bluuebunny/crossref_metadata_2025_split huggingface dataset:
Everolimus Exposure as a Predictor of Toxicity in Renal Cell Cancer Patients in the Adjuvant Setting: Results of a Pharmacokinetic Analysis for SWOG S0931 (EVEREST), a Phase III Study (NCT01120249)
Authors: Synold Timothy W. , Plets Melissa , Tangen Catherine M. , Heath Elisabeth I. , Palapattu Ganesh S. , Mack Philip C. , Stein Mark N. , Meng Maxwell V. , Lara Primo , Vogelzang Nicholas J. , Thompson Ian Murchie , Ryan Christopher W. 
Published: April 2019

Background: S0931 is assessing recurrence-free survival in renal cell carcinoma (RCC) patients randomized to receive everolimus (EVE) versus placebo for one year following nephrectomy. Due to a higher than expected dropout rate, we assessed EVE trough levels in the adjuvant setting to evaluate the relationship between EVE exposure and probability of toxicity. Methods: Patients received 10 mg daily EVE for nine 6-week cycles. Pre-dose whole blood samples were collected pre-cycle 2 and pre-cycle 3 and analyzed for EVE. Patients with pre-cycle 2 and/or pre-cycle 3 EVE results were used in the analysis. Patients were segregated into quartiles (Q) based on EVE levels and logistic regression was used to model the most common adverse event outcomes using EVE trough as a predictor. Hazard and odds ratios were adjusted for age, BMI and performance status. Results: A total of 467 patients were included in this analysis. Quartiles normalized to an EVE dose of 10 mg/day were < 9.0, 9.0–12.9, 12.9–22.8, and > 22.8 ng/mL, respectively. EVE trough levels increased with increasing age ( p < 0.001). Furthermore, EVE trough levels were higher in men than women (19.4 versus 15.4 ng/mL, p = 0.01). Risk of grade 2 + triglycerides was increased in Q2 and Q3 vs Q1 (OR = 2.08; p = 0.02 and OR = 2.63; p = 0.002). Risk of grade 2 + rash was increased in Q2 and Q4 vs Q1 (OR = 2.99; p = 0.01 and OR = 2.90; p = 0.02). There was also an increased risk of any grade 3 + tox in Q2 vs Q1 (OR = 1.71; p = 0.05). Conclusions: We identified significant gender and age-related differences in EVE trough levels in patients receiving adjuvant treatment for RCC. Furthermore, our analysis identified significant associations between EVE exposure and probability of toxicity.
The role of zinc supplementation for diarrhoea in children: a critical review
Authors: Putri Wulandari Berliani , Akhmad Syaefudin Ali , Desrini Sufi 
Published: April 2019

Background: Nearly 1.7 million children suffer from diarrhoea and around 760,000 die each year. The high prevalence of diarrhoea in the developing countries is closely related to lack of safe drinking water, inadequate sanitation and hygiene, and poor health and nutritional status. These environmental conditions facilitate the spread of infectious disease easily. The great morbidity and mortality of this preventable and treatable disease raise concern on how to save children from this fatal disease by improving management of diarrhoea. Several studies suggest that zinc deficiency contribute towards high morbidity and mortality in diarrhoea. Further, there is an area of uncertainty regarding how significant zinc supplementation will help to reduce the duration and severity of diarrhoea in children compared to the diarrhoea management without zinc?
Objective: To critically analyse the current evidences of zinc supplementation in diarrhoea.
Data Sources: Keywords searching through MEDLINE Ovid database and additional references from retrieved articles. Study Selection: Limited to randomized controlled trial(RCT) study design and systematic review studies which were conducted from 2006 to 2016. However, there is one prospective cohort study included as it is a follow-up of subjects who participated in the previous double-blind randomized placebo-controlled trial.
Data Synthesis: This review involves a summary of 10 articles that have been appraised on their relevance in evaluating the role of zinc in reducing severity and duration of diarrhoea in children. Further, the literature found is synthesised through method used in the studies and the effectiveness of zinc therapy
Conclusion: Zinc is relatively safe to be used and it can improve diarrhoea management especially in developing countries.
Bangladesh Journal of Medical Science Vol.18(2) 2019 p.190-195
Red cell indices and peripheral blood film findings of anti-Psychotic treatment and treatment naïve Psychiatic patients in a tertiary Hospital in Nigeria.
Authors: Shittu AO , Adewoye AO , Olawumi HO 
Published: April 2019

