantly higher in the AP group of 19 patients in comparison to the non-AP group of 56 patients (P = 0.005 and P = 0.009, respectively). ROC curve analyses showed an area under curve (AUC) of 0.705 (CI: 0.57-0.84; P = 0.008) for CHADS2 score ≥3 and AUC of 0.699 (CI: 0.57-0.82; P = 0.01) for CHA2DS2-VASc score ≥4. Vascular diseases were more frequent in the AP group and these patients were older than the patients in the non-AP group (P = 0.025, P = 0.024; respectively).

Conclusions:
CHA2DS2-VASc score ≥ 4 and CHADS2 score ≥3 may be used as a predictor of the occurrence of IS despite regular antiplatelet use and suggest an embolic source which will respond better to anticogulation. Our results support that CHADS2 and CHA2DS2-VASc scores may be useful to identify subgroups among patients with CIS for individualizing diagnostic approach, planning future workup and preventive treatment.
Morphometric Analysis of parameters of Internal Carotid Artery—Potential Clinical Implications
Authors: Sharma Suyashi , Dixit Shilpi G , Khera Pushpinder S , Nayyar Ashish K , Ghatak Surajit 
Published: December 2021

Abstract

Background:
The study in consideration aimed to do morphometry of internal carotid artery (ICA) and substantiate any differences significant in relation to sex and age on digital subtraction angiography (DSA) imaging.

Objectives:
Our study aims to ascertain morphometric parameters of ICA through DSA evaluation and to build a normative data which is accurate enough for the neurovascular procedures to be performed. The study will also carry out correlation of morphometry of intracerebral blood vessels with sex, age, and side-related dimorphism.

Material and Methods:
Our study, cross-sectional in design was done on 70 patients (>20 years). Diameter of different segments of ICA were measured after imaging was done on DSA using a Philips biplane system clarity (Allura FD20/20). Statistical analysis was done.

Result and Conclusion:
In males, mean diameter of petrous, cavernous, supraclinoid, and choroidal segments of ICA were more when compared to females. Statistically significant differences were found in supraclinoid segment of ICA between males and females. The mean diameter of supraclinoid and choroidal segments of ICA showed a decreasing trend from younger to older age groups. The difference in the mean diameter of petrous segment of ICA with increasing age was statistically significant. The results of our study show that differences were statistically significant in supraclinoid segment of ICA in males and females. Neurosurgeons in order to be confident in tackling the various emergencies in this region need to have in-depth knowledge of morphometery of cerebral arterial circle.
Real-Time 2D Ultrasound Guided Frameless Biopsy of a Multifocal Glioma
Authors: Yeole Ujwal , Singh Vikas , Shetty Prakash , Moiyadi Aliasgar 
Published: December 2021

Abstract

Background and Introduction:
Intraoperative ultrasound imaging can be a multi-dimensional tool with various applications, including localization, resection control, and biopsy of brain tumors.

Objective:
We demonstrate a frameless biopsy technique by using real-time 2D ultrasound (RT-2DUS) for localizing and guiding the biopsy of cranial tumors.

Technique:
A 60-year-old male presented with progressive right hemiparesis, memory, and behavioral disturbances. MRI brain showed a multifocal lesion in the left temporal, parietal, and occipital lobes with extension into the splenium. He underwent left parietal mini-craniotomy with frameless RT-2DUS-guided biopsy.

Result:
Postoperative US scan showed a small biopsy site hematoma. Histopathology confirmed it to be IDH-negative primary glioblastoma. For multifocal glioma, the patient underwent adjuvant WBRT with concurrent and adjuvant temozolomide.

Conclusion:
RT-2DUS improves the sampling accuracy of the tumor by detecting the solid component of the lesion intraoperatively. In addition, the detection of operative site hematoma can be picked up immediately, avoiding post-procedure imaging.
Multiple Sclerosis-Minimizing Errors in Radiological Diagnosis
Authors: Boski Neha , Gulati Vaibhav , Raj Rohan , Gulati Parveen 
Published: December 2021

Abstract

Background:
Multiple sclerosis is a chronic demyelinating disorder with a myriad of imaging and clinical features that overlap with number of other neurological conditions. Incorrect diagnosis poses a significant risk to patients, it may lead to delays in management, increased morbidity, and also adds to the financial cost.

Objective:
The aim of this study was to highlight strategies for the efficient differentiation of multiple sclerosis from other diseases which may masquerade as MS clinico-radiologically.

