bluuebunny/crossref_metadata_2025_split huggingface dataset:
An exploration into EFL learners’ perspectives on online computerized listening comprehension dynamic assessment
Authors: Ebadi Saman , Karimi Elham , Vakili Shokoufeh 
Published: January 2023

AbstractAs a part of a more extensive computerized dynamic assessment (CDA) project delivered through a dedicated website, www.lingeli.com, this study explores EFL learners’ perspectives on an online listening comprehension dynamic assessment software focusing on inferential listening skills while trying to minimize the guessing effect. The study participants were 94 Iranian EFL learners selected through convenience sampling to participate in a 1-month dynamic assessment targeting EFL learners listening comprehension using the developed software. The researchers involved half of the study participants in semi-structured interviews held in their native language (Persian) to shed light on the pros and cons of the software. Six major themes emerged from the interviews’ content analysis, encapsulating participant’’ generally positive perceptions and some negative perspectives about the software. They perceived the CDA software as novel and interesting, stress-relieving, supportive, convenient, and cost-effective in terms of time and money, and removing the time and location limitations. In contrast, a few others assumed it was time-consuming and stressful, with limited learning and ignoring the benefits of social aspects of teaching. The study’s findings recommend that learners’ perspectives be considered when developing future CDA listening comprehension software to increase the validity of CDA projects by addressing their drawbacks and fully implementing the CDA test's potential to enhance EFL learners’ listening comprehension abilities.
Error and optimism bias regularization
Authors: Sohaee Nassim 
Published: January 2023

AbstractIn Machine Learning, prediction quality is usually measured using different techniques and evaluation methods. In the regression models, the goal is to minimize the distance between the actual and predicted value. This error evaluation technique lacks a detailed evaluation of the type of errors that occur on specific data. This paper will introduce a simple regularization term to manage the number of over-predicted/under-predicted instances in a regression model.
Association of serum electrolyte changes during haemodialysis with stimulation of premature ventricular contractions
Authors: Anno Emi , Sato Yukihiro , Hoshimoto Ainori , Harano Makiko , Hagiwara So , Imai Eri , Kaneko Shuzo , Tsukamoto Yusuke 
Published: January 2023

Abstract
Background
Patients on haemodialysis are predisposed to heart rhythm disorders, including bradyarrhythmia, atrial fibrillation (AF)/atrial flutter, supraventricular/ventricular arrhythmias and sudden cardiac death (SCD) (Turakhia et al. in Eur Heart J 39:2314–2325, 2018). In addition to the fact that patients on haemodialysis have a high prevalence of underlying cardiac disease, the stress of haemodialysis itself might also contribute to increased rates of arrhythmias and SCD (Samanta et al. in Can J Cardiol 35:1228–1240, 2019).

Methods
A Holter 24-h electrocardiogram was set up immediately before the start of haemodialysis for 72 haemodialysis patients (dialysis vintage: 6–8734 days) to record premature ventricular contractions (PVCs) as a marker of arrhythmogenesis for 24 h. Blood samples were also collected every hour during haemodialysis treatment. Each patient was dialyzed against a dialysate consisting of Na+140 mEq/L, K+ 2.0 mEq/L, Ca+ 3.0 mEq/L, Mg2+ 1.0 mEq/L, Cl− 110 mEq/L, CH3COO− 8 mmol/L and HCO3− 30 mEq/L.

Results
The frequency of PVCs significantly increased in the 4th (80 ± 34 beats/hour, mean ± S.E.), 5th (79 ± 31 beats/hour) and 6th (105 ± 36 beats/hour) hours (F = 5.24, p < 0.00001, n = 72). The lowest left ventricular ejection fraction (LVEF, p = 0.001) and the highest b-type natriuretic peptide (BNP) levels (p = 0.049) were found in patients with the highest PVC counts. There was an association of positive changes in both serum K+ (β ± S.E., 9.7 ± 2.4, p = 0.0002), Mg2+ (43.2 ± 10.3, p = 0.0001) and HCO3− (5.3 ± 1.8, p = 0.005) with the frequency of PVCs for 4 h immediately after dialysis. During the same period, there was an association of lower serum K+ (− 8.37 ± 2.16, p = 0.0003) and higher Ca2+ (73.4 ± 18.0, p = 0.0002) with the frequency of PVCs.

