bluuebunny/crossref_metadata_2025 huggingface dataset:
Otizmi Yeniden Anlamak: Parçalanabilir Belirtiler ve Nicel Genetik
Authors: ZIVRALI YARAR Esra
Published: June 2021

Otizm spektrum bozukluğu, sosyal etkileşimde ve iletişimde güçlükler ile kısıtlı/tekrarlayan davranışlar ve ilgi alanları temelinde tanımlanmaktadır. Otizmin etiyolojisini anlamak ve etkili müdahale yolları üretmek, bozukluğun karmaşık doğası ve belirtilerin farklı şekillerde görülebilmesi gibi sebeplerden dolayı zorlayıcı olabilmektedir. Konu hakkında kısıtlı ilerlemenin sebeplerinden biri birbirinden oldukça farklı belirti gruplarını açıklayan tek bir sebep aranması olabilir. Parçalanabilir otizm üçlemesi hipotezi, otizmi karakterize eden belirti gruplarının davranışsal, bilişsel ve genetik düzeylerde büyük ölçüde birbirinden bağımsız olabileceğini önermektedir. Bu makale, söz konusu hipoteze kanıt teşkil edebilecek nicel genetik yöntemler ile elde edilen bulguları değerlendirmeyi amaçlamaktadır. Söz konusu bulgular, otizm belirtilerinin genetik temellerinin farklılık gösterebildiğine işaret etmekte ve parçalanabilir otizm üçlemesi hipotezini desteklemektedir. Tek yumurta ikizlerinde görülen fenotipik varyanslar, belirti grupları arasında yeterli düzeyde anlamlı ilişkinin bulunamayışı ve hem genetik hem de çevresel faktörlerin etkisi açısından tespit edilen farklılıklar otizm belirtilerinin birbirinden bağımsız değerlendirilebileceğine işaret etmektedir. Belirli kısıtlılıklar ve bunlara yönelik öneriler ışığında tartışılan bulgular otizmin heterojen yapısını anlamayı kolaylaştırmakta ve etkili müdahale teknikleri geliştirilebilmesi için yol göstermektedir. Böylece, belirli belirti gruplarında daha çok güçlüğü bulunan otizm tanısı almış bireyler kadar tanı kriterini karşılayacak kadar çeşitli belirtilere sahip olmayan ancak yoğun güçlük yaşayan bireyler için faydalı olacak müdahale protokollerinin oluşturulabileceğine dikkat çekilmiştir.
14-19 Yaş Aralığındaki Ergen Örnekleminde Savunma Düzenekleri ve Ergen Ruhsal Gelişimi üzerine TAT ile bir Araştırma
Authors: DÜŞGÖR Bengi , KALEM Erkan , KOÇ Kübra , İKİZ Tevfika
Published: June 2021

Psikanalitik kurama göre ergenlik dönemi, erinlik değişimlerinin uyumlanma süreci olarak ele alınabilir. Ergenlik, ani bir büyüme içermesi nedeniyle kendi başına kırılgan bir dönemdir. Araştırmanın amacı, ergen örnekleminde yaş gruplarına, cinsiyete ve sosyoekonomik duruma göre savunma düzeneklerinin kullanımı ve ruhsallığın gelişiminde cinsiyet, yaş ve sosyoekonomik durumun etkilerinin, İstanbul’da yaşayan bir ergen örnekleminde, TAT kullanılarak incelenmesidir. Bu çalışmanın ana hipotezi, ergenlik boyunca, yaş aralıklarına göre ketlenme, narsisistik savunmalar ve çatışmanın ifadesinde farklılıklar olacağı yönündedir. Geç ergenlik dönemi diğer yaş gruplarına göre belirgin farklılıklar göstermektedir. 18-19 yaş grubundaki kadın ve erkekler daha olumlu narsisistik savunmalar göstermektedir. Özdeşimler ise daha sabit hale gelmekte ve sabit bir kimlik oluşmaktadır. Mantıksal düşünce daha da gelişmiştir ve sonuç olarak daha olgun bir anlayış gelişmektedir. Entellektüalizasyon bu dönemde her iki cinsiyette de arttığı gözlenmiştir. Dramatizasyon kadınlarda artarken, erkeklerin bu yaş döneminde daha çok izolasyona başvurdukları görülmüştür. 18-19 yaş grubu sınırların da daha netleştiği bir döneme işaret etmektedir. Sonuç olarak, ergenlik döneminin kendi içinde farklı yaş gruplarıyla değerlendirilmesinin önemi ortaya çıkmaktadır.
Görüntülü Görüşme ile Yabancı Dilde Semptom-Odaklı Bilişsel Davranışçı Psikoterapi Uygulaması: Bir Olgu Sunumu
Authors: AKYUNUS Miray
Published: June 2021

Pratik veya zorunlu gerekçeler dolayısıyla psikoterapi uygulamalarının yabancı dilde ve/veya çevrimiçi internet aracılığı ile sunulması yaygınlaşmaktadır. Bu vaka çalışması her iki koşulda bilişsel davranışçı terapinin (BDT) uygulanmasına bir örnek niteliğindedir. Türkiye’nin küçük şehirlerinden birinde yaşamakta olan İngiliz bir danışan, depresyon ve kaygı belirtileri şikayetleri ile, semptomlardan kurtulma ve iş levselliğini artırma amaçlı olarak bilişsel-davranışçı yaklaşımla çalışan bir psikoterapiste İngilizce psikoterapi için başvurmuştur. Vakanın geçmiş çözümlenmemiş travmaları bulunmakla beraber, kendi talebi ve en yüksek yararının gözetilmesi çerçevesinde semptom-odaklı BDT yürütülmüştür. Sunulan bu vaka örneğinde, terapötik ittifakın çevrimiçi terapi uygulamasında geleneksel terapilere benzer şekilde kurulabilmesi, BDT tekniklerinin bu ortamda uygulanmaya uygun olması ve danışanın terapiye uyumu tedavinin etkinliğine katkıda bulunmuştur. Bu vaka çalışması, görüntülü görüşme ile ve yabancı dilde olmakla birlikte, BDT yaklaşımına yatkın danışanlarla, yapılandırılmış bir yaklaşımla çalışmanın semptom-odaklı tedavilerde etkinliğini ortaya koyması açısından önemlidir. Diğer taraftan, intihar riski gibi kriz durumlarının ele alınmasının ve yıkıcı travmatik yaşantılar gibi hassasiyeti yüksek meselelerin çalışılmasındaki güçlükler ise, geleneksel olmayan bu psikoterapi ortam ve koşullarının sınırlılıklarını ortaya koymuştur.
Gelişimsel Krize Müdahalede Kısa-Yoğun-Acil Psikoterapinin Kullanımı: Bir Olgu Sunumu
Authors: KAYA M. Siyabend , YİLDİRİM Taşkın
Published: June 2021

