bluuebunny/crossref_metadata_2025 huggingface dataset:
Biodynamics of Hepatitis C Virus in Haemodialysis Patients in Pahang
Authors: AM Mohammed Saad , AM Mohammed Imad , HH Aini , MR Seman
Published: January 2021

Introduction: HCV infection is frequent in patients undergoing maintenance haemodialysis, with prevalence between 8 and 10%. Hepatitis C has an adverse effect on both patient and graft survival in those who get renal transplants. There are relatively scarce reports on the natural fluctuation in viral load level in patients on chronic haemodialysis. Materials and Methods: This is a longitudinal short-term three months study, where 27 chronic haemodialysis patients infected with known HCV genotypes were recruited from seven haemodialysis centres in Pahang. Serum samples were collected monthly, both pre- and post-haemodialysis sessions, over a period of three months. Viral RNA was extracted from serum using QIAamp Viral RNA Extraction kit (Qiagen). The HCV viral load was measured using one-step reverse transcriptase qPCR (Applied Biosystems) targeting the 5`HCV non-coding region (5’UTR). The serum α-IFN level was measured using commercial ELISA kit (Amersham, UK). Six biochemical liver function tests (AST, ALP, TP, albumin, ALT and TB) were also done for all pre-haemodialysis samples. Results: All patients showed persistent low level viral load that varied significantly over the study period (p = 0.001). HCV genotype 1 viral load was significantly higher than that of genotype 3. Conclusion: No apparent correlation could be recognized between the viral loads and the corresponding interferon-alpha levels which were detectable in only a few patients during the period of study.
Hypophosphatemia in the Intensive Care Unit: Incidence, Predictors and Management
Authors: MN Basri , AJ Janattul , MR Azrina , M Abdul Hadi
Published: January 2021

Introduction: Our objectives are to identify the incidence of hypophosphatemia and the associated risk factors. We also want to establish intravenous replacement therapy that is effective for ICU patients. Methods: A prospective observational study assessing adults admitted to ICU in between March and May 2009. All patients without baseline phosphate level and renal failure were excluded. They were evaluated for the occurrence of common risk factors. Association with independent variables that includes age, gender and BMI were verified. Evaluation of IV replacement therapy was done in the treated patients. Results: From 50 patients that were reviewed, nine were excluded. There were 66% male and 34% female with mean age 46.88±17.89. The mean ICU stay was 8.00±6.41 days. The incidence of hypophosphatemia was 29% (n=12/41). Gender and creatinine clearance was found to be significantly different between normophosphatemia and hypophosphatemia patients. There was no significant association for each potential risk factor and the number of risk factors (≥3) with the incidence of hypophosphatemia. Multi-linear regression analysis showed that lactate, creatinine clearance and pH were significant predictors to the serum levels. A significant difference of mean serum phosphate was seen after repletion by total dose of 10, 20 and 40 mmols in the treatment subgroups. Conclusions: The incidence of hypophosphatemia in our ICU was high and comparable to previous studies. None of the commonly reported risk factors is associated with hypophosphatemia in this studied population. Among all significant correlated variables, only pH was found to be a significant predictor for serum phosphate. Baseline phosphate level may guide the initial replacement dose to prevent delay in normalization of serum levels.
Isolated Metacarpal Bone Metastasis from Advanced Rectosigmoid Carcinoma
Authors: AR Fadli , MN Azmi , O David , MH Zailani
Published: January 2021

Distant metastasis is a common sequelae of stage III colorectal adenocarcinoma. Liver and lungs are the most common sites for distant metastases, but, metastases to extremities are very rare. We report a case of rectosigmoid adenocarcinoma, which metastasizes to left first metacarpal bone, which is the first occurrence in our experience. The investigations and management of the patient are discussed.
Religious Personality and Smoking among Form Two Students in Rural Schools in Malacca, Malaysia
Authors: MZ Nor Afiah , MA Rahmah , MS Salmiah , I Fazilah , S Shamsul Azhar
Published: January 2021