Conclusions
Haemodialysis stimulated PVC generation, and this effect was especially prominent during the period immediately after haemodialysis. Some serum electrolyte changes affected this PVC stimulation. A positive change in serum K+ or Mg2+ and a negative change in serum Ca2+ during dialysis are risk factors for stimulating PVCs, particularly in patients with lower serum K+ or higher serum Ca2+ levels at the start of dialysis.
A newly developing case of adrenal insufficiency developing after Coronavirus disease
Authors: Özer Özge , Yorulmaz Göknur , Tekin Melisa Şahin 
Published: January 2023

Abstract

Introduction
Although some short and long-term effects of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) infection on the endocrine system are shown, there are still much more remaining to be clarified. A few case reports have shown that adrenal insufficiency can develop after COVID-19 infection due to adrenal hemorrhage or infarction. However, the exact effects of infection on cortisol dynamics are still poorly understood. This case report highlights an unusual case of acute adrenal insufficiency in a Covid-19.

Clinical Case
A 30-year-old female patient with no history of chronic disease applied with complaints of nausea, abdominal pain, and weakness for nearly 2 weeks. She was hospitalized. Her vitals were stable at the admission. Her initial laboratory evaluation showed serum sodium: 119 mEq/L, potassium: 5.38 mEq/L, creatinine: 1.35 mg/dL, aldosterone 2.33 ng/dL (1.46–17.4), plasma renin activity 40.56 ng/ml/h (0.06–4.69). Hemogram and liver function tests were normal. The basal ACTH value was measured 1142 pg/mL (7.2–63.3), and cortisol was 0.29 (6.24–18).The diagnosis of tuberculosis was ruled out with the quantiferon and the PPD test performed. In the detailed questioning of the patient, it was learned that she had Covid-19 infection about 3 months before the onset of symptoms. In this process, the patient's skin color was significantly darkened, and it was confirmed in comparison with the old photographs and from the patient's declaration. She was diagnosed with adrenal crisis, and corticosteroid therapy (80 mg/day intravenous methylprednisolone) and intravenous hydration were started. On the other hand, imaging and endoscopic evaluations were performed to exclude other intra-abdominal pathologies. No pathology was detected. Adrenal glands were normal in abdominal tomography. Stress dose steroid therapy was adjusted by reducing the daily dose. In the follow-up, the patient's complaints decreased and disappeared. Fludrocortisone was added to her treatment because electrolyte disturbances continued as hyponatremia and hyperkalemia. In the first week of treatment the patient's electrolyte disturbances improved and she was discharged with oral hydrocortisone and fludrocortisone treatment. The patient's skin color was observed lighter than before in the control examination, one week after discharge.

Conclusion
Although cases of adrenal insufficiency due to Covid-19 infection are found in the literature, their number is limited. The underlying causes are usually shown as hemorrhage and thrombosis. The absence of these findings in our case supports that the underlying cause is autoimmune and brought a different perspective to the issue. Our case also drives attention to the evaluation of patients in terms of adrenal insufficiency not only in the acute period but also in the later periods, since the diagnosis was made 3 months after the disease.
How the algorithms can change during the COVID-19 pandemic: A case of primary hyperaldosteronism
Authors: Iremli Burcin Gonul , Sendur Suleyman Nahit , Yildiz Bulent Okan 
Published: January 2023

Abstract

Introduction
Primary hyperaldosteronism (PA) is an important reason of secondary endocrine hypertension. The etiology is either an aldosterone producing adenoma or bilateral adrenal hyperplasia in 90% of cases. The diagnosis is based on specific algorithms starting with screening the population at risk and continues with confirmatory testing of positive resulted individuals. According to current recommendations, adrenal vein sampling (AVS) and imaging should both be used to classify the subtypes of PA; but during the COVID-19 pandemic, the algorithms may have to be changed. Here, we present a case diagnosed with PA and successfully treated during pandemic.