Yaşam dönemleri düşünüldüğünde, gelişimsel krizlerin bireyleri etkilemesi beklendiktir. Buna rağmen, gelişimsel krizlere zamanında ve etkili şekilde müdahalede bulunulmazsa, üstesinden gelinmesi daha zor krizlere dönüşebilmektedir. Bu nedenle zaman zaman sorun yaşayan bireyler, yaşadıkları sorunları çözmek için profesyonel bir destek aramaktadır. Bu çalışmanın amacı; depresyon, yas ve travmatik sorunlarda başarıyla kullanılan dinamik yönelimli kısa – yoğun – acil psikoterapi uygulamasını, gelişimsel kriz yaşayan bir üniversite öğrencisinin sorunu üzerinden betimlemektir. Bu çalışmada psikoterapi araştırmaları için önem arz eden bir yöntem olan vaka çalışması yöntemi kullanılmıştır. Bu bağlamda, psikoterapi almaya gönüllü bir üniversite öğrencisi ile dokuz oturumluk kısa – yoğun – acil psikoterapi uygulaması gerçekleştirilmiştir. Danışana Semptom Tarama Listesi (SCL–90 R), Hacettepe Kişilik Envanteri (HKE), Beck Depresyon Envanteri (BDE), Beier Cümle Tamamlama Testi B Formu öntest – sontest – izleme testi olarak uygulanmıştır. Araştırmada kullanılan ölçme araçları psikoterapi sürecine dair nicel verileri ortaya koyarken, anamnestik görüşmeler ve terapi oturumları sürece dair nitel verileri ortaya koymuştur. Ardından bu veriler nitel içerik analizine tabi tutulmuştur. Sonuç olarak bu terapi yönteminin, danışanın sorunlarının çözümünde etkili olduğu tespit edilmiştir.
Obsesyonel Yapıda Baba İşlevinin Lacanyen Açıdan İncelenmesi
Authors: YAKA Ali İhsan
Published: June 2021

Freud’un (2010/1925) Olumsuzlama (Negation) makalesinden yola çıkarak üç temel ruhsal yapıyı (psikotik, pervert/sapkın ve nevrotik) olumsuzlamanın üç biçimi olarak yorumlayan Lacan, bu ruhsal yapıları baba işlevi (paternal function) üzerinden açıklamıştır. Ruhsal yapının oluşumunun ödipal ilişkilere dayandığını ve ödipal ilişkilerin, öznenin baba işleviyle olan ilişkisinin bir temsili olduğunu ve böylece öznenin fallus olmaktan fallus sahibi olmaya geçiş dinamiğinin baba işlevi üzerinden gerçekleştiğini belirtmiştir. Bu noktada gerçek, imgesel ve simgesel baba ayrımları üzerinde durarak ödipal süreçte devreye giren baba figürünün imgesel olduğunu belirten Lacan, simgesel babanın yapısal olarak devreye girmesinin ise tamamen simgesel veya dil üzerinden fallik gösterenin (phallic signifier) etkisiyle gerçekleştiğini ve fallik gösteren etkisinin, baba işlevi üzerinden gerçekleştiğini ifade etmiştir. Lacan, nesne ilişkileri seminerinde, obsesyonel yapıyı L şeması üzerinde imgesel karşılık (imaginary reciprocity) kavramını kullanarak açıklamış ve böylece obsesifin imgesel düzeyde kendisi için önemli olan nesne konumundaki anne ile özdeşleştiğini belirtmiştir. Lacan’a göre, Başka’nın arzusunu reddeden obsesif aynı zamanda Başka’nın kastrasyonunu reddetmiş olur. Böylece L şemasında obsesifin kendisi için önemli olan nesne ile özdeşleşimi imgesel eksende imgesel baba figürü üzerinden gerçekleşir. Obsesyonel yapıdaki bilinçdışı özne ise L şemasında simgesel eksende Başka’yı korumak için Başka’nın konumlandığı yerde seyirci konumundadır. Dolayısıyla, obsesifin imgesel eksende kendisi için önemli olan nesneyle olan fantazmatik ilişkisinin düzenleyicisi konumundaki fallusun yeniden konumlanabilmesi, imgesel baba üzerinden değil; simgesel baba işlevi yoluyla sağlanabilecektir. Bu çalışmada, Lacan’ın obsesyonel yapı ve baba işlevi hakkındaki görüşleri ilgili literatür çerçevesinde ele alınmış ve obsesyonel yapılanması olduğu düşünülen N. Bey vakası, ruhsal yapı ve baba işleviyle olan ilişkisi bağlamında incelenerek tartışılmıştır.
Tepedeki Ev: Korkularımız, Kayıplarımız ve Keşkelerimiz
Authors: ALPARSLAN Büşra
Published: June 2021

Bu makalede, Shirley Jackson'ın aynı adlı romanından uyarlanan The Haunting of Hill House (Tepedeki Ev) dizisi incelenmiştir. Tepedeki Ev, bir ailenin yaşadığı travma ve yasları büyümenin çetin süreci içinde incelikle anlatmıştır. Dizideki hayaletler, yaşamdaki kayıpları, keşkeleri ve irili ufaklı korkuları sembolize eder. Dizinin anlatısı; aile temsili, yas kavramı ve ayrışma-birleşme süreci ekseninde incelenmiştir. Bu anlatı içinde aile; geleneksel heteronormatif roller üzerine kurgulanmıştır ve ailenin insanın hayatında bıraktığı köklü etkiler örneklenmiştir. Ev kurgusunda, bir nesne olarak annenin taşıdığı sembolizmden de faydalanılmıştır. Evin ve içindeki hayaletlerin arzusu, insanların orayı asla terk etmemeleridir; bu aile kurumuna bir eleştiri olarak okunabilir. Tepedeki evin temsil ettiği aile, bir hatıradan öte gerçekten de bir ömür peşimizi bırakmayan bir hayalet gibidir. Dizi, yas kavramını ele alırken yasın beş evresini aktarmıştır ve anlatı içinde hikayedeki beş kardeş, Kübler-Ross’un yas kuramının beş evresini simgelemektedir. Yasın evrelerinin birbirinden kopuk olmadığı ve bu evrelerin doğrusal ilerlemediği, zaman zaman evreler arası geçişler görülebildiği kardeşlerin üzerinden sembolik biçimde aktarılmıştır. Dizinin irdelediği bir diğer nokta ayrışma-bireyleşme sürecidir. Dizinin anlatısı, bu sürece çocukların perspektifinden ziyade annenin gözünden yaklaşmıştır. Bu sürecin anne tarafından zorlukla karşılanması ve annenin simbiyotik ilişkinin kırılmasına direnç göstermesi dizideki anne üzerinden sembolik olarak anlatılmıştır.
Lacanyen Psikanalizde Travma ve Düşlem
Authors: KORKMAZ Ayça
Published: June 2021