Introduction: There is an increasing trend in smoking among rural adolescents compared to urban adolescents in Malaysia. This study was to determine the relationship between religious personality and smoking among form two students from the rural schools in Malacca. Methods: This was an unmatched case-control study conducted from May 2010 to August 2010 among form two school children from rural area in Malacca. There were 484 cases, and 444 controls selected using randomized cluster sampling. The dependent variable was smoking, and the independent factors were religious personality. Validated and reliability-tested questionnaires were used for data collection. Results: The mean age (year) at which smoking was first tried among the cases was 11.39 + 2.107. There were eleven out of twenty three significant differences between religious personality statements in the cases and control group. Those were: reciting the Quran/Holy book/Scriptures even when busy, making efforts to deepen the understanding of the religion, trying to understand the teachings of the religion in the Holy book/Quran, inviting others to perform solat/prayer/religious service, making sure all the family members are following the teachings according to the religion, referring to the learned people when feeling uncertain about the rulings/teachings of the religion, performing work duties enthusiastically because of the religion/God, making efforts to remember death and afterlife often, making efforts to internalize the ethical conduct of the religion in daily life, setting aside money every year for religious purposes and looking for opportunities to give charity. Conclusion: Religious personality is an important factor which may influence adolescents volved in smoking.
A Rare Case of Traumatic Bilateral Sixth Cranial Nerve Palsy
Authors: BB Hamidon , HS Md Shariful , MZ Nasaruddin
Published: January 2021

Traumatic bilateral sixth cranial nerve palsy is a rare condition which is typically associated with additional intracranial, skull, and cervical spine injuries. We describe a case of complete bilateral sixth nerve palsy in a 28-year-old female patient after an alleged motor vehicle accident. She had altered level of consciousness but no intracranial lesion or associated skull or cervical spine fracture was detected. In this case, we discussed the differential diagnoses, initial workup, and possible treatment options in cases of traumatic 6th nerve palsy.
Pilot Study on the Effect of Yasiin Recitation on the Haemodynamics of Ventilated Patients
Authors: MS Ariff , NT Mai Ashikin , R Maryamjameelah , J Bushra , WA Wan Azman
Published: January 2021

Introduction: Qur’anic verses recitations to ill patients are practiced by many Muslims as a form of healing and worship. The effectiveness has been observed in many medical institutions; however, it has never been objectively measured and documented. This pilot study was conducted to construct a methodological approach to evaluate the therapeutic effects of Yasiin recitation on the haemodynamics of critically ill patients. Methods: Ventilated Muslim patients in coronary care unit of a teaching hospital were evaluated. Yasiin was recited twice; by one of the researchers and then by the patients’ relatives. Mean arterial blood pressure, pulse rate, oxygen saturation level and electrocardiographic changes, were observed. The difference of the parameters before and during recitation was analysed. Results: Five patients fulfilling the selection criteria were selected; two acute myocardial infarctions, two congestive cardiac failures, and a third-degree atrioventricular block. Based on a non-parametric two-related-sample test, the haemodynamic parameters were not significantly affected by Yaasiin recitation. At the end of the study, two of the patients passed away, one patient was extubated and survived. Two patients were still on ventilators when the study had been completed. Limitations in the study were observed and highlighted in explaining the equivocal results. Conclusions: The effect of Yasiin recitation on heamodynamics of patients was not proven in this study. Further refinements might be needed based upon the observation on limitations encountered. It is hoped that this humble effort would pave the way for further studies to explore this field.
A Case of Acute Hepatitis E Complicated by Acute Pancreatitis in Eastern India
Authors: P Rudrajit , D Shubhabrata , P Sourav , SC Partha , M Jayati , R Bhattacharya
Published: January 2021

Viral hepatitis may be occasionally associated with acute pancreatitis. Usually the patient presents with abdominal pain in the second or third week of illness. Hepatitis A or E viruses are mostly implicated. HEV related acute pancreatitis was first reported only 12 years ago. We report a case of a young male presenting with acute Hepatitis E infection complicated by pancreatitis. He had an uneventful recovery. This is probably the first report of this association from Eastern India.
Gender Identity Disorder is Not Simply Two in One
Authors: A Syed Masroor , K Abdul Ghani
Published: January 2021

A Case Report on Gender Identity Disorder with Recurrent Depressive Disorder is presented. Individuals having this disorder often exhibit discomfort about their actual anatomic gender, and they may have wished to alter their bodies. Sex role-stereotypes adopted during childhood are the beliefs, characteristics and behaviors of individual cultures that are considered normal and appropriate for boys and girls to possess. These "norms" are influenced by one's family and friends, the mass-media, and their community. Since some cultures disapprove of cross-gender behavior, it often results in significant problems for affected individuals and those in close relationships with them. The importance of treatment is not only because of the high rate of mental-health problems, including Depression but with higher suicide rate among untreated transsexual people than in the general population. These problems are not usually related to the gender identity issues themselves, but the social and cultural responses to gender-deviated individuals. An example which classically illustrates Gender Identity Disorder is the case of a young man from Brunei Darussalam, who was seen and treated. This contribution will highlight the cultural and religious perspective of this Disorder.
Production of monoclonal antibodies to immunogenic peptides of ω-glaidin/c-hordein and rye-secalin for gluten free food screening
Authors: Abd Wahab Widya , Julia Ellis H , J Ciclitira Paul
Published: January 2021