Background: The overall burden of morbidity and mortality from psychiatric disorders is on the rise. Holistic approach in the care of this group of patients has become inevitable. There is need for collaboration between psychiatrists and other physicians, laboratory physicians inclusive. Study design: cross sectional descriptive case- control study.
Materials and method: A total of 198 patients including controls were recruited for this study. Patients with schizophrenia constituted majority of the respondents, 86.4% of antipsychotic-naïve patients and 90.9% of patients on antipsychotics. A comprehensive medical examination was carried out on every participant. On every sample, automated Full Blood Count was performed using Sysmex2000i and peripheral blood film was made and examined.
Result: 51.5% and 47% of anti-psychotropicnaïve patients and patients on anti-psychotic were 18-40 and 41-60 years respectively. Male (57.6%), predominated the anti-psychotic naïve group while female (51.5%) predominated the group on anti-psychotics. Schizophrenia was the diagnosis in the majority of patients, 86.4% and 91% respectively in anti-psychotic naïve and antipsychotic treatment groups. Other diagnoses were depressive illness, substance use disorder and dementia. Of all the subjects, one (1.5%) schizophrenic patients and two (3%) of controls had abnormal haemogram results. For the schizophrenic patient with abnormal results, haematocrit was 12g/dl, MCV of 75fl and MCH of 26pg, while the two controls with abnormal results had only haematocrit deranged with value of 12.3g/d. Neutrophil hypersegmentation was seen on the film of five antipsychotic-naïve patients (7.5%) diagnosed with Schizophrenia and one (1.5%) of the controls. Macrocytosis was only seen in three (4.5%) of the five antipsychotic-naïve patients that had neutrophil hypersegmentation.
Conclusion: No significant difference was noted in the Full Blood Counts among the two sets of patients and controls, although there were isolated cases of neutrohil hyperesegmentation and macrocytosis.
Bangladesh Journal of Medical Science Vol.18(2) 2019 p.196-205
Anthropometric Measurement of External Ear and Correlation with Age in North Regional People of Bangladesh
Authors: Asadujjaman Md , Rashid Md Harum Or , Rana Sohel 
Published: April 2019

Objective: The purpose of this study was to build an external ear anthropometric database in North regional people of Bangladesh. This study also aimed to show the morphological variations between male and female as well as changes in ear anthropometry with age.
Materials and Methods: Ear dimensions of 313 people (150 male and 163 female), aged between 18-75 years, were measured pursuant to standard anthropometric measurement procedure. A total of five external ear dimensions- ear length, ear breadth, base of the auricle, lobe length and lobe breadth was measured. Pearson correlation coefficient was used to determine the relationship among various ear measurements, and linear regression analysis was used to estimate ear dimensions from the age of the people.
Result: All ear dimensions were found larger in male than in women. The result also revealed that, dimensions of ear parameters increase proportionally with the increase of age, except male left-lobe breadth and female lobe breadth in both sides.
Conclusion: Of course, this study of human ear morphology will serve as a quantitative database and play an enormous importance of anatomy and human factors engineering point of view.
Bangladesh Journal of Medical Science Vol.18(2) 2019 p.206-210
Cardiac Function in Uncomplicated Type 2 Diabetes Mellitus
Authors: Agrawal Bimal K , Jain Parul , Marwaha Saurabh , Goel Richa , Kumar Himanshu D , Jagdish - 
Published: April 2019

