bluuebunny/crossref_metadata_2025_split huggingface dataset:
Myasthenic Crisis in a Child: Successful Recovery after Early Identification and Intervention
Authors: Jaggi Ishmeet Kaur , Dewan Pooja , Harit Deepika , Kaushik Jaya Shankar , Yadav Mukesh 
Published: May 2024

Background:
Juvenile myasthenia gravis (MG) is a rare autoimmune neuromuscular disorder and has a varied presentation in childhood making it a diagnostic challenge.

Clinical Description:
An 8-year-old girl presented to the pediatric emergency with multiple episodes of falling, drooling of saliva, dysphagia, and bilateral ptosis. Within a few hours of admission, she had acute deterioration, developed respiratory failure, and was put on ventilatory support.

Management and Outcome:
A myasthenic crisis was suspected and a neostigmine challenge test was done. She was managed in the emergency with atropine, neostigmine, intravenous immunoglobulin, and supportive care. Subsequently, she achieved complete remission with steroids, physostigmine, and oral mycophenolate mofetil over the next 6 weeks.

Conclusion:
Juvenile MG may rarely be the cause of generalized muscular weakness. A strong suspicion of myasthenic crisis must be kept in case of sudden deterioration involving bulbar and respiratory muscles, in a patient with neurologic weakness. Early intervention in this rare condition can be lifesaving.
Monogenic Autoinflammatory Disease Due to Blau Syndrome with Nucleotide Oligomerization Domain 2 Gene Mutation in an Indian Family
Authors: Magar Suvarna , Perveen Naziya , Kale Anjali , Agrawal Srishti 
Published: May 2024

Background:
Blau syndrome is a monogenic disease resulting from mutations in nucleotide oligomerization domain 2 (NOD2) and is phenotypically characterized by a triad of dermatitis, arthritis, and uveitis. We report Blau syndrome in a child who had been symptomatic for years, without the typical clinical triad.

Clinical Description:
A 7-year-old girl child presented with bilateral knee, wrist, and ankle joint swelling since the age of 2 years. She had recently developed a rash on the body. Her mother, mother’s identical twin sister, and the latter’s 5-year-old daughter had similar joint pain and swellings since childhood. In view of the strong positive family history of polyarthritis, monogenic cause of arthritis was suspected.

Management and Outcome:
Complete blood count was unremarkable. Erythrocyte sedimentation rate was 20 mm at C-reactive protein was 36 mg/L, antinuclear antibody and rheumatoid arthritis factor were negative. X-ray of the knee joints and wrist joints showed soft-tissue swellings around the knee and lumbar scoliosis. A heterozygous pathogenic variant in NOD2 gene confirmed the diagnosis of Blau syndrome. After receiving the genetic report, the girl was started on prednisolone and weekly methotrexate.

Conclusion:
Early-onset arthritis, with recurrent episodes of fever, is not to be ignored if autoimmune markers are negative. Knowledge about the clinical features of autoinflammatory diseases and the spectrum of NOD2 variants will enable physicians to carry out specific investigations, especially genetic analysis for confirmation of the diagnosis and hence administer the right treatment.
Severe Hypertriglyceridemia in a Child with Refractory, Fatal Diabetic Ketoacidosis: A Case Report with Review of Literature
Authors: Soin Shyna , Kaur Gurmeet , Kaul Varun , Batra Dorthy 
Published: May 2024

Background:
Diabetic ketoacidosis (DKA) is an acute life-threatening complication of diabetes. Dyslipidemia due to disturbance in glucose metabolism can cause elevation in serum triglyceride levels. Severe hypertriglyceridemia is a complication of DKA, rarely reported in children.

Clinical Description:
A 3-year-old girl, newly diagnosed, but untreated type 1 diabetes mellitus (DM), presented with DKA. The first blood sample showed serum as grossly milky, with highly raised levels of triglyceride (2170 mg/dL) and cholesterol (791 mg/dL). Many of the blood parameters were erroneous due to the lipemic sample. Serum amylase and lipase were normal, ruling out pancreatitis.

Management and Outcome:
Correction of dehydration, insulin infusion, antibiotics, and vasopressor support were started. Despite treatment with insulin and supportive care, the patient had a rapidly deteriorating course and ultimately succumbed to the illness.

