bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Cross-sectional Analytical Study of Morphological Patterns of Acanthosis Nigricans and Its Association with Components of Metabolic Syndrome
Authors: Parmar Brijesh Vinubhai , Pala Nilam 
Published: June 2024

Background:
Acanthosis nigricans (AN) is a dermatosis that manifests as asymptomatic and symmetrical darkening, affecting the skin of intertriginous areas. It is a marker of insulin resistance and is usually associated with metabolic syndrome (MS). The present study was conducted to study the morphological patterns of AN and to assess its correlation with different components of MS.

Methodology:
Using the purposive sampling technique (1-year period), 100 patients fulfilling the case definition of AN were enrolled based on the inclusion and exclusion criteria. A detailed history and a cutaneous examination (color, texture, and sites of AN) were done. Anthropometric measurements and scoring of the AN were done. Investigations were reviewed. Data were recorded, and MS was diagnosed using the National Cholesterol Education Program’s Adult Panel III criteria. The data were analyzed using Microsoft Excel 13 software.

Results:
The mean age was 36.9 ± 10.1 years, with a male-to-female ratio of 1:1.38. The mean duration of AN was 18.8 ± 12.5 months. Seventy percent of cases had involvement of two or more sites. MS was present in 55% of cases of AN. Gender, duration of AN, site of AN, neck and axilla severity, and total cholesterol were not statistically significantly associated with MS (P > 0.05). Its association with systolic and diastolic blood pressure, waist circumference, fasting blood sugar, and high triglyceride was found to be statistically significant (P < 0.05). A low high-density lipoprotein level was found to be highly significant (P < 0.01). On applying the Chi-square test, all five parameters of MS had a significant association with AN.

Conclusion:
Understanding the relationship between AN and MS is important, as patients with AN are at risk for all the components of MS individually and collectively.
Let’s Talk About Epilepsy
Authors: Bennet Divya 
Published: June 2024

Epilepsy, a brain disorder marked by recurrent, unprovoked seizures, affects over 50 million people globally according to the WHO. Modern medicine has evolved to offer various antiepileptic medications and precision-targeted medicine, highlighting the critical role of continued research and financial investment in developing innovative treatments. Brazilian Ronaldo Nazario, who is one of the greatest football players, had seizures throughout his career. The most critical seizure that he had was during the final of the FIFA World Cup in 1998, which affected his performance and led to his team’s defeat. Legends with epilepsy did not let epilepsy define them; they struggled and believed that they could. After all, NO PAIN, NO GAIN. While legal advancements, such as amendments to the Hindu Marriage Act in India, which permits those with epilepsy to marry, have been made, challenges persist. Today, there are restrictions on obtaining a driving license, illustrating the ongoing battle against societal barriers. Purple Day, observed annually on March 26, symbolizes a global effort to raise epilepsy awareness. The choice of purple is related to the lavender flower, which is associated with solitude – a reflection of the isolation that people with epilepsy may feel. Stigma leads to depression, and a decline in self-esteem, underlining the importance of comprehensive support systems. Epilepsy may bring challenges, but it also brings strength and resilience. As health-care workers, we are bound to help in spreading awareness, alleviate the stigma, and provide holistic care to those with epilepsy. The love and support that we render will help them take more steps forward and come out with flying colors in this battle against epilepsy. Let us help them “Seize the day.”
“Courage is not having the strength to go on, it is going on when you don’t have the strength.”–Theodore Roosevelt
Diabetes Mellitus Induced by Nivolumab plus Regorafenib in a Patient with Esophageal Cancer
Authors: Lin Mei-Chen , Bai Li-Yuan , Yeh Shih-Peng , Chiu Chang-Fang , Lien Ming-Yu 
Published: June 2024