Material and Methods:
A systematic literature review was conducted through online databases including PubMed and Medline. Relevant publications on radiological aspects of multiple sclerosis, white matter diseases and mimickers of Multiple sclerosis were included in the analysis.

Results:
Common mimickers of MS include small vessel disease, acute disseminated encephalomyelitis, neuromyelitis optica, anti-MOG encephalomyelitis, vasculitis, and CADASIL. Contrast-enhanced MRI study performed using MS protocol on high strength MRI system evaluated following a structured protocol along with clinical correlation is effective in differentiating MS from its mimickers.

Conclusions:
Contrast-enhanced MRI performed on a high strength scanner using MS protocol with structured protocol for evaluation along, with a better collaboration between radiologists and clinicians may help in minimizing errors in diagnosis of multiple sclerosis.
Recurrent Spontaneous Cerebrospinal Fluid Leaks at Multiple Levels
Authors: Bhoi Sanjeev Kumar , Naik Suprava , Gupta Devendra , Pradhan Prasanta K , Kalita Jayantee , Misra Usha K 
Published: December 2021

Abstract
Intracranial hypotension due to multiple spinal epidural cerebrospinal fluid (CSF) leak is rare and has multiple etiologies. These patients require epidural blood patches (EBP). We report a patient with recurrent paraplegia due to intracranial hypotension following recurrent epidural CSF leak. Cerebrospinal fluid leak was noted at D1, D10, D11, and L2 levels. Autologous epidural blood patch (EBP) at lower thoracic (3 ml) and lumbar region (4 ml) was performed. The patient developed paraplegia with sensory level at D2 for which 3 ml of EBP was done at D1 level after two months. Following EBP, the patient developed quadriplegia and root pain, which recovered in one month. The patient was free of symptoms for 18 months. Spinal epidural CSF leak should be suspected in patients with features of low pressure headache and recurrent paraplegia at multiple levels. Nuclear scintigraphy and CT myelography help in localizing the site of leak.
New Onset Refractory Status Epilepticus as a Manifestation of Tuberculosis of the Central Nervous System
Authors: Shah Preet M , Deshmukh Varun , Poncha Fali , Dhakre Vijay 
Published: December 2021

Abstract
A 28-year-old male presented to us with new onset refractory status epilepticus. Prior to his seizures, he had a history of fever, headache and blurring of vision, for which he was admitted elsewhere. No cause was found; he was treated symptomatically and was discharged as his symptoms had abated. Post-discharge, he started having multiple seizures. Neuro-imaging suggested encephalitis. He progressed to status epilepticus and was referred to our center. We intensified the anti-epileptic medications but owing to no response, he had to be put under coma with thiopental, yet the seizures persisted. Workup for the etiology of his seizures was negative except for CSF TB-PCR (Gene Xpert) being positive and hence anti-tuberculous therapy was initiated. By this time, he developed rhabdomyolysis, and thereafter renal failure with dyselectrolytemia, and thus there was a plan to initiate dialysis. But before this could be done, he succumbed to a cardiac arrest secondary to ventricular tachyarrhythmias. We believe this to be the first reported case of new onset refractory status epilepticus secondary to tuberculosis of the central nervous system.
Surgical Management of Tuberculum Sellae Meningioma
Authors: Sankhla Suresh K , Jayashankar Narayan , Khan Maqsood A , Khan Ghulam M 
Published: December 2021

Abstract

Background:
Tuberculum sellae (TS) meningiomas are benign lesions that produce neurological deficits through a mass effect on vital neurovascular structures. The treatment of choice is surgical removal with the ultimate goal to improve vision and achieve total tumor removal.

Objective:
We analyzed clinical features, tumor characteristics, and surgical approaches in 62 consecutive patients with TS meningiomas to identify factors influencing the postoperative outcome.

Methods:
The authors reviewed the medical records of all patients of TS meningiomas who underwent surgery at our institute between 2005 and 2018. Pre- and postoperative clinical data, including the operative findings, of these patients were analyzed.

Results:
Sixty-two patients who underwent surgery for removal of TSM, transcranial (TCA) in 38, and endoscopic endonasal (EEA) in 24, were identified. Gross total resection was performed in 84% and 87.5% patients in the TCA and EEA groups, respectively. A significantly higher rate of visual improvement was observed in the EEA group as compared to TCA (96% versus 79%). Visual worsening after surgery was greater with TCA than EEA (21% versus 4%). Fourteen (37%) patients in the TCA group experienced different postoperative complications, and CSF leak was the main complication in the EEA group.