Objective: Diabetic cardiomyopathy (DC) is a myocardial disease characterized by myocyte hypertrophy, interstitial fibrosis, protein glycosylation and intra-myocardial micro-angiopathy due to prolonged exposure of myocardial tissues to hyperglycemia in diabetes mellitus (DM) patients. Alteration in cardiac function can be non-invasively assessed via echocardiography. The early recognition of cardiac dysfunction can prevent the symptomatic heart failure in DM patients. The study aimed at evaluating cardiac function in uncomplicated type 2 diabetes mellitus.
Materials And Methods: Sixty Type 2 DM patients without any feature of the coronary arterial disease (CAD), hypertension, nephropathy and respiratory illness were enrolled in the study and compared with the sixty age matched healthy controls. Echocardiographic assessment was done in all subjects to evaluate the cardiac function.
Results: Diastolic dysfunction was more common in diabetic patients when compared with normal healthy population. Systolic dysfunction progresses with age of the diabetic patient.
Conclusion: Echocardiography is a simple noninvasive cost effective test for detecting cardiac dysfunction in Type 2 DM patients and should be applied to detect early Left ventricular(LV) dysfunction so that corrective measures may be initiated early and cardiac functions may be preserved for long.
Bangladesh Journal of Medical Science Vol.18(2) 2019 p.211-215
Prevalence of Acute and Chronic Forms of Leukemia in Various Regions of Khyber Pakhtunkhwa, Pakistan: Needs Much More to be done!
Authors: Ahmad Shujaat , Kifayatullah - , Shah Kiramat Ali , Hussain Haya , Haq Anwar Ul , Ullah Abid , Khan Asaf , Rahman Najm Ur 
Published: April 2019

Background and objective: Leukemia is one of the fatal diseases and their morbidity and mortality rates increases day by day all over the world. This piece of research study was designed in order to find out the prevalence of different types of leukemia in Khyber Pakhtunkhwa, Pakistan during January 2015 to December 2016.
Material and Method: The retrospective research study was carried out at Institute of Radiotherapy and Nuclear Medicine (IRNUM) Peshawar. A data of 400 admitted patients of leukemia were evaluated.
Result: It was observed that acute leukemia (80%) was more prevalent than chronic leukemia (20%). Amongst types of leukemia, Acute Lymphocytic Leukemia (ALL) 49.5% (n=198) was more prevalent than Acute Myelogenous Leukemia (AML) 31.25% (n=125), Chronic Myelogenous Leukemia (CML) 10% (n=40) and Chronic Lymphocytic Leukemia (CLL) 9.25% (n=37) was less prevalent in this study. It was also found that leukemia was more prevalent in male patients 64.5% (n=258) as compared to females 35.5% (n=142) and male to female ratio was 1.8:1. Most of the patients were under the age of 20 years.
Conclusion: Acute leukemia was more prevalent than chronic leukemia during this study in this part of the country and needs to be address.
Bangladesh Journal of Medical Science Vol.18(2) 2019 p.222-227
Factors Affecting Nurses’ Perceived Organizational Commitment: A Qualitative Study
Authors: Sepahvand Faribah , Shoorideh Foorozan Atashzadeh , Parvizy Soroor , Tafreshi Mansoureh Zagheri 
Published: April 2019

Objective: Nurses’ organizational commitment is one of the most important factors that facilitates their professional evolution and influences the method of care provision, quality of care, and patients’ satisfaction. The aim of this study was identified the factors that affect nurses’ perceived organizational commitment.
Material and Methods: This qualitative study, conducted on 16 clinical nurses employed in Social Security Hospital of Khorramabad, Iran, during five months from May to September 2015, used deep semi-structured interviews. Purposive sampling method was used for the selection of nurses and the data were analyzed using conventional qualitative content analysis. Lincoln & Guba’s criteria were used to secure data accuracy and stability.
Results: Sixteen subcategories, five categories, and three themes were distilled during content analysis process. The abstracted themes included “organizational factors”, “occupational challenges”, and “contributory management”.
Conclusion: Our findings showed that numerous factors present in nurses’ profession and work environment may influence the rate of nurses’ interest and commitment in the hospital and the related organization. Hence, nurse managers can foster the promotion of nurses’ organizational commitment through creating the required suitable conditions.
Bangladesh Journal of Medical Science Vol.18(2) 2019 p.303-311
Correlation between Digit Ratio and Incidence of Meningioma and its Clinical Profiles
Authors: Brilliantika Surya Pratama , Arifin Muhammad Thohar , Istiadi Hermawan , Winarni Tri Indah , Muhartomo Hexanto 
Published: April 2019