Abstract
Nivolumab is now preferred as first-line and second-line treatment for advanced esophageal cancer, while regorafenib improves survival in refractory gastroesophageal cancer. The combined use of nivolumab and regorafenib has shown promising results. Nivolumab-induced thyroid dysfunction is a common immune-related adverse event (irAE), while type 1 diabetes mellitus induced by immune checkpoint inhibitors is rare and usually permanent. It is unclear whether the combination of regorafenib and nivolumab increases the risk of irAEs. We report a patient with recurrent esophageal squamous cell carcinoma who was treated with nivolumab plus regorafenib and developed thyroiditis and diabetic ketoacidosis. The rechallenge was successful, and the patient achieved a good treatment response.
Meeting Notes of the Taiwan Neuroendocrine Tumor Society & Taiwan Society of Nuclear Medicine Joint Conference - Peptide Receptor Radionuclide Therapy Targeting for Gastroenteropancreatic Neuroendocrine Tumors: Basic Principles and State-of-the-art Clinical Practice
Authors: Cheng Mei-Fang , Yen Chih-Chieh , Du Jeng-Shiun , Chiu Yu-Li , Chen Ming-Huang , Tsai Hui-Jen , Wu I-Chen , Shen Hueng-Yuan , Yen Ruoh-Fang , Chen Li-Tzong ,   On Behalf of Taiwan Neuroendocrine Tumor Society and Taiwan Society of Nuclear Medicine
Published: June 2024

Abstract

Objective:
The current study aimed to investigate the basic principles and clinical applications, including the selection of proper candidates, follow-up strategies, and radiation protection issues relating to peptide receptor radionuclide therapy (PRRT).

Data Sources and Study Selection:
We searched various scientific databases using specific keywords.

Results:
Due to the overexpression of somatostatin receptors in neuroendocrine tumors (NETs), PRRT is currently considered an important therapeutic modality for the management of NETs.

Conclusion:
PRRT incorporates the systemic administration of a tumor-targeting radiolabeled peptide to patients with tumors, allowing for more precise delivery of radiation doses to tumor sites while sparing normal tissues.
Clinico-Epidemiologic Profile and Response to Levocetirizine in Chronic Spontaneous Urticaria: A Retrospective Cohort Study from a Tertiary Care Center in North India
Authors: Ashraf Raihan , Bishnoi Anuradha , Mehta Hitaishi , Parsad Davinder , Kumaran Muthu Sendhil 
Published: June 2024

Abstract

Background:
Comprehensive long-term follow-up data regarding chronic spontaneous urticaria (CSU) among general populations, especially from the Indian subcontinent is scanty.

Aim and Objectives:
The aim of the study were to analyze the clinico-epidemiological profile, comorbidities of CSU patients, and factors affecting patient response to various doses of levocetirizine.

Materials and Methods:
In this retrospective cohort study, complete history regarding demographic profile, clinical examination, investigations, treatment given, and follow-up details of all CSU patients attending urticaria clinic between 2010 and 2019 were analyzed. These were considered variables to determine the factors playing a role in response to various doses of levocetirizine.

Results:
Totally, 1104 files of CSU were analyzed. The male-to-female ratio was 1:1.5 with a mean age of 33.03 ± 14.33 years. Thyroid dysfunction and atopy were seen in 142 (12.8%) and 184 (16.7%) patients, respectively. Vitamin D deficiency and high serum immunoglobulin E (IgE) levels were seen in 461 (41.7%) and 340 (30.7%) patients, respectively. Immunosuppressives were required at some point in 196 (17.7%) patients. Patients with higher levels of serum IgE and D-dimer (P < 0.05) were found to require frequent updosing of levocetirizine, while age, sex, duration of illness, presence of angioedema, co-morbidities, identifiable precipitating factors, presence of diurnal variation, family history, and vitamin D deficiency were found to not have an effect on levocetirizine dosing.

Conclusion:
Ours is a large single-center study exemplifying the biomarkers including baseline serum IgE and D-dimer levels, which could identify a CSU patient who could warrant a higher dose of antihistamine/antihistamine refractory urticaria.
Perception on self-directed learning among medical students: A qualitative analysis
Authors: Anil Deepak , Kumar D. Sunil , Divya K. L. 
Published: June 2024

Introduction:
Self-directed learning (SDL) is defined as learning on one’s initiative, with the learner having primary responsibility for planning, implementing, and evaluating the effort. The present study aims to evaluate the effects of SDL on medical students and to find out how well they understood it and how to make it better.

