bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Rare Case of Hoarseness: Laryngeal Amyloidosis
Authors: Carnate Jose M. 
Published: April 2019

This is the case of a 72 year old male who presented with a three year history of hoarseness. Two years prior to admission, he developed dyspnea, dysphagia and odynophagia. Three months prior to admission, the patient visited a private physician who noted a 3 cm diameter ill-defined laryngeal thickening and advised biopsy, hence the present consult. A biopsy and subsequent hemilaryngectomy were performed.
Histologic sections from the mass show an abundant subepithelial deposition of an acellular, extracellular, eosinophilic and non-fibrillar matrix that surrounds atrophic mucous acini (Figs. 1, 2, 3). Scattered lymphocytes and foreign-body-type giant cells are noted. Congo-red histochemical stains show a characteristic salmon-pink reaction (Fig. 4) which on polarizing microscopy showed a characteristic apple-green birefringence. No evidence of malignancy is seen. The diagnosis was localized laryngeal amyloidosis.
Laryngeal amyloidosis is rare, accounting for less than 1% of benign laryngeal tumors. Most are localized - not associated with deposits elsewhere in the body, and are primary – not associated with any known systemic or neoplastic diseases such as disseminated tuberculosis or certain lymphomas and multiple myeloma. Adults are usually affected although rarely, children can develop the condition. Almost all patients present with hoarseness, in addition to symptoms related to the size, extent and location of the deposits. The false vocal cord is often affected although multifocality within the larynx occurs in 15% of cases. 1, 3
Careful histologic evaluation should exclude the presence of a coexistent laryngeal condition, particularly the malignant neoplasms stated above, as these would require more extensive management. Other differential diagnoses include vocal cord polyps and papillomas. 2, 3
The prognosis for isolated laryngeal amyloidosis is excellent although occasional repeat surgeries may be necessary for recurrent disease. On the other hand, the prognosis of laryngeal amyloidosis associated with systemic or neoplastic conditions is dictated largely by the course of the coexisting disease processes. 1
Although rare, laryngeal amyloidosis should not be overlooked in the differential diagnosis of hoarseness particularly in adults. An attempt to exclude a co-existing systemic or neoplastic disease should always be made.
Cutaneous Metastases from Nasopharyngeal Carcinoma: A Rare Manifestation
Authors: Sawali Halimuddin , Yunus Mohd Razif Mohamad , Ai Ong Cheng , Athar Primuharsa Putra Sabir Husin 
Published: April 2019

Objective: In this article, we report on two unusual cases of advanced nasopharyngeal carcinoma (NPC) with distant cutaneous metastases.

Methods:
Design: Case Report
Setting: Tertiary Referral Center
Patients: Two
Results: Two patients with advanced NPC developed multiple nodular skin metastases, one after completing radiotherapy and another during concurrent chemo-radiotherapy. Biopsies of these skin lesions confirmed metastatic NPC and both patients succumbed to the disease.

Conclusion: Nasopharyngeal carcinoma with skin metastases carries a very poor
prognosis. Early detection, diagnosis and treatment are still the best management strategy
for nasopharyngeal carcinoma.

Keywords: Nasopharynx, nasopharyngeal carcinoma, skin metastases, cutaneous
metastases
Lipofibromatosis: An Unusual Head and Neck Mass in the Paediatric Age Group
Authors: Kadian Yogender Singh , Rattan Kamal Nain , Aggarwal Shalini , Modi Shilpi , Kalra Rajnish 
Published: April 2019

Objective: To describe a rare case of lipofibromatosis presenting as a head and neck mass in a
6-year-old child.

Method:
Design: Case Report
Setting: Tertiary Public General Hospital
Patient: One

Result: A six-year-old male child admitted with a large right head and neck region mass underwent
complete excision of a possible soft tissue neoplasm following investigations which included Fine
Needle Aspiration Cytology, Ultrasonography and Computed Tomography. Histopathological
examination yielded lipofibromatosis, a very rare lesion with a distinctive fibrofatty pattern. The
patient was well with no recurrence after three months of follow up.

