bluuebunny/crossref_metadata_2025_split huggingface dataset:
Student ICT resources and intergenerational transmission of educational inequality: testing implications of a reproduction and mobility perspective
Authors: Loh Renae Sze Ming , Kraaykamp Gerbert , van Hek Margriet 
Published: March 2023

Abstract
Information and communication technology (ICT) is often heralded to boost student learning. In this paper, we investigate the supposed benefits of ICT on student educational performance by considering the varied forms of ICT resources – access, skills, efficacy and different usage practices. We also examine the relationship between parental background, ICT and educational performance, employing notions from social reproduction and mobility theory, thereby investigating its role in processes of intergenerational transmission of educational inequality. Using PISA 2018 data, we examine 123,006 students’ performance in Math and Reading. Results from fixed effects models indicate that ICT resources have a generic benefit to student learning, and mostly function as means to social reproduction. Our results indicate that having more ICT access and ICT skills seem to be most beneficial for students from advantageous family backgrounds, whereas using ICT for gaming seems most detrimental for high-SES students.
C5. Acute limb ischemia in COVID-19 patient: a case report
Authors: Kristianti S , Lizarda A 
Published: March 2023

Abstract

Background
Spread of coronavirus has led to the coronavirus disease (COVID-19) pandemic and resulting in new challenges. COVID-19 can cause thrombotic complications such as acute limb ischemia (ALI). This complication may increase the risk of morbidity and mortality in COVID-19 patient. A high index of suspicion should be maintained for ALI in COVID-19 patient, which is a vascular emergency.

Case Description
A-53 year old male presented to the emergency department with acute left leg pain and shortness of breath since two days before admission. Physical examination revealed heart rate of 120x/min, blood pressure 130/100 mmHg, and oxygen saturation 96%. The patient had bilateral crackles on lung auscultation and absent left dorsalis pedis pulse. His left foot was discoloured, cold to the touch, and mottled in appearance. He had elevated D-dimer. Chest x-ray showed bilateral hazy infiltrates. COVID-19 was diagnosed on the basis of RT-PCR testing. He received antibiotic, antiviral, and enoxaparin. Unfortunately, he underwent amputation procedure.

Discussion
COVID-19 has been associated with systemic effects resulting in cardiovascular, hematologic, neurologic, immunologic, and renal complications. Arterial thrombosis is an important consideration in COVID-19 patient associated with systemic inflammatory response, hypercoagulable states, and endothelial injury. ALI can occur during in-hospital evolution of COVID-19 infection or they can be admitted to the hospital for this vascular condition with mild or no respiratory symptoms. Some patients are able to achieve revascularization with observation or medical and/or surgical intervention, but other patients succumb to either amputation or death.
C7. Air Traveling – Related Acute Decompensated Heart Failure, The Nightmare Begin in The Sky: A Case Report
Authors: Abdul G , Akhtar F M 
Published: March 2023

Abstract

Background
Patients with heart failure are prone to experience problem contributed air travel. The major cardiovascular problem with aviation is mainly as a result of dropping air pressure. During flight the cabin pressure will drop and be maintained at 8000 ft, bringing oxygen levels down to 15%.

Case Summary
A 50 yo woman presented with diaphoresis, acute worsening of dyspnea, and hypoperfused after air travel. In the first 10-15 minutes of 1-hour flying, she felt tachycardic and becoming increasingly short of breath that doesn’t relieve after debarking off. The previous history included chronic heart failure due to severe mitral regurgitation and hypertension. Echocardiography study revealed severe mitral regurgitation due to prolapse AML and dilated LA with preserved ejection fraction. Initial management with dobutamine and norepinephrine and then furosemide improved her clinical status. The patient was discharged with planning for surgical correction for mitral regurgitation.