Lacan, psikanaliz çalışmalarını Freud’a dönüş hareketi olarak adlandırmıştır. Freud’a dönüş hareketi, Freud’un psikanaliz öğretisine dönüşü işaret etmekle beraber post-Freudyen olarak adlandırılan diğer analistlerin çalışmalarının da eleştirisini kapsamaktadır. Lacan’ın psikanaliz öğretisi ve kuramı, Freud’un bilinçdışı çalışması üzerine temellenmiş, 1933’ten 1980’e kadar değişiklikler geçirerek evrimleşmiş ve süreç içerisinde inşa edilmiştir. Bu makalede, Lacanyen psikanalitik kuramda düşlem ve travmanın ilişkisini anlayabilmek için Freud’un kuramında travma ve fantezi ilişkisine ve bu iki kavramın tarihçesine değinilecektir. Freud, travmayı Emma, Katharina ve Kurt Adam vakalarında baştan çıkarma kuramı, sonradan anlamlandırma (nachträglichkeit) ve fantezi kavramları üzerinden tartışmıştır. Freud’un kuramında fantezi, bilinçdışı arzuları temsil eden sahneye karşılık gelmektedir. Lacan, post-Freudyen psikanalitik çalışmalarda kullanılan fantezi kavramının imgesel boyuta vurgu yapılarak kullanılmasını eleştirir ve simgesel ve imgesel düzenleri kapsayan kurgusal bir yapıya işaret etmek için düşlem (fantasme) kavramını kullanmıştır. Düşlem, ilk Başka olan annenin eksiği ile ilişkili olarak das Ding, objet petit a ve fallus kavramlarının inşa aşaması üzerinden incelenecektir. Başka’daki eksiğin fallik formda algılanması sonucunda bir savunma olarak düşlem oluşmaktadır. Travma, Başka’daki eksik imgesel ve simgesel düzende yorumlanamadığında, gerçek ile karşılaşma anında ortaya çıkar. Kuramsal bilgilerin ışığında, travmatik etkiler yaratan bir olay üzerine terapiye başlayan T. Hanım vakası düşlem kavramı ile birlikte aktarılacaktır.
Ebeveyn Gelişim Görüşmesi Üzerinden Yapılan Yansıtıcı İşleyiş Kodlama Sisteminin Psikometrik Özellikleri
Authors: BESİROGLU Burcu , HALFON Sibel
Published: June 2021

Ebeveynin yansıtıcı işleyişi kendisi, çocuğu ve ikisi arasındaki ilişkiye dair zihin durumları hakkında düşünebilme, bunları birbirine bağlayabilme ve etkilerini tahmin etme becerisidir. Bu çalışmada, Ebeveyn Gelişim Görüşmesi üzerinden yapılan yansıtıcı işleyiş kodlama sisteminin psikometrik özellikleri incelenmiştir. Çalışmaya bir üniversite kliniğinde psikoterapi hizmetine başvurmuş 115 anne (Ortyaş = 36.01 yaş, SS = 4.96) ve çocukları (Ortyaş = 6.99 yaş, SS = 2.09, %41.7 kız) katılmıştır. Ebeveynlerle Ebeveyn Gelişim Görüşmesi yapılmış, görüşme yansıtıcı işleyiş kapasitesi kodlama sistemi üzerinden değerlendirilmiştir. Ayrıca, ebeveynlerin sosyo-demografik bilgileri ve bağlanma stili ile çocukların duygu düzenlemesi, ifade edici dil becerisi, çocukluk çağı deneyimleri ve davranış sorunları ile ilgili bilgiler toplanmıştır. Açımlayıcı ve Doğrulayıcı Faktör analizi sonuçları üç faktörlü bir yapı ortaya çıkarmış ve her faktörün iç tutarlılık değerlerinin yeterli olduğu görülmüştür. Bunlar kavramsal olarak, çocuk- (ebeveynin çocuğunun duygularını yansıtıcı işleyiş kapasitesi), ilişki- (ebeveynin anne-çocuk arasındaki ilişkiyle ilgili yansıtıcı işleyiş kapasitesi) ve kendi-odaklı (ebeveynin kendi duygularını yansıtıcı işleyiş kapasitesi) faktörler şeklinde isimlendirilmiştir. Çocuk-odaklı yansıtıcı işleyiş kapasitesi sosyoekonomik durum ile pozitif yönde ilişkilidir. İlişki-odaklı yansıtıcı işleyiş kapasitesi ebeveynin kaçınmacı bağlanma stili, eğitim seviyesi, sosyoekonomik durumu, annenin sahip olduğu çocuk sayısı ve çocuğun olumlu ve olumsuz deneyimleri ile ilişkilidir. Kendi-odaklı yansıtıcı işleyiş kapasitesi ise annenin sahip olduğu çocuk sayısı, çocuğun ifade edici dil becerisi, duygu düzenlemesi ve dışsallaştırma sorunlarıyla ilişkilidir. Sonuçlar Ebeveyn Gelişim Görüşmesi üzerinden yapılan yansıtıcı işleyiş kodlama sisteminin Türkiye’deki klinik örneklemde kendi-ve ilişki-odaklı yansıtıcı işleyiş kapasitesini ölçmek için yeterli olabileceğini, çocuk-odaklı yansıtıcı işleyiş kapasitesini ölçmek için geliştirilmesi gerektiğini göstermektedir.
WITHDRAWN
Authors: Doe Jane
Published: June 2021

