bluuebunny/crossref_metadata_2025_split huggingface dataset:
Before Low Serum Cortisol Can Be Attributed to SARS-Cov-2 Infection, Alternative Causes Must Be Ruled Out
Authors: Finsterer Josef , Mohana Sundaram Arun Sundar , Mehri Sounira 
Published: August 2024

We read with interest Banu et al.,’s article about a cross-sectional study of adrenal function using blood levels of cortisol and adrenocorticotropic hormone (ACTH) in 91 patients with acute SARS-CoV-2 infection. It was found that 27% of patients with severe COVID-19, 26% with mild COVID-19 and 4% with moderate COVID-19 had adrenal insufficiency. Decreased cortisol reserve was found in 6.6% of all patients. It was concluded that the adrenocortical response was impaired in a significant number of non-critically ill COVID-19 patients, with the percentage being highest in patients with severe COVID-19 disease.1 The study is impressive, but some points should be discussed.
The major limitation of the study is that imaging of the pituitary gland and hypothalamus was not performed. To rule out pituitary adenoma, hypophysitis, pituitary apoplexy, pituitary abscess, sellar tuberculoma, or hypothalamic stroke or bleeding, magnetic resonance imaging (MRI) of the pituitary gland and the hypothalamus with contrast agent must be performed. Like any other infection, SARS-CoV-2 infection can trigger the appearance of symptoms of a pituitary pathology.2
A second limitation is that imaging of the suprarenal glands was not performed. To assess whether there was adrenal atrophy, adenoma, ischemia, bleeding, or carcinoma, adrenal imaging is mandatory. 3
A third limitation is that current medication was not reported. Several medications are known to affect serum cortisol levels, making it imperative to know all medications regularly taken by the included patients. Ketoconazole, isilodrostat, vitamin D and omega-3 fatty acids in particular are known to be able to reduce cortisol levels in the blood.4
A fourth limitation is that no ACTH stimulation test was performed to determine whether primary or secondary suprarenal insufficiency was present. Determining cortisol levels alone without ACTH stimulation testing is not reliable with regard to cortical adrenal function.
A fifth limitation is that serum dehydroepiandrosterone (DHEA) levels were not measured. Since DHEA is the antagonist of cortisol and decreases with age, it is conceivable that high levels of DHEA promoted the reduction of serum cortisol.5
Since low thyroxine levels may be associated with low cortisol levels,6 it would also be desirable to know whether thyroid function was normal or abnormal in the included patients.
In summary, the excellent study has limitations that should be addressed before drawing final conclusions. Clarifying the weaknesses would strengthen the conclusions and could improve the study. Serum cortisol levels may be low not only due to SARS-CoV-2 infection but also due to several other causes. Before adrenal insufficiency can be attributed solely to inadequate cortical cortisol production, the entire hypothalamic-pituitary-adrenal axis must be thoroughly examined.
Windswept Deformity
Authors: Ferwani Pankaj , Bhushan Jajoo  , Sandeep Shrivastava  
Published: August 2024

Primary hyperparathyroidism (PHPT) in adolescents is rare and has severe manifestations as compared to adults. Skeletal involvement in primary hyperparathyroidism in the form of deformities like genu valgus, genu varus and cubitus varus is rare and limited to case reports and case series. There is only one case of genu varus with genu valgus on the contralateral extremity (windswept deformity) that has been reported to date in the literature. We report the case of a 19-year-old male who presented with isolated progressive bending of his legs at the knee (windswept deformity) for three years. He was found to have hypercalcemia, hypophosphatemia, high alkaline phosphatase, high intact parathyroid hormone (iPTH), normal 25-hydroxy vitamin D level and a normal kidney function test. A diagnosis of primary hyperparathyroidism was made. On imaging studies, a left inferior parathyroid adenoma was localized and was successfully removed surgically. Serum calcium and iPTH normalized post-operatively. The patient is being planned for corrective osteotomy after stabilization of alkaline phosphatase levels.
Effectiveness of modern immunotherapy in combination treatment of patients with renal cancer and bone metastases
Authors: Kostritskiy S. V. , Shirokorad V. I. , Semenov D. V. , Kalpinskiy A. S. , Kononets P. V. 
Published: August 2024