Discussion
The presentation of signs and symptoms denote clinical conditions termed acute decompensated heart failure wet and cold type. The onset of symptoms revealed that this situation related to air traveling. Drop in air pressure and oxygen levels that occur at the cabin during flight make physiological and psychological stress, hypoxia, and raised sympathetic tone. In the patient with preexisting chronic heart failure, these responses will lead to clinical decompensation and deterioration.
C8. An Extremely Rare Case: Cardiac Contusion Presenting with an Atrioventricular Block, An Unfortunate Fall
Authors: Akbar R R , Nugraha M T 
Published: March 2023

Abstract

Background
Blunt cardiac injury (BCI), also referred to cardiac contusion, is a known cause of myocardial injury. It is often challenging to diagnose in the absence of clear diagnostic criteria. The clinical manifestation ranges from none to fatal arrhythmias to cardiac wall rupture seen on post-mortem examination. Cardiac biomarkers and electrocardiograms are usually helpful in identifying cardiac trauma but are not necessarily abnormal in all cases.

Case Illustration
A 55-year-old male with no history of cardiac disease was brought to the emergency department after a motor vehicle collision resulted in chest wall injury. The patient was found to have left clavicle fracture, left costae II-VII fractures, and hematothorax followed by chest tube insertion. The patient had multiple episodes of complete heart block with junctional escape rhythm alternate with high degree 2:1 AV conduction, and sometimes became a normal sinus rhythm. A temporary pacemaker was inserted. After the patient underwent the ORIF procedure, cardiac rhythm revealed normal sinus rhythm and temporary pacemaker is removed.

Discussion
High-degree AV block has been reported in human studies following BCI, secondary to necrosis, inflammation, or fibrotic changes in the subendocardial tissue. 50% of patients reviewed in the literature had a recurrence or permanent complete heart block requiring pacemaker implantation and complete heart block secondary to BCI which was associated with a 20% mortality in the post-traumatic period. Our patient developed a fatal heart block in the early period which could have easily been missed.
C10. An ultra-rare case of Hutchinson–Gilford progeria syndrome with severe aortic regurgitation due to bicuspid aortic valve in a 9-year-old girl
Authors: Rasaki R , Novita  , Heriansyah T 
Published: March 2023

Abstract

Background
Hutchinson-Gilford progeria syndrome (HGPS) is an ultra-rare autosomal dominant that result in progressive premature aging syndrome. Cardiovascular diseases become the main cause of mortality including myocardial infarction, interstitial myocardial fibrosis, hypertension and calcification of the mitral and aortic valves. However, the relationship between HGPS and bicuspid aortic valve (BAV) has not been documented yet.

Case Summary
A 9-year-old girl with HGPS presented to the outpatient clinic with a complaint of shortness of breath since 5 years ago, especially when she did moderate physical activity. Chest pain and palpitation were denied. Her physical examination revealed short stature, thin, wrinkled skin, craniofacial disproportion with alopecia, shrunken facies and prominent scalp veins. There was failure to thrive and diastolic murmur grade 2/4 is heard on the aortic area. Laboratory test showed leukocytosis. Transthoracic echocardiogram showed severe aortic regurgitation due to calcified bicuspid aortic valve and mild mitral regurgitation. She was managed by conservative therapy because her parents were still considering the aortic valve repair procedure.

Discussion
The HGPS patient with severe aortic regurgitation due to BAV should be managed to reduce cardiovascular complications. Aortic valve repair is an interesting alternative to replacement managing aortic regurgitation due to BAV in young adults. Recently, advanced science about BAV disease and refinement of surgical techniques improved standardization of BAV repair procedure.
C11. Aorto-Pulmonary Window in Tetralogy of Fallot with Absent Pulmonary Valve Syndrome : A Rare Case Report
Authors: Suryawan Willy , Sakidjan Indriwanto 
Published: March 2023

Abstract

Background
Aorto-pulmonary window and Tetralogy of Fallot with absent pulmonary valve syndrome (TOF-APVS) are very rare entities. The combination of the two defects in adolescence patient made the diagnosis based on standard imaging modalities challenging.

