bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hypertensive Phenotypes and Pattern of Ambulatory Blood Pressure in Patients of Diabetes Mellitus of Kashmir Valley
Authors: Bhat Tariq A. , Mir Mohammad R. , Naqati Shaariq , Naik Muzafar , Naqash Mubarik 
Published: April 2022

Background:Patients of diabetes mellitus (DM) with hypertension (HTN) have a fourfold increased risk of cardiovascular disease (CVD) as compared to normotensive nondiabetic controls. However, many patients of DM who are normotensive or have controlled blood pressure on office BP measurement (OBPM) may assume that they do not have increased risk of CVD but may be having HTN or uncontrolled blood pressure on ambulatory blood pressure monitoring (ABPM).Study Design Objective:A cross-sectional observational study to compare OBPM with ABPM and thus predict various hypertensive phenotypes like masked hypertension (MH) and white coat hypertension and pattern of blood pressure in diabetic patients of our population.Materials and Methods:Two hundred patients of DM with or without HTN were included in this study. The cases were subjected to detailed history, clinical examination, OBPM, and ABPM.Results:Out of 200 patients of DM, 32 were normotensives, 46 were hypertensives controlled on antihypertensive treatment, 22 were hypertensives not on anti-hypertensive treatment, and 100 were hypertensives uncontrolled on anti-hypertensive treatment. Among 32 normotensive diabetics, 17 (53%) patients hadMHon ABPM. Out of these 32 normotensive patients, 7 (21.8%) hadisolated nocturnal hypertension, 3 (9.3%) hadisolated day-time HTN (IDH)and 7 (21.8%) hadday-time and nocturnal HTN (DNH). Patients with MH had higher BMI, an observation that was statistically significant. Non-dipping pattern was found in 53% of patients of masked HTN. Out of 46 hypertensive diabetics with controlled OBPM on antihypertensive treatment, 26 (56.5%) hadmasked effect or masked uncontrolled hypertensionon ABPM. Out of 22 diabetics with treatment naïve HTN, 7 (32%) were found to havewhite coat hypertensionon ABPM. Fifteen (15%) patients out of 100 hypertensive diabetics with uncontrolled OBPM despite on anti-hypertensive were found to havewhite coat effecton ABPM. Patients with white coat effect had higher body mass index an observation that was statistically significant (p = 0.039). Non-dipping pattern was significantly associated with longer duration of diabetes (≥ 120 months), retinopathy and neuropathy.Conclusion:To rely exclusively on OBPM to diagnose HTN and monitor blood pressure may underestimate the CVD risk especially in diabetics. ABPM is a tool that may not only help clinicians in starting anti-HTN treatment perspicuously, but also may help in avoiding unnecessary anti-hypertensive treatment and/or withdrawing anti-hypertensive treatment as indicated and thus avoiding credulity.
Adrenal Incidentaloma Needs thorough Biochemical Evaluation – An Institutional Experience
Authors: Shah Akash N. , Saikia Uma K. , Chaudhary Bipul K. , Bhuyan Ashok K. 
Published: April 2022

Context:Adrenal incidentalomas (AIs) are seen in around 2% of apparently healthy individuals. These require careful evaluation for the hormone excess state and the presence of malignancy prior to intervention.Aims:To study the clinical, biochemical, and imaging characteristics of the patients with AI and correlate the diagnosis with the histopathology findings in patients undergoing surgery.Settings and Design:Retrospective observational study.Methods and Material:Patients with adrenal incidentaloma presenting between January 2017 and January 2021 were evaluated as per guidelines provided by the European Society of Endocrinology and the European Network for the Study of Adrenal Tumors. Patients were given final diagnosis on the basis of imaging impression, hormonal activity, and biopsy results (when applicable).Results:Forty-eight patients were evaluated, with 25 being male, the mean age being 40.9 years (8–71), and the mean size of the mass being 6.21 (1.4–13.7) cm. Thirty-five (72.9%) of them underwent surgical excision. The most common diagnosis was myelolipoma (16), followed by pheochromocytoma (10) and adenoma (9). Nineteen patients were found to have hormone-secreting masses. Two patients with pheochromocytoma were normotensive. There was discordance between imaging diagnosis and hormonal status in two patients, with final diagnosis of pheochromocytoma. One patient with extramedullary erythropoiesis of the adrenal gland was subsequently diagnosed with sickle cell anemia and adrenal insufficiency.Conclusions:The study highlights the rare possibility of discrepancy between non-contrast CT diagnosis and functional status of AI. There is also a rare possibility of extramedullary erythropoiesis presenting as AI with adrenal insufficiency. Specific evaluation for such rare possibilities should be considered in AI cases as per clinical scenario.
Medullary Thyroid Cancer: An Experience from a Tertiary Care Hospital of a Developing Country
Authors: Khan Sajjad A. , Aziz Abdul , Esbhani Umer A. , Masood Muhammad Q. 
Published: April 2022