Conclusions:
TCA and EEA are both associated with higher rates of GTR and visual improvement without compromising the safety of the procedure. An optimal outcome, however, depends on the careful selection of cases based on the tumor location and morphology, and the surgeon's familiarity with the surgical approach.
Recurrent Ischemic Strokes
Authors: Mathew Thomas , John Saji K , Souza Delon D , Nadig Raghunandan , Badachi Sagar , Sarma GRK 
Published: December 2021

Abstract

Background:
Antiplatelet therapy (APT) is an integral part of secondary stroke prevention. Noncompliance to APT is an important factor in stroke recurrence. In this study, we have evaluated the reasons for noncompliance to APT.

Objective:
The aim of this study was to identify the various causes of nonadherence to APT in recurrent stroke patients.

Material and Methods:
The study was conducted in a tertiary care hospital in south India with a huge stroke burden. The study period was from October 2017 to September 2018. A total of 60 consecutive patients of recurrent stroke who were nonadherent to antiplatelet therapy were evaluated for various factors that prevented compliance.

Results:
During the 12-month study period among 604 ischemic stroke patients, 128 (21%) had recurrent strokes. Of this 128, 60 (46.8%) were due to discontinuation of APT. The main factor for nonadherence to APT was lack of awareness about the need for lifelong medication (41/60; 68.3%). 10 patients (16.7%) stopped treatment as they opted for alternative therapy and 4 (6.7%) discontinued antiplatelets due to side effects. A small proportion of the patients (3.3%) cited financial constraints and forgetfulness as the issue, while 1.7% had difficulty in finding assistance to administer medicine. 27 (45%) patients had recurrent stroke within 2-15 days of stopping APT.

Conclusions:
The main reason for nonadherence to antiplatelet therapy is lack of awareness about the need for lifelong antiplatelet therapy. Stroke patients should be educated about the importance of lifelong antiplatelet therapy to prevent recurrent strokes.
Proportion of rapid eye movement sleep related obstructive sleep apnea (REM related OSA) in patients with sleep disordered breathing: A cross sectional study
Authors: Nair Sharada C , Arjun Padmanabhan , Azeez Ameer Kavarathukudy , Nair Sanjeev 
Published: December 2021

Background and Objectives:
Obstructive sleep apnea (OSA) during rapid eye movement (REM) stage of sleep is gaining importance in recent years. This study was done to determine the proportion of REM-related OSA and its associated polysomnographic features.

Methods:
One hundred forty-two patients were included in the study. REM-related OSA was defined based on previously established broad and strict criteria (REM apnea–hypopnea index [AHI]/non-REM [NREM] AHI ratio ≥2 and REM AHI >5 with NREM AHI <5, respectively), and its association with polysomnographic features was studied using appropriate statistical tools.

Results:
The proportion of REM-related OSA in the study was 56.3% and 25.3% as per broad and strict criterion, respectively. The REM-related OSA group had a mean younger age (47.4 ± 13.2 years) as compared to NREM-related OSA group (52.6 ± 15.8 years). Females (34 out of 45; 75.6%) were more likely to have REM-related OSA as compared to males (46 out of 107; 47.4%). Supine AHI, arousal index, oxygen desaturation index, length of the longest event, and the lowest oxygen saturation recorded during sleep had a significant association with REM-related OSA. 74% of patients with overall AHI <5 and 87% patients with overall AHI 5 to 15 satisfied the criteria for REM-related OSA as per broad criterion.

Conclusion:
REM-related OSA was quite prevalent in the study population (56.3%) and was more common in the mild and moderate severity subgroups of OSA.
The clinical experience of macitentan in pulmonary hypertension in Indian cohort: 12-month follow-up
Authors: Jariwala Pankaj , Maturu Venkata Nagarjuna , Jadhav Kartik Pandurang , Punjani Arshad , Boorugu Harikishan 
Published: December 2021

Background:
The effectiveness and safety of macitentan, an endothelin-receptor antagonist (ERA) in the treatment of pulmonary arterial hypertension (PAH), has been demonstrated in numerous randomized clinical trials including SERAPHIN, focused on the reduction of morbidity and mortality.

Objectives:
Our aim was to demonstrate the clinical and echocardiographic progression using macitentan in Indian patients with PAH.

Settings and Design:
It was a retrospective study of 20 patients with multiple etiologies of PAH who had begun macitentan in routine clinical practice from a single center. There were 55% of patients with existing PAH therapies.