Conclusion:
Uncontrolled, untreated DM in a child can result in decompensated DKA, which is usually associated with severe hypertriglyceridemia, and a rapidly progressive fatal course.
Streptococcus sinensis Causing Tricuspid Endocarditis in a Child: An Unusual Pathogen at an Unusual Site: A Case Report with Review of Literature
Authors: Manugu Navya Sree , Gadhiraju Manisha Varma , Chityala Stephen , Yerroju Kodandapani , Tummala Sadanand Reddy 
Published: May 2024

Background:
Infective endocarditis (IE) involving tricuspid valve is rarely reported in children. Common etiological organisms of IE include Staphylococci, viridans group Streptococci, and Enterococci. Other less frequent organisms include Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, and Kingella (HACEK) group, and Candida, accounting for 1% of cases. We describe the rare case scenario of tricuspid valve endocarditis caused by an unusual pathogen.

Clinical Description:
An 8-year-old girl presented with complaints of cough, shortness of breath, and intermittent fever for the past 2 months. Since 10 days before presentation, the fever had become high grade, continuous, and associated with chills and rigors. As per parents, the child had incidentally been detected with some congenital heart disease (CHD) at 3 months of age, documents being unavailable, child remaining asymptomatic till this presentation, without any medications. On examination, the child was malnourished with pallor, Grade 3 clubbing, tachypnea, and tachycardia. Auscultation revealed bilateral basal crepitations and a pansystolic murmur of Grade 4 in tricuspid area.

Management and Outcome:
Along with routine investigations, a two-dimensional echocardiography was done which revealed perimembranous ventricular septal defect with left-to-right shunt, tricuspid valve vegetations with anterior tricuspid leaflet prolapse with ruptured chordea, severe tricuspid regurgitation, and thickened aortic valve with good biventricular function. Blood culture showed growth of Streptococcus sinensis. The child was treated with oxygen, diuretics, and intravenous ciprofloxacin and gentamicin according to antibiotic sensitivity pattern. The child became hemodynamically stable and symptomatically improved after 3 weeks of treatment.

Conclusion:
This case creates awareness regarding an usual pathogen – S. sinensis as an etiological agent of IE, involving an unusual site – the tricuspid valve, in a child with CHD.
An algorithmic approach to pulmonary function tests for cardiologists
Authors: Gureja Sarthak , Haque Amirul , Kumar Avi , Agrawal Rajat , Jain Peeyush 
Published: May 2024

Abstract
Pulmonary function tests (PFTs) and chest roentgenogram form a gateway to more advanced tests during diagnostic workup of a suspected respiratory disorder. Since the heart and lungs form an integrated physiological system, cardiovascular and pulmonary disorders coexist frequently. For this reason, and several other reasons, cardiologists should have an understanding of pulmonary function testing to manage their patients effectively. Interpreting PFTs may seem complex for a nonpulmonologist, but a systematic approach makes it really a simple process to facilitate a correct cardiopulmonary diagnosis in many instances.
An unintended connection – Radial arteriovenous fistula after coronary angiogram
Authors: Praveen G. , Khan Mohammed Fahad , Augustine Rohan , Siddini Vishwanath , Ballal H. Sudarshan 
Published: May 2024

Abstract
The following case is of a 44-year-old female undergoing maintenance hemodialysis (MHD) due to chronic interstitial nephritis, utilizing a left brachiocephalic (BC) arteriovenous fistula (AVF). Following presentation with retrosternal anginal pain, diagnosed as high lateral wall myocardial infarction, coronary angiogram revealed normal coronaries. Subsequently, dilated veins along the right forearm were noticed, attributed to a patent right radiocephalic AVF. Despite being asymptomatic, the patient underwent a Doppler ultrasound confirming a blood flow of 400 ml/min through the AVF. No further intervention was planned as the patient continued MHD through the left BC AVF.
Echocardiographic evaluation of mitral inflow e wave velocity-to-tissue Doppler e’ wave velocity ratio (E/e’) as a prognostic indicator in ST-elevation myocardial infarction
Authors: Bandil Vaibhav , Shrivastava Sameer , Sharma Vinay Kumar , Bhandari Suman 
Published: May 2024

Abstract

AIMS AND OBJECTIVES:
To study the clinical characteristics and to assess the usefulness of echocardiographic evaluation of mitral inflow E wave velocity-to-tissue Doppler e’ wave velocity ratio (E/e’) as a prognostic indicator in patients admitted with ST-elevation myocardial infarction (STEMI) with or without revascularization therapy to predict in-hospital mortality.

BACKGROUND:
Myocardial infarction is a high-risk condition, especially when filling pressure is raised, and earlier reports have suggested that E/e’ is associated with poor outcome. However, whether E/e’ predicts risk better than left ventricular ejection fraction (LVEF), which is the current standard of practice, is not known.