The document associated with this DOI has been withdrawn.
Feminisme Dakwah Perempuan Dalam Film Habibie & Ainun 3
Authors: Dwi Anggraini Rinta , Nurcholis Ahmad
Published: June 2021

Feminism is suspected of being a women’s rebellious movement to deny the nature of being a woman and as a driving force to obtain women rights. Feminist ideology demands gender injustice. In preaching, men dominate the spread of Islam than women. Although the implementation of da’wah is predominantly male, there are also many da'iyah in Indonesia, one of which is Ainun. Gender differences do not make Ainun despair in achieving her dream as a doctor. So that this becomes unique to examine. This research uses qualitative methods with a feminist approach. The result of this study was the determine Ainun da’wah massage in the movie Habibie & Ainun 3, as well as the problems of Ainun as a da’iyah in Indonesia. Ainun can be used as an aspiration and role model for Indonesian people in education, concern, and desire to realize their dreams.
Madrasah: Sejarah dan Dinamikanya
Authors: Zainuddin Zainuddin
Published: June 2021

The long journey of madrasas cannot be separated from the long history of this world. Its existence which is full of twists and turns in order to maintain the existence of Islam becomes something unique to him. Since Indonesia's independence even long before that, the madrasa has contributed a lot in educating the lives of Muslim communities. Although in its journey, it always gets a stumbling around the regulations. The dynamics they experience make madrasa always up to date to discuss.
A Review of Traumatic Axonal Injury
Authors: Karakaya Dicle , Işıkay Ahmet İlkay
Published: June 2021

Traumatic brain injury is a major cause of mortality and neurological disability worldwide and varies according to its cause, pathogenesis, severity and clinical outcome. This review summarizes a significant aspect of diffuse brain injuries – traumatic axonal injury – important cause of severe disability and vegetative state. Traumatic axonal injury is a type of traumatic brain injury caused by blunt head trauma. It is defined both clinically (immediate and prolonged unconsciousness, characteristically in the absence of space-occupying lesions) and pathologically (widespread and diffuse damage of axons). Following traumatic brain injury, progressive axonal degeneration starts with disruption of axonal transport, axonal swelling, secondary axonal disconnection and Wallerian degeneration, respectively. However, traumatic axonal injury is difficult to define clinically, it should be considered in patients with Glasgow coma score < 8 for more than six hours after trauma and diffuse tensor imaging and sensitivity-weighted imaging MRI sequences are highly sensitive in its diagnosis. Glasgow coma score at the time of presentation, location and severity of axonal damage are prognostic factors for clinical outcome.
Underlying Causes and Risk Factors of Chronic Renal Allograft Dysfunction Among Renal Transplant Recipients
Authors: Güven Göksel , Yılmaz Şeref Rahmi , Yıldırım Tolga , Akı Fazıl Tuncay , Erdem Yunus
Published: June 2021

Objective: Dialysis or renal transplantation are the two treatment options for end-stage renal disease patients. Renal transplantation from an appropriate donor increases survival and quality of life compared to treatment with dialysis. Recent advances in immunosuppressive therapy have significantly improved the success in 1-year graft survival. However, the long-term graft survival remains the same. Therefore, we aimed to determine the underlying causes and risk factors of chronic allograft dysfunction in renal transplant recipients.

Materials and Methods: From 2000 to 2012, all consecutive renal transplant recipients followed in our tertiary referral center who underwent renal biopsy due to an increase in serum creatinine level were enrolled. Etiologies of chronic allograft dysfunction were assessed according to pathologic results of renal biopsy specimens and laboratory findings. The immunological and non-immunological risk factors of chronic allograft dysfunction were screened and recorded retrospectively.

Results: Eighty (80) renal transplant recipients with a mean age of 38±10 years were included in the study. Delayed graft function (p=0.007), history of acute rejection (p<0.001), positive panel reactive antibody (p=0.033) (Class I (p=0.013), Class II (p=0.006)), positive donor specific antibodies (p=0.001), number of recurrent acute rejections (p<0.001), number of human leukocyte antigens mismatches (p=0.051), cold ischemia time (p=0.001) were found to be risk factors for chronic allograft dysfunction. The donor specific antibodies positivity (p<0.001) and the panel reactive antibody positivity (Class I (p=0.003), Class II (p=0.001)) were significantly higher in patients with antibody mediated rejection than patients without antibody mediated rejection (p=0.002).

Conclusion: Delayed graft function, presence and the number of acute rejections, increased cold ischemia time, panel reactive antibody positivity, donor specific antibodies positivity, and the number of human leukocyte antigens mismatches were risk factors for chronic allograft dysfunction.
FUNCTIONAL OUTCOME OF DISTAL FEMORAL FRACTURES AND THEIR MANAGEMENT
Authors: Shrivastava Raman , Shrivastava Namita
Published: June 2021

Background: Fractures of distal end of femur are complex injuries which are difficult to manage. These fractures often are unstable and comminuted. Despite advances in surgical techniques and improvement in implants, treatment of distal femoral fractures remains a challenge in many situations. This study was done to analyse the functional outcome and this management of distal femoral fractures.
Material & Methods: This study has been done between August 2008 to March 2010 on patients coming to Orthopaedics Department at Jawaharlal Nehru Hospital and Research Center, Bhilai. It is a prospective study which includes 25 patients with 10 Type A, 7 Type B and 8 Type C fractures of distal femur after fulfilling the inclusion and exclusion criteria.
Results: Mean age of 47.08 years with sex incidence of 3.17:1(M:F). Mode of injury was RTA in 16, simple fall in 6, fall from height in 2 and railway track accident in 1 patient. There were 5-A1, 1-A2, 4-A3, 3-B1, 1-B2, 3-B3, 1-C1, 4-C2 and 3-C3 fractures. Results were found to be excellent in 17, good in 1, moderate in 3 and poor in 4 patients.
Conclusion: We conclude that minimally invasive surgical techniques and with the availability of locking type of plates distal femoral fractures can now be dealt with more precessions and more satisfactory results can be produced.
Keywords: Distal fractures, Muller Classification, Management, Femoral fractures
INDICATIONS OF CAESAREAN ACCORDING TO ROBSON’S CRITERIA
Authors: Vaghela Jayshree , Parmar Dipti. C.
Published: June 2021

Introduction: There has been an increase in rate of caesarean section over past five decades. This is matter of public health concern as it increases the caesarean section related maternal morbidity and mortality. Asadvised by WHO guidelines and US health initiative C-section rate should not beyond 15%. According to NHFS-4 C-section rate in India 17.2%. The aim of present study aimed to assess the rate of CS and perform and analysis based on Robson classification system.