Subjects and Methods:
The World Health Organization functional class (WHO-FC), 6-min walking distance, N-terminal prohormone of brain natriuretic peptide level (NT-pro-BNP), and echocardiographic data such as tricuspid annular plane systolic excursion (TAPSE), systolic pulmonary artery pressure (sPAP), and the occurrence of pericardial effusion were collected at baseline and 12-month follow-up. The statistical analysis was performed using SPSS software.

Results:
Of the 20 PAH patients, 70% were women. The majority were in WHO FC II (50%), while 35% were in FC III and 15% were in FC IV. The mean age was 43.4 years at the start of the therapy with macitentan. After 6 months of macitentan therapy, 85% showed substantial improvement in their FC, each increased its 6-min walking distance test (P < 0.0001), and there was a significant reduction in plasma levels of NT-pro BNP (P < 0.0001). There has also been an improvement in echocardiographic parameters such as TAPSE and sPAP (P < 0.0001).

Conclusions:
Our findings indicate that macitentan has been well tolerated and beneficial in Indian patients with PAH and further, future research is required to verify these results.
SAHİPSİZ HAYVANLARIN ŞEHİR, ÇEVRE VE HALK SAĞLIĞI, HAYVAN SAĞLIĞI VE HAYVAN REFAHI YÖNÜNDEN KONTROLÜNDE BAKANLIKLAR ARASI İŞBİRLİĞİNDE KARŞILAŞILAN AKSAKLIKLAR VE ÇÖZÜM ÖNERİLERİ
Authors: BİLGİLİ ALİ 
Published: December 2021

Başıboş dolaşan kedi ve köpekler dünya genelinde olduğu gibi ülkemizde de sahipsiz hayvan olarak değerlendirilmektedir. Varlığı, çevre ve insan sağlığı açısından hoş karşılanmayan sahipsiz hayvanların kontrol dışı üremesi, sahipli hayvanların terkedilmesi, sahipli hayvanların yavrularının çevreye bırakılması gibi sebepler sahipsiz hayvanların mevcudunu giderek arttırmaktadır. Dolayısıyla insanlarla iç içe bir yaşam söz konusudur. Durum böyle olunca da onların sağlığı ve refahı direkt olarak insanları ilgilendirmektedir.
Avrupa Birliği müzakere pozisyonunun esaslarında yer alan çok önemli konular arasında hayvan refahına da yer verilmektedir. İngiltere’de kurulan Hayvan Refahı Komitesi 1993 yılında hayvan hakları bağlamında “1- Hayvanların açlık, susuzluk vb. şeklinde ihtiyaçlarından yoksun bırakılmaması, 2- Hayvanların bulundukları çevre şartlarından rahatsız olmamaları, 3- Hayvanların acı ve ağrıya neden olan çarpma, yaralanma ve hastalıklardan korunması, 4- Hayvanların normal davranışlarını sergileyebilmesi, 5- Hayvanların korku ve strese neden olan olaylardan korunması” şeklindeki beş maddeyi yayınlamıştır.
Hayvan Refahı; hayvanların rahat, huzurlu, sağlıklı ve kolaylıkla yaşam sürmesinin sağlanması olarak tanımlanabilir. Bu çalışma kapsamında öncelikli olarak dünya ülkelerinde sokak hayvanlarının refahına yönelik genel bilgilerin yanında, özellikle yakın coğrafyamızda yer alan Ermenistan, Azerbaycan, Arnavutluk, Moldova ve Ukrayna gibi ülkelerde hayvanların refahının korunması yönündeki yetersiz uygulamalardan bahsedildi. Ayrıca Finlandiya, Hollanda, İtalya, Almanya, İngiltere ve Fransa gibi ülkelerde ileri düzeydeki çalışmalardan da özet bilgiler verildi. Ülkemizdeki İçişleri Bakanlığı, Orman ve Su İşleri Bakanlığı, Sağlık Bakanlığı, Gıda Tarım ve Hayvancılık Bakanlıkları’nın sahipsiz hayvanların refahı ve kayıt altına alınmaları ile Elektronik Bilgi Sistemi kurulması uygulamalarına yönelik mevcut durum ve sorunlar irdelenerek, çözüm önerileri hakkında özlü bilgiler sunuldu.
FORENSIK DIGITAL SISTEM INFORMASI BERBASIS WEB
Authors: Andria Andria 
Published: December 2021

