bluuebunny/crossref_metadata_2025_split huggingface dataset:
Adult T-type lymphoblastic lymphoma presenting as hypercalcemic crisis and aplastic anemia: a case report
Authors: Essouma Mickael , Soh Dorothée M. , Temgoua Mazou N. , Gobina Ronald M. , Nono Aristide T. , Atenguena Etienne Olivier , Maimouna Mahamat , Ashuntantang Gloria E. 
Published: October 2019

Abstract

Background
Hypercalcemia and aplastic anemia are two uncommon presentations of non-Hodgkin lymphoma that potentially worsen the disease prognosis. Although hypercalcemia has been reported in the B-cell subtypes and some T-cell subtypes of non-Hodgkin lymphoma, it has not been described in T-cell lymphoblastic lymphoma. The same applies to aplastic anemia, which is also not described in T-type lymphomas.

Case presentation
We report a case of a 52-year-old Cameroonian man with acute kidney injury who presented with confusion, abdominal pain, constipation, polyuria, polydipsia, calciphylaxis, enlarged lymph nodes, tachycardia, and a blood pressure of 170/88 mmHg. Laboratory investigations revealed hypercalcemia (total/ionized 199.5/101.75 mg/L), normal serum phosphorus (40.20 mg/L), and a low intact parathyroid hormone (9.70 pg/ml). Complete blood count revealed pancytopenia. Peripheral blood smear confirmed thrombocytopenia but showed neither blasts nor flower cells. Bone marrow aspirate revealed hypocellularity with no blasts or fibrosis. Lymph node biopsy was suggestive of T-cell precursor lymphoma. T-lymphoblastic lymphoma presenting with hypercalcemic crisis and aplastic anemia was diagnosed, and the patient received the cyclophosphamide-doxorubicin-vincristine-prednisone protocol of chemotherapy together with filgrastim and whole-blood transfusion for aplastic anemia. The short-term outcome was fatal, however.

Conclusions
Severe hypercalcemia and aplastic anemia are potential paraneoplastic syndromes of adult T-type lymphoblastic lymphoma, with fatal short-term outcome.
Biomechanical comparison of bi- and tricortical k-wire fixation in tension band wiring osteosynthesis
Authors: Nowotny J. , Bischoff F. , Ahlfeld T. , Goronzy J. , Tille E. , Nimtschke U. , Biewener A. 
Published: October 2019

AbstractBackgroundPatients with a simple transversal fracture of the olecranon are often treated with a tension band wiring (TBW), because it is known as a biomechanically appropriate and cost-effective procedure. Nevertheless, the technique is in detail more challenging than thought, resulting in a considerable high rate of implant-related complications like k-wire loosening and soft tissue irritation. In the literature, a distinction is generally only made between transcortical (bi-) and intramedullary (mono-) fixation of the wires. There is the additional possibility to fix the proximal bent end of k-wire in the cortex of the bone and thus create a tricortical fixation. The present study investigates the effectiveness of bi- and tricortical k-wire fixation in a biomechanical approach.MethodsTBW of the olecranon was performed at 10 cadaver ulnas from six donors in a usual manner and divided into two groups: In group 1, the k-wire was inserted by bicortical fixation (BC), and in group 2, a tricortical fixation (TC) was chosen. Failure behavior and maximum pullout strength were assessed and evaluated by using a Zwick machine. The statistical evaluation was descriptive and with a pairedttest for the evaluation of significances between the two techniques.ResultsThe average age of the used donors was 81.5 ± 11.5 (62–92) years. Three donors were female, and three were male. Ten k-wires were examined in BC group and 10 in the TC group. The mean bone density of the used proximal ulnas was on average 579 ± 186 (336–899) HU. The maximum pullout strength was 263 ± 106 (125–429) N in the BC group and increased significantly in the TC group to 325 ± 102 (144–466)N[p = .005].ConclusionThis study confirms for the first time biomechanical superiority of tricortical k-wire fixation in the olecranon when using a TBW and may justify the clinical use of this method.
Identifying vertical partnership among automotive component companies: empirical evidence from automotive industry in Jabodetabek, Indonesia
Authors: Syah Donny Oktavian 
Published: October 2019