Methods: In present study all the cases delivered by caesarean section during period of six months were recorded. Data were collected from medical records of women who delivered from October to march 2021.They were classified according to Robsons’10 group classification system. This was an attempt to see which relevant group contributed most to the c- section rates. Results: There was a trend of increased percentage of caesarean section in group5 patients in present study. Poor tolerance to pain and increased rate of previous c section contributes to this.

Conclusion: We should make use of vaginal delivery after caesarean section but not at the cost of maternal and fetal health. These target groups require more in depth analysis to identify modifiable risk factors and apply specific intervention to reduce cs rates.

Keywords: Indications, Caesarean, Robsons criteria.
ROLE OF HEMATOLOGICAL PARAMETERS IN EARLY DIAGNOSIS OF COVID-19 IN A TERTIARY CARE CENTRE
Authors: Saha Angira , Saxena Sakar , Srivastava Romi , Narang Sanjeev
Published: June 2021

Aim: To evaluate the role of biomarkers from blood samples of COVID-19 patients admitted in Index Medical College Hospital & R.C.

Material & Methods: Hematological parameters such as Neutrophil lymphocyte ratio (NLR), Platelet lymphocyte ratio (PLR) & Systemic Inflammatory Index (SII) were studied in RT-PCR positive patients to evaluate the utility of these parameters for early diagnosis of COVID-19.

Results: The study showed that there was statistically significant difference in test groups in reference to Neutrophil lymphocyte ratio (NLR) & SII values (p<0.05). But no statistically significant difference was observed between test groups in reference to Platelet lymphocyte ratio (PLR) values (p>0.05).

Conclusion: Leukocyte, Neutrophil, NLR & SII values can be used in the early diagnosis of COVID-19.

Keywords: NLR, SII, Leukocyte, Neutrophil
COMPARATIVE STUDY OF ROLE OF WOUND OUTCOME IN VACUUM ASSISTED CLOSURE OF WOUNDS TO CLASSICAL (MOIST) WOUND CLOSURES
Authors: Kumari Aprajita , Vyas Atul
Published: June 2021

Background & Method: This study is conducted at General Surgery department of Index Medical College Hospital and Research Centre, Indore (M.P.) To Analysis of wound outcome in Vacuum assisted closure of wounds in comparison to classical (moist) wound closure in terms of rate of granulation tissue formation, culture at presentation, complications and recommendations. The wound of the patient was assessed by measuring the maximum length and maximum width of the wound. Then on day 7th, 14th and day 21st, the maximum length and maximum width of the granulation tissue covering the same wound was measured.

Result: In Group I Mean age of patients is 39 ± 13 years and in Group II it is 42 ± 14 years. In Group I and Group II there is no difference in the gender wise distribution. The most common disease in both the groups I and II is bed sore followed by compound fractures. The most common organism on culture in group I is S. aureus (9) followed by polymicrobial growth (7), and in group II is S. aureus (10) followed by E.coli (7). The average rate of granulation in group I on day 7th is 27.63 ± 23.23, on day 14th it increased to 35.92 ± 25.75, and on day 21st it further increased to 65.6 ± 15.20. The average rate of granulation in group II on day 7th is 31.34 ± 18.22, on day 14th it is increased to 57.4 ± 17.55, and on day 21st it further increased to 75.16 ± 6.732. Group I had higher number of complications (8) in comparison to group II (6). There is no complication in 44 patients of group II and 42 patients of group I.

Conclusion: In our present study it was concluded that the rate of granulation tissue formation was better in the VAC group in comparison to the conventional dressing group. Vacuum assisted closure dressing was found to be totally safe, although technically demanding. Thus, we conclude that the surgeon’s discretion is very much needed in VAC being the choice of dressings in certain wounds and where there is much difficulty in performing VAC dressings, the conventional dressings should be the choice.

Keywords: wound, vacuum, moist & outcome.
A RETROSPECTIVE STUDY OF FETOMATERNAL OUTCOME IN HIV POSITIVE PREGNANT WOMEN
Authors: Dhamat Krishna , Nakum Kanaklata D.
Published: June 2021

Introduction: In present scenario Acquired immunodeficiency syndrome is one of the worst global health concerns.HIV has a dramatic impact on the health of mother and children. Parent to child transmission of HIV is a major route of new infection in children.   

Objective: Aim of my study is to find out the prevalence of HIV status among pregnant women delivering in our hospital and to determine maternal and fetal outcome in those HIV positive pregnant women.   

Materials and Methodology: A retrospective study conducted in Government medical college and sir T hospital, Bhavnagar from May 2019 to April 2021. All HIV positive pregnant women with >28 weeks gestation and who are on ART or not and delivering in our hospital were selected. Maternal and fetal outcome variables were analysed.

Results: Total deliveries during the study period were 9526. Of these HIV positive pregnant women were 58, prevalence being 0.6%. Primigravida were found to be 34.48%, 48.27% were diagnosed HIV positive during pregnancy, vaginal deliveries were 75.86% and caesarean section was 24.13%. Birth weight <2kg in 20.68%.Exclusive breast feeding in 81.13%. Nevirapine prophylaxis were given to 96.22% of neonate. 

Conclusion: Early diagnosis and initiation of therapy will prevent transmission to their children and better fetomaternal outcome. Awareness and information is important to increase access to PPTCT services. Team approach involving an experienced obstetrician, neonatologist and physician gives hope of having a healthy uninfected baby for HIV infected mothers.

Keywords: fetomaternal, HIV
OUTCOME COMPARISON OF TREATMENT BASICERVICAL NECK OF FEMUR FRACTURE USING HEMIARTHROPLASTY VERSUS DYNAMIC HIP SCREW
Authors: Singh Manpreet , Dhaker Anurag , Mundotiya Pradeep Kumar
Published: June 2021

Background: The present study was conducted to compare outcome of hemiarthroplasty with dynamic hip screw for basicervical neck of femur fracture.