Clinical Case
A fifty-one-year-old male patient was referred to our department from internal medicine clinic with hypertension and hypokalemia. He was hypertensive since 30 years old, but he had no history or clinical symptoms of hypokalemia or hypertension associated organ injury. His blood pressures (BP) were under control with 10 mg of amlodipine. But for the last 2 years, his blood pressures couldn't be managed with just amlodipine. Despite losing weight, BP was still higher than 160/100 mmHg. When he evaluated by his internal medicine physician, K level was significantly low (2.57 mEq/L). After oral potassium replacement and discontinuation of thiazide, it increased to only the lower limit (3.4 mEq/L). Abdominal CT showed bilateral adrenal thickness with 13 HU on the right and 10 HU on the left. On physical examination, he had no characteristic findings of hypercortisolemia or acromegaly. His BP was 180/100 mmHg, even he adopted salt-free diet and antihypertensive therapy with candesartan, thiazide, amlodipine. His echocardiography and retinal examination were normal. His catecholamine excretion on 24h urine was normal. After discontinuing aldosterone receptor blocker and thiazide, aldosterone and plasma renin activity were 73 ng/dL and 0.59 ng/mL/h respectively. The ratio was 123.7 and suspected highly of PA. The patient didn't want to be admitted to hospital for saline infusion test. He was directed to AVS. After medically controlling his BP, AVS was performed successfully in May 2022. His results are shown in Table-1. After this result, right adrenal gland was considered as PA source and right adrenalectomy was performed. The patient is on follow-up with single dose of candesartan within normal BP limits and normal K levels.

Conclusion
COVID-19 pandemic has indisputably changed certain algorithms in every field. On this matter, patient specific approaches have become more important. Most specifically for this case, even when the hypertension started early-on-set, clinicians should seek the hypertensive end-organ injuries to understand the onset of the secondary reasons of hypertension. It should be remembered that not every early-on-set hypertension is secondary, and not every late-on-set hypertension is essential.
Cushing's syndrome, pheochromocytoma, or both?
Authors: Kullamaa Liisa , Ryhänen Eeva , Söderlund Sanni , Bärlund Milla Rosengård , Viukari Marianna , Muona Kirsi , Pekkarinen Tuula , Matikainen Niina , Jäntti Camilla Schalin 
Published: January 2023

Abstract

Clinical Case
A 45-year-old woman presented to the emergency department with weakness and was found to have a Hb level of 68 g/l. She was also tachycardic (pulse 118 x/min) and hypertensive with a BP of 210/108 mmhg.
She had a history of ulcerative colitis, menorrhagia and seronegative arthritis for which she had been using 5mg prednisolone daily for several years. The patient had suffered and episode of heart failure 4 years earlier of unknown etiology, during which she was tachycardic, hypertensive and her LVEF was decreased to 35%. In 2016 the patient had undergone an abdominal CT that had shown an incidental finding of a mass in the right adrenal gland, but she did not show up for additional investigations.
During the previous year, the patient had developed symptoms of decreased physical fitness, increased weight, livedo reticularis-type skin changes (Figure), agitation, hirsutism and swelling on the neck.
Gastroscopy revealed esophageal candidiasis and abdominal CT-scan showed a mass in the right adrenal gland that had increased in size from 2 cm to 3.8 cm compared to the previous CT in 2016 with a density of 21 HU.
The patient had clinical Cushing's syndrome, that was confirmed in the lab tests (Table). In addition, lab tests showed an excess production of catecholamines.
MRI of the sellar region was performed, that showed a 3×4×3 mm size Rathke's cleft cyst/microadenoma.
A CRH stimulation test with inferior petrosal sinus sampling was performed and results were consistent with ectopic ACTH production.
The clinical studies were consistent with pheochromocytoma that was also producing ACTH.
The patient underwent unilateral adrenalectomy after having been treated with metyrapone and phenoxybenzamine preoperatively.
Histopathology was compatible with pheochromcytoma. ACTH staining was negative, but CRH staining was not available. MIB-1 proliferation index was ≤3%.
Postoperatively hypercortisolism and catecholamine excess have subsided. The patient has stopped diabetic and antihypertensive medication and she also been cured of the notable livedo reticularis-type skin changes (Figure).

Conclusion
The clinical presentation of pheochromocytoma in our patient was atypical with coexistence of ACTH-dependent Cushing's syndrome. Furthermore, the patient had a mass in the hypophysis that could have been a potential cause for ACTH-secretion. The clinical and biochemical signs were completely reversed with adrenalectomy, compatible with ectopic Cushing's syndrome due to a pheochromytoma that produced both catecholamines and most probably CRH.
In summary pheochromocytomas can rarely also secrete other hormones such as interleukins, calcitonin, ACTH or CRH and this can significantly alter the clinical presentation of both Cushing's syndrome and pheochromocytoma. A recent meta-analysis (Elliott, JCEM 2021) reported 99 published cases of ACTH/CRH-producing pheochromocytomas.
A rare case of concomitant hypophosphatemic osteomalacia and neurofibromatosis type 1
Authors: Şehit Kara Canan , Hacıoğlu Ayşa , Karaca Züleyha , Ünlühızarcı Kürşad 
Published: January 2023

Abstract

Introduction
Neurofibromatosis type 1 is a rare genetic disorder with an increased susceptibility to develop skeletal abnormalities. However, the association of hypophosphatemic osteomalacia and neurofibromatosis type 1 is extremely rare. Herein, we report a case of hypophosphatemic osteomalacia in concomitant with neurofibromatosis type 1.