Background:Medullary thyroid carcinoma (MTC) is a rare type of thyroid cancer that occasionally occurs as part of MEN2A. The universal treatment of MTC is total thyroidectomy with central lymph node dissection. For disease progression, carcinoembryonic antigen (CEA) and calcitonin (CTN) need to be followed. Our aim was to study the presence and patterns of the above-mentioned characteristics of MTC in our population.Methodology:This retrospective study was conducted in a tertiary care hospital of Pakistan in which data of thirty-two medullary thyroid cancer patients over the past 20 years were reviewed and analysed after fulfilment of inclusion criteria. Their clinical, pathological, biochemical and treatment modalities were recorded through a retrospective review of their medical record files.Results:The mean age of patients was 42.88 ± 2.67 years in our study, with a male-to-female ratio of 2:1. Patients with sporadic MTC were 68.8%, while 31.2% were familial. The rates of metastasis were highest in bones followed by lungs and liver. Total thyroidectomy was performed in 26 (81.2%) patients and among those chemotherapy and XRT were performed in one and two patients, respectively. Histologically, the mean tumour size was 7.62 ± 3.64 cm. Median pre-surgery calcitonin was 5756 pg/ml that decreased to 29.3 pg/ml post-surgery. Median pre-surgery CEA level was 246.5 ng/ml that decreased to 6.39 ng/ml post-surgery. Two patients were RET positive.Conclusion:MTC usually presents in the fourth decade of life with male predominance and mostly sporadic occurrence. Total thyroidectomy with subsequent serial calcitonin and CEA levels thereafter are the mainstay of treatment and follow-up.
Ultrasonographic Evaluation of Painful Joints in Rheumatoid Arthritis
Authors: Sultana Sadaf , Ahmad Mehtab , Ahmad Ibne , Usmani Hammad , Arif Mohammad 
Published: April 2022

Context:
High-frequency ultrasound (US) of painful rheumatoid joints allows an increasingly refined analysis of the extent of joint involvement and disease activity.

Aims:
The aim of this study was to establish the role of the US in the evaluation of painful hand joints in patients with rheumatoid arthritis (RA) and its comparison with Conventional Radiography (CR) changes.

Settings and Design:
Cross-sectional study.

Subjects and Methods:
Patients diagnosed with RA were assessed by a thorough clinical examination and relevant laboratory investigations. After X-ray imaging, grayscale, and power Doppler US examination of the wrist, metacarpophalangeal, and proximal interphalangeal joints of both hands were performed using a high-frequency linear transducer.

Statistical Analysis Used:
SPSS version 20.0 (a statistical package for the social sciences) was used to collect, tabulate, and analyze all data. The results were presented as mean standard deviation or percentage. Differences in categorical data were compared using the Chi-square test and Fisher's exact test. A P < 0.05 was considered statistically significant.

Results:
Thirty-two of the 51 individuals studied had radiographic abnormalities, whereas 44 had abnormal findings in the US. The US can detect erosions in 37 patients, including all 15 of those who had radiographically visible erosions. A statistically significant difference was noted between the findings of radiography compared with US findings (P < 0.001).

Conclusions:
US is more sensitive than CR for the detection of erosion and can complement the CR in the evaluation of these patients.
Utility of Ultrasound-Guided Erector Spinae Plane Block in Patients Presenting to the Emergency Department with Rib Fractures
Authors: Srinivasarangan Madhu , Prasad Shetty Bellipady Shyam , Patil Akkamahadevi , Sivasankar Abhijith 
Published: April 2022

Context:
Alleviating significant pain and enhancing lung function in patients with multiple rib fractures presents a formidable challenge to all emergency physicians (EPs). Conventional pharmacological measures and traditional thoracic regional analgesia techniques are not always feasible or safe in the emergency department (ED). Therefore, an effective, feasible, and safe method for providing analgesia in such patients will be extremely advantageous to all patients and EPs alike. Here, we describe the utility of a regional block technique that can be applied in patients suffering from multiple rib fractures in the ED.

Aims:
The aims of this study were as follows: (1) to determine the effectiveness of an ultrasound-guided erector spinae plane block (ESPB) in ameliorating pain and improving lung function in patients presenting to the ED with multiple rib fractures and (2) to assess the safety and the feasibility of the ESPB in the ED.