Methods: Hospital based, randomized prospective, comparative interventional study conducted on Basicervical neck of femur fracture cases attending with orthopaedics department of S.M.S. Medical College and Hospital, Jaipur (Rajasthan, India)

Results: As per the post operative complications in Hemiarthroplasty and DHS groups respectively, no significant difference was observed among the group. As per the age groups clinical score (merle's d aubigne), at 6m and 12 m Group H was better than group D. As per average functional outcome at 3,6 ,12months. Score improved with the time.

Conclusion: We concluded that Hemiarthroplastymay allow better restoration of function and should be favoured for treatment of fracture neck of femur in patients that meet the indications for surgery whenever the technical competence and facilities exist.

Keywords: Femur, Hemiarthroplasty, DHS
OPEN REDUCTION AND INTERNAL FIXATION COMPARED WITH ORIF AND PRIMARY SUBTALAR ARTHRODESIS FOR TREATMENT OF SANDERS TYPE IV CALCANEAL FRACTURES: A RANDOMIZED COMPARATIVE PROSPECTIVE STUDY
Authors: Mundotiya Pradeep Kumar , Dhaker Anurag , Singh Manpreet
Published: June 2021

Background: The present study was conducted to open reduction and internal fixation compared with ORIF and primary subtalar arthrodesis for treatment of sanders type IV calcaneal fractures

Methods: Randomized comparative prospective trial conducted on Calcaneum fracture cases attending with orthopaedics department of S.M.S. Medical College and Hospital, Jaipur (Rajasthan, India)

Results: SF 36, MFA, AHS and VAS score showed almost same results in both groups at 3 months which showed statistically non significant results.

Conclusion: A randomized trial was unable to demonstrate any significant difference between ORIF compared with ORIF + PSTA for the treatment of isolated Sanders type IV fractures with respect to long-term outcome. ORIF + PSTA however, should be considered for patients with Sanders type IV fractures, and the health care system as they heal at a much more rapid rate, and will not require additional surgery. This must be considered as the choice of treatment may have profound economic effects on the patient. More research is needed to find the best solutions for these difficult fractures.

Keywords: ORIF, PSTA, Fracture.
BLOOD TRANSFUSION PRACTICES IN OBSTETRICS AND GYNAECOLOGY AT TERTIARY CARE CENTRE: A RETROSPECTIVE STUDY.
Authors: Singh Shailendra , Bhardwaj Shantipriya , Jareda Kuldeep , Sharma Amit , Shekawat Keshari Singh
Published: June 2021

Background: This study was undertaken to ascertain the total patients receiving a transfusion, indications for transfusion, various blood components used, the timing of transfusion, and the presence of any risk factors in the patients transfused.

Methods: Transfusion request forms of 2998 patients admitted to the Department of Gynaecology and Obstetrics in the zanana Hospital, SMS Medical College and attached group of hospitals Jaipur from May 2020 to July 2020were retrospectively reviewed for the types and volume of blood component transfused. Indication for each blood component transfusion was noted. Patients who had MOH were further analyzed to estimate the ratio of components transfused.

Results: We have experienced 898 obstetric patients who underwent blood component transfusion during the study period. Out of these, 440 (49%) and 458 (51%) were primigravida and multigravida respectively. The mean age of patients who received transfusion was 27 years. The maximum number of patients was in the age group of 21–32 years

Conclusion: Anemia during pregnancy is a significant cause of maternal mortality and morbidity. The decision for transfusion was done in this study when the Hb<7 gm%, and there were <4 weeks for delivery or in labor

Keywords: Hb, Anemia, Pregnancy.
EEG Artifact Removal System for Depression Using a Hybrid Denoising Approach
Authors:   Department of Electronics and Communication Engineering, Panjab University, Chandigarh, India., Kaur Chamandeep , Singh Preeti ,   Department of Electronics and Communication Engineering, Panjab University, Chandigarh, India., Sahni Sukhtej ,   Department of Psychiatry, Cheema Medical Complex, Mohali, India.
Published: June 2021

Introduction: A number of computer- aided diagnosis systems for depression are being offered to be used by the clinicians as a method to authorize the diagnosis. EEG may be used as an objective analysis tool for identification of depression in the initial stage so as to avoid it from reaching a severe and permanent state. However, artifact contamination reduces the accuracy in EEG signal processing systems. Methods: This work proposes a novel denoising method based on EMD (Empirical Mode Decomposition) with detrended fluctuation analysis (DFA) and wavelet packet transform. As the first stage, real EEG recordings corresponding to depression patients are decomposed into various mode functions by applying EMD. Then, DFA is used as the mode selection criteria. Further wavelet packets decomposition (WPD) based evaluation is used to extract the cleaner signal. Results: Simulations have been carried out on real EEG databases for depression to demonstrate the effectiveness of the proposed techniques. To conclude the efficacy of the proposed technique, SNR and MAE have been identified. The results show improved signal to noise ratio and lower values of MAE for the combined EMD-DFA-WPD technique. Also, Random Forest and SVM (Support Vector Machine) based classification shows improved accuracy of 98.51% and 98.10% for the proposed denoising technique. Whereas the accuracy of the EMD- DFA is 98.01% and 95.81% and EMD combined with DWT technique is 98.0% and 97.21% for the EMD- DFA technique for RF and SVM respectively as compared to the proposed method. Also, the classification performance for both the classifiers has been compared with and without denoising to highlight the effectiveness of the proposed technique. Conclusion: Proposed denoising system results in better classification of depressed and healthy individuals resulting in better diagnosing system. These results can be further analyzed using other approaches as a solution to the mode mixing problem of EMD approach.
Translation and Cross-cultural Adaptation of the Aphasia Check List in Persian Speakers With Aphasia
Authors:   Department of Speech and Language Pathology, School of Rehabilitation Sciences, Tehran University of Medical Sciences, Tehran, Iran., Modarres Zadeh Amin , Mehri Azar ,   Department of Speech and Language Pathology, School of Rehabilitation Sciences, Tehran University of Medical Sciences, Tehran, Iran., Jalaei Shohreh ,   Department of Physical Sciences, School of Rehabilitation Sciences, Tehran University of Medical Sciences, Tehran, Iran., Khatoonabadi Ahmad Reza ,   Department of Speech and Language Pathology, School of Rehabilitation Sciences, Tehran University of Medical Sciences, Tehran, Iran., Kalbe Elke ,   Medizinische Psychologie Neuropsychologie und Gender Studies, Centrum Für Neuropsychologische Diagnostik und Intervention (CeNDI), Prodekanin Für Akademische Entwicklung and Gender, Köln, Germany.
Published: June 2021