Clinical Case
A 45-year-old Turkish female patient, who was followed up in another hospital due to osteoporosis and kyphoscoliosis, applied to us with the complaints of persistent bone pain and inability to walk. She had no chronic diseases other than osteoporosis. The physical examination revealed widespread freckling over her trunk and proximal parts of upper and lower extremities and multiple neurofibromas and cafe au lait spots all over her body (figure 1). It was learned that her 2 brothers, mother and daughter also had the widespread freckling. They have no known chronic diseases. She had a severe degree of kyphoscoliosis. She had not have any complaints up to 24 years of age, and low back pain started after delivery. She was diagnosed with osteoporosis at the age of 29. In about 15 years, her height decreased from 167 cm to 135 cm. She had a severe degree of kyphoscoliosis and severe bone pain and was unable to walk on her own because of pain. Bilateral ophthalmic examination revealed no Lisch nodules. Audiometer revealed no abnormalities. Laboratory findings were as follows: Ca: 9.4 (8.4–10.6 mg/dl), phosphorus: 1.8 (2.3–4.7 mg/dl), albumin: 4.2 g/dl, parathormone: 88.3 (11–80 pg/ml), 25 hydroxy vitamin D: 26.1 ug/L, creatinine: 0.4 mg/dl, alkaline phosphatase: 79 (35–105 U/L), the 24-hour urinary excretion of calcium: 187.5 mg/24 h, the 24-hour urinary excretion of phosphorus: 253 mg/24 h, fractional excretion of phosphate: %8.5 and maximum transport of phosphorus in the renal proximal tubules (TmP/GFR): 0.74 (0.88–1.42 mmol/L). According to laboratory data there was a hyperphosphaturia. On the basis of the physical examination, laboratory and radiological findings, she was diagnosed with neurofibromatosis type 1 and hypophosphatemic osteomalacia. Oral phosphate solution (1.5 gram as elemantary phosphorus per day in 3 divided doses) and calcitriol (1 microgram per day in 2 divided doses) were started. After 6 months of therapy, bone pain was significantly decreased and her serum phosphorus level increased. The results of genetic analysis are awaited.

Conclusion
The coexistence of hypophosphatemic osteomalacia and neurofibromatosis type 1 have been reported in less than 50 cases in the literature. The underlying mechanism is not clarified. The diagnosis of hypophosphatemic osteomalacia should be kept in mind in patients with neurofibromatosis type 1, as they will benefit greatly from oral phosphorus solution and active vitamin D.
Primary hyperparathyroidism: Brown tumor in hand, foot, and femur
Authors: Pekkolay Zafer 
Published: January 2023

Abstract

Introduction
Bone fractures due to primary hyperparathyroidism/brown tumor can still be seen today, albeit rarely.

Clinical Case
A 47-year-old migrant woman had a right femur fracture after a simple fall. The patient's laboratory values were found as calcium 16.3 (8.4–10.2) mg/dl, phosphorus 2.5 (3.2–5.5) mg/dl, Alkaline phosphatase: 1131 (40–150) U/L, Parathormone 1711 (15–65) pg/ml. A 40×30 mm parathyroid adenoma was detected in the lower left side of the patient, who was suspected of having primary hyperparathyroidism. Parathyroid adenoma in the same localization was also observed in neck tomography. At the same time, a brown tumor was detected on the hand and foot bones. The patient underwent a left parathyroid adenomectomy. Intravenous calcium infusion was given to the patient who developed hungry bone syndrome in the postoperative period. Calcium, phosphorus, and parathormone levels of the patient who was treated for hungry bone syndrome returned to normal. Later on, the patient underwent a right femoral prosthesis operation.