Materials and Methods:
A longitudinal study was conducted among 131 1st-year medical students for a period of 12 months. A poster competition was conducted, and students were approached by the research team through an in-depth interview to know their experience regarding SDL 10 days following the assignment. Students were asked how the exercise changed their perception of their SDL skills and what improvements they could make. Descriptive statistics were used to analyze sociodemographic data. Thematic analysis was applied to the comments.

Results:
SDL improved the participants’ comprehension of the subject matter, which made learning easier and more engaging. In addition, discussions in groups assisted students in developing their critical thinking and creative abilities. In addition, it enhanced their capacity for cooperative learning and teamwork. Students said that SDL might assist them in examining many facets of their education and modifying it for situations that arise in the real world. The students expressed a desire to participate in more group and individual activities that would increase their engagement, strengthen and improve their learning, and help them develop their abilities.

Conclusion:
This study shows that SDL methods are likely to be positively appraised by the students, where they improve the cognitive, psychomotor, and affective skills of the students. The students commented that adding more creative SDL activities can further make it interesting helping them learn on their own to gain valuable experience and social skills.

The following core competencies are addressed in this article: Medical knowledge, Practice-based learning and improvement, and Interpersonal and communication skills.
Impact of using active learning principles on perception of medical students toward e-learning environment
Authors: Irfan Ali Syed , Begum Jarina , Lakshmi Lalitha D. , Manasee Panda 
Published: June 2024

Introduction:
The COVID-19 pandemic has necessitated a transition from face-to-face to e-learning, which caught many medical educators unaware. However, it is imperative to develop skills as an e-educator through the application of active learning (AL) principles based on Bloom’s taxonomy. This study highlights the effect of using AL principles on the perception of students toward an e-learning environment using Dundee ready education environment measure (DREEM) questionnaire. The aims of this study were as follows: (1) to introduce the AL principles during online teaching learning sessions. (2) To assess the feedback on the module among the students. (3) To evaluate the change of perception of students toward the e-learning environment through the DREEM questionnaire.

Materials and Methods:
An educational interventional study was carried out among (76) undergraduate students of a medical institution in coastal Andhra Pradesh. Perception toward the e-learning environment was collected through the DREEM questionnaire online before and after the intervention (application of AL principles as per the Bloom’s taxonomy during online T/L sessions).

Statistical analysis:
The data thus collected were analyzed using IBM SPSS version 20 statistical software, descriptive and inferential statistics for quantitative data and thematic analysis for qualitative data.

Results:
The Global DREEM score was 122 which was 62 before the intervention. Similarly, 68% reported positive perception which was only 37% initially. Students’ social self-perception scored lowest initially, but scores were improved to 2nd highest after the intervention. For a few items such as teacher-centered, nonstimulating teaching, not being able to memorize, lack of motivating environment, feedback, feeling lonely, bored, and not having a good support system, the individual scores were negative, i.e., <2 which became positive, i.e., >3.5 after.

Conclusion:
There was a significant change perceived by the students toward the e-learning environment with increased DREEM scores. Thus, this study concludes use of AL principles in online platforms is effective in improving students’ perception of the e-learning environment.

The following core competencies are addressed in this article: Practice-based learning and improvement, Medical knowledge, Interpersonal and communication skills.
Total risk approach for noncommunicable diseases: A review of cardiovascular disease risk prediction tools for Indian setting
Authors: Das P. Ananda Selva , Nongkynrih Baridalyne , Kaur Ravneet , Salve Harshal Ramesh 
Published: June 2024