Objektif. Pengungkapan suatu kejahatan siber seperti peretasan situs web diperlukan adanya forensik digital yang bertujuan untuk mengidentifikasi, menganalisa dan memetakan jaringan komunikasi pada suatu sistem informasi berbasis web.
Material dan Metode. Forensik digital dalam penelitian ini menggunakan aplikasi Maltego yang dapat melakukan footprinting yaitu mengumpulkan informasi sebanyak mungkin dari situs web yang dilakukan forensik digital. Sistem operasi yang digunakan untuk menjalankan aplikasi Maltego yaitu Linux yang merupakan sistem operasi open source.
Hasil. Hasil peneltian ini dapat digunakan sebagai solusi dalam menangani sebuah kasus yang membutuhkan barang bukti digital. Informasi yang didapatkan dapat divisualisasikan dalam bentuk pemetaan jaringan komunikasi dan informasi yang mudah dipahami.
Kesimpulan. Forensik digital sangat diperlukan dalam mendapatkan barang bukti digital dari pengungkapan suatu kasus kejahatan siber. Saran untuk penelitian selanjutnya yaitu melakukan komparasi penggunaan aplikasi forensik digital untuk dapat melihat perbandingan hasil yang lebih lengkap dan akurat.
A CRITICAL REVIEW OF COMPANY PERFORMANCE IN RESPONSE TO DIVIDEND PAYOUT POLICY IN THE PERSPECTIVE OF PAKISTAN
Authors: Bazmi Dr. Nisar Ahmad 
Published: December 2021

The current study explains the relationship of dividend payout policy on the business performance of companies that exist in sugar of Pakistan. 100 companies are selected from sugar sector. Relationship of dividend payout policy and business performance was controlled with four variables based on relevant theories. These variables include size of company, growth of company, leverage (debt to equity ratio) and corporate governance index. Panel data is collected from 2012-2017 (six years) and then analyzed with unit root, descriptive statistics, correlation analysis, OLS regression, Lagrange multiplier, Huasman test, Fixed effect and Random effect models. Following key findings for each research objective were obtained by applying the adopted research method on the data through the adopted method of analyses: The results of the study show sugar companies showed no sign of a relationship between their dividend payout policy and profitability and so there is no controlling factor effective due to the absence of any relationship. Thus, the hypotheses were rejected in case of these two industries.
Key Words: Company Performance, Dividend Policy, Tobin’s Q, Size, Growth, Leverage, Corporate Governance Index, Dividend Payout
THE CRITICAL ANALYSIS OF THE CAUSES OF POLITICAL INSTABILITY IN PAKISTAN FROM 1988 TO 1999 (SPECIAL REFERENCE TO SINDH PROVINCE)
Authors: Siyal Nazir 
Published: December 2021

This research article’s primary goal is to determine the triggers and implications of Pakistan’s political instability and its effects on the political situation of Sindh during the democratic decade from 1988 to 1999. Despite abundant natural resources, Pakistan is one of the only countries where political unrest has severely hampered the social and political development of the country. So, this paper aims to understand the leading factors of political instability that weakened the country’s political growth and led the nation in general and Sindh province, in particular, to suffer social and ethnic problems in society. To understand the issue deeply, the researcher used unstructured Interviews as a research tool with law-makers, academicians, and political scientists. However, many interviewees accepted that the lack of enthusiastic leadership, the Role of the weak judiciary, the passive role of civil bureaucracy, and political ethnicity had been the leading factors for political and social unrest. Thus, the study’s findings would help the law-makers and academicians of different colleges and universities to design their policies and curriculum. Additionally, this paper would help various nationalists and political parties of Sindh province to comprehend the genuine reasons for unrest in the area from 1988 to 1999.
Key Words: Political instability, Weak Judiciary, Political ethnicity, Foreign interference, Role of civil bureaucracy
EFFECTS OF COMMUNICATIVE STRATEGIES AND WRITING SKILLS ON STUDENTS’ LEARNING AT SECONDARYLEVEL IN PAKISTAN
Authors: Khan Mubashar Mahmood 
Published: December 2021

The study examines the effects of communicative strategies and writing skills on students learning atsecondary level in Pakistan. The study is experimental in nature and the researcher applieda pre-test post-test equivalent group experimental design to draw the conclusion.For the facilitation of study, the researcher presumed the male students of grade 10 studying at Government Higher Secondary School Renala Khurd.Government Higher Secondary School Renala Khurd was selected as population in Okara district as the spot for intervention.The selection of the students was made through convienience and informed consent which tantamounted to simple random sampling technique. Experimental group and control group comprised of thirty students each as such sample size for this experimental study was stretched over 60 students. The experimental group was exposed to communicate through communicative language teaching-based activities included in the (NECL, 2006) for grade 10 while the control group was imparted intervention through traditional methods for two months.