Abstract
The goal of this research is to examine the relation between technology transfer, technical exchange, government role, and supplier performance of automotive industry in Jabodetabek, Indonesia. There are 99 companies in this study, consisting of 6 assembler companies, 59 tier-1 companies, and 34 tier-2 companies. The research was conducted by visiting sites and filling questionnaires based on Likert scale to the person in charge at middle-up management level who understand or is responsible for measuring product quality (purposive sampling). The result of the questionnaires was processed and analysed by partial least square path modelling (PLS-PM), using Smart PLS 3.2.7 software. The result showed that there was a significant impact of government role to technology transfer (p value 0.000), technology transfer to supplier performance improvement (p value 0.056), and technical exchange to supplier performance improvement (p value 0.074). However, there was no significant impact of government role to supplier performance improvement (p value 0.179).
Mental health problems and psychological burnout in Medical Health Practitioners: A study of associations and triadic comorbidity
Authors: Ashraf Farzana , Ahmad Hassaan , Shakeel Muneeba , Aftab Sana , Masood Afsheen 
Published: October 2019

Background and Objective: Mental health problems not only affect the common person but also medical health practitioners (MHPs) dealing with health care issues of patients. The current study aimed to explore the triadic (three dimensional) comorbidity of mental health problems and its association with three forms of psychological burnout (person, client and work related).
Methods: This correlational study was conducted at three hospitals of Islamabad/ Rawalpindi (Holy Family Hospital=57, District Headquarter Hospital=60, and Benazir Bhutto Hospital=40) from June 2018 to September 2018. The sample comprised of 157 medical health practitioners (medical doctors) serving in general ward (n=64), emergency (n=60) and OPD (n=33) sections. The participants were administered self-report measures of DASS-21 and Copenhagen Burnout Inventory.
Results: Triadic comorbidity of depression, anxiety and stress ranged from 9% to 26% for excessive severe and normal levels respectively. Comorbidity of work related and personal related burnout at severe level was found 8%. Further, depression, anxiety and stress symptoms were strongly associated with psychological burnout at .0001 significance level.
Conclusion: MHPs demonstrated excessive severe comorbidity of depression, anxiety and stress simultaneously. Along with this triadic comorbidity, the presence of severe psychological burnout is alarming and affecting overall efficiency and mental health of doctors which need to be identified, screened out and managed timely and managed properly.
doi: https://doi.org/10.12669/pjms.35.6.444
How to cite this:Ashraf F, Ahmad H, Shakeel M, Aftab S, Masood A. Mental health problems and psychological burnout in Medical Health Practitioners: A study of associations and triadic comorbidity. Pak J Med Sci. 2019;35(6):1558-1564. doi: https://doi.org/10.12669/pjms.35.6.444
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Undiagnosed Hemoglobinopathies: A potential threat to the premarital screening program
Authors: Hamali Hassan Abdu , Saboor Muhammad 
Published: October 2019

Objectives: To evaluate the prevalence of undiagnosed hemoglobinopathies among individuals visiting the premarital screening Centre.
Methods: This study was conducted at Premarital Screening Centre, King Fahad Central Hospital and Research Centre, Jazan, between January 2018 and October 2018. A total of 3,970 (male n =1,859 and female n = 2,111) individuals were included in the study. Data of complete blood count, hemoglobin electrophoresis and sickling tests of all individuals recruited in the study were obtained and statistically analyzed.
Results: One thousand three hundred and twelve individuals had abnormal complete blood counts or hemoglobin electrophoresis results, that include sickle cell trait (13.5%), sickle cell disease (0.7%), β thalassemia with sickle cell trait (2.46%), β thalassemia trait (1.51%), β thalassemia major (0.075%), suspected α thalassemia or other hemoglobinopathies (4.43%), hemoglobin H (0.3%), hemoglobin E (0.075%), undiagnosed cases (0.91%) and iron deficient (7.23%).
Conclusion: A high percentage of individuals are suspected for α thalassemia or other hemoglobinopathies that needs to be diagnosed. Further investigations shall be included in the premarital screening program to diagnose these inconclusive cases. Coexistence iron deficiency with thalassemia shall also be ruled out during premarital screening program.
doi: https://doi.org/10.12669/pjms.35.6.976
How to cite this:Hamali HA, Saboor M. Undiagnosed Hemoglobinopathies: A potential threat to the premarital screening program. Pak J Med Sci. 2019;35(6):1611-1615. doi: https://doi.org/10.12669/pjms.35.6.976
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
ESTIMASI HERITABILITAS DAN RESPONS SELEKSI IKAN NILA HITAM (Oreochromis niloticus) DI TAMBAK
Authors: Robisalmi Adam 
Published: October 2019