Introduction: The Aphasia Check List (ACL) is a comprehensive, time-saving tool for language evaluation in aphasia, including a cognitive assessment part. This cross-sectional study aimed to translate ACL into Persian and analyze the psychometric features of the translated version. The original version of the ACL was translated and adapted from German; its psychometric features were then determined. Methods: Twenty People With Aphasia (PWA) and 50 age- and education-matched, cognitively healthy controls participated in this research. Possible floor and ceiling effects, discriminant validity, test-retest reliability, and internal consistency of the test were analyzed in addition to the evaluation of internal correlations between the test parts (language & cognition). Results: Regarding the performance of PWAs in the language section and the cognitive subtests assessing attention, memory, and reasoning, there were no floor and ceiling effects. Adequate discriminant validities for the language section of the test [i.e., total score: (Mann-Whitney U= 6.000, P<0.001); diagnostic subtests scores: (Mann-Whitney U= 3.000, P<0.001), and each subtest individually. Besides, the attention subtest of the cognition section (Mann-Whitney U= 16.500, P<0.001) was also observed. There was no difference between the control and patient groups in the subtests of memory (Mann-Whitney U= 497.500, P=0.973) and reasoning (Mann-Whitney U= 3.000, P= 308). The test-retest reliability was acceptable in all subtests (ICC agreement= 0.573-0.984). The ACL-P suggested appropriate internal consistency (Cronbach’s alpha coefficient= 0.761 for test & retest scores). There were also significant correlations between language and cognition in the control and patient groups. Conclusion: The ACL-P test indicated sufficient reliability and validity for the evaluation of Persian-speaking PWAs and is suggested to be used in studies on this population.
A New and Simple Method for Spinal Cord Injury Induction in Mice
Authors:   Department of Neuroscience, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran., Zeraatpisheh Zahra , Mirzaei Esmaeil ,   Department of Medical Nanotechnology, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran., Nami Mohammad ,   Department of Neuroscience, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran., Alipour Hamed ,   Department of Tissue Engineering & Applied cell Sciences, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran., Ghasemian Somayeh ,   Genetic Laboratory, Shiraz Fertility Center, Shiraz, Iran., Azari Hassan ,   Department of Neurosurgery, McKnight Brain Institute, University of Florida, Gainesville, Florida 32611, USA., Aligholi Hadi ,   Department of Neuroscience, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran.
Published: June 2021

Introduction: Spinal Cord Injury (SCI) is a devastating disease with poor clinical outcomes. Animal models provide great opportunities to expand our horizons in identifying SCI pathophysiological mechanisms and introducing effective treatment strategies. The present study introduces a new murine contusion model. Methods: A simple, cheap, and reproducible novel instrument was designed, which consisted of a body part, an immobilization piece, and a bar-shaped weight. The injury was inflicted to the spinal cord using an 8-g weight for 5, 10, or 15 minutes after laminectomy at the T9 level in male C57BL/6 mice. Motor function, cavity formation, cell injury, and macrophage infiltration were evaluated 28 days after injury. Results: The newly designed instrument minimized adverse spinal movement during injury induction. Moreover, no additional devices, such as a stereotaxic apparatus, were required to stabilize the animals during the surgical procedure. Locomotor activity was deteriorated after injury. Furthermore, tissue damage and cell injury were exacerbated by increasing the duration of weight exertion. In addition, macrophage infiltration around the injured tissue was observed 28 days after injury. Conclusion: This novel apparatus could induce a controllable SCI with a clear cavity formation in mice. No accessory elements are needed, which can be used in future SCI studies.
Dangers of Using Skin Whitening Products in the Cosmetic Market of Bangladesh
Authors: Rahman Md Hasibur
Published: June 2021

Abstract not available

CBMJ 2015 July: Vol. 04 No. 02 P: 01-03
Open Cholecystectomy: Muscle Splitting Versus Muscle Cutting Incision: A Randomized Study
Authors: Islam Md Shafiqul , Hasan Muhammad Masud , Islam AKM Sadequl
Published: June 2021

The objective of this study is to compare open cholecystectomy through right subcostal incision (Kocher's incision) between muscle splitting and muscle cutting in terms of duration of operation, postoperative pain, length of hospital stay, morbidity and cosmetic outcome. It is a prospective randomized 3 (three) years study which includes 400 patients who underwent open cholecyslectomy from January 2012 to December 2014 at Islamia General Hospital (private) and Al Raji clinic (private) of Mymensingh, Bangladesh. Study shows that open cholecystectomy with muscle splitting has significant advantages over open cholecystectomy with muscle cutting in terms of duration of operation time and postoperative pain. Muscle splitting incision is another option to offer patients who elect to undergo open cholecystectomy with less pain and hospital stay.

CBMJ 2015 July: Vol. 04 No. 02 P: 4-7
Results of Hemi Arthroplasty in Fracture Neck of Femur in Elderly Person, CBMCHB Experience
Authors: Uddin Md Nasir , Islam Md Saiful , Chowdhury Mamunur Rashid , Khan Md Abul Kalam Azad , Hasan Md Rajibul , Ashik Md Sabbir Hasan
Published: June 2021

Intracapsular femoral neck fracture is a common injury in elderly person. The primary goal of treatment is to return the patient to him or her pre-fracture functional status. The surgical treatment is the treatment of choice, lip replacement arthroplasty (hemi or total) is a viable treatment option. Thirty elderly patients (age 50-80 years) with a displaced intracapsular femoral neck fracture were under treatment over a five year period (January 2010 to December 2015). All of them underwent hemiarthroplasty either unipolar or bipolar, after appropriate medical and anesthetic fitness. The patients were reevaluated at six weeks, at six months postoperative interval and assessed using Harris hip score (HHS) and visual analogue scale (vas) for evaluation of outcome. The mean age of patients was 64.5 years and male female ratio was 43.3% - 56.7%. The mean HHS score was 85.3 by the end of the 6 months. The mean score on VAS scale was 60mm (moderate) at 2 weeks, 40mm (mild) at six weeks and 4mm (mu) at 6 months follow up visit. No significant complications were observed except hip pain. No patients needed revision surgery. Herniarthroplasty is the treatment of choice in elderly population with displaced femoral neck fracture (Garden type III or IV); provides early ambulation, good functional outcome, pain free joint with minimal complications without the need for revision surgery.