Abstract
Risk stratification approach considering total cardiovascular disease (CVD) risk and providing appropriate interventions is one of the WHO best-buys for tackling noncommunicable diseases (NCDs). Various risk prediction tools are available to assess total CVD risk and help identify high-risk individuals. Similarly, tools are available for the prediction of risk for specific NCDs such as diabetes and hypertension. Since these tools are context specific, we reviewed the CVD risk prediction tools and disease-specific risk scores relevant for Indian setting. A literature review was performed in PUBMED and Google Scholar using the keywords. A comparison of CVD risk prediction charts applicable for India has been carried out and includes WHO CVD risk charts, WHO/ISH risk charts, Globorisk, and INTERHEART modifiable risk charts. Among these, WHO CVD risk charts are highly recommended for use in India because of its robust methodology in development and have been externally validated. Disease-specific risk scores for Indian setting include Indian Diabetes Risk Score and Hypertension Risk Prediction Tool.
Socioclinical risk factors for cervical dysplasia and presence of human papillomavirus among women attending a tertiary care teaching hospital of Central Odisha
Authors: Ashe Swetaleena , Nanda Saumya , Rattan Roma , Behera Tapas Ranjan 
Published: June 2024

Abstract

Introduction:
Carcinoma cervix being the second-most common gynecological malignancy in India contributes nearly 14% of all cancers in females. Cervical dysplasia and presence of human papillomavirus (HPV) DNA are the two most important factors for developing cervical cancer. Hence, our study aims to be a flag bearer to raise the awareness for cervical screening with the main objective (i) to estimate the magnitude and distribution of cervical dysplasia among the women of 21–65 years and (ii) to find association between different socio-clinical risk factors and cervical dysplasia and HPV infection among the study subjects.

Methods:
It was a cross-sectional study carried out in a tertiary care hospital of Central Odisha, with a sample size of 176. Purposive sampling was done. Predesigned pretested questionnaire along with Pap smear and endocervical smear sample for HPV determination were used for data collection.

Results:
Nearly 62% of women suffered from cervical dysplasia. Women aged ≥35 years were found to have nearly thrice the risk of having cervical dysplasia. Nearly 20% of women tested positive for HPV DNA and these women were found to be 11 times more prone for developing cervical dysplasia compared to women tested negative for HPV DNA.

Conclusion:
Women with repeated genital infection with HPV and aged more than 35 years were more susceptible to cervical dysplasia. Those with early age at menarche, itching per vaginum, postcoital bleeding, and postmenopausal bleeding, etc., had a significant risk for developing cervical dysplasia. Hence, such symptomatic women should be made aware to undergo screening for cervical cancer at the earliest.
Steering the medical maze beyond memorization: Harnessing the potential of open-book tests in medical learning
Authors: Shrivastava Saurabh RamBihariLal , Shrivastava Prateek Saurabh 
Published: June 2024

Abstract
In the field of medical education, we have employed the closed-book test format as the standard approach for carrying out assessments for many decades. An open-book test in medical education is an assessment method wherein medical students are permitted to refer to learning resources during the examination. Thus, students do not rely primarily on their memory and understanding of the subject rather can access external resources to supplement their problem-solving and decision-making abilities. Even though multiple merits have been attributed to open-book tests, we must give attention to the time duration and the kind of references students can access during such tests. At this juncture, we must reiterate that we are not advocating that open-book tests should be introduced and they should replace the conventional closed-book tests. However, there is immense scope for open-book tests in medical education, and every medical institution must explore the scope and feasibility to introduce open-book tests within their settings.
Bed-up-head-elevated Position versus Supine Sniffing Position in Patients Undergoing Rapid Sequence Intubation Using Direct Laryngoscopy in the Emergency Department – A Randomized Controlled Trial
Authors: Reddy Admala Anudeep , Ayyan S. Manu , Anandhi D. , Ganessane Ezhilkugan , Amrithanand V. T. 
Published: June 2024

Introduction:
The objective of this study is to compare bed-up-head-elevated (BUHE) position with supine sniffing position (SSP) in patients undergoing rapid sequence intubation (RSI) using direct laryngoscopy in the emergency department (ED).