Setting and Design:
This was a retrospective observational clinical study conducted in the ED of a tertiary care hospital over a period of 12 months.

Subjects and Methods:
Data regarding all patients with rib fractures who had undergone an ESPB in the ED were extracted from the ED procedure register, and the inpatient case sheets were obtained from the medical records department for review and analysis. The data included, but were not limited to, the Numerical Rating Scale (NRS) for pain and respiratory parameters, i.e., respiratory rate and peak expiratory flow rate (PEFR) at 30 min post procedure and subsequently after every top-up dose up to a period of 48 h.

Statistical Analysis:
Descriptive statistics such as mean, standard deviation, frequency, and percentage were used. Inferential statistics such as repeated-measures ANOVA were done using SPSS software version 22 (IBM).

Results:
The mean NRS was significantly reduced by >50% at 30 min and by 72% over a 48-h period (P < 0.001). Meaningful improvements in the respiratory parameters were also observed during the same period with significant increments in the PEFR values (49% increase [P < 0.001]) as well as a decrease of 36% in the respiratory rate (P < 0.001). The mean time for performing the procedure was 16.27 min, and no adverse events were observed as a consequence of the block.

Conclusion:
The study demonstrates the efficacy of USG-guided ESPB in ameliorating pain as well as improving lung function for multiple rib fracture patients. This procedure can be performed in a short time making it suitable for application in the ED. No adverse events as a consequence of the ESPB were noted.
Increased skin reactions with hydroxychloroquine during breast radiotherapy
Authors: Yıldırım Halil Cumhur , Şahin Merve , Engin Burhan , Öksüz Didem Çolpan 
Published: April 2022

ABSTRACT
With the advances in radiation technology, skin reaction due to postoperative radiotherapy (RT) in breast cancer patients is generally mild and tolerable. However, certain drugs may increase the radiation effect. In literature, only few cases of adverse reactions in the radiation field have been reported with the use of Chloroquine. This report describes the case of a 30-year-old young female who had enhanced skin reactions with hydroxychloroquine (HCQ) treatment during breast RT. HCQ should be used with caution in patients undergoing RT due to its potential radiosensitizer effect.
Role of rapid arc-image-guided radiotherapy in hepatocellular carcinoma with portal vein tumor thrombosis: A study from tertiary care center in Punjab, India
Authors: Sidhu Manjinder Singh , Ramandeep  , Sood Sandhya , Aggarwal Ritu , Singh Kulbir , Sood Divyanshi 
Published: April 2022

ABSTRACT

Background and Objectives:
Treatment of hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT) is very challenging with poor outcome. In this situation, radiotherapy has become an alternative treatment modality, more precisely due to advances in radiation techniques. The goal of our study is to do analysis of these patients treated with rapid arc image-guided technology (RA-IGRT) at our institution.

Materials and Methods:
Thirteen patients were included in the study. As per intuition policy, patient set up, contouring, and treatment plans were generated. Radiological response assessment was done 1-month post-radiotherapy. Survival analysis curve along with Chi-square test for prognostic factors assessment was done using SPSS.

Results:
With median dose of 45 Gy in 20 fractions, we were able to achieve 27.3% objective response rate with median survival of 5 months in eligible patients.

Conclusions:
One-year overall survival up to 30% can be achieved in HCC with PVTT, especially in patients with objective response to radiotherapy with Japan Integrated Staging score 2, provided it is precisely hit by RA-IGRT.
Subjective and perceptive assessment of speech/voice and swallowing function before and after radiation therapy in patients of head-and-neck squamous cell cancer
Authors: Aggarwal Vasundhara V. , Waghmare Chaitali Manohar , Lolage Saroj N. , Pawar Hemant J. , Ravichandran Meenakshi , Bhanu Arya 
Published: April 2022

ABSTRACT

Aim:
To prospectively assess subjective and perceptive speech/voice and swallowing function before and after radiation therapy (RT) in patients of head-and-neck squamous cell cancer (HNSCC).

Materials and Methods:
The study cohort comprised eligible consecutive HNSCC patients planned for curative RT from April 2018 to July 2018 who consented for the study. Prospective evaluation of speech/voice and swallowing function was done before and after RT. For subjective and perceptive evaluation of speech/voice, speech handicap index (SHI) and Grade, Roughness, Asthenia, Breathiness, and Strain (GRABS) Scale was used, respectively. For subjective and perceptive evaluation of swallowing, M D Anderson Dysphagia Inventory (MDADI) and Performance Status Scale for head and neck (PSSHN) were used, respectively. All patients were taught speech/voice and swallowing exercises before RT. Statistical analysis was performed using SYSTAT version-12 (Cranes software, Bengaluru).