Conclusion
Brown tumor is often seen in the bones of the hands, feet, and long bones.
Mask parathyroid adenoma in morbid obese woman with secondary adrenal insufficiency
Authors: Altemimi Mahmood Thamer , Mansour Abbas Ali 
Published: January 2023

Abstract

Introduction
Primary hyperparathyroidism (PHPT) and metabolic syndrome (MS) are independently increase cardiovascular morbidities; however, this association is still controversial. The pathogenic mechanisms of MS among PHPT are not completely clear and the association with calcium metabolism is being studied, since calcium is pivotal for many metabolic processes. The association between these entities is complex and may be a source of additional morbidity and mortality. Objective is to highlight the mask features of parathyroid adenoma in morbid obese woman with secondary adrenal insufficiency.

Clinical case
A 33-year-old female presented with discomforting polyarthralgia and weight gain for the last 2 years that was labelled as nonspecific arthritis and treated by multiple intra-articular injections of glucocorticoids. After a careful history and examination with baseline analysis, she was discovered to have MS (dysglycemia, high insulin resistance and hypertension). A feature glucocorticoid induced adrenal insufficiency was documented and work up for any evidence of osteoporosis was initiated. A high parathyroid hormone with hypercalcemia was documented and an established osteoporosis was evident. Furthermore, a large left side parathyroid adenoma was observed by a neck sonography and confirmed by a four-dimension computed tomography of the neck. Surgical exploration with excision of the parathyroid adenoma was performed, following which the patient recovered uneventfully.
The patient was initially managed as a case of MS with secondary adrenal insufficiency due to glucocorticoid misuse. Although not suspected initially, an extensive work up for osteoporosis screening and accidental hypercalcemia increase the chance of high index of suspicion for hyperparathyroidism. Further investigations then revealed the presence of a solitary parathyroid adenoma with coexistent hyperparathyroidism which was then managed surgically.

Conclusion
Despite the majority of PHPT is asymptomatic and over masked by MS, Active surveillance for any evidence of hypercalcemia and bone metabolism have to be judged carefully to reduce further morbidity and mortality.
Acute Charcot neuropathy: A devastating consequence of diabetes mellitus
Authors: Iremli Burcin Gonul , Sendur Suleyman Nahit , Yildiz Bulent Okan 
Published: January 2023

Abstract

Introduction
Acute Charcot neuropathy (ACN) is a complication of diabetes mellitus. The prevalence of ACN may be up to 13% in diabetic individuals. ACN has a complex etiology. Although it mostly affects middle of the foot, hind-foot joints, the ankle, and forefoot joints; upper limp may also be affected. Here, we present a case with ACN, whose diagnosis was hard to differentiate and manage.

Clinical Case
A fifty-nine-year-old female admitted to our emergency department with a complaint of pain, numbness, swelling, edema and erythema on left arm. When questioned, she had a history of type 2 diabetes for 22 years and had impaired glycemic regulation with 12.2% HbA1c level. She had all macro and micro vasculary complications of diabetes. On physical examination, her left arm was swollen, pulses were not palpabl. With a suspicion of acute thromboembolism, doppler ultrasound was performed and USG showed no arterial occlusion, but thrombosis from the basilic vein to the proximal brachial vein was seen. She initiated anticoagulant therapy with heparin. After 2 weeks, her complaints increased and pallor, coldness, and pain with passive movements on the left arm were added. She admitted to our intensive care unit with a diagnosis of compartment syndrome. She was followed in ICU with stable hemodynamics and without oxygen supplementation. She had transient acute kidney injury due to rhabdomyolysis but resolved without hemodialysis. Despite fasciotomy, myonecrosis developed on left arm and transhumeral resection was performed. After this devastating result, the patient transferred to endocrinology clinic. Intensive insulin therapy and appropriate antibiotic treatment were continued. During her stay in our clinic, she had the same complaints and physical examination findings on her left foot. Imaging studies (X-ray, bone scintigraphy) showed no osteomyelitis but acute charcot arthropathy was seen. Her glucose levels were regulated, and antibiotics completed. The physical strengthening and ROM exercises for lower extremity and oral total calorie intake was adjusted. Her HbA1c level was decreased to 6.2% without hypoglycemia and she is stable on follow-up.

Conclusion
ACN is a devastating complication of diabetic neuropathy with its consequences. The diagnosis may mislead clinicians to cellulitis, acute venous thrombosis, arthritis or gout. Misdiagnosis or delay in diagnosis may result in serious consequences such as infection, ulceration even amputation as in our case. A multidisciplinary approach and close monitoring of the findings may provide huge benefit for the patient.