bluuebunny/crossref_metadata_2025_split huggingface dataset:
Screening of Antenatal Patients for Anemia and Hemoglobinopathies
Authors: Ahuja Tejal Vishandas , Bhatnagar Nidhi , Shah Mamta C. , Shah Sangeeta D. 
Published: November 2024

ABSTRACT

Background and Objectives:
Anemia is an extremely common condition in pregnancy worldwide, which confers several health risks to mother and child. Iron deficiency is the most widespread micronutritional deficiency in the world and disproportionately affects females because of increased iron requirements during menstruation, pregnancy, and lactation. Hemoglobinopathies are a group of inherited disorders because of abnormalities in hemoglobin (Hb) synthesis or structure. Thalassemia and sickle cell anemia are the most prevalent hemoglobinopathies and a national health burden in India so identifying these disorders during the antenatal period is necessary to take appropriate measures. This study aimed to ascertain the prevalence and spectrum of thalassemia/hemoglobinopathy amongst antenatal patients and also to analyze the ability of red cell indices to differentiate beta thalassemia trait from mild iron-deficiency anemia (IDA).

Methods:
A prospective study of screening for Hb variants in Antenatal Patients due to low Hb and evaluation of other causes was performed for 1 year with 570 samples. In low Hb, patients’ complete blood count, Reticulocyte staining, and sickling test were performed. Hb analysis was done by high-performance liquid chromatography Bio-Rad Variant II. In IDA Serum ferritin and Serum Iron level were done and in megaloblastic anemia (MA) Vitamin B12 levels were done.

Results:
The prevalence of anemia in antenatal patients was 90.25%; in this, IDA presented at 84.21%, MA at 4.73%, and dimorphic anemia at 1.27%. The prevalence of hemoglobinopathies in the current study was 9.75%; in this beta-thalassemia minor presented at 5.08%, sickle cell trait at 4.03%, Hb D Punjab at 0.52%, and Hb Q India at 0.17%.

Conclusion:
Antenatal screening for genetic disorders, such as beta-thalassemia and sickle cell anemia, aims to reduce the burden of these diseases by offering information to individuals with a high likelihood of giving birth to affected babies and giving parents more choices regarding their reproductive decisions. For this, premarital and antenatal screening should be mandatory to prevent the birth of affected offspring.
Rare Presentation of Myelin Oligodendrocyte Glycoprotein Antibody-associated Disease in Four Children
Authors: Venkatachalam Vinothini , Palaniappan Ayyammal , Ramalingam Ramakrishanan Tirupur Chinnappan , Gopalakrishnan Srimathi , Benjamin Antony Terance , Maheswaran Anupama 
Published: November 2024

Abstract

Background:
Myelin oligodendrocyte glycoprotein antibody associated disease (MOG-AD) is an inflammatory disorder of the central nervous system, identified more frequently in children than adults. We report 4 children with MOG-AD.

Clinical Description:
Cases 1–3 presented with fever, headache, and vomiting for varying durations. Case 4 presented with acute-onset impaired vision, after a prior episode of meningoencephalitis-like picture. Examination showed that Cases 1 and 2 had neck rigidity, and Case 4 had papilledema along with reduced visual acuity. Other cranial nerves, power, tone, and reflexes were normal in all children.

Management and Outcome:
Laboratory investigations were largely normal except elevated total leukocyte count and C-reactive protein in Cases 1 and 3 with a marginal rise in C- reactive protein in Cases 2 and 4. Cerebrospinal analysis showed pleocytosis with lymphocytic predominance and increased protein in Cases 3 and 4. Magnetic resonance imaging revealed features consistent with meningoencephalitis in Cases 1 and 3, acute disseminated encephalomyelitis in Case 2, and optic neuritis in Case 4. All the children had positive titers of anti-MOG, thus being diagnosed as MOG-AD. All the children were treated with intravenous methylprednisolone with a few of them requiring additional immunomodulator therapy. All the cases showed excellent recovery and remained in remission till the last follow-up.

Conclusion:
Children presenting with features simulating meningoencephalitis may be due to the rare condition of MOG-AD. A knowledge about this condition and specific investigations with expert interpretation and specific treatment can result in favorable outcomes.
Acute Pure Erythroid Leukemia Presenting with Chloroma in a Child: A Case Report with Review of Literature
Authors: Bhattacharya Sudipto , Verma Nishant 
Published: November 2024

Abstract

Background:
Pure erythroid leukemia (PEL) is the rarest subtype of acute myeloid leukemia (AML), characterized by clonal proliferation of cells of erythroid origin with minimal myeloblast proliferation. It is typically a disease of the adults and presentation in children in association with chloroma is extremely rare.