Case Illustration
14-year-old boy was referred from Borneo Hospital with failure to thrive and shortness of breath symptoms. He was underwent multiple modalities procedure and it shows the presences of features of tetralogy of Fallot : right ventricular hypertrophy, sub-aortic ventricular septal defect and pulmonary infundibular stenosis. Pulmonary valve leaflets are not seen with mild dilatation of the main and left pulmonary artery (Absent PV syndrome) and a connection from Pulmonary Artery and Ascending Aorta (Aorta-Pulmonary Window)

Discussion
TOF-APVS is a relatively rare variant of TOF. Its co-existence with Aorto-Pulmonary Window make this case was very exceptional. There are only a few reported cases diagnosed with TOF-APVS in adult age in the literature as most of them are diagnosed at younger ages. The unique physiology due to the large connection of Ascending aorta and the main pulmonary artery resulting in L-R Shunt. The large connection from Ascending Aorta to Main Pulmonary artery (L-R Shunt) prompt this patient to pulmonary hypertension (before and after surgery) and heart failure, hence initial treatment of ACE-I and sildenafil was very necessary.
C13. Atropine Challenge: Bedside Diagnosis of Block Level
Authors: Akbar R R , Wasyanto T 
Published: March 2023

Abstract

Background
The concept of 2:1 AV block remains poorly understood by many physicians even after so many years of advancement in the field of electrophysiology. It cannot be classified into type I or type II second-degree AV block because there is only one PR interval to examine before the blocked P wave.

Case Illustration
Case 1 . A 78-year-old male with asymptomatic bradycardia was referred to our hospital. Resting ECG revealed 2:1 conduction AV block. In order to define the site of block we performed the atropine challenge test, revealed improvement of AV block to Mobitz I and then 1st degree AV block, suggesting the suprahissian block. Case 2. A 74-year-old male with inferoposterior and right ventricular STEMI was referred to our hospital. His resting ECG revealed 2:1 conduction of P wave. The atropine challenge test revealed improvement of block to 1st degree AV block, suggesting the suprahissian block.

Discussion
It is often difficult to distinguish intranodal and infranodal blocks when 2:1 conduction is present. Therefore, a careful search of a long ECG tracing for two consecutive P waves should be made. In addition, atropine can improve AV node conduction due to sympathetic and/or parasympatholytic stimulation. Therefore, it may increase AV node conduction but worsen infranodal block without affecting the refractory period of the infranodal. This case illustrates the importance of a noninvasive test for confirming the location of a 2:1 conduction AV block, as guide to diagnostic and therapeutic determinations.
C14. Benefit and Safety of Cardiac Rehabilitation Program in Pulmonary Hypertension Patient after Atrial Septal Defect Closure with Fenestration
Authors: Etami H V , Anggrahini D W , Arso I A 
Published: March 2023

Abstract

Background
ASD closure with surgical fenestration is purposed to reduce pulmonary hypertension (PH) crisis. PH is still found in patient conducting this procedure. Some issues told that PH patient should restrict activities due to complaints aggravation. Proper cardiac rehabilitation gives clinical improvements and safe for stable PH patient.

Case summary
A 20-year-old male, diagnosed as left to right shunt ASD with pulmonary hypertension (mPAP 41 mmHg, PVRI 4.86, and Qp/Qs 1.62), was conducted surgical closure with fenestration. Patient was given cardiac rehabilitation program from 6-minute walking test result. It was done twice a week for 1 month after surgery by walking on treadmill for 600 meters in 30 minutes and was increased 100 meters per meeting, the heart rate target was 107 – 125 beats per minute. The program evaluation by treadmill test on the last session showed increase of fitness capacity (9.33 METs from 2.34 METs) and decrease of symptoms. There was no incident during exercise. Education were given for PH evaluation and healthy lifestyle.

Discussion
Cardiac rehabilitation program was emphasized for PH management. Continuous and moderate intensity exercise is recommended than high intensity exercise. The cardiac rehabilitation program showed improvement of physical capacity, quality of life, and reduction of NT pro BNP by increasing peak oxygen uptake, anaerob threshold, pulmonary perfusion, muscle function and decreasing inflammatory response, oxidative stress, smooth muscle cell proliferation. It is save for stable PH patient under healthcare supervision.
C18. Cardiac AA amyloidosis presenting with refractory heart failure complicated by polymorphic ventricular tachycardia: a case report
Authors: Susanti M , Subagjo A 
Published: March 2023

Abstract

Background
Systemic AA amyloidosis is a rare infiltrative disease representing a complication of chronic inflammatory disorders. Cardiac involvement is rare and is associated with a poor prognosis. Early recognition is imperative as appropriate measures, and treatment of the underlying disease may prevent death from refractory heart failure and fatal arrhythmias.