Aim. To evaluate the effectiveness of modern immunotherapy in combination treatment of patients with renal cancer (RC) and bone metastases (BM).Materials and methods. Retrospective analysis of 19 patients with RC BM who received nivolumab and ipilimumab at standard dose and frequency in the 1st line of treatment and palliative orthopedic surgeries at the Moscow City Oncological Hospital No. 62 between 2015 and 2023.Results. Median follow-up was 17 months. Median progression-free survival (PFS) was 6 months (interquartile range (IQR) 4–10 months). One-year PFS was 13 %. Median overall survival (OS) was 13.0 months (IQR 10.5–18.0 months). One-year OS was 60 %, 2-years OS was 42 %, 3-year OS was 29 %. Disease control was achieved in 13 (68.4 %) patients: in 1 (5.3 %) – complete response, in 12 (63.1 %) – stable disease. Adverse events (AEs) of any grade were registered in 15 (79.0 %) patients. Grade III treatment-associated AEs were observed in 2 (10.5 %) patients. There was no therapy discontinuation due to AEs.Analysis of the effect of the International Metastatic Renal Cell Carcinoma Database Consortium (IMDS) prognosis group on PFS showed insignificant trend towards higher median PFS in intermediate prognosis group compared to the unfavorable prognosis group (p = 0.073). IMDC prognosis group significantly affected OS. Median OS in the intermediate prognosis group was 9.5 months higher than in the unfavorable prognosis group: 16.0 and 6.5 months respectively (p = 0.002). Statistically significant prognosis factors affecting OS in patients with RC BM were concomitant lung and lymph node metastases. Median OS in patients with concomitant lung metastases was 9.0 months, without lung metastases – 16.5 months (log-rank, р = 0.004). Median OS in patients with lymph node metastases was 12.0 months, without lymph node metastases – 17.0 months (log-rank, р = 0.02).Conclusion. In wide clinical practice, cytoreductive surgeries for symptomatic metastatic bone lesions clinically benefit patients with RC BM providing disease control, increased PFS and OS, improved quality of life.
Multicenter non-interventional study of prevalence of homologous recombination gene mutations and approaches to treatment of metastatic castration-resistant prostate cancer in Russia (ADAM)
Authors: Alekseev B. Ya. , Anzhiganova Yu. V. , Sultanbaev A. V. , Bystrov A. A. , Orlov A. S. , Gopp G. V. , Kopyltsov A. V. , Lykov A. V. , Atduev V. A. , Alekseeva G. N. , Rodygin L. M. , Varlamov S. A. , Shestakov A. V. , Maturov M. R. , Urmantsev M. F. , Lankina L. V. , Parsadanova E. L. , Startsev V. Yu. , Vedrova O. V. , Andreev S. Yu. , Perevoshchikov A. A. , Mailyan O. A. , Kalpinskiy A. S. 
Published: August 2024

Background. Prostate cancer (PCa) is one of the most common cancers of men. In 2022, 48,025 new PCa cases and 12,896 deaths from the disease were reported in Russia. Metastatic castration-resistant PCa still is one of the common causes of death in men.Aim. To evaluate prevalence of homologous recombination repair gene (HRR) mutations in patients with metastatic castration-resistant PCa in Russia and to identify differences in clinical characteristics and treatment outcomes of patients with these mutations and without them.Materials and methods. The study included 329 patients with metastatic castration-resistant PCa from 20 centers. Patients underwent molecular genetic analysis using next-generation sequencing to identify mutations in 14 HRR genes. The mutation status was determined in 3 routine laboratories and further validated in a central independent laboratory.Results. The HRR gene mutations were detected in 59 (19.28 %) of 329 patients. The most common were ATM mutations – in 14 (4.57 %), BRCA2 – in 14 (4.57 %), BRCA1 – in 6 (1.96 %). All the patients received first-line therapy, with newgeneration antiandrogens and taxanes being used most frequently. The patients with HRR gene mutations had nearly1.5 times lower median of progression-free survival (PFS) with first-line therapy: 12.8 months vs. 20.8 months in patients without mutations (p = 0.048). There was statistically significant difference in PFS between the observed groups with first-line therapy depending on the treatment group. In patients of general group having been treated with new-generation antiandrogen therapy, the median of PFS was 22 months, while in patients who had received taxanes it was 8.22 months (p <0.05). In patients with HRR gene mutations having been treated with first-line antiandrogenes of novel generation, the median of PFS was 20.5 months, while in patients without mutations the PFS median was 23.1 months (p = 0.14). In patients with mutations and having been treated with first-line taxanes, the PFS median was 6.15 months, while in patients without mutations it was 8.55 months (p = 0.4).Conclusion. In our ADAM study in the Russian population, the proportion of carriers of the HRR gene mutations was slightly lower (19.28 %) than that reported in published randomized trials. There is also a different distribution structure and frequency of the most frequent mutations. Patients with the HRR gene mutations exhibited worse PFS rates and more aggressive course of the disease, which requires a special approach to treatment of this group of patients.
Does threatened miscarriage have an influence on maternal & fetal outcomes during pregnancy? - Our experience in Kozhikode, North Kerala
Authors: Narayanan Saikrishna , Rajan Ambika Prema , Kalliyil Fathimathul Jusna , Nair Lakshmi Rajappan , Tajunnisa Tajunnisa M , Shenoy T Heera 
Published: August 2024