Clinical Description:
A 20-month-old boy presented with left eye proptosis, and fever for a month, with bleeding from the eye for 10 days. He was febrile with pallor, and a nontender, nonfluctuant swelling with subconjunctival hemorrhage in the left eye and hepatomegaly.

Management and Outcome:
Investigations showed anemia and thrombocytopenia with 30% blasts in peripheral smear. Bone marrow examination was suggestive of acute leukemia and immunophenotype was confirmatory for PEL. The child was treated with cytarabine, doxorubicin, and etoposide during induction phase followed by high-dose cytarabine consolidation. The child remained in remission for 6 months, after which his disease relapsed in bone marrow and the family opted for palliative care.

Conclusion:
Rapidly developing nontender unilateral proptosis with bleeding may be a manifestation of chloroma associated with PEL. A combination of bone marrow, immunophenotyping, and karyotyping is required for its diagnosis. Conventional therapy for AML is poor.
Retroperitoneal Teratoma: A Rare Entity in a Young Infant
Authors: Sharma Rahul Deo , Achugatla Sushma , Singh Surendra , Thakur Sonia , Redkar Rajeev Gurunath 
Published: November 2024

Abstract

Background:
Primary retroperitoneal teratoma of infancy is rare, comprising only 3.5%–4% of all germ cell tumors. The presentation may range from an asymptomatic mass to an abdominal lump causing symptoms due to mass effect on the neighbouring organs. We present a young infant with an abdominal mass who posed a diagnostic challenge.

Clinical Description:
A 3monthold female infant with an uneventful antenatal and perinatal history presented with complaints of abdominal distension since 1½ months of age. A lump was palpable involving the entire right side of the abdomen, crossing the midline.

Management and Outcome:
Despite detailed radiological imaging and trucut biopsy, the diagnosis was unclear. A complete open laparoscopic excision of the mass followed by a biopsy confirmed the diagnosis of grade 2/3 immature teratoma. Serum alphafetoprotein levels and betahuman chorionic gonadotropin levels were normal. Chemotherapy was not administered. The patient has been on followup for the past 2½ years, doing well without any complaints.

Conclusion:
Early recognition and complete excision of primary retroperitoneal teratoma with mature or partly immature histopathology carries a good prognosis.
Xanthogranulomatous Pyelonephritis Incidentally Detected in a Young Infant
Authors: Philip Jeena Annie , Veena R. , Thomas Christy Cathreen , Radhakrishnan Radhika C. , Kumar Ashok , Uthup Susan 
Published: November 2024

Abstract

Background:
Xanthogranulomatous pyelonephritis (XGP) is a chronic inflammatory condition of the kidney, rarely reported in children, and often misdiagnosed as a neoplasm.

Clinical Description:
A 2-month-old preterm baby boy was hospitalized for bronchiolitis. Examination showed tachypnea, normal pulses, improper weight gain since birth, hypertension and was incidentally detected to have palpable right kidney, without any abnormality in urinary stream.

Management and Outcome:
Routine blood investigations and urinalysis were normal. Chest X-ray was consistent with bronchiolitis and the baby was managed accordingly along with nifedipine for hypertension. Ultrasound abdomen showed an enlarged right kidney with hypoechoic mass in the upper pole and magnetic resonance imaging further showed the mass having areas of necrosis infiltrating into surrounding tissues. Considering a possibility of neoplasm, nephrectomy was performed. However, histopathological evaluation showed evidence of XGP. The baby thrived well, postnephrectomy and remained asymptomatic.

Conclusion:
This case creates awareness regarding occurrence of XGP in such a young infant, where diagnosis was made incidentally, only during a thorough systemic examination, followed by radiological imaging and histopathology.
Neurocysticercosis Encephalitis in a Child with Disseminated Cysticercosis
Authors: Kumar Mritunjay , Sukumar P. Sunny , Suman Arvind Kumar , Upadhyay Ashish , Garg Pragati 
Published: November 2024

Abstract

Background:
Cysticercosis, a common parasitic infestation in endemic regions, may rarely cause widespread dissemination throughout the body resulting in disseminated cysticercosis (DCC), scarcely reported in children.