Introduction: The ω-glaidin/c-hordein (QPFPQPEQPFPW) and rye-secalin (QPFPQPQQPIPQ) peptides have previously demonstrated immunogenicity in sensitised coeliac T cell lines. The development of monoclonal antibody to those immunogenic peptides is presented with a view of developing an improved enzyme linked immunosorbent assay (ELISA) as a reliable tool to screen the safety of foods specialised for coeliac disease (CD) patients. Methods: Balb/C mice were fed with gluten free food. The immunogens were conjugated to purified tuberculin protein derivative (PPD) with glutaraldehyde and emulsified in Freund’s adjuvant. The employed immunization schedule included 3-5 weeks intervals, followed by a final intravenous injection without adjuvant, 3-4 days prior to fusion. Results: The antibody produced was IgM rather than IgG, although the hybridoma was successfully generated. The IgM class antibody is known to be relatively unstable, so could not be used in kits designed for food screening. Conclusions: The immunogenic peptides could possibly be used to raise monoclonal antibodies for gluten screening. However, a single booster injection might be insufficient to stimulate the spleen directly or the mice should be immunized with higher concentration of immunogen. This could be improved by including multiple booster administrations and increasing the dose.
Contraception use and its associated factors among grand multipara mothers in Kuantan
Authors: Abdullah Che Azunie Che , Daud Azlina , Ismail Aisyah
Published: January 2021

Introduction: Pregnancy and childbirth bring health risks for women, and it is magnified in grand multipara mothers. Effective practice of contraceptive is important in spacing out childbirth to ensure both mother and child acquire optimum quality of life. Thus, with increasing number of grand multipara mothers who would face a greater reproductive risk, it is crucial to have a better understanding of their reproductive health. This study aimed to determine the contraceptive use and to identify associated factors influencing contraceptive use among grand multipara mothers in Kuantan. Methods: A descriptive cross sectional study was carried out in Klinik Kesihatan Ibu dan Anak Jaya Gading using purposive sampling. 49 respondents had been selected. The data of this study were analyzed and transformed by using statistical software. Results: The prevalence of contraceptive use among grand multipara mothers was 51%. Grand multipara mothers who had high level of knowledge (p=0.030) regarding contraceptive, positive attitude (p=0.017) toward contraceptive use and having discussions with the spouse on contraception (p = 0.008) were more likely to use contraception. There was no statistically significant difference between the practice of contraceptive use and occupation (p=0.175) or number of living children (p=0.250). However, in this study, we found a statistically significant association between the contraceptive use and educational level (p=0.036). Conclusions: The prevalence of contraceptive use in this study compared relatively low to other studies. Effective health promotion programs need to be done to encourage the practices of contraceptive.
Assessment of Marital Dissatisfaction and Its Association with Sexual Dysfunction and Psychiatric Morbidities among Primary Health Attenders in Malaysia
Authors: S Ahmad Faizal , Sidi Hatta , Wahab Suzaily , Ss Leny , Mat Zin Nora , Baharuddin Najwa
Published: January 2021

Introduction: Marital satisfaction is vital to the wellbeing and functioning of the individual and family. Marital dissatisfaction can lead to detrimental effects on mental, physical and family health. The study aimed to determine the proportion of marital dissatisfaction in outpatient setting and its association with sexual functioning and psychiatric morbidity in Kuala Lumpur, Malaysia. Materials & Methods: A crosssectional study was conducted in selected primary care using purposive sampling. Data collection was done using socio-demographic questionnaire and several validated Malay version of self-administered questionnaires. Marital satisfaction was measured by the Malay version of Golombok–Rust Inventory of Marital State (Mal-GRIMS). Results: The prevalence of marriage dissatisfaction in sample population was about 37.3% with almost equal prevalence in both, 36.5% (male) and 37.8% (female). Using a regression analysis, the significant factors that affect marital dissatisfaction were respondent’s age group between 31- 40 years old (Adjusted Odds Ratio, AOR. =11.4, 95% Confidence Interval, CI. =1.2-110.9), spouse’s salary of RM1000-RM2000 (lower income category) (AOR=7.3, 95% CI= 1.9-28.1), anxiety case (AOR= 4.8, 95% CI=1.1- 21.5), depression case (AOR= 4.8, 95% CI=1.0-22.8), female sexual dysfunction in term of arousal function (AOR= 0.01, 95% CI=0.0-0.7), satisfaction dysfunction (AOR= 9.4, 95% CI= 1.5-58) and pain function (AOR=43.7, 95% CI=1.28 - 1489.2). Conclusion: Marital dissatisfaction can be influenced by financial factor, sexual dysfunction and presence of psychiatric morbidity. Hence, in management of marital discord, thorough screening of these factors should be prioritized in clinical setting.
Morphometric and Morphological Study of Mental Foramen in the Malaysian Population: Anatomy and Forensic Implications
Authors: Alias Aspalilah , Ibrahim AbdelNasser , Abu Bakar Siti Noorain , Shafie Mohamed Swarhib , Das Srijit , Mohd Nor Faridah
Published: January 2021