Methods:
This single-center randomized controlled superiority trial was carried out from September 2021 to December 2022 in an academic emergency medicine department. The patients undergoing RSI in ED were grouped into two arms, namely BUHE position and SSP. The primary outcome was the time taken for endotracheal intubation. The secondary outcomes were the first-pass success rates and postintubation complications.

Results:
A total of 136 patients were enrolled in the study. Time for intubation in the BUHE group was no different from SSP (32.09 s [interquartile range (IQR): 23.30–42.68] vs. 33.40 [IQR: 27.53–45.90], P = 0.17). There was a modest reduction in intubation time when performed by trained experts (22.5 s [IQR: 17.7–25.3] versus 30.3 s [IQR: 21.3–33.2], P = 0.04). The first-attempt success rate in the BUHE position was also similar to the SSP position ([91.18% vs. 90.91%] P = 0.958). Postintubation complications were lesser in BUHE compared to the SSP group ([7.4% vs. 19.7%] P = 0.04).

Conclusions:
In our study, BUHE position did not improve time to intubation and first-pass success rate in ED patients compared to SSP. A modest decrease in intubation time was noted while experts used the BUHE position. The postintubation complications were slightly lesser in the BUHE group.
Outcomes of Video-assisted Thoracic Surgery-guided Early Evacuation of Traumatic Hemothorax: A Randomized Pilot Study at Level I Trauma Center
Authors: Kumar Abhinav , Gora Dinesh , Bagaria Dinesh , Priyadarshini Pratyusha , Choudhary Narendra , Priyadarshi Amit , Gupta Sahil , Alam Junaid , Gupta Amit , Mishra Biplab , Kumar Subodh , Sagar Sushma 
Published: June 2024

Introduction:
Traumatic hemothorax is accounted for about 20% of traumatic chest injuries. Although majority can be managed with the timely placement of intercostal tube (ICT) drainage, the remaining pose a challenge owing to high complication rates associated with retained hemothorax. Although various treatment modalities including intrapleural instillation of fibrinolytics, radioimage guided drainage, VATS guided evacuation and thoractomy do exist to address the retained hemothorax, but indications along with timing to employ a specific treatment option is still unclear and ambiguous.

Methods:
Patient with residual hemothorax (>200 mL) on ultrasonography after 48 h of indwelling ICT was randomized into either early video-assisted thoracic surgery (VATS) or conventional approach cohort. Early VATS cohort was subjected to video-assisted thoracoscopic evacuation of undrained blood along with normal saline irrigation and ICT placement. The conventional cohort underwent intrapleural thrombolytic instillation for 3 consecutive days. The outcome measures were the duration of indwelling ICT, removal rate of tube thoracostomy, length of hospital stay, duration of intensive care unit (ICU) monitoring, need for mechanical ventilation, incidence of pulmonary and pleural complications, and requirement of additional intervention to address undrained hemothorax and mortality rate.

Results:
The early VATS cohort had shorter length of hospital stay (7.50 ± 0.85 vs. 9.50 ± 3.03, P = 0.060), reduced duration of indwelling ICT (6.70 ± 1.25 vs. 8.30 ± 2.91, P = 0.127) with higher rate of tube thoracostomy removal (70% vs. 30%, P = 0.003) and lesser need of additional interventions (0% vs. 30%, P = 0.105). Thoracotomy (3 patients) and image-guided drainage (4 patients) were additional interventions to address retained hemothorax in the conventional cohort. However, similar length of ventilator assistance (0.7 ± 0.48 vs. 0.60 ± 1.08, P = 0.791) and prolonged ICU monitoring (1.30 ± 1.06 vs. 0.90 ± 1.45, P = 0.490) was observed in early VATS cohort. Both the cohorts had no mortality.

Conclusion:
VATS-guided early evacuation of traumatic hemothorax is associated with shorter length of hospital stay along with abbreviated indwelling ICT duration, reduced incidence of complications, lesser readmissions, and improved rate of tube thoracostomy removal. However, the duration of ventilator requirement, ICU stay, and mortality remain unchanged.