Clinical Description:
An 8-year-old boy from rural India presented with a 2-week history of headache, abnormal movements, intermittent fever, vomiting, and altered sensorium. Clinical examination revealed generalized hypertonia and signs of raised intracranial pressure. Brain imaging displayed a “starry sky” pattern indicative of neurocysticercosis (NCC) encephalitis. Further imaging revealed cystic lesions throughout the thoracic, abdominal, and paraspinal muscles, confirming DCC.

Management and Outcome:
The patient was managed with intravenous methylprednisolone, antiepileptics, and acetazolamide, avoiding albendazole due to the risk of exacerbating cerebral edema. The patient regained consciousness after the fifth pulse of steroids and progressively improved thereafter being asymptomatic and seizure-free at the last follow-up, 3 months after discharge.

Conclusion:
This case creates awareness regarding a rare entity of NCC encephalitis seen in DCC. The condition may be considered in children presenting with encephalopathy in endemic regions. Supportive treatment with steroids without antiparasitic treatment may be successful.
Congenital Total Colonic Duplication with Double Anus-Recognized Late in a Child
Authors: Kumar Parveen , Manchanda Vivek , Kumar Chandrodaya 
Published: November 2024

Abstract

Background:
Double ani with colonic duplication is rarely seen in children. There are no standard management strategies.

Clinical Description:
A 6-year-old girl presented with fecal discharge from an abnormal site in the perineum in addition to defecation through the normal anal opening. Although present since birth, parents did not seek medical/surgical care till school age. Perineal examination revealed normal labia majora, minora, and clitoris, normally placed urethral opening, septate vagina, and vestibular fistula with a normal anus. Digital rectal examination could not appreciate any abnormal communication.

Management and Outcome:
Initially, a diversion stoma was planned. At surgery, a duplicated colon was identified, dye study confirming duplication of hindgut without any communication distally. During definitive surgery, the vestibular fistula (abnormal bowel opening in the vestibule) was mobilized and the common wall of duplicated rectum was divided the end of the vestibular colon was closed, and the perineal body was reconstructed. At the time of stoma reversal, after 3 months, proximal communication between duplicated colons found up to ileocecal region. Both proximal and distal limb common walls were divided with stapler, and bowel continuity was restored. The child remained well and continent till a follow-up of 2 years.

Conclusion:
Our case highlights the importance of a thorough perineal examination including all orifices at birth or during routine health checkup visits. A second anal orifice may remain unrecognized till later childhood, as defecation predominantly occurs through the true anus, the duplicate anal orifice being minimally functional or nonfunctional.
Test–retest Reliability of Perceived Wellness Survey among Community-dwelling Geriatric Population: An Observational Study
Authors: Verma Chhaya V. , Baburaj Binita , Patil Madhura Rajesh 
Published: November 2024

Abstract

Introduction:
The aging population faces unique challenges, so incorporating their perspective is necessary for providing patient-centered care and enhancing the quality of life for older adults. However, this self-assessed well-being of the elderly population is not extensively documented, despite being a key approach in the health and welfare domain. The Perceived Wellness Survey (PWS), designed to assess well-being across multiple dimensions, could be suitable for determining wellness among the elderly. Therefore, this study seeks to evaluate the test–retest reliability of the PWS among the geriatric population.

Subjects and Methods:
An observational study was conducted which included 100 subjects in the age group of 60–74 years, at a government tertiary care hospital, in Mumbai, after procuring approval from the departmental review board. The participants completed the questionnaire at two different time points, separated by 1 week. The test–retest reliability was assessed using the Pearson’s product-moment correlation coefficient test, and the internal consistency was tested by Cronbach’s alpha.

Results:
One hundred subjects were recruited, of which 45% were female and 55% were male, with a mean age of 66.38 ± 3.96 years. The Pearson coefficients for test–retest reliability among observations varied between 0.870 and 0.946, indicating good reliability. Internal consistency ranges between 0.930 and 0.970, suggesting excellent reliability.