Introduction: The mental foramen is present on either side of the body of the mandible bone. This foramen transmits mental vessels and nerves. In forensic anthropology, mental foramen may be important for differentiating sex, estimating age and identifying various races based on morphology. The main aim of the present study was to determine the position, shape and diameter of the mental foramen according to sex, age and race by postmortem computed tomography in the Malaysian population. Materials and Methods: A total of 79 dentulous patients (48 males, 31 females) from 3 age groups (18-30 years, 31– 50 years, 51-74 years) were selected for this study, and ten parameters were observed for each mandible. The parameters were divided into two morphological and eight morphometric parameters. The morphometric parameters were measured by using Osirix MD Software 3D Volume Rendering. Results: Results showed that mandibular body length and height were significantly greater in males than in females by independent t-test. (p< 0.05). However, the mandibular body height was found to decrease significantly with age in both sexes by one-way Anova. It was observed that the shape of mental foramen was 45.6% oval and 54.4% rounded. About 44.3% of them were in line with the longitudinal axis of the second premolar tooth. Conclusion: It was concluded that mental foramen may be used for identification purposes, particularly for sex, age and race determination.
Foot Care Practices And Its Associated Factors among Type 2 Diabetes Patients attending Health Care Clinics in Kuantan
Authors: A Abdul Hadi , NH Azmi , MA Md Aris , EH Nasreen , A Che Ahmad
Published: January 2021

Introduction: Diabetes patients are predisposed to several micro as well as macrovascular complications. One most important and debilitating complication of diabetes are foot problems. However, it is preventable by simple intervention such as foot screening and foot care education to detect early problem so that early intervention can be done. This study aims to assess foot care practice among Type 2 diabetes patient attending primary health clinics in Kuantan. Materials and method:  This was a cross-sectional study conducted at four primary health clinics in Kuantan involving 450 study participants who were selected by using convenient sampling method. Level of awareness and practice towards diabetic foot care was assessed using validated self-administered questionnaire. Multiple logistic regressions were performed to identify factors associated with foot care practice among the respondents. Results: Mean age of respondents involved was 56.36 (SD±10.9) years. About 59.6 % of respondents had poor foot care practice. Multivariate logistic regression analysis identified that, increasing age (aOR 0.97, 95% CI: 0.955-0.993) and good awareness towards foot problem (aOR 0.43, 95%CI: 0.289-0.643) were associated with good foot care practice. However, Malay patients (aOR 1.81, 95% CI: 1.002-3.271) and obese patients (aOR 1.9, 95% CI: 1.225-2.976) were associated with poor foot care practice after controlling other variables. Other factors such as education level, diabetes control as well as overweight did not show any significant association with foot care practice.  Conclusion:  Based on the result, majority of respondents had poor foot care practice. Poor awareness was associated with poor foot care practice. It can be concluded that sustainable patient education and compliance towards foot care practice at primary care level should be emphasized more to ensure good foot care practice implementation.
Infected Pseudoaneurysm in a Tertiary Centre: A Retrospective Audit
Authors: DS Sanjay , Dhayalan G , MNA Abdul Rahman , F Othman
Published: January 2021

Introduction: Infected pseudoaneurysms among intravenous drug abusers are a serious clinical condition that carries significant morbidity and mortality. The management of such cases has been controversial on deciding the need of revascularisation following simple ligation and local debridement. In this audit, we present the results of simple ligation and local debridement of our patients with infected pseudoaneurysm. Materials and methods: We conducted a retrospective review from 2013 to 2018 on 15 of our patients who are intravenous drug abusers that underwent simple ligation and local debridement for an infected pseudoaneurysm. Results: All 15 patients underwent simple ligation and local debridement. They were all male patients, and majority of the patients were between group ages of 30-40 years old at 66.7%. The oldest patient was 63 years old. All the patients self-injected the affected site for a minimum duration of 36 months. 73% of the patients had femoral pseudoaneurysm, making it the most common affected site in our audit. The remaining patients had axillary and radial pseudoaneurysm and none of our patients had brachial pseudoaneurysms. Majority of our patients were underlying Hepatitis C at 46.7%, 2 of our patients were HIV positive and only one had Hepatitis B. The remaining 5 patients’ statuses were unknown. In accessing the complications, two patients had re-bleeding after the procedure and were eventually discharged well and were uneventful. One patient required amputation as he developed a gangrenous limb within the same admission after ligation and excision of the infected pseudoaneurysm. There were two deaths due to sepsis with multiorgan failure. 10 patients were discharged well without any complications after surgery. Conclusion: Infected pseudoaneurysms can be safely managed with simple ligation and local debridement without revascularisation as they pose acceptable complication rates.
The Effect of Low Heel Raise to Forefoot Plantar Pressure in Diabetic Patients with Tight Tendon Achilles
Authors: Hassan Salmah Anim Abu
Published: January 2021