Genetic improvement in the establishment of a rapid growth strain of Nile tilapia might be achieved through selective breeding program This research was aimed to estimate heritability and response selection of nile tilapia in brackishwater pond. Breeding activity was carried out in fresh water in hapa 2x1x1 m. Males and females were breeding in pairs with a ratio of 1: 1. The number of established families was 19 families of 50 broodstock pairs. Harvesting of larvae was done on day 14. Larvae were collected and then kept in net 2 x 2 x1 m with stocking density 125 fish/m2 for 60 days. The next stage was sexing by grouping the male and female populations in each family. Grow out was carried out in net cage (3 x 5 x1.5 m ) that were placed in brackiswater pond at salinity 25–30 g/L with density 10 fish/m2. Selection of broodstock in the male and female populations was done on weight of 250–300 g. Cut off selection was determined on weight from 316 to 382g (male) and 221–315 g (female). The results of this study showed that the estimation value for heritability of male and female were 0.42 ± 0.22 and 0.42 ± 0.23 and the estimation value for response selection were 10.66% (male) and 10.92% (female).
237  Increased Polyp Detection Using a Novel 360 Degree Integrated View Colonoscope in Colon Models
Authors: Hoerter Nicholas , Gross Seth 
Published: October 2019

INTRODUCTION:
Colorectal cancer remains the second leading cause of cancer death in the world. Incidence has declined as rates of screening colonoscopy have increased, but colonoscopy is not perfect. Low adenoma detection rates (ADR's) have been associated with increased interval cancers. Both optical and mechanical devices for improving ADR have shown promising results. Here we demonstrate a novel colonoscope with a 360° integrated view to improve visualization behind folds (Figure 1). The aim of this study is to compare polyp detection rates using the novel 360° scope and a standard forward only view (FOV) scope in colon models.

METHODS:
324 endoscopists around the US were enrolled in the study. 20 anatomic colon models (Champerlain Group, Great Barrington, MA) containing simulated 6–15 mm polyps were used. Polyps varied in number, location, and shape. Models were examined in a tandem fashion with the 360° scope and the FOV scope. Endoscopists were randomly assigned to perform the initial exam with either scope. The primary outcome was the number of polyps identified during withdrawal. Subgroup analysis was performed evaluating effects of order of examination, experience, and practice setting. Means were compared with a paired T-test and subgroups were compared with ANOVA.

RESULTS:
153 endoscopists performed their initial exam with the 360° scope, and 171 with the FOV scope. The 360° view colonoscope identified significantly more polyps overall (13.2 vs 7.7, mean difference 5.5, P < 0.0001). Each individual endoscopist identified more polyps with the 360° scope. The difference persisted regardless of which scope was used first. The difference also persisted between endoscopists of different experience and practice environments (Table 1). The only statistically significant difference was between endoscopists stratified by years of training, in which the <5 year group had a larger difference in polyp detection (P = 0.0006).

CONCLUSION:
This study shows that the 360° integrated view colonoscope is more effective at polyp detection than a traditional colonoscope in simulated models. The increased polyp detection is not dependent on experience level or practice environment. The expanded field of view allows endoscopists to identify polyps that may be missed by a traditional scope such as behind folds. Further studies in humans will be needed to prove safety/efficacy for clinical use but these initial results show promise for increasing ADR using this novel colonoscope.
353 Multi-Center Randomized Trial Comparing Standard Forceps Biopsies to Wide-Area Transepithelial Sampling Brush for Finding Intestinal Metaplasia and Dysplasia in the Esophagus and Gastroesophageal Junction
Authors: DeMeester Steven , Smith Chris , Severson Paul , Jobe Blair , Woodworth Phillip , Dunst Christy 
Published: October 2019

INTRODUCTION:
Intestinal metaplasia (IM) in the esophagus is a potentially pre-malignant mucosal change. The aim of this study was to compare the frequency of IM detection during upper endoscopy by biopsy forceps versus wide-area transepithelial sampling (WATS) brush.

METHODS:
Patients presenting for upper endoscopy for foregut symptoms or Barrett’s surveillance were prospectively enrolled and randomized to either biopsies or WATS brush from October1, 2017 to December 31, 2018. Patients with a history of malignancy were excluded. This study was IRB approved and funded by CDx Diagnositics.