Conclusion:
The PWS is a reliable and internally consistent tool for assessing wellness perception among the geriatric population.
Immunotherapy in Oral Cancer
Authors: Rajeev R. , Dixit Parul , Choudhary Kanaram 
Published: November 2024

Abstract
Squamous cell carcinoma of the head-and-neck (HNSCC) ranks sixth in global cancer incidence and poses significant challenges in terms of morbidity and mortality. The tumor microenvironment in HNSCC is a complex milieu involving immune cells, stromal elements, and cytokines, among other factors. Immunotherapy has emerged as a potent therapeutic avenue, particularly through immune checkpoint inhibitors (ICIs), for modulating this intricate environment. ICIs have garnered approval for first-line use in recurrent and metastatic HNSCC. However, recent clinical observations underscore the variability in treatment response to immunotherapy. This necessitates a thorough exploration of diverse ICI agents and combination strategies to optimize therapeutic outcomes. A comprehensive assessment and focused investigation of the immune contexture in HNSCC patients undergoing ICI therapy are pivotal for advancing treatment efficacy. Numerous innovative immunotherapeutic modalities, including chimeric antigen receptor-T-cell therapy, oncolytic virus therapy, and vaccination strategies, are actively under development. Furthermore, identifying robust biomarkers to guide patient selection for immunotherapy is of paramount importance. The quest for optimal combination regimens incorporating novel immunotherapies represents a recent paradigm shift in the management of HNSCC. This review is a concise summary of the clinical progress and ongoing trials in immunotherapy for HNSCC, highlighting the dynamic landscape of treatment approaches in this challenging disease context.
Four Node Sampling: Is It an Effective Alternative to Sentinel Lymph Node Biopsy in Low-resource Settings for Breast Cancer Management
Authors: Pothina Sreehari , Sharma Manisha , Takkar Puneet , Gadikota Parameswar Reddy 
Published: November 2024

Abstract

Background:
Breast cancer is the most common malignancy among women globally, with regional lymph nodal involvement being a key determinant in staging. “Node positive” breast cancer patients have 40% higher mortality. Axillary lymph node dissection (ALND) is the standard of care in the surgical management of the axilla but is associated with significant morbidity, especially lymphedema. To decrease morbidity especially in node-negative patients, sentinel lymph node biopsy (SLNB) has emerged as an alternative due to its low false-negative rates (FNRs), better sensitivity and specificity. However, in austere settings scenarios where the facility for SLNB is not available, four-node axillary sampling (FNAS) has been explored with variable outcomes. This study evaluates the feasibility of FNAS in the management of node-negative, postneoadjuvant, operable breast cancer patients at our institution.

Methods and Results:
This observational prospective study included 37 patients with clinically node-negative, operable breast cancer, following neoadjuvant chemotherapy. FNAS was performed using methylene blue dye to identify and dissect four axillary nodes and sent for a frozen section. Subsequently, ALND was done as per standard practice. The performance of FNAS as an alternative to SLNB showed a sensitivity of 81%, specificity of 100%, positive predictive value of 100%, and negative predictive value (NPV) of 69%. The FNR was 19.2% with an overall diagnostic accuracy of 86%.

Conclusion:
While ALND remains the standard for axillary staging in operable breast carcinoma, SLNB is validated as a useful method for axillary staging in node-negative patients. FNAS demonstrated high false-negative rates and limited diagnostic value in this study. Further research, including larger studies and randomized controlled trials comparing FNAS with SLNB is needed to establish its efficacy and potential role in the management of node-negative breast cancer.
Significance and Correlation of Lupus Anticoagulant and Anticardiolipin Antibody Assay in High-risk Pregnancy
Authors: Mathew Blessy , Singh Beenu , Kaur Gurpreet , Ahuja Metaanksha , Ankur Ahuja , Gaurav Gahlot P. S. 
Published: November 2024

Abstract

Background:
Antiphospholipid antibodies (aPL), a heterogeneous group of circulating antibodies including lupus anticoagulant (LAC), anticardiolipin antibodies (aCL), & anti-beta-2-glycoprotein 1 antibodies (aβ2GP1) that have been associated with increased risks for thrombosis and adverse obstetric outcomes.

Aims and Objectives:
The lupus anticoagulant tests have variable sensitivity of different clot-based assays i.e. aPTT-LA and dRVVT. The utility & comparison of each lupus anticoagulant assay will be analyzed in high-risk pregnancy clinics.