Background: Proliferation and progression of meningioma were influenced by the balance of estrogen and testosterone. Digit Ratio (DR) was a sign of prenatal exposure to estrogen and testosterone. This study intends to find the relationship between Digit Ratio and meningioma.
Aim: To determine the relationship between DR and incidence of Meningioma and its Clinical Profiles (age at the onset, sex, Body Mass Indec (BMI) and histopathology grading)
Methods: Analytical observational study was used with case-control design. Case group consisted of patients clinically and histopathologically diagnosed with meningioma (n=25). Patients who were not diagnosed with primary intracranial tumors were included in the control group (n=25). Matched group were conducted. Subjects of this study were patients of RSUP dr Kariadi in the period of January 2016-August 2017. This study was conducted by collecting data consisted of DR, age, sex, BMI, and grading histopathology. Tests used in this study are Chi-Square Test, Mann-Whitney Test and Fishers exact Test.
Results: Digit Ratio Mean for right, left and right-left difference were 1.0041; 1.0104 and 0.0357 while for the right and left DR cutoff value 0.993; 0.989. There is a relationship between right and left Digit Ratio and incidence of meningioma (p = 0,000) with OR (Odds Ratio) Right DR = 11.17(CI95% 2,864 – 43,464) and OR left DR = 16,00 (CI95% 4,002 – 63,975). There is a relationship between Right Digit Ratio andBMI case group (p = 0,022). There is no relationship of Digit Ratio and age at onset, gender and histopathology grading (p <0.05).
Conclusion: DR is risk factor of Meningioma
Bangladesh Journal of Medical Science Vol.18(2) 2019 p.347-352
Thyroid status in the combination of atrial fibrillation with subclinical thyrotoxicosis
Authors: Rakhmatullov Ruslan F , Rakhmatullov Artur F , Rakhmatullov Fagim K , Burmistrova Larisa F , Moiseeva Inessa J 
Published: April 2019

Objective: To study the factors in the development of atrial fibrillation in patients with subclinical hyperthyroidism on the background of angina pectoris as a result of a comprehensive analysis of the electrocardiographic and echocardiographic indicators of the heart, thyroid volume, thyroid hormone levels and lipid profile.
Materials and Methods: The risk factors for atrial fibrillation (AF) were studied in patients with subclinical hyperthyroidism (SH) and angina pectoris. It was revealed that the starting factor for the occurrence of AF in patients with subclinical hyperthyroidism is a shift in the reference values of thyroid hormones. It was established that the total depression of the ST segment reflects the degree of coronary reserve in patients with AF on the background of SH.
Results and Discussion: It has been shown that in patients with subclinical hyperthyroidism, there is a normal level of total cholesterol and LDLP, a low level of triglycerides and atherogenicity, and a high level of HDLP. When combined with subclinical hyperthyroidism and paroxysmal AF, there is an increase in the level of total cholesterol, LDLP, TG, atherogenicity and decreased HDLP.
Conclusion: It has been proven that diastolic dysfunction of the left ventricle of the first type is formed on the background of SH.
Bangladesh Journal of Medical Science Vol.18(2) 2019 p.402-410
Prosthetic rehabilitation of a microtia patient by adhesive retained auricular prosthesis: A dental technique.
Authors: Nizami Md Minhaz Ul Islam , Rahman Ahmed Mushfiqur , Jamayet Nafij Bin , Alam Mohammad Khursheed , Ghani Zuryati Ab , Husein Adam 
Published: April 2019

Introduction: Auricular deformity can be emotionally traumatising and affects social behavior of an individual. In such cases, aesthetically acceptable prosthesis serves as a viable alternative technique to surgical reconstruction.
Case description: Impression of the auricular defect was taken by light and regular body of poly vinyl siloxane impression material. Wax sculpting was challenging due to the bulgy remnant of the defected ear. The wax pattern was made very thin to accommodate and mask the remnant without compromising the aesthetic. Trial on the patientwas done for correction of the contours, angulation, height and width according to the normal contralateral ear. The intrinsic coloration of a Room Temperature Vulcanizing silicone was done and poured in a custom-made three-piece mold. Before the final issue of the auricular prosthesis, extrinsic coloration was done based on the surrounding area of the defect.
Discussion: Fabrication of adhesive retained prosthesis is challenging in patients with large deformed soft tissue who refuse to undergo surgical repair. A modified wax sculpting was done to overcome this challenge. Medical grade silicone was the choice of material because of its flexibility, biocompatibility and life like appearance.
Conclusion: Replacement of missing ear is a difficult and multi-step task in which extensive array of materials and techniques need to be employed. This fabrication technique is alternative to surgical repair with the utilization of available and economical materials.
Bangladesh Journal of Medical Science Vol.18(2) 2019 p.437-439
Tuberculous Spondylitis involving Sacrum- a rare location and presentation of Pott’s disease: Case report and review of the Literature
Authors: Khan Shahidul Islam , Ahmed Nazmin , Rahman Asifur , Mahmud Abdullah Al , Islam Rafiqul , Ahsan Md Kamrul 
Published: April 2019