Case Summary
A 53-years-old male patient with psoriatic arthritis presented with heart failure and nephrotic syndrome. Electrocardiogram revealed first-degree AV block, low voltage QRS complexes, and prolonged QT interval. On echocardiography, a normal systolic function of hypertrophic left ventricle with signs of diastolic dysfunction was present. An abdominal fat pad punch biopsy was able to confirm amyloid deposition. Self-terminated polymorphic ventricular arrhythmia was recorded by 24-hour Holter. Immunosuppressive, anti-inflammatory, anti-arrhythmic, and heart failure agent were promptly instituted, which are ineffective.

Discussion
Restrictive cardiomyopathy is the hallmark finding in cardiac amyloidosis that caused by the interstitial deposits of amyloid fibrils. Clinically, this manifests in progressive diastolic dysfunction, elevated left ventricular filling pressures, and heart failure with preserved ejection. The presence of rapidly progressed heart and renal failure with characteristic features of ECG should prompt further evaluation to confirm an infiltrative cardiomyopathy. This is highly suggestive that the natural course of cardiac amyloidosis often unpredictable and can be aggressive if left undiagnosed and untreated.
C19. Cardiac Amyloidosis: A Great Pretender of Left Ventricular Hypertrophy with Systemic Manifestation
Authors: Tampi G G , Farissa I P , Nugroho M A , Dewi R A C K , Pangarsa E A , Hellmi R Y , Rahardjo S B , Puspasari D 
Published: March 2023

Abstract

Background
Systemic amyloidosis encompasses an underdiagnosed disorder characterized by the extracellular deposition of amyloid in one or more organs, including the heart. The therapeutic strategy depends on the characterization of amyloid protein type and the extent of the disease. When founding a pathological left ventricular hypertrophy, initial clues provided by electrocardiography and echocardiography combined with other clinical manifestations could support a suspicion of cardiac amyloidosis.

Case Summary
A 54-year-old male patient was repeatedly admitted to a local hospital for recurrent heart failure and refractory bilateral pleural effusions of unknown cause. There was intolerance of any heart failure medications and repeated thoracocentesis failed to control the pleural effusion. The echocardiogram revealed severely impaired left ventricular function with phenotypic overlap between hypertrophic and restrictive cardiomyopathy. In contrast, we found a low voltage electrocardiogram. After an extensive diagnostic workup, including speckle tracking echocardiography, cardiac magnetic resonance, serum immunofixation and free light chain, bone marrow biopsy, and also Congo Red staining for amyloid, the final diagnosis was light chain (AL) amyloidosis.

Discussion
Cardiac involvement in systemic amyloidosis is the leading cause of morbidity and mortality. Frequently, myocardial wall thickening is incorrectly referred to as hypertrophy which may potentially lead to the wrong diagnosis and therapy. However, a need remains for improved awareness and expertise, while a multidisciplinary approach is important in making the correct diagnosis and management of this debilitating disease.
C20. Cardiac Arrest in COVID-19 Patient Presenting with Takotsubo Cardiomyopathy
Authors: Wardhani Louisa Fadjri Kusuma , Suwanto Denny , Sativa Oryza , Lefi Achmad 
Published: March 2023

Abstract

Background
Takotsubo cardiomyopathy (TC) presents as a result of catecholamine surge. There are increase of TC among COVID-19 patients, which is induced by cytokine storm. TC is previously known as a self-limiting and benign cardiac manifestation, but it has been uncovered that TC can be associated with fatal cardiac outcome due to cardiogenic shock and life-threatening arrhythmia.

Clinical Presentation
A 54-year-old woman presented to the emergency department with a fever since 9 days before admission accompanied by DOE, PND, and fatigue that worsened since 5 days before admission. Fifteen days before her complaints, she experience bereavement from his son death from motorcycle accident. She was referred from regional hospitals due to respiratory failure necessitating ventilator support. Physical examination revealed normal blood pressure and desaturation. ECG shows tachycardia with global ST-elevation. CXR shows cardiomegaly (CTR 62%) and pneumonia. The laboratory demonstrated increased Neutrophil to Lymphocyte Ratio (NLR), C-Reactive Protein, Troponin, and positive PCR COVID-19 swab. An echocardiography presented regional wall motion abnormality with apical ballooning appearance and reduced systolic function with LVEF of 51% resembling Takutsubo cardiomyopathy. Despite maximal ventilatory and pharmacology, she experienced malignant ventricular tachycardia not responding to defibrillation and expired in only 6 hours