: Bleeding in early pregnancy is a threat to developing embryo and constitute a significant source of anxiety to both parents, obstetrician. Adverse outcomes included miscarriage, placenta previa, abruption, preeclampsia, caesarean section, preterm labor, and preterm premature rupture of membranes, fetal growth restriction, and low birth weight.: The aim of this study was to find the association between threatened miscarriage and adverse pregnancy outcomes in both mother and fetus. Objective was to compare the pregnancy outcomes in normal patients (controls) and in those with threatened miscarriage (cases).: A 1year prospective study was conducted in Kozhikode; Kerala. The study included 140 antenatal patients who were grouped into 70 cases and 70 controls.: P-value is less than the significance level 0.05. It was found that caesarean section was significantly higher in case (66.2%) than control (42.9%). Pre-term delivery was also found to be higher in case (60.3%) compared to control (15.7%). PPROM was significantly higher in case (11.4%) compared to control (2.9%). Low birth weight was also higher in case (16.2%) than control (1.4%). : There was significant association between threatened miscarriage and outcomes like Preterm Labor, preterm premature rupture of membranes, caesarean section, fetal growth restriction, and low birth weight. There was no significant association between threatened miscarriage and outcomes like miscarriage, placenta previa, placental abruption, preeclampsia.
A cross sectional study to estimate the health care needs of perimenopausal and postmenopausal women
Authors: Kaur Sukhpal , Rawat Bhim Singh , Saini Sushma Kumari , Sikka Pooja , Saha Pradeep Kumar , Rawat Sarita 
Published: August 2024

Perimenopause is the period when a woman moves from the reproductive phase to non-reproductive. Postmenopause is a complete cessation of menstrual cycles for 12 months or more. Menopausal symptoms may affect their health and quality of life. To estimate the health care needs of perimenopausal and postmenopausal women. It is a cross-sectional study of one hundred women. Participants of the age group 40-70 years were recruited by using consecutive sampling technique. Data was collected by interviewing participants as per a pretested, and validated questionnaire. Apart from the information profile, data was collected regarding the reproductive profile; Obstetrics history; prevalence of perimenopausal and postmenopausal symptoms; and sources used to acquire information about menopause. The mean age of participants was 53.04 ± 7.35 years. Mean age of attaining menopause was 46.88 ± 4.93 years. Majority of the participants (96%) were vegetarian, half (50%) were overweight as per their BMI. More than half (56%) of the participants reported never doing exercises. The commonly prevalent menopausal symptoms were hot flushes (88%), more tired than usual (86%), joint pains (82%), depressed mood (78%), facing difficulty falling asleep (65%). Most of the participants (74%) rated their level of knowledge little regarding menopausal symptoms and their management. The most frequently used source of information were television/ internet (52%), and friends (47%). Participants require education, appropriate health-related information, counselling services, and availability of affordable, reliable, and accurate health care services for the management of menopausal symptoms.
Serum human pregnancy specific glycoprotein 1 in pregnant women with preeclampsia in comparison with normal pregnancy
Authors: Hussein Shatha Sami , Murad Ali Mohamed , Ibraheem Ban Hussein , Ali Sarah Ismael , Saad Liqa Ameer 
Published: August 2024