MATERIALS AND METHODS AND RESULTS:
The echocardiographic evaluation of mitral inflow E wave velocity-to-tissue Doppler e’ wave velocity ratio (E/e’) as a prognostic indicator in ST-elevation myocardial infarction” was carried out on 100 patients admitted in the Department of Cardiology of Fortis Escorts Heart Institute, Okhla, New Delhi, from November 2019 to March 2021. The mean age of the patients with ST-elevation myocardial infarction was 59.8 ± 11.3 years. In patients who had E/e’ >15, male predominance and higher age (mean 63.7 ± 7.7 years) were found. Out of common cardiovascular risk factors, smoking and diabetes mellitus were found to be statistically significant. 67.7% of patients were belonged to the Killip Class II or more. In patients who had E/e’ >15, 29 (93.5%) patients had LVEF ≤45%. Twenty-seven (87.1%) patients had deceleration time (DT) ≤140 ms. Moderate or severe mitral regurgitation (MR) was found in 19.4% of patients, while the mean values of LVEDD and LVESD were 50.4 ± 2.15 mm and 39.7 ± 3.3 mm, respectively. The mean velocity of E and A was 0.87 ± 0.12 m/s and 0.75 ± 0.11 m/s, respectively. The mean E/A ratio was 1.1 ± 0.22. The mean velocity of e’ was 5.02 ± 0.45 cm/s and E/e’ ratio was 17.48 ± 1.57. The association of various clinical features showed that male gender, higher age, smoking, and diabetes mellitus, cardiogenic shock, and Killip Class II or greater were significant factors associated with E/e’ >15. Echocardiographic findings showed that LVEF ≤45%, higher LVEDD and LVESD, higher peak E velocity, DT ≤140 ms, lower mitral annulus e’ velocity, higher E/e’ ratio, and moderate or severe MR were significantly associated with E/e’ >15.

CONCLUSION:
The current study concluded that Doppler echocardiographic estimation of E/e’ ratio can be used as a marker of elevated left ventricular filling pressure and hence can be used as a prognostic marker in risk stratification of patients admitted in coronary care units. The E/e’ ratio is an independent and powerful predictor of the in-hospital mortality.
Pineapple (Ananas comosus) Ameliorates Depressant-like Behaviors in Rats Induced by Lipopolysaccharide
Authors: Nurrahma Herlin Ajeng , Meliala Andreanyta , Vikawati Nura Eky , Narwidina Paramita , Supriyanto Irwan 
Published: May 2024

Background:
Lipopolysaccharide (LPS) injection can lead to depression and mood disorders by reducing tryptophan availability through increased activity of the enzyme indoleamine 2,3-dioxygenase. Tryptophan, sourced from fruits such as pineapple (Ananas cosmosus), is vital for the body, especially the serotonergic system.

Aim:
This study aims to assess how pineapple pulp (PP) counters LPS-induced depressive behaviors in male Wistar rats.

Methods:
The experiment involved force-feeding PP for 28 days before LPS injection (0.5 mg/kg intraperitoneal [i.p.]) in 30 male Wistar rats, divided into five groups. Groups I (normal) and II (LPS control) received 15 ml aquadest/kg/day. Test Groups III, IV, and V were given varied doses of PP; low dose (3.75 ml/kg/day), medium dose (7.5 ml/kg/day), and high dose (15 ml/kg/day). At the study’s end, rats underwent the open field test (OFT) and the tail suspension test (TST). In addition, blood and brain samples were analyzed for neuroendocrine markers related to depression.

Results:
LPS triggers depressive symptoms, as evidenced by increased immobility time in the TST and altered behaviors indicative of anxiety in the OFT, especially in groups not receiving PP. This is followed by decreased serotonin levels in both plasma and brain when compared to groups given PP. In addition, higher corticosterone levels were observed in the LPS group than in the PP-treated group. Administering PP at 7.5 ml/kg/day for 28 days can alleviate the depressive effects induced by LPS injection.