Conclusion: Although lipofibromatosis is a rare lesion in children and has a predilection for distal
extremities, it may also present as a mass in the head and neck area. Complete surgical excision is
feasible and is the only treatment option available for this rare lesion

Keywords: lipofibromatosis
Spontaneous Passage of Ingested Coin in Children
Authors: Estolano Patrick Joseph L. , Chua Antonio H. 
Published: April 2019

Objective: To determine the factors related to spontaneous passage of ingested coins in children.
Methods:
Study Design: Retrospective Study
Setting: Tertiary Government Hospital
Subjects: The records of 136 pediatric patients with a history of coin ingestion seen at the emergency room department of our institution between December 2012 and May 2014 were retrospectively reviewed. Demographic data such as age and gender of the patient were recorded, including the type of coin, location of coin in the esophagus, time of ingestion and time of spontaneous passage into the stomach (for those that passed spontaneously).
Results: Spontaneous passage in 27 out of 136 pediatric patients with radiographic evidence of a round radio-opaque foreign body initially located in the esophagus eventually passed into the stomach or intestines, accounting for 20% of the total number of cases. Coin ingestion was more common in patients aged 5 to 6 years (33% of cases), with slight male predominance (58%). One peso coins were the most common type of coin ingested, however only 24% of these spontaneously passed. The rate of spontaneous passage was highest in smaller sized coins (5 and 25 centavo coin) compared to larger sized coins (5 peso). Proximally located coins, albeit more common than middle and distally located coins, were the least likely to spontaneously pass (12%). Average time interval from ingestion to passage of the coin was 12 hours.
Conclusion: Many factors are related to spontaneous passage of foreign bodies in the esophagus. The age of the patient, type of coin ingested, and initial location of the coin in the esophagus should be considered. Older patients, smaller sized coins, and distally located coins have the highest probability of spontaneous passage beyond the esophagus. A 12-hour observation period may be considered in patients with single esophageal coin ingestion.
Keywords: foreign body, esophagus, esophagoscopy
Proboscis Lateralis with Rhinosinusitis
Authors: Vera Cruz Laurence Michael N. , Vicente Gil M. 
Published: April 2019

Objective: This report aims to describe unique manifestations of proboscis lateralis and highlight the importance of a multidisciplinary approach to address the problems that arise from this rare congenital anomaly.
Methods:
Study Design: Case Report
Setting: Tertiary Government Hospital
Patient: One
Results: A 13 year-old girl diagnosed with proboscis lateralis presented with a trunk-like appendage projecting from the surface of the right supramedial canthal area. She also had clear nasal discharge, nasal congestion, mouth-breathing, and snoring since birth. Paranasal Sinus (PNS) CT scan with 3D reconstruction showed agenesis of the right paranasal sinuses, and expansile aeration of the left paranasal sinuses. Due to her condition, the drainage system of the paranasal sinuses was obstructed, causing chronic rhinosinusitis (CRS). This hindered plans for reconstructive surgery despite medical management, hence the patient underwent Endoscopic Sinus Surgery (ESS).
Conclusion: Proboscis lateralis is a rare congenital anomaly that results in aesthetic problems as well as airway concerns, such as rhinosinusitis and obstructive sleep apnea syndrome (OSAS). Management entails a multidisciplinary approach to address functional and aesthetic problems of the patient.
Keywords: proboscis lateralis, chronic rhinosinusitis, obstructive sleep apnea, endoscopic sinus surgery, multidisciplinary approach, plastic surgery, reconstructive surgery
Double Ectopic Thyroid Gland in a 10-Year-Old Filipino Boy
Authors: Mendez Tomas Joaquin C. , Locsin Cecilia Gretchen Navarro 
Published: April 2019