To compare the serum pregnancy specific glycoprotein 1 values of women with preeclampsia with the values of healthy pregnant women. A total of 90 pregnant women, whom were recruited during their antenatal care visits to the obstetrical department in Hospital, were included. They were divided into two groups: 45 women with diagnosis of preeclampsia and 45 controls who were the women with healthy pregnancy. Blood samples were collected from both groups and the measurement of pregnancy specific glycoprotein 1 was done using an enzyme immunometric assay. The groups of preeclampsia pregnant women had markedly lower pregnancy specific glycoprotein 1 than the women with the uneventful pregnancies (9.8±3.8 vs 14.3±6.0 ng/ml; p value &#60;0.001). Pregnancy specific glycoprotein 1 can significantly predict preeclampsia (P value &#60;0.001) with an odds ratio of 0.839 and 95% confidence interval of 0.763 – 0.924. By application of receiver operating characteristic curve analysis, it was observed that the cut-off value of pregnancy specific glycoprotien1 for predicting preeclampsia was 10.4 ng/ml with 77% sensitivity and 60% specificity, the area under the curve 0.728 with 95% confidence interval between 0.622 and 0.835, P value &#60; 0.001. Pregnancies complicated by preeclampsia are associated with decreased maternal serum level of pregnancy specific glycoprotien. This abnormally decreased levels of might be a reflection of stressed or dysfunctional syncytiotrophoblasts, which is related to the pathogenesis of this placental disorder.
Doppler abnormalities and perinatal outcome in growth restricted fetuses in a tertiary care center: A retrospective study
Authors: Vinodhini K  , Coumary A Sendhil 
Published: August 2024

Intrauterine Growth Restriction (IUGR), is a significant contributor to foetal and neonatal morbidity and mortality. The majority of prenatal problems that result in negative outcomes can be avoided with early identification and prompt management measures. Doppler ultrasonography is widely used to make the diagnosis of IUGR in foetuses and to monitor the progression in-utero. The purpose of the current study is to predict the perinatal prognosis of foetuses with growth restriction based on doppler abnormalities. A retrospective analysis was conducted among 134 cases of diagnosed IUGR in routine ultrasound from the year 2015 to 2021. Socio-demographic data, baby delivery details, and the ultrasound details regarding doppler evaluation of Umbilical Artery (UA) and Middle cerebral artery (MCA) were collected. The fetal cerebro-placental ratio (CPR) was then analysed with the fetal outcomes in the cases. Abnormal doppler was found in 31 out of 134 cases, with a CPR&#60;1. There was significant association of gestational age, mode of delivery and birth weight variables with abnormal doppler. The mean birth weight of the baby (2052 grams), and NICU admission of the babies (17.6%) have also shown statistical association with abnormal doppler (p&#60;0.05).Doppler velocimetry is the non-invasive method for identifying foetal growth restriction and anticipating perinatal difficulties, which aids the obstetrician in providing good antenatal care and prompt intervention and prevention of perinatal morbidity and mortality.
Histopathological insights into ovarian tumors: A case series perspective
Authors: Savale Apeksha Suresh , Chawla Archi Arun , Jadhav Priyanka Nimbalkar , Sahu Shilpi 
Published: August 2024

: Ovarian cancer stands as the third most prevalent cancer among women in India and contributes to 6% of cancer-related facilities emphasizing its significant impact on mortality. Usually, it manifests with nonspecific symptoms in correlation with age, leading to a frequent oversight in early diagnosis causing more advanced stages when intervention becomes challenging.Case records of six patientsshed light on the diverse spectrum of ovarian neoplasms encountered in clinical practice, highlighting the complexity and heterogeneity within this disease entity of different age groups. In our case series, we found that the overall burden of ovarian cancer was heaviest in the age group 20–45, while the increase was the largest in the age group 50 years and above. Given their asymptomatic nature, late onset of symptoms, and lack of effective screening facilities, ovarian cancers are known as the “silent killer”. Hence, histopathological examination plays a prime role in diagnosis and for primary optimum treatment management. Tumor markers such as AFP, LDH, and beta hCG serve as supplementary tools in the initial diagnostic process, monitoring treatment response, and post-treatment surveillance. Proactive measures targeting diverse risk factors are essential for effective prevention and treatment strategies. This case series underscores the critical importance of timely diagnosis of ovarian tumors, particularly in young females. Heightened vigilance is warranted given the potential for diverse presentations, therefore precise categorization into specific histological types is crucial for clinicians to devise timely management strategies for affected patients.
Identification of Laboratory Management Systems at Senior High Schools In Mataram City
Authors: Suyantri Eni , Handayani Baiq Sri , Lestari Tri Ayu , Setiawan Heru 
Published: August 2024