Background: Spinal tuberculosis is a common form of extrapulmonary manifestation of tuberculosis. Among them tubercular involvement of the lumbosacral region or isolated involvement of sacram is very rare presentation.
Aim of the work: The aim of this case presentation is to describe two rare cases of Pott’s disease which clinically mimicked spinal tumor.
Case report: A 60-year-old hypertensive, diabetic male patient admitted with low back pain radiating to both lower limbs for 7 months along with low grade fever, generalized weakness and weight loss for the same duration. Clinically, patient had features of flaccid paraparesis, tenderness at the lumbosacral junction, restricted SLR on both sides. There was no features of autonomic dysfunction. MRI of lumbosacral spine showed infective spondylodiscitis at L4 to S1 level with collapse of L5 vertebrae along with paravertebral and epidural abscess. Diagnosis was confirmed by CT guided FNAC from the lesion. Next case was a 23-year-old male patient presented with back pain and walking difficulty for 5 months with some constitutional symptoms.MRI of the dorsal spine with whole spine screening showed multifocal skipped lesion involving whole spine with presence of huge presacral collection. Percutaneous transpedicular aspiration of the purulent material under C-Arm guidance was done and tuberculous infection confirmed by Gene Xpert.
Conclusion: Though sacral tuberculosis is rare presentation of Pott’s disease but it should be considered as one of the differential diagnosis in any lytic lesion involving the sacrum in perspective of our country.
Bangladesh Journal of Medical Science Vol.18(2) 2019 p.440-445
La responsabilità professionale medica oggi
Authors: Fontanella Guest Editors: A. , Gnerre P. , Nardi R. 
Published: April 2019

La responsabilità penale e civile del medico oggi: oneri e onori delle linee guida nella legge Bianco-GelliG. Gallone, C. Palermo
La responsabilità contrattuale ed extracontrattuale: quali differenze?D. Amati, A.P. Rossi
La legge Gelli-Bianco dal punto di vista della giurisprudenzaS. de Vito
La posizione di garanzia del primarioA. de Palma, M. Alessandri
La responsabilità dell’organizzazione sanitaria: adeguatezza di strumenti e dotazioni strutturaliG. Lo Pinto
La responsabilità delle Direzioni Mediche nel Middle managementC. Coppo, S. Nola
Il dipartimento come modello di responsabilità organizzativaR. Tassara, P. Gnerre
I requisiti di validità del consenso nel trattamento sanitarioG.B. Ferro
Assicurazione obbligatoria e rischio sanitarioL. Longo
A che punto ci troviamo con le assicurazioni o polizze per le professioni sanitarie dopo la legge Gelli-Bianco?S. de Vito, P. Gnerre, D. Montemurro, M. Zippi
Medicina difensiva ed errore in ambito internisticoM. La Regina, E. Romano

La responsabilità nella sperimentazione clinica: Sperimentatore, Sponsor e Comitato EticoG. Gussoni, A. Crespi, S. Frasson, A. Valerio, C. Vertulli, E. Zagarrì
La responsabilità dello specializzando: diritti e doveriP. Di Silverio, M. d’Arienzo
La responsabilità del medico di Pronto Soccorso e del medico di guardia: ruoli e responsabilità all’interno di una struttura ospedalieraC. Rivetti, A. Spedicato
Il trattamento di fine vita alla luce delle ultime novità legislativeA.N. Rosato, F. Rosati, C. Santini
Il trattamento sanitario obbligatorioF. Bandini
La responsabilità professionale medica secondo il codice di deontologiaL. Corti

ConclusioniA. Fontanella