CBMJ 2015 July: Vol. 04 No. 02 P: 8-12
Pattern of Congenital Heart Disease Diagnosed by Echocardiogram in Patients Admitted into a Rural Setup Tertiary Hospital
Authors: Ahmed Tofayel Uddin , Rahman M Mafizur , Quddush ASM Rushul
Published: June 2021

Congenital heart disease is a defect in the structure of heart and great vessels present at birth. Early recognition will help to treat the child and if possible get corrective surgery done. The aim of this study was to observe the pattern of congenital heart disease in our set-up. This descriptive study based on echocardiographic findings over a period of 3 years from January 2013 to December 2015 conducted in Community Based Medical College Bangladesh, Mymensingh. Patient's consent was obtained from patient's parents before echocardiography. A total of 100 children found to have congenital heart disease determined by echocardiography were studied and analysed for frequencies of lesions, sex ratio and mean age. One hundred patients, comprising 55(55%) male and 45(45%) female had congenital heart disease as diagnosed by echocardiogram had, their age ranged from 0.01 to 15 years with a mean age of 6.4±5.3 years and male to female ratio 1.2:1. Sixty six percent of patients were diagnosed as non-cyanotic heart defects and rest 34% cyanotic heart defects. Atrial septal defect (35%) was the most frequent form of non-cyanotic congenital heart defect, followed by ventricular septal defect (15%), pulmonary stenosis (6%) patent ductus arteriosus (5%), endocardial cushion defect (3%) and coarctation of aorta (2%). Whereas fallot's tetralogy (17%) followed by transposion of great arteries (10%) and ebstein's anomaly (7%) were the commonest cyanotic congenital heart defects. Congenital heart diseases are common in our set-up. Atrial septal defect is the commonest non-cyanotic and Fallot's tetrology as cyanotic congenital heart disease.

CBMJ 2015 July: Vol. 04 No. 02 P: 20-26
Admission Pattern and Outcome in a Pediatric High Dependency Care (PHDC) Unit of a Tertiary Care Children Hospital in Bangladesh
Authors: Mobarak Mohammed Reaz , Bhuyian AKM Tajuddin , Islam Md Rafiqul , Begum Ferdousi , Islam Md Atiqul , Akand Nabila , Farhana Tanzila
Published: June 2021

Pediatric high dependency care (PHDC) is a care comprising of close observation, monitoring and management of children who are vulnerable to physiological instability. To determine the pattern of admission and register outcome of patients in the pediatric high dependency care (PHDC) of Dhaka Shishu( Children) Hospital, a tertiary level referral children hospital in Bangladesh. This is a retrospective study of the record of patients admitted to the PHDC unit at the Dhaka Shishu Hospital from May 2015 to February 2016. The information obtained from the admission/discharge record as well as the patients' case notes included demographic data, working diagnosis, type of management, length of stay (LOS) in the PHDC unit and outcome. A total of 140 children were admitted during the study period comprising of 80 (57.15%) males and 60 (42.85%) females, giving a male: female ratio of 1.33:1. The age ranged from one day to 12 years with a mean of 35.44±3.1 months. Meningitis (both bacterial and viral) accounted for 24 (17.14%) followed by encephalitis, 21 (15%) were the major indications for admission. Other indications included seizure disorders (both febrile and afebrile), 18 (12.85%); bronchopneumonia including acute bronchiolitis, 15 (10.71%); neonates with different indications 13(9.28%); typhoid fever with complications 5 (3.57%); mumps with complications, 4(2.85%); chickenpox with complications, 3(2.14%); surgical conditions, 7 (5%), and others, 30(21.42%). There were no post-operative surgical cases. The length of stay (LOS) in the unit ranged from 1 day to 34 days with mean of 7.9±0.5 days. The treatment expenses ranged from 1000 BDT to 50,000 BDT with a mean of 12297.14±888.69 BDT. Out of total 140 admissions, 82 (58.57%) were discharged in a satisfactory condition; discharge on request (DOR), 30 (21.42%); referred to intensive care unit (ICU), 7 (5%); left against medical advice (LAMA), 15(10.71%) and death, 6 (4.2%); case fatality rate (CFR), 4.2/100 admission. Among the death cases there were 2 meningitis, 2 encephalitis, 1 acute bronchiolitis and 1 preterm very low birth weight (VLBW). Meningitis, encephalitis, bronchopneumonia, seizure disorder were the major causes of admission in PHDC unit, while case fatality was the highest for meningitis and encephalitis. Therefore, awareness regarding prevention, early detection and management of meningitis and encephalitis should be emphasized.

CBMJ 2015 July: Vol. 04 No. 02 P: 27-30
Study on Cutaneous Manifestations of Leukemia and Lymphoma
Authors: Wahab Md Abdul , Haque AKM Rejaul , Khan Md Rafiquzzaman , Hassan Biswas Shaheen , Rahman Md Moksedur , Rahman M Hasibur , Islam Md Aminul , Khatun Masuda , Kumar Saha Bijoy
Published: June 2021

Leukemia and Lymphoma can present with various cutaneous manifestations. These include specific cutaneous diseases and non-specific cutaneous lesions. Non-specific skin lesions are more common in patients with Hodgkins diseases. Leukemia cutis (specific skin lesions of Leukemia) most commonly occurs concommitent with or following the diagnosis of leukemia. The skin may also be the site of relapse of Leukemia after chemotherapy. Uncommonly leukemia cutis may be identified while the bone marrow and peripheral blood are normal. Those patients are classified as aleukemic leukemia cutis. The objective of this study is to know the prevalence of skin manifestations of hematologic malignancies and to help the diagnosis and management of hematologic malignancies in some extent. It is a cross sectional observational study in which the skin lesions of the patients in hematologic malignancies who were already diagnosed & hospitalized in the hematology department of Bangabandhu Sheikh Mujib Medical University were evaluated in the period of one year. We found malignant infiltrative lesions & hemorrhagic findings both were predominate in leukemia. Infections were predominant in both Leukemia & Lymphoma.

CBMJ 2015 July: Vol. 04 No. 02 P: 31-34