Results:
The study cohort comprised 30 patients of HNSCC with a median age of 57 years and male-to-female ratio of 4:1. The most common subsite was the oral cavity (43.33%) and a majority (76.66%) presented in the locally advanced stage. Post-RT there was significant improvement in speech/voice function (SHI P = 0.0006, GRABS score P = 0.003). Perceptive assessment of swallowing function by PSSHN showed significant improvement (P = 0.0032), but subjective assessment by MDADI showed no significant (P = 0.394) improvement until the first follow-up.

Conclusion:
Speech/voice function improved significantly after radiotherapy when combined with rehabilitation exercises. Swallowing function did not improve till the first follow-up. Future studies with the large number of patients and long-term follow-up are needed to document the changes in organ function.
Efficacy and safety of hydroxychloroquine for managing glycemia in type-2 diabetes: A systematic review and meta-analysis
Authors: Dutta D , Jindal R , Mehta D , Kumar M , Sharma M 
Published: April 2022

Aims:
No Cochrane meta-analysis with grading of evidence is available on use of hydroxychloroquine (HCQ) in type-2 diabetes (T2DM). This meta-analysis evaluated the efficacy and safety of HCQ in T2DM.

Methods:
Electronic databases were searched using a Boolean search strategy: ((hydroxychloroquine) OR (chloroquine*)) AND ((diabetes) OR (“diabetes mellitus”) OR (glycemia) OR (glucose) OR (insulin)) for studies evaluating hydroxychloroquine for glycemic control in T2DM. The primary outcome was a change in glycated haemoglobin (HbA1c). The secondary outcomes were changes in other glycemic/lipid parameters and adverse effects.

Results:
Data from 11 randomized controlled trials (RCTs) (3 having placebo as controls [passive controls] and 8 having anti-diabetes medications as controls [active controls]) involving 2,723 patients having a median follow-up of 24 weeks were analyzed. About 54.54% of the RCTs were of poor quality as evaluated by the Jadad scale. The performance bias and detection bias were at high risk in 63.64% of the RCTs. The HbA1c reduction with HCQ was marginally better compared to the active (mean differences [MD]-0.17% [95%, CI:-0.30–-0.04;P=0.009;I
2=89%; very low certainty of evidence, VLCE]), and passive (MD-1.35% [95%CI:-2.10–-0.59;P=0.005;I
2=74%]) controls. A reduction in fasting glucose (MD-16.63mg/dL[95%, CI: -25.99 – -7.28mg/dL;P<0.001;I
2=97%;VLCE]) and post-prandial glucose [MD -8.41mg/dL (95%CI: -14.71 – -2.12mg/dL;P=0.009;I
2=87%;VLCE]), appeared better with HCQ compared to active controls. The total adverse events (risk ratio [RR]0.93 [95% CI:0.68–1.28]; P=0.65;I
2=66%) were not different with HCQ compared to the controls.

Conclusion:
The routine use of HCQ in T2DM cannot be recommended based on the current evidence.
Utility of CD200 Expression by Flow Cytometry in Lymphoproliferative Disorders and Plasma Cell Dyscrasias
Authors: Divya Pavuluri , Vangala Navatha , Uppin Megha S. , Uppin Shantveer G. , Gundeti Sadashivudu , Bacchu Srinivas , Radhika K. K. , Parvathi A , Paul Tara Roshni 
Published: April 2022

ABSTRACT

Background:
The cluster of differentiation 200 (CD200) is a recently introduced marker, used to differentiate various lymphoproliferative disorders (LPDs) and is a potential target for chemotherapy.

Objective:
The objective is to study the utility of CD200 expression by flow cytometry (FC) in various LPDs and plasma cell disorders.

Materials and Methods:
This is a retrospective study done over a period of 2 years. The study group included 52 cases with a clinical suspicion of LPD (n = 40) or plasma cell disorder (n = 12). Clinical data, morphological data on peripheral blood, and/or bone marrow examination were analyzed and correlated with the final results on FC.

Results:
Out of 40 LPDs, chronic lymphocytic leukemia (CLL) accounted for a majority of the cases accounting for 57.5% (23 cases). Plasma cell myelomas (PCM) were the most common plasma cell disorders accounting for 75% (nine cases). All cases of CLL showed CD200 expression and the two cases of mantle cell lymphoma (MCL) were CD200 negative. Splenic marginal zone lymphomas (MZL) involving marrow showed dim CD200 expression. Bright CD200 expression was also observed in all cases of hairy cell leukemia (HCL) and 67% of cases diagnosed as PCM.