Objective: To present a case of a double ectopic thyroid gland in a 10-year old boy and discuss the pros and cons of the different management options that were available.
Methods
Design: Case Report
Setting: Tertiary Hospital in Metro Manila
Subject: One (1)
Results: A 10-year-old boy presented with hoarseness and easy fatigability for 6 years. Rigid endoscopy and CT scan showed an infraglottic mass originating from the anterior tracheal wall causing obstruction. Biopsy revealed thyroid tissue with atypia. Thyroid scintigraphy showed uptake in the submental and midline anterior neck. Thyroid hormone levels were consistent with hypothyroidism. Levothyroxine returned hormone levels to normal and resulted in complete regression of the mass with no symptoms of dyspnea, stridor or bleeding.
Conclusion: The management of ectopic thyroid presents a challenge as there are no guidelines for optimal treatment. Thyroid hormone insufficiency is a frequent occurrence, and emphasis must be given to its monitoring. Surgery in a critical airway lesion such as this may be reserved for cases where the patient experiences dyspnea and stridor or lack of response to thyroid hormone treatment.
Keywords: Ectopic thyroid, direct laryngoscopy, thyroid hormone, levothyroxine
Tracheal Diameter Estimates Using Age-Related Formula Versus Radiographic Findings: Which Approximates the Actual Tracheostomy Tube in Pediatric Patients?
Authors: De Guzman Isaac Cesar S. 
Published: April 2019

Objective: To compare actual tracheostomy tube sizes with estimated endotracheal tube sizes using age-related formula and tracheal diameter from preoperative radiographs among pediatric Filipino patients aged 0-18 years old undergoing tracheostomy.
Methods:
Study Design: Review of records
Setting: Tertiary Private University Hospital in Dasmarinas, Cavite, Philippines
Patients: Pediatric patients regardless of gender, aged 0 to 18 years old, with a preoperative radiograph of the trachea, and who subsequently underwent tracheostomy anytime from January 1, 2007 to December 31, 2016 were considered for inclusion. Radiographs were measured, endotracheal tube sizes were computed using age-related formula, and recorded tracheotomy tube sizes were retrieved.
Results: Twenty-two patients (12 males, 10 females) aged 10 months to 18-years-old (median age: 11 years) were included in the study. Mean tube sizes were 6.46mm (+/- 1.492 SD) for age-related formula, 5.67mm (+/- 1.1849 SD) for radiograph-based estimation, and 5.0 for actual tracheostomy tube inserted in each patient. The Bland-Altman plot showed the bias estimate at 0.7913 and the lower and upper limits of agreement at -1.3598 and 2.9423 (confidence level 95% or 2 standard deviations away from the mean).
Conclusions: The average value derived from radiograph-based estimation is less than the corresponding average value from age-related formula. There is a significant difference between age-related formula-based estimation and actual tracheostomy tube inserted. Since the range of differences between the two estimation methods is high, these results imply that the bias or the difference between measures from the two methods is not consistent, with the two methods exhibiting very poor agreement.
Keywords: Tracheostomy, Intubation, Intra Tracheal, Penlington Formula, Trachea Radiograph Measurement, age related formula for endotracheal tube estimation
Respiratory Epithelial Adenomatoid Hamartoma
Authors: Carnate Jose M. , Abelardo Agustina D. 
Published: April 2019

A 65-year-old man consulted with a history of chronic snorting with a sensation of obstruction in the left side of the nasopharynx particularly when in supine position. A few days prior to consult, the patient had blood-tinged nasal discharge, thus this admission. No other symptoms were reported.

Nasal endoscopy showed a sessile exophytic lesion with a vaguely nodular surface, seen as a polypoid nasopharyngeal mass on Computed Tomography scan. (Figure 1)

Excision of the mass was performed. Received in the surgical pathology laboratory was a 1.8 x 1.5 x 0.6 cm red to brown, rubbery to firm, vaguely ovoid mass with a nodular external surface. Cut section showed a light gray solid surface.

Microscopic examination shows a broad-based exophytic mass with invaginations of the surface epithelium and proliferated glands within the stroma. (Figure 2) The glands are tubular or variably dilated - many are lined by a respiratory-type epithelium with goblet cells and a thickened basement membrane, while the tubular glands are lined by a monolayered cuboidal epithelium. (Figure 3) Based on these features, we signed the case out as a respiratory epithelial adenomatoid hamartoma (REAH).