Materials and Methods:
This retrospective and prospective observational study was conducted over 200 high risk pregnancy cases from Nov 2017 to Jan 2018 at a tertiary care Armed Forces Institute. Equal number of high risk pregnancy cases as patients & normal antenatal patients matched for age as controls were included. 10 ml venous blood collected in tubes in a 9:1 ratio of blood to 3.2% trisodium citrate solution for lupus anticoagulant assay & 3 ml venous sample collected in serum vacutainer for anticardiolipin antibody assays. The STA-Staclot dRVV Screen and STA-Staclot dRVV Confirm kits were used for the detection of lupus anticoagulants in the plasma of patients. The Chi square test & results were analyzed using SPSS version 20.

Results:
A statistically significant positive association between history of IUGR with aCL IgG/IgM antibodies (p-value 0.008) and an insignificant association with the LAC assay was observed.

Conclusion:
Using both aPTT-LA & dRVVT tests as per ISTH recommendation resulted in more prevalence of LAC (24.6%).
The Relevance of the Passing of Time in Criminal Law, with Special Reference to Due Process
Authors: Pápai-Tarr Ágnes 
Published: November 2024

The requirement for the conclusion of criminal proceedings within a reasonable time appears as a component of the right to a fair trial in international human rights documents as well as among the national fundamental rights. The passage of time and the prolongation of criminal proceedings are considered by courts as mitigating factors during sentencing. However, taking these factors into account as mitigating circumstances is not unproblematic, as there is no objective point in time after which one can definitively state that the criminal authorities violated the requirement for adjudication within a reasonable time. In my study, I am investigating the criteria by which the European Court of Human Rights (ECHR) examines compliance with the requirement of reasonable time and how the prolongation of proceedings is treated as a mitigating factor in Hungarian judicial practice.
Апофатическое понятие Божественной красоты у свт. Василия Великого и в последующей греческой патристике
Authors: А.В. Овчаренко 
Published: November 2024

С недавних пор в русскоязычном пространстве стала набирать популярность богословская эстетика. Одним из важных понятий, используемых и развиваемых в рамках данного направления, является понятие красоты Бога. Его важность объясняется тем, что оно пересекается с областью догматического и мистического богословия. В работах основателя богословской эстетики Г. У. фон Бальтазара под красотой Бога понимается эстетически воспринимаемая форма Христа, которая открывается человеку в трансцендентном свете или славе Святого Духа. Сам Г. У. фон Бальтазар, однако, упоминает об апофатическом восхождении человека к присущей Самому Богу красоте как об этапе, который следует за созерцанием красоты, являемой в форме Христа. Последующая богословская эстетика оставляет без внимания апофатическое понятие о красоте Бога и воспринимает в качестве основного катафатическое понятие о красоте как об имманентной форме, в которой является трансцендентный Бог. Рассмотрение показало, что у ряда греческих отцов Церкви под красотой Бога подразумевается апофатическое понятие, не сопряженное с эстетическим созерцанием формы. Это понятие зарождается в ранних работах свт. Василия Великого. Далее оно используется как дополнительное средство для выражения учения о Божественном свете в Макарьевском корпусе, в сочинениях прп. Симеона Нового Богослова и свт. Григория Паламы. Анализ позволяет постулировать разницу в понимании Божественной красоты в современной богословской эстетике и у греческих отцов Церкви.
Since recently, theological aesthetics has started gaining popularity in the Russianspeaking society. One of the important notions used and developed in the field discussed is that of Divine beauty. Its importance stems from the fact that it intersects with the field of dogmatic and mystical theology. In the works of H. U. von Balthasar, the Divine beauty is understood as the aesthetically perceived form of Christ, which is revealed to man in the transcendental light or glory of the Holy Spirit. However, H. U. von Balthasar himself mentions the apophatic ascent of man to the inherent beauty of God Himself as the stage that follows the contemplation of the beauty revealed in the form of Christ. Subsequent theological aesthetics leaves the apophatic concept of the beauty of God out of consideration, and considers the cataphatic notion of beauty as of an immanent form of appearance of the transcendental God to be the main one. The research has shown that a number of Greek Church Fathers understood the beauty of God, implying an apophatic notion not related with aesthetic contemplation of the form. This concept originates in the early works of St. Basil of Caesarea. Further, it is used as an additional means to express the Divine light doctrine in Corpus Маcarianum, in writings of St. Simeon the New Theologian and St. Gregory Palamas. The analysis makes it possible to posit a difference in the understanding of the Divine beauty by modern theological aesthetics and Greek Church Fathers.