RESULTS:
There were 1002 patients enrolled at 9 centers. Patient demographics and indications for endoscopy are shown in Table 1. A total of 509 patients had biopsies and 493 had WATS. A columnar-lined esophagus (CLE) of any length was seen in 282 patients, while in 720 patients there was no CLE and the biopsy or WATS was from a normal or irregular appearing gastroesophageal junction (GEJ). The median length of CLE when present was 3 cm. The overall frequency of finding IM by biopsy was 19.45% and by WATS 22.72%, P = 0.2. Table 2 shows the frequency of finding IM in the 817 patients that had upper endoscopy with no prior history of IM, compared to the frequency of finding IM in patients undergoing endoscopy for Barrett’s surveillance or follow-up after ablation (n = 185). In patients without a prior history of IM, biopsy and WATS found IM with similar frequency overall, but WATS found significantly more IM in patients with any endoscopically visible length of CLE. Biopsy found one cancer, and low-grade dysplasia was found in one patient each with biopsy and WATS. In the 185 patients that had their endoscopy for follow-up of Barrett’s or ablation there was no difference in the frequency of IM detection for biopsy vs WATS, and was similar in patients with < 3 cm CLE and in those with ≥ 3 cm CLE. Dysplasia or cancer was found in 5 patients in this group, 2 by WATS and 3 by biopsy.

CONCLUSION/DISCUSSION:
Both biopsy and WATS detect a similar frequency of IM overall; however, WATS was over twice as likely as biopsies to find IM in patients without a history of IM who had a CLE on endoscopy. In patients undergoing surveillance for Barrett’s or follow-up after ablation both WATS and biopsy showed IM and dysplasia with similar frequency. These findings suggest that WATS can be used instead of biopsies of the GEJ and esophagus with similar or improved efficacy at detecting IM and dysplasia.
449 Cost-Effectiveness of Adjunctive Wide Area Transepithelial Sampling With Computer-Assisted Analysis in Screening for Barrett’s Esophagus
Authors: Singer Mendel E. , Gross Seth , Kaul Vivek , Smith Michael S. 
Published: October 2019

INTRODUCTION:
Screening for Barrett’s Esophagus (BE) in chronic gastroesophageal reflux disease (GERD) using targeted and random forceps biopsy (FB) is recommended by current ACG guidelines. A recent study of 10,412 screening patients showed that Wide Area Transepithelial Sampling with 3D computer-assisted tissue analysis (WATS) increases detection of Barrett’s esophagus (BE) when used adjunctively to FB. We analyzed the cost-effectiveness implications of this study’s findings.

METHODS:
A decision analytic model compared the effectiveness and cost-effectiveness of two alternative screening strategies for BE in chronic GERD patients: FB alone vs. FB combined with WATS. The reference case was a 60 year old male. BE detected by positive FB or WATS was referred for surveillance. False positive WATS+/FB- were confirmed after a second negative surveillance FB. Cost and effectiveness of surveillance were based on published models with ablation for low or high grade dysplasia, available on the National Cancer Institute CISNET website. See Table 1 for an overview of model parameters. Effectiveness was measured in quality-adjusted life years (QALYs). Cost was measured in 2018 US$ and the incremental cost-effectiveness ratio (ICER) was measured in $/QALY. Model parameters are outlined in Table 2. We considered 3 values of added yield (213% from the study, half of that, one-third of that) and 3 values of false positives among the added yield (5%, 15%, 25%) and calculated the ICER for all 9 pairwise combinations of those two parameters. We considered two thresholds for cost-effectiveness: $100K/QALY and $150K/QALY. Cost and QALYs were discounted at 3% per year.

RESULTS:
The ICERs for all 9 combinations of added yield and false positives are in Table 3. Use of FB plus WATS was cost-effective in all 9 combinations at the lower $100K/QALY threshold. Using the worst case for added yield (1/3 of the value from the study), FB plus WATS was cost-effective at the $150K/QALY for a false positive rate below 56%. Using the worst case for false positive rate (25%), FB plus WATS was cost-effective at the $150K/QALY for added yield of over 38%.