Conclusion:
CD200 is a very useful marker in the diagnosis of various LPDs especially CLL, HCL, and PCMs. It can be used as an additional marker particularly in distinguishing CLL/small lymphocytic lymphoma (SLL) from MCL and atypical CLL from other CD5+ B-cell neoplasms and extranodal MZL.
Perancangan Sistem Informasi Penjualan Baju Secara Online (E-Commerce) pada Toko Hermanto Jakarta
Authors: Aini Setyawati Nur , Fadholi Arief 
Published: April 2022

Dengan kemajuan teknologi terutama pada bidang teknologi informasi, website salah satu media yang tepat untuk memberikan layanan informasi. Dengan membanguni sebuahi perangkati lunaki layanan informasii berbasisi mediai website, tentunyai segala layanani informasii yangi hendaki diberikani terhadap masyarakati ataupuni sekedari mengenalkani identitas perusahaani itui sendirii dapati menggunakani media websiteo tanpai adai keterbatasani ruangi informasi karenai websitei bersifati dinamisi sehinggai dapat berubah-ubah isi website itu sendiri sesuai dengan kebutuhan. Perancangan sistem informasi ini diharapkan menjadi metode alternatif dalam melakukan promosi dan transaksi pembelian yang lebih mudah, efektif dan efisien. Sistem ini terfokus pada user (pembeli) dan admin. Fitur yang dapat diakses oleh pembeli setelah melalukan pendaftaran dan login yaitu melakukan proses pemesanan. Pembuatan sistem penjualan ini memudahkan pelanggan dalam melakukan proses pembelian serta memudahkan pemilik toko dalam melakukan promosi produknya agar lebih efektif dan efisien.
Kata kunci : Perancangan, sistem informasi dan penjualan pakaian.
Evaluasi Kenyamanan Mahasiswa Terhadap Penggunaan Seragam STIKES Yayasan RS Dr. Soetomo
Authors: Masyfufah Lilis , Rose Mawati Aprilia , Novitasari Dyah , Indah Puspitasari Devi 
Published: April 2022

Sekolah Tinggi merupakan Perguruan Tinggi yang menyelenggarakan pendidikan akademik dan dapat menyelenggarakan pendidikan vokasi dalam satu rumpun Ilmu Pengetahuan atau Teknologi tertentu dan jika memenuhi syarat, sekolah tinggi dapat menyelenggarakan pendidikan profesi. Hal ini tidak hanya berdampak pada penampilan mahasiswa melainkan jugaakan berpengaruh dalam konsentrasi belajar mahasiswa. Oleh karena itu peneliti melakukan penelitian tentang kenyamanan penggunaan seragam pada Stikes Yayasan Rs Dr Seotomo. Penelitian ini adalah untuk mengembangkan desain seragam di kampus STIKES Yayasan Rs DR. Soetomo Surabaya. Penelitian ini merupakan jenis penelitian dan pengembangan atau Research and Development (R&D). Penelitian ini menggunakan kerangka konsep teori SDLC untuk pengembangan model seragam di STIKES Yayasan Rs Dr Soetomo. Pada penelitian ini peneliti melakukan penelitian dan pengembangan pada seragam kampus. Tingkat kenyamanan penggunaan seragam yang dapat mempengaruhi proses belajar mahasiswa di kampus. Rancangan penelitian menggunakan cross sectional untuk mempelajari korelasi antara faktor-faktor risiko dengan efek, dengan cara pendekatan observasi atau pengumpulan data sekaligus pada satu waktu. Dengan menggunakan populasi sebanyak 100 mahasiswa STIKES Yayasan Rs. DR Soetomo. Sampel dari penelitian ini menggunakan Quota Sampling yaitu teknik sampling dengan mengambil jumlah sampel sebanyak jumlah yang telah ditentukan yakni 40 mahasiswa mengisi kuesioner untuk identifikasi awal beberapa permasalahan di Stikes Yayasan Rs. Dr. Soetomo. Indicator yang digunakan dalam penelitian ada 3 yaitu menganalisis kebutuhan, identifikasi penggunaan dan ketentuan seragam, dan pengembangan desain seragam. Instrument penelitian ini menggunakan checklist sehingga peneliti membuat dan menyebarkan kuisioner dalam bentuk online yaitu google form yang akan diisi oleh mahasiswa sehingga data yang diperoleh dalm bentuk data primer.
Kata kunci : SDLC, pengembangan dan tenaga kesehatan.