REAH is a benign proliferation of sinonasal tract glands derived from the surface epithelium.1 It occurs primarily in male adults, with a median age in the sixth decade of life. Most cases arise in the posterior nasal septum, while less common sites of involvement include other parts of the nasal cavity, the nasopharynx, and paranasal sinuses.2 Common symptoms include nasal obstruction, stuffiness, and epistaxis.1,3,4

REAH presents as a polypoid lesion and may measure up to 6 cm in widest diameter.1 Microscopically, there is a proliferation of small to medium-sized glands dispersed in abundant stroma. Invagination of the glands from the surface epithelium may be seen.3 The glands are round to oval, lined by respiratory-type epithelium with admixed goblet cells. Thickened basement membranes surround some of the glands, and smaller seromucinous glands lined by cuboidal epithelium may also be admixed among the latter. Other alterations may include squamous, chondroid, and osseous metaplasia.1,4

Rarely, REAH may occur synchronously with inverting sinonasal papillomas or inflammatory polyps.1 It may be mistaken for these two entities along with sinonasal low-grade adenocarcinomas. Careful attention to the typical morphology including absence of an infiltrative growth pattern and atypia allow distinction from these entities particularly the malignant mimics.3 A related entity is a seromucinous hamartoma with which REAH is believed to form a morphological spectrum.1

REAH is benign and complete excision confers cure.1 Malignant transformation has not been reported.1,3,4
Estudio de las características personales, educativas y socio- productivas de los pequeños y medianos emprendedores de las provincias de Carchi, Esmeraldas, Imbabura y Sucumbíos
Authors: Cahuasqui Cevallos Edwin Marcelo 
Published: April 2019

El propósito de esta investigación es determinar el perfil personal, educativo y socio-pro- ductivo del pequeño y mediano emprendedor de la zona 1 del Ecuador y el contexto donde se desarrolla. Esta investigación descriptiva sirve como punto de partida para que las insti- tuciones involucradas en el tema, adopten propuestas y estrategias pertinentes y coherentes, que logren un impacto positivo en el desarrollo del emprendimiento en la zona, además, que puedan direccionar sus estrategias en función de los requerimientos reales de estos empresa- rios y de las necesidades especialmente de formación del pequeño y mediano emprendedor. Este estudio tomó en cuenta a emprendedores de diferentes actividades comerciales, de servi- cios e industriales de las principales ciudades de la zona 1 del país, estableciéndose diferencias sustanciales entre una provincia y otra, especialmente en el factor educativo y socio-productivo. Se demostró que los componentes culturales, idiosincráticos, de idioma, de clima y geográ- ficos; han afectado el perfil emprendedor de cada una de las provincias, teniéndose resulta- dos interesantes. Esta investigación comprende un análisis sobre la conceptualización del emprendimiento, desde una óptica epistemológica, un análisis crítico del emprendimiento en norte del Ecua- dor, y la descripción detallada del perfil del emprendedor de esta zona. Para el autor de esta investigación como para el equipo involucrado en la misma, fue muy enriquecedor intercambiar experiencias con los pequeños empresarios de la zona, se pudo conocer sus intereses y motivaciones, sus frustraciones y limitaciones al momento de hacer empresa, información importante que se debe tomar en cuenta para desarrollar una activi- dad emprendedora más segura y eficiente.
Evaluación de amenazas y vulnerabilidades informáticas en sistemas académicos universitarios, aplicando ISO 27000
Authors: Pusdá Chulde Marco , Imbaquingo Esparza Daisy 
Published: April 2019