The Laboratory for Biology serves an effective educational facility for learning of biology, where biology subject often requires lab activity. Proper management of the laboratory is a crucial aspect for the smooth execution of practical activites by both teachers and students. The objective of this research was to determine the biology laboratory management system at SMA Negeri 3 Mataram. This research is descriptive research using observation and interview methods. The data collected in two types, the primary data is observation questionnaire and the result of interview to the biology teachers of SMAN 3 Mataram. The development of the observation questionnaire for the standardization of biology laboratory refers to the National Education Minister’s Regulation No. 24 of 2007, and the laboratory management standards refer to The Minister of Education and Culture’s Regulation No.8 of 2018. There are ten aspects considered in the observation of the biology laboratory, including the evaluation of the laboratory space, the completeness of laboratory equipment and materials, and the cleanliness of the laboratory. Based on the research found that eight aspects were categorized as very good, and two aspect were categorized as as good. The completeness of laboratory tools and materials, as well as laboratory safety, need to be improved.
Board nationality diversity and shareholder value creation
Authors: Zvinowanda Douglas , Mafini Chengedzai , Beneke John D. 
Published: August 2024

The study examined the influence of board nationality diversity on shareholder value creation of non- financial companies listed on the JSE for a 10- year period from 2013 to 2022.The study used quantitative quasi-experimental research design. The study measured board nationality diversity using proportion of foreign directors on board, Blau index for board nationality diversity, dummy variables for one, two and three or foreign directors. The proxies of shareholder value creation included standard market value added, market- to book ratio and Tobin’s Q and fixed effects model based on linear and curvilinear models were used to test the hypotheses. Main findings of the study demonstrate that proportion of foreign directors on board has an insignificant negative impact on standardised market value added and Tobin’s Q, while significant negative impact on market to book ratio. Blau index for board nationality diversity has insignificant negative impact on standardised market value added and market to book ratio, yet insignificant positive impact on Tobin’s Q. One foreign director on board has significant positive impact on standard market value added and market to book ratio, while insignificant positive impact on Tobin’s Q. Two and three foreign directors on board have insignificant positive impact on all shareholder value creation measures. In relation to curvilinear models, proportion of foreign directors on board and Blau in index for board nationality diversity have both positive and negative impact on all shareholder value creation measures highlighting an inverted U- shaped effects.
The influence of work-related stress on emotional and psychological well-being and performance of secondary school leadership in Vulindlela Circuit
Authors: Linda Kgomotlokoa , Dlamini Mbuyiseni , Mthiyane Nonhlahla 
Published: August 2024

The problem this study investigated was high rates of school leaders’ work-related stress results with mental illness and death. The primary objective of the study was to investigate the influence of work-related stress on emotional and psychological well-being and performance of school leaders in Vulindlela Circuit. The study was premised within interpretivism, and we used interviews qualitative technique, to elicit data from 25 secondary school leaderships about their reflections and experiences with work-related stress. The interview transcripts were analysed using NVivo version 14, a program for qualitative data analysis, analyzing the reoccurring themes and patterns of the study, supplemented with narratives. The study discovered that role conflict, role ambiguity, and overload were common workplace stressors affecting the emotional and psychological well-being of school leaderships. The findings are important because they will serve as awareness and mitigation of school leaders’ work-related stress. The study recommends the rolling out of tailormade wellness programmes that will promote mental wellness, and support well-being and stress-reduction techniques through greater task clarity. This study contributes education research on school leadership workplace stressors in Vulindlela Circuit and larger South African context, by laying the groundwork for future studies on interventions to improve school leaderships' performance and well-being.