CONCLUSION:
We demonstrate that WATS, when used adjunctively with FB for screening 60 year old males with chronic GERD, is a cost-effective approach to reducing morbidity and mortality from esophageal cancer.
1621 Extramedullary Plasmacytoma of the Colon
Authors: Ajanaku Folabomi , Mekasha Getachew , Scott Victor 
Published: October 2019

INTRODUCTION:
Plasma cell tumors can be categorized into multiple myeloma or plasmacytomas. Plasmacytoma is the proliferation of neoplastic monoclonal plasma cells in sites other than the bone marrow. This case illustrates a rare case of plasmacytoma in the colon.

CASE DESCRIPTION/METHODS:
A 49-year-old man with medical history of type 1 DM and GERD presented for average risk screening colonoscopy. Colonoscopy showed a 12mm transverse colon polyp that was resected via hot snare polypectomy. Pathology of the 12mm polyp showed lamina propria expansion with large sheets of plasma cells. On immunohistochemistry (IHC), the plasma cells showed kappa light chain restriction. IHC gene rearrangement studies showed a low level of immunoglobulin heavy chain amplification. Pathology was consistent with plasmacytoma associated with tubular adenoma without high grade dysplasia. Margins were negative. A complete blood count obtained by primary care physician demonstrated Hgb of 14.1 g/dl. Complete metabolic panel was normal. Serum protein electrophoresis, urine Bence Jones protein, bone marrow biopsy, skeletal bone survey and PET CT scan were recommended to exclude multiple myeloma and involvement at other sites.

DISCUSSION:
Plasmacytoma can be either be solitary bone plasmacytoma or solitary extramedullary plasmacytoma. The diagnosis of solitary plasmacytoma depends on the exclusion of multiple myeloma via normal bone marrow biopsy, normal skeletal survey and absence of end organ damage. If multiple myeloma is present, the lesion is characterized as an extramedullary manifestation of multiple myeloma. Solitary bone plasmacytoma occurs most commonly in the vertebrae. Solitary extramedullary plasmacytoma involves sites other than bone or bone marrow. It most commonly involves the nasopharynx or upper respiratory tract and is observed in 3-5% of plasma cell tumors. Colonic extramedullary plasmacytoma is rare and occurs in approximately 10% of extramedullary cases. Clinical presentations of extramedullary plasmacytoma are variable and depend on site of involvement. There are no current guidelines for the treatment of patients with colonic plasmacytoma. It is unclear whether endoscopic or surgical resection alone suffices as conclusive management or additional treatment modalities like radiotherapy or chemotherapy is necessary.
Effect of Community-Based Group Exercise Interventions on Standing Balance and Strength in Independent Living Older Adults
Authors: Alqahtani Bader A. , Sparto Patrick J. , Whitney Susan L. , Greenspan Susan L. , Perera Subashan , VanSwearingen Jessie , Brach Jennifer S. 
Published: October 2019

Background and Purpose:
Many interventions to improve mobility in older adults often include exercises to address underlying impairments such as strength deficits. Task-oriented exercise interventions that focus more on walking and stepping tasks that may be encountered in the community have been considered for improving mobility in older adults. The main purpose was to examine the effect of task-oriented and impairment-based group exercise interventions on standing balance and lower extremity muscle strength.

Methods:
This is an ancillary study to a cluster-randomized clinical trial. Participants included 107 older adults. Participants were randomized by facility to 1 of 2 different interventions, or a waitlist control group. The On the Move (OTM) task-oriented intervention consisted of warm-up, timing and coordination (stepping and walking patterns), strengthening, and stretching exercises. The standard of care impairment-based exercise intervention (STD) consisted of warm-up, strength, endurance, and stretching exercises. Postural sway and balance measures were recorded before and after the 12-week interventions. An accelerometer was used to collect postural sway for 6 different standing balance conditions. A portable load cell was used to assess lower extremity muscle strength for 3 muscle groups.

Results and Discussion:
The OTM group had a significant reduction in sway acceleration during most of the balance conditions over the 12-week period, whereas the STD had smaller, nonsignificant reductions. Both exercise interventions had a significant reduction in sway compared with the waitlist control group in at least 1 balance condition. The OTM and STD groups had significant increases in hip abduction strength during the intervention and the STD group also had an increase in knee extension strength. The waitlist group had a significant reduction in strength in all muscle groups during the 12-week period. Strength changes in both exercise groups were significantly different from the waitlist group but not from each other.

Conclusion:
Both exercise intervention groups had an improvement in standing balance and lower extremity strength when compared with a waitlist group that did not receive exercise. Although the exercise groups did not significantly differ from each other, the OTM exercise group showed a trend toward improvement in static standing balance conditions.