Conclusion:
PP may have antidepressant properties, potentially by mitigating behaviors leading to depressive symptoms.
Indian Thyroid society expert consensus on salt Iodisation
Authors: Pandav Chandrakant S. , Bajaj Sarita , Yadav Kapil , Joshi Shashank R , Seshadri Krishna G , Kalra Pramila , Rajput Rajesh , Ghosh Sujoy , Menon Arun S , Pillai Mini G. , Jabbar P K , Puri Surabhi , Gupta Sushil , Ganie Mohd Ashraf , Rao Himagirish K , Shenoy Mohan T. , Joshi Ameya 
Published: May 2024

ABSTRACT
Iodine, an essential micronutrient, is crucial for the production of thyroid hormones - triiodothyronine(T3) and thyroxine(T4). Thyroid hormones regulate the optimum mental development, physical growth and development, regulation of body metabolism, heat generation, and maintenance of body temperaturein an individual. Geological processes like flooding, soil erosion, deforestation, and rivers changing course, deplete the surface soil of iodine, as it is present in the top layers of soil and easily soluble in water. As a result, the population residing in the area with iodine-deficient soil, becomes susceptible to a spectrum of functional and developmental abnormalities due to dietary deficiency of iodine. Universal Salt Iodization (USI) for prevention of IDDs in India is a public health success story. The adoption of the salt iodization strategy serves as a textbook example of the journey of an intervention through the iterative loop of research to policy to programme. Salt iodization has proved to be a safe, accessible, available, affordable, and cost-effective strategy to address the burden of IDDs in India. India has been at the forefront of the efforts to control IDDs globally. India is on its way to achieving the target of > 90 percent household coverage of adequately iodized salt. Revised Food Safety and Standards (Fortification of Foods) Regulations released in 2019 introduced an upper limit for iodine concentration in salt, the adequate iodine level required at the production and consumer level, including the distribution channel at 15 – 30 ppm. Universal Salt Iodisation (USI) is India’s public health success story. There is a need to consolidate progress so far and focus on strategy to reach the “last mile”. Sustainable elimination of Iodine Deficiency Disorders (IDDs) with Universal Salt Iodisation (USI) being the primary strategy needs to also factor in harmonisation with salt reduction strategy for control of non-communicable diseases.
Invariant scalar-flat Kähler metrics on line bundles over generalized flag varieties
Authors: Yao Qi 
Published: May 2024

Abstract
Let G be a simply connected semisimple compact Lie group, let X be a simply connected compact Kähler manifold homogeneous under G, and let L be a negative holomorphic line bundle over X. We prove that all G-invariant Kähler metrics on the total space of L arise from the Calabi ansatz. Using this, we show that there exists a unique G-invariant scalar-flat Kähler metric in each G-invariant Kähler class of L. The G-invariant scalar-flat Kähler metrics are automatically asymptotically conical.
ETIKA KOMUNIKASI MAHASISWA TERHADAP DOSEN DALAM INTERAKSI AKADEMIK MELALUI MEDIA DIGITAL
Authors: Sudarto Sudarto 
Published: May 2024

Penelitian ini merupakan penelitian survey yang bertujuan untuk mengetahui gambaran bentuk etika komunikasi antar mahasiswa dan dosen dalam melakukan interaksi akademik melalui media digital. Teknik pengumpulan data yang digunakan dalam penelitian ini, yaitu teknik observasi. Instrumen penelitian yang digunakan adalah lembar observasi dan lembar pencatatan harian. Teknik analisis data yang digunakan adalah teknik analisis data deskriptif. Hasil dan kesimpulan: Etika komunikasi mahasiswa dalam media digital terhadap dosen yang paling buruk adalah “mengirim pesan kepada dosen bahwa dirinya sakit, tetapi tidak ada surat keterangan sakit dari dokter yang dicantumkan”, disusul etika “lambat merespon pesan dosen”. Selanjutnya, etika komunikasi mahasiswa dalam media digital terhadap dosen yang paling baik adalah membalas pesan dosen dengan kalimat “terima kasih, Pak/Bu” atau “Terima kasih, Puang” jika mendapat informasi dari dosen yang ditunjukkan, disusul oleh etika “membalas “Terima kasih kembali, Pak/Bu” jika dosen mengrimkan pesan berupa ucapan “terima kasih. Secara umum, dapat dikatakan bahwa prilaku buruk mashasiswa dalam berinteraksi dengan dosen dalam media digital masih memprihatinkan.
Darbo saugos kultūra apskrities greitosios medicinos pagalbos tarnyboje
Authors: Laura Luneckienė  , Olga Riklikienė  
Published: May 2024

Tyrimo tikslas – įvertinti darbo saugos kultūrą apskrities greitosios medicinos pagalbos tarnyboje slaugos specialistų požiūriu.
Tyrimo medžiaga ir metodai. 2023–2024 m. vykdytas kiekybinis tyrimas, kuriame dalyvavo skubiosios medicinos pagalbos slaugos specialistai, dirbantys Vilniaus apskrities greitosios medicinos pagalbos tarnybose. Apklausoje naudotas Požiūrio į saugą klausimynas. Užpildytos 139 anketos, iš kurių analizuota 111 anketų. Tyrimui atlikti gautas Lietuvos sveikatos mokslų universiteto Bioetikos centro leidimas 2023‑03‑03 Nr. BEC-SL(M)-121.
Rezultatai. Dauguma Vilniaus apskrities greitosios medicinos pagalbos tarnybų slaugos specialistų darbo saugos kultūrą vertino mažiau nei 75 balais. Tai reiškia, kad svarbūs saugos kultūros aspektai nėra įgyvendinami jų darbo vietoje arba įgyvendinami tik iš dalies. Respondentai aukštesniais balais vertino pasitenkinimą darbu (73,65 balo), vadovų požiūrį į saugą (69,65 balo), darbo sąlygas (69,09 balo); žemiausiais balais tiriamieji vertino streso pripažinimą darbe (63,40 balo). Saugos klimatą, vadovų požiūrį į saugą ir darbo sąlygas dažniau teigiamai vertino ilgesnę darbo patirtį (≥ 16 metų) turintys darbuotojai. Rezultatai atskleidė, kad kuo vyresnis respondentų amžius, tuo streso pripažinimas darbovietėje mažėja, o vadovų požiūris į saugą yra dažniau vertinamas teigiamai.
Išvados. Tyrimo rezultatai atskleidė, kad apskrities greitosios medicinos pagalbos įstaigų slaugytojai nėra visiškai patenkinti jų darbo aplinkoje vyraujančia darbo saugos kultūra. Greitosios medicinos pagalbos tarnybose svarbu atkreipti dėmesį į klaidų bei streso pripažinimą, tinkamo saugos klimato formavimą ir komandinį darbą. Respondentų darbo patirties trukmė siejosi su darbo vietos saugos kultūros vertinimu – ilgesnę patirtį turintys darbuotojai buvo labiau patenkinti saugos klimatu, vadovų požiūriu į saugą ir darbo sąlygomis, o darbuotojų amžius turėjo reikšmingą ryšį su streso atpažinimu bei vadovų požiūriu į saugą. Saugos kultūros tobulinimui apskrities greitosios medicinos pagalbos tarnyboje reikalingas didesnis dėmesys, nes daugelis saugos kultūros sričių nesiekia pageidaujamo lygio.
Impact of the European Union's Carbon Border Adjustment Mechanism - Evidence from India and Other Selected Trading Partners of EU
Authors: Majumder Piyali , Mathur Somya , Pohit Sanjib 
Published: May 2024

The European Union (EU) recently introduced the Carbon Border Adjustment Mechanism (CBAM) with the intention to impose a pricing mechanism on carbon emissions, originating during the production process of emission-intensive products, imported by EU from its non-EU trading partners. However, CBAM is facing a lot of criticism - as an unfair, protectionist measure that threatens the principles of multilateral trading system and has a disproportionately biased impact on the overall welfare of the low-income developing countries. In this context, the paper empirically examines the impact of the European Union's Carbon Border Adjustment Mechanism on its trading partners by using the CGE GTAP-E model. The impact has been assessed across three pathways - export sales of the trading partners, the emission intensity of the products, and the overall impact on the welfare of the European Union's (EU's) trading partners using the GTAP 11 database. The impact varies across countries and sectors. The model estimates indicate that due to the imposition of CBAM, countries with existing domestic carbon pricing mechanism experience marginal increase in welfare with the UK being an exception. Contrastingly, countries with no carbon pricing mechanism will experience a decrease in overall welfare. Countries with a higher share of the EU in their total export basket are affected in terms of their export sales. India's cement sector export is affected the most due to the imposition of CBAM. However, India's total amount of exports of cement to the EU's market is negligible. India's export of iron and steel to the EU constitutes a larger share but the impact of CBAM is found to be negligible on the same.

Received: 14 November 2023 | Revised: 20 April 2024 | Accepted: 08 May 2024

Conflicts of Interest
The authors declare that they have no conflicts of interest to this work.

Data Availability Statement
Data available on request from the corresponding author upon reasonable request.

Author Contribution Statement
Piyali Majumder: Conceptualization, Methodology, Formal analysis, Investigation, Resources, Writing - original draft, Writing - review & editing, Visualization. Somya Mathur: Methodology, Software, Validation, Formal analysis, Investigation, Resources, Data curation, Writing - original draft, Writing - review & editing, Visualization. Sanjib Pohit: Conceptualization, Methodology, Validation, Writing - review & editing, Supervision.