Discussion
The presence of cardiac arrhythmia followed by cardiac arrest in COVID-19 patient complicated by TC can be a direct effect of catecholamine surge and myocardial injury or indirect effect from QT-prolongation and inflammatory process. Concurrent COVID-19 pneumonia and TC may progress with dismal prognosis, so that in need of prompt referral system.
C21. Cardiac Complications in Immunocompromised Patient : A Case Report
Authors: Hanafiah R , Candra V F K 
Published: March 2023

Abstract

Background
Cardiovascular diseases in human immunodeficiency virus (HIV)-positive patients are becoming increasingly detected in developing countries. Pericardial involvement may be manifested as acute pericarditis, constrictive pericarditis, symptomatic pericardial effusion and cardiac tamponade. The aim of this report is to present a patient with AIDS clinical stage IV who developed pericarditis and pericardial effusion.

Case Summary
A 27-year-old male came to our ER with 7-day fever and delirium syndrome. He has been diagnosed with AIDS clinical stage IV for the past 3 years with the latest CD4 count was 6/mm3. Serial Transthoracic Echocardiography (TTE) revealed small to moderate circumferential pericardial effusion, thickening of pericardium and reduced left ventricular ejection fraction without signs of cardiac tamponade from TTE. Upon hospitalization, he developed signs of hypotension without distended jugular veins nor muffled heart sounds. It was decided to initiate supportive treatment and NSAIDs without pericardiocentesis. The patient recovered uneventfully. As an outpatient, no other cardiovascular complications developed.

Discussion
Pericardial conditions are the most frequent cause of heart disease in patient with HIV infection. Most cases are mild and asymptomatic. Pericardial effusion may be marker of end-stage HIV infection because it is associated with low CD4 cell count and is often caused by opportunistic infections and malignant neoplasms. Treatment of pericarditis in HIV patients is no different from that in general population. Asymptomatic patients with small pericardial effusion without tamponade require no intervention.
C22. Cardiac Morphology in Congenital Heart Disease with 3D Modeling, 3D Printing and Augmented Reality Smartphone Application: a Case Series of Cardiac Computed Tomography Assessment of Right Ventricular Outflow Tract Obstruction with Shunt
Authors: Laode M , Nurawita R , Andi A U , Julius P , Nikmatiah L 
Published: March 2023

Abstract

BACKGROUND
Obstruction of the right ventricular outlet may include stenosis of the Right Ventricular Outflow Tract (RVOT) or the presence of atresia in the valve or pulmonary artery. The Cardiac Computed Tomography (CCT) examination for RVOT obstruction with a shunt has several indications, including pulmonary and coronary artery assessment, and lesions accompanying RVOT obstruction with a shunt.

CASE DESCRIPTION
In this report, we present five cases with RVOT obstruction with shunts in the form of Tetralogy of Fallot (ToF), pulmonary atresia with Ventricle Septal Defect (VSD), and pulmonary stenosis with Double Outlet Right Ventricle (DORV). The first patient with ToF and infective endocarditis. The second patient with atypical ToF, cardiac dextroposition, and suspect Scimitar Syndrome. The third patient with pulmonary atresia, VSD, and post-R-BT shunt. The fourth patient with pulmonary stenosis, DORV, remote VSD, post-BT shunt, and suspect Criss Cross Heart. The fifth patient with pulmonary stenosis, DORV, RA isomerism, malposition of the great artery, bilateral SVC, and dextrocardia.

DISCUSSION
The CCT assessment can be carried out in a segmental sequential to systematically and comprehensively approach. For complex lesions, CCT provides 3D printing of the heart and may help to understand the cardiac morphology easily. CCT is a recommended examination for RVOT obstruction with shunt, shows a good sensitivity for assessing BT-shunt, and provides good spatial resolution for assessing the pulmonary and coronary arteries. 3D printing and augmented reality can improve practitioners' understanding of RVOT obstruction with shunt, including the accompanying lesions.