La información es un recurso indispensable para el desarrollo de las organizaciones, en especial en las instituciones educativas de nivel superior como la Universidad Técnica del Norte, la misma es necesaria para ser competitivas, lograr objetivos, obtener ventajas, brindar buenos servicios. Con el avance del internet y dispositivos de conectividad, en la actualidad existen amenazas y vulnerabilidades que pueden ocasionar graves problemas a la seguridad de la información. El presente artículo se enfoca la determinación de amenazas y vulnerabilidades del módulo de gestión académica, utilizando controles del estándar ISOiIEC 27000, marco de gestión de la se- guridad de la información, aplicable a cualquier tipo de organización. Siguiendo los controles recomendados por ISO 27002:2013, se utilizó la metodología para análisis y gestión de riesgos MAGERIT, que permite recomendar las medidas apropiadas adaptables para controlar todo tipo de riesgos en seguridad informática. Para seguir las recomendaciones de la metodología se incorporó PILAR, software que considera diferentes campos de la seguridad como: con- fidencialidad, integridad, disponibilidad, autenticidad y trazabilidad de la información. Luego de un análisis de cumplimiento de la norma ISOiIEC 27002:2013 al módulo de gestión académica, se determinó que existen diversas debilidades relacionadas con la se- guridad de la información: apoyo y concienciación de la dirección, el establecimiento de políticas, procedimientos y falta de personal cualificado.
قياس وتحليل تقلبات أسعار النفط واتجاهات الإنفاق الحكومي على قطاعي الأمن والصحة في العراق للمدة ( 2006 _ 2016 )
Authors: عباس صلاح مهدي , عبد الله حسين علي 
Published: April 2019

هدف الدراسة : تشخيص واقع العلاقة بين تقلبات أسعار النفط العالمية وانعكاسها على اتجاهات الإنفاق الحكومي على قطاع يالامن والصحة.
توصلت الدراسة : إلى أن النفقات العامة تسهم في زيادة الاستهلاك القومي وذلك من خلال شراء الدولة للسلع الاستهلاكية اللازمة لقيام الدولة بواجباتها,أو دفع أجور الموظفين العاملين بالقطاع العام وبذلك يكون هناك تأثير مباشر لهذه النفقات على مستوى الاستهلاك القومي. أظهرت نتائج الاختبارات القياسية انه لا يوجد تكامل مشترك بين تقلبات أسعار النفط والإنفاق الحكومي على قطاع (الأمن) وذلك من خلال اختبار(ARDL)إذ بلغت القيمة الجدولية لمعلمة الحد الأدنى هي (3.62) عند مستوى معنوية 5% وهي اكبر من قيمةFالمحتسبة والتي بلغت(1.055303)وذلك بسبب الظروف الأمنية التي مر بها العراق بعد عام 2003 والتي استلزمت إنفاق على الأمن بصورة كبيرة حتى مع انخفاض أسعار النفط, كذلك من خلال اختبار ARDL التي اجري للتأكد من وجود تكامل مشترك بين الإنفاق على القطاع الصحي وتقلبات أسعار النفط للمدة(2006_2016) تبين ان قيمةfالمحتسبة (1.501817)عند مستوى معنوية 5% وهي اصغر من القيمة الجدولية للحد الأدنى للمعلمة ذاتها والتي بلغت 4.16,مما يدل على انه لاتوجد علاقة أو تأثير متبادل للمتغير المستقل على المتغير التابع والعكس بالعكس.
اوصت الدراسة : على العراق تنويع اقتصاده وعدم الاكتفاء بالنفط كعامل وحيد في تعظيم الإيرادات العامة, وهذا الأمر لايجب التفكير فيه عند انخفاض أسعار النفط فقط, بل التفكير وإيجاد حلول جدية لهذا الموضوع ,وأنشاء صناديق سيادية للاستفادة من الوفرة في الإيرادات في حال ارتفاع أسعار النفط لمواجهة الانخفاضات التي تحدث في أسعار النفط مستقبلا.
التنقيب المحاسبي عن البيانات باستخدام الشبكات العصبية (حالة دراسية)
Authors: رمو وحيد محمود 
Published: April 2019

واجهت منظمات الاعمال في العصر الراهن تحديات عديدة أهمها تقنيات المعلومات وذلك لانتشارها الواسع وسهولة استخدامها، اذ أدى استخدامها الى تضخم حجم البيانات التي تتعامل معها منظمات الاعمال بصورة لم يسبق لها مثيل واصبح حجم البيانات المتاحة من خلال الانترنت مشكلة تسعى اطراف عديدة لإيجاد حلول لها فما هو الجدوى من وجودها بهذا الحجم وبهذه الصورة العشوائية، وكشفت التوقعات أنه في العام 2017 سيكون هناك أجهزة متصلة بالإنترنت تقدر بثلاثة أضعاف سكان الأرض، وفي العام 2015 تم نقل أكثر من مليون ونصف المليون غيغا بايت من البيانات في كل دقيقة عالمياً. من هنا ظهر ما يسمى بالتنقيب عن البيانات Data Mining كتقنية تهدف إلى استنتاج المعرفة من كميات هائلة من البيانات، تعتمد على الخوارزميات الرياضية والتي تعد أساساً للتنقيب عن البيانات وهي مستمدة من العديد من العلوم مثل علم الإحصاء والرياضيات والمنطق وعلم التعلم، والذكاء الاصطناعي والنظم الخبيرة، وعلم التعرف على الأنماط وغيرها من العلوم والتي تعتبر من العلوم الذكية وغير التقليدية. وتجسدت مشكلة البحث في ان الازدياد المضطرد في حجم البيانات فضلأ عن ظهور مجالات انية عديدة تحتاج الى بيانات مختلفة نتيجة البيئة المعاصرة لمنظمات الاعمال اليوم يجعل نظم المعلومات غير قادرة على تلبية احتياجات هذه المنظمات الانية وهذا ينطبق تماما على نظم المعلومات المحاسبية كونها النظام الرئيس في منظمات الاعمال اليوم، فان هذه النظم قد تم تصميمها لتلبية حاجات محددة جعلها تعجز اليوم عن تلبية الاحتياجات المختلفة وفق البيئة المعاصرة لمنظمات الاعمال اليوم، فضلاً عن عجزها في التعامل مع حجم البيانات المضطرد الذي اوجدته تقنيات المعلومات. واطلق البحث من فرضيتين اساسيتين الاولى ان اعتماد التنقيب المحاسبي عن البيانات يؤدي الى توفير بيانات لم يكن نظام المعلومات المحاسبي قادر على توفيرها فضلاً عن اختصار الوقت والجهد اللازم في الحصول عليها. بينما كانت الثانية في ان اعتماد التنقيب المحاسبي عن البيانات يمكن من اعتماد أساليب الذكاء الصناعي في معالجة تلك البيانات لتوفير معلومات مفيدة لترشيد القرارات. وقد توصل البحث الى مجموعة من الاستنتاجات منها ان التزايد المضطرد بحجم البيانات عموماً ولاسيما البيانات المحاسبية يجعل من التعامل وفق الاطر التقليدية مسالة صعبة جداً كما انه يؤدي الى ضياع الوقت والجهد في استخلاص المعلومات. وان ظهور كثير من المتغيرات الانية نتيجة المتغيرات في بيئة العمل يتطلب وجود ادوات تقنية لديها المرونة الكافية للتعامل معها. وكذلك ان ادوات التنقيب عن البيانات لديها القدرة في استنتاج علاقات بناء على قواعد البيانات الموجودة لديها لم تكن موجودة في السابق. توصل البحث الى مجموعة من التوصيات اهمها ضرورة اعتماد النموذج الذي قدمه البحث وهو شبكة (Multilayer Perceptron) وتوجد هذه الشبكة ضمن برنامج (SPSS) الذي يتيح امكانية استخدام هذه الشبكة بسهولة في ترشيد قرار اختيار المشاريع المنفذة في مجالس المحافظات
Math and Science Teacher Candidates’ Use of Technology to Facilitate Teaching and Learning During Student Teaching
Authors: Tassell Janet , Stobaugh Rebecca Ruth , McDonald Michael 
Published: April 2019

The goal of this study is to determine how effectively student teachers from a large comprehensive institution have used technology to compliment their teaching in mathematics and science. The researchers reviewed the required Teacher Work Sample (TWS) capstone projects of student teachers. The TWS is an authentic assessment instrument designed to guide student teachers in designing, implementing, reviewing, and adjusting instruction. The TWS document narratives articulated the use of technology, and this use was compared to the 2008 U.S. Department of Education (USDE): Measures of Teacher and Student Technology Use. Data gathered in the study revealed both strengths and weaknesses regarding the student teachers’ use of technology to enhance their teaching goals.