Introduction: The purposes of this study were to investigate the effects of raising the heel to the forefoot plantar pressure (PP) in diabetic patients with or without limited ankle dorsiflexion due to tight tendon Achilles (TA).  Materials and methods:  Plantar pressure recordings and gait tests were performed in the two groups of subjects with diabetes (tight TA, n=17; normal TA, n=13) with the heel raised from 1 cm to 3 cm. Results: There were no significant forefoot pressure difference between both intervention groups (p < 0.05).  Plantar pressure reduction was seen in the medial (10-30%) and lateral metatarsal heads (20-50%) as well as the heel (2-38%) when heel raise was increased from 1 to 3 cm. However, reciprocal pressure increase was seen at hallux (11-76%), toes (1-200%) and midfoot (22-100%) with increased heel height.  Conclusion:  Heel elevation up to 2 cm is recommended for footwear prescription for to diabetic patients. A higher heel raise may may cause plantar pressure elevation to the hallux which is one of the high risk regions for plantar ulceration in diabetics.
Periodic Assessment of Antenatal and Post Natal Serum Endothelin-1 (ET-1) and Nitric Oxide (NO) Levels in Hypertensive Disorders of Pregnancy (HDP)
Authors: I Hidayah , A.R. Tariq , Jamani N.A. , M.Z. Maizura
Published: January 2021

Hypertensive Disorders of Pregnancy (HDP) is an independent risk factor of cardiovascular (CVS) disease with endothelial dysfunction postulated to be the pathophysiology. Endothelin-1 (ET-1), a potent vasoconstrictor, has been identified as a pivotal mediator in HDP. Disturbances in nitric oxide (NO) bioavailability found in endothelial dysfunction may increase susceptibility to cardiovascular diseases such as hypertension. The study aims to determine serial ET-1 and NO levels in patients with HDP and its role in persistent endothelial dysfunction. Thirty-six pregnant women from the following categories (i) normal pregnant women (Control) (ii) chronic hypertension during pregnancy (CH) and (iii) pregnancy induced hypertension (PIH) participated in this study. Blood pressure indices measurements and sample collection were done at antepartum (32 weeks) and postpartum (8 weeks and 12 weeks). ET-1 and serum NO were measured using the Human ET-1 (Endothelin-1) ELISA Kit and Nitric Oxide (total) detection kit respectively. Results: Serum ET-1 was significantly higher in patients with CH (55.3 pg/ml) and PIH (35.6 pg/ml) compared to Control (11.8 pg/ml) during antenatal until 3 months postpartum (CH 38.3 pg/ml, PIH 29.5 pg/ml, Control 1.9 pg/ml). This was accompanied by significantly lower levels of serum NO in HDP patients. Persistently higher than normal levels of ET-1 and lower than normal levels of NO up to 3 months postpartum in patients with history of HDP indicate presence of persistent endothelial dysfunction despite BP normalisation in PIH patients. Long term NO/ET-1 imbalance may account for the increased CVS disease risk.
Outcome of Core Out Fistulectomy and the Ligation of Anal Fistula Tract: A Single Center Experience in Malaysia
Authors: C.Z M Salehudin , M. Nor Azmi , Mohd Rus R
Published: January 2021

Introduction: Fistula-in-ano is a benign anorectal disease which always poses a big dilemma to the surgeons because of their significant recurrent rate following surgery. Materials and Methods: A cross-sectional study involving 42 patients undergoing core out fistulectomy in the Hospital Tengku Ampuan Afzan, Kuantan, Pahang, Malaysia were included in this study. Demographic data of patients were assessed. Endoanal ultrasound (EAUS) was done prior to the surgery to determine types of fistula and classified using Park’s classification. Follow up was made post-operatively at 4th week, 2nd month, 3rd month, 4th month, 5th month and 6th month to look for the duration of healing or recurrence. Results: 5 out of 42 patients were lost to follow up leaving 37 patients available for the analysis. Mean age of the patient was 38.4 (13.8) years old. Transphincteric and intersphincteric type of fistula accounted for 54.5% and 40.1%, respectively. 62.2% (n=23) of patients achieved primary healing after the procedure. The mean for healing duration was 3.7 (3.1) months. Recurrence of the disease was seen only in 37.8% (n=14) of the patients. Conclusions: Even though we managed to achieve significant success rate cumulatively, recurrence of fistula still impose a significant challenge toward patient’s management. Therefore, further prospective study with a bigger sample size is recommended to look into this method to reduce recurrence of fistula.
Performance of the Final Year Medical Students - Universiti Malaysia Sabah in the End Surgical Senior Posting (SSP) Examination
Authors: AMHA Basim , FT Chee
Published: January 2021

Introduction: Assessment methods are used to provide students with both formal and informal feedback on their progress, and should be congruent with the objectives of the curriculum. To achieve this, it is necessary to bring the theories of learning and assessment together. Senior surgical posting is an intensive eight weeks attachment with overall surgical revision, provide an opportunity for the students to develop clinical skills, knowledge and attitudes, at it’s end the students will be evaluated through three forms of assessment, their knowledge by MCQs, MEQs, and essay and their clinical skills by OSCE, short case and long case examination together with that there was continues assessment (log book and two handwritten case reports), the passing marks is 65 of 100, and passing the clinical section is mandatory. Materials and Methods: This paper studied the performance of final year (Year 5) medical students Universiti Malaysia Sabah (UMS)-school of medicine in the end senior surgical posting examination. Results and Conclusion: Through analysis of the data of their assessment results in this examination, it shows that the continuous assessment have strong effect on the final results of the students, and students have defect in theory back ground reflected by their poor MCQs performance, and the mode of UMS students learning is more towards deep approach.
Predicting Falls Risk in Hospital; KPJ Seremban Experience
Authors: A Maygala , SHA Primuhasa Putra , AR Aziz , MR Ainol , J Zainah , A Asrina , K Suzana , MN Zainab , MB Nisha
Published: January 2021

Introduction: Falls may result in injuries, prolonged hospitalization, increase in morbidity and mortality, incur cost to the individual and the healthcare system and increase potential litigation. Various hospital fall prevention programs such as Morse Fall Scale Assessment Tool have been implemented in the last decade; however most of the program had no sustained effects on falls reduction over extended period of time. Benchmarking from private hospitals showed patients fall increased by 27% in 2008 as compared to 2007 (MPC report, 2008). There were 25 cases of falls in 2008 at KPJ Seremban Specialist Hospital. The objective of this program is to comply with The Joint Commission’s National Patient Safety Goals 9, “reduce the risk of patient harm resulting from falls” and to formulate evidence based best clinical practice recommendations on assessment and prevention of falls in the hospital for all inpatients, outpatients, customers and staffs within hospital premises. Materials and Methods: Contributing factors were identified based on the retrospective analysis of falls from 1st.January 2008 to 30th September 2008. A fall risk assessment tool identified as KPJ FRAT (KPJ Fall Risk Assessment Tool) for inpatient was developed and various other strategies to reduce the risk of falls throughout the hospital premises were identified. Points of engagement for inpatient assessment using KPJ FRAT were on admission, transfer in or when there is a change in patients’ condition. A prospective descriptive study was done and data was collected from 1st January 2009 till 31st December 2009 through interview with patients, healthcare providers and review of adverse event reports and medical records. Results: No of inpatients during this study were 37058 and there were 13 falls. The post implementation data reflects for every 1000 inpatient days the fall rate decreased to 4.3 falls. Conclusion: The use of KPJ FRAT and Fall Prevention program implemented throughout KPJ SSH has reduced the incidence of falls significantly by 48%. This might be due to increase awareness among the staff, hospital wide policy to report all cases and the formation of patient safety committee to formulate policy and reinforce the implementation processes. Limitation of the study include under reporting and heavy workload.
Primary Systemic Amyloidosis: a Case Report and Review of Clinical Features
Authors: HQ Hu , SC Wang , X Cao , BZ Cao
Published: January 2021

Primary systemic amyloidosis is a rare disorder that has multisystemic manifestations. The diagnosis is very difficult because of non-specific clinical signs. We report a patient with primary systemic amyloidosis manifesting as peripheral neuropathy, nephrotic syndrome, gastrointestinal syndrome, orthostatic hypotension, pericardial fluid, weight loss and so on. Histopathological examination of kidney and sural nerve showed Congo red positive deposits. Primary systemic amyloidosis should be considered in any patient older than 40 years who has the following symptoms and signs: fatigue, weight loss, edema, paresthesias, muscle weakness, noninfectious diarrhea, skin and soft-tissue lesions, and the complications of nephrotic syndrome, congestive heart failure (not on an ischemic basis), peripheral neuropathy, or unexplained hepatomegaly. All patients need the diagnosis confirmed histologically by biopsy of an involved organ.
«Фальшивомонетничество в Центральной и Восточной Европе в эпоху Средневековья и раннего Нового времени»
Authors: Bakalets Oleksiy
Published: January 2021

РЕЦЕНЗІЯ на нумізматичне видання на тему: «Фальшивомонетничество в Центральной и Восточной Европе в эпоху Средневековья и раннего Нового времени».

Рецензент: Олексій Бакалець – кандидат історичних наук, доцент кафедри історії, правознавства та методики навчання Глухівського національного педагогічного університету імені Олександра Довженка, здобувач Інституту історії НАН України, член НСКУ.
Монети Київської Русі
Authors: Boiko-Gagarin Andrii
Published: January 2021

РЕЦЕНЗІЯ на книгу на тему: «Coins of Kievan Rus», («Монети Київської Русі»)

Рецензент: Андрій Бойко-Гагарін – кандидат історичних наук, провідний науковий співробітник сектору нумізматики, фалеристики, медальєрики та боністики Національного музею історії України, м. Київ.
WHIGS AGAINST TORIES: THE DEVELOPMENT OF AMERICAN DRAMA
Authors: Janjatovic Violeta
Published: January 2021

The overwhelming sarcasm and the taunting satire are certainly the feelings that accompanied the American revolutionary period. Approaching both the struggle for independence and the American Revolution, it is discovered that the colonists' sense of laughing and ridiculousness became more pronounced and readier in recognizing the weakness of its enemy and presenting it to the world through the biting laughter of satires. Many satires of this character did not suddenly appear. Their appearance leads to a period many years before the outbreak of the War of Independence and the famous Bacon Rebellion in 1676. Nevertheless, what cannot be denied is that by the approach
of 1776, dramatic creativity started its rapid development. Immediately after the first war blow, satires began to be published in nearly every newspaper in the American colonies. American dramatists took an active part in the struggle for independence. At first, the potential, and later, an inevitable revolution made dramatists from the ranks of patriots and loyalists define themselves, their opponents, and the nature of the conflict itself in a way that remains intriguing and powerful over two hundred years later
SENSE AND MASKS - A RIDDLE IN STEVAN RAIČKOVIĆ‘S OPUS
Authors: Potić Dušica
Published: January 2021

A riddle in StevanRaičković’s work comes into existence primarily as a pattern interpolated in a new text, which demands formal modification. Research focus at typology pattern underlines Raičković’s creative approach to tradition. In the opus aimed at adults, we are
more cautious when speaking about its presence – it is more about our own interpretative position then the author’s poetic selfconsciousness. In the opus aimed at children, a playful potential of the genre has been adjusted to the supposed audience, developing their intelligence and imagination, but also introducing themto the complex and magnificent world of literature.
浅谈PDCA管理工具在医院改进执行三四级手术术前讨论中的应用（以某三甲医院为例）
Authors: 赵 磊 , 曾 丽蓉
Published: January 2021

通过调查PDCA循环管理模式在三四级手术术前讨论中的实际运用,以及PDCA在国内医院管理中的使用情况对其作用进行简要探究。调查PDCA管理工具在医院改进执行三四级手术术前讨论中的应用情况。PDCA是适合医院质量管理的有效方法,在一定层次上是值得推广应用。它作为思维方法和行为模式,适合于对事情作出动态改进的过程,PDCA 要作为一种思维方法融入脑子里边,转化成为思维和行为习惯。
患者对医生选择意愿的影响因素研究
Authors: 王 红军
Published: January 2021

随着人民生活水平的不断提高,我国人民日益增长的医疗需求与医疗资源配置不充分、不合理之间的矛盾日益突出。互联网技术的不断发展,充分推动了在线咨询行业的快速发展。利用该技术合理分配医疗资源,建立分级医疗服务体系,提高在线咨询平台的用户耐心,增加就诊人数,具有重要意义。当前,在网络医学领域中很少有从患者的角度去探讨关于患者如何选择医生的研究。基于此,我们不考虑短期不稳定的因素,而是研究患者选择医生的意愿的影响因素,并以此为基础收集相关数据做出如下分析。
Pengaruh Penghindaran Pajak dan Ukuran Perusahaan Terhadap Struktur Modal Perusahaan Kosmetik Tahun 2018-2019
Authors: Saragi Ibrani , Hutabarat Francis
Published: January 2021

The purpose of this study was to determine the effect of tax avoidance and company size on the capital structure of cosmetic companies in 2015-2019. This type of research is quantitative using secondary data from the financial and annual report data of cosmetic companies for the years 2015-2019. The research sample was obtained from 6 companies from 2015-2019, thus 30 research samples were found. The data analysis technique uses statistical analysis from SPSS software such as descriptive statistical analysis, correlation coefficient, coefficient of determination, significant F test and t test, classical assumption test and multiple linear regression analysis. The results showed that there was a significant influence between tax avoidance and firm size on capital structure as seen from the F-count value of 2.521 at p value <10% (Sig. 0.099).
Modelo de gestión de responsabilidad social para distribuidoras de productos agrícolas del cantón Santo Domingo
Authors: Pilay Toala Félix Sixto , Aguirre Zambrano Ana Ayleen , Altuna Quishpe Viviana Elizabeth
Published: January 2021

La responsabilidad social empresarial ha sido aplicada por  las  empresas  multinacionales  con mayor énfasis en los últimos años; no obstante,  algunas  entidades  en  el  Ecuador  apenas se encuentran incorporando esta práctica a la gestión empresarial. El objetivo de la investigación es desarrollar un modelo de gestión y definir la situación actual de la práctica    de la responsabilidad en las unidades económicas dedicadas a distribución de productos agrícolas. La metodología implementada en la investigación es de carácter cuantitativa, que consideró como técnicas de recolección de información a la aplicación de un cuestionario en una muestra de 52 empresas distribuidoras de productos agrícolas, entrevistas con preguntas estructuradas y semiestructuradas a empresarios del sector de esta rama de la producción, los resultados obtenidos a partir del estudio con base en cuatro estratos de la dimensión social, tales como: clientes, empleados, proveedores y comunidad. Se obtiene que las entidades sí desarrollan en su gestión prácticas socialmente responsables, sin embargo, en lo relacionado a la acción frente comunidad, la mayoría de las entidades no realizan actividades relacionadas con la responsabilidad social. Se concluye que las distribuidoras estudiadas carecen de una vinculación directa con sus stakeholders y la comunidad, resaltando así, la deficiencia de actos socialmente responsables y poco compromiso con la colectividad.
Zapatos personalizados Doux Shoes en la ciudad de Pasto
Authors: Cerón Castro Lisseth Karolina , González Martínez Nubia
Published: January 2021

Este proyecto fue un plan de negocios enfocado en la creación de una empresa dedicada a la elaboración de zapatos personalizados, con ello se quiso plasmar las ideas de cada cliente, así elaborar un calzado al gusto de cada quien; que pueda escoger sus imágenes, colores, fondos   y pueda tener su propia identidad; para esto se pretendió unificar dos procesos industriales totalmente diferentes como son el diseño, impresión y sublimación con el proceso tradicional de calzado tecnificado. La etapa de sublimación es un proceso innovador donde la tinta pasa de un estado sólido a un estado gaseoso por medio del calor, al combinarlo con el proceso de calzado se puede plasmar en los zapatos Para la etapa de diseño se necesitó personal calificado y practicantes que tengan conocimiento sobre esto o poder brindarles una capacitación en esta área, con respecto al proceso de calzado tradicional se debe vincular a personal que tenga el conocimiento y la experiencia empírica, lo cual nos permite integrar a personal que pertenece a la población vulnerable ayudando a disminuir parte del porcentaje de desempleo en la región. El presente proyectos e enmarca dentro del sector secundario en la industria del calzado. La industria de calzado, contribuye con el 2,1 % del PIB industrial del país. El sector del cuero, marroquinería y calzado y sus partes genera más de 100.000 empleos directos y 50.000 indirectos anualmente. Metodológicamente el proyecto se enmarca en un paradigma cuantitativo, de tipo descriptico, enfoque empírico analítico.
"Ejemplos prácticos en el laboratorio de cyberseguridad - UPEC"
Authors: Yandún Velasteguí Marco Antonio , Hidalgo Guijarro Jairo Vladimir
Published: January 2021

En la actualidad, por medio del internet, existen personas que buscan vulnerar los sistemas o aplicaciones, para ello utilizan diferentes ciberataques, se puede mencionar varias técnicas como Session Hijack, o ataque de suplantación y herramientas como John the Ripper, estos son los ataques más utilizados por los hackers para obtener la sesión de los usuarios conectados en la red. Este tipo de ataque se lo realiza a través de la red aprovechando las debilidades del sistema o aplicativo, ya que se conoce que la información sensible se transporta entre sesiones, para ello se utiliza el envenenamiento ARP con el Sniffer que permiten capturar y visualizar todo el tráfico de la red, obteniendo así el puerto y protocolo que se están utilizando para la conexión. En el presente documento se realizaron las prácticas en el laboratorio de CyberSeguridad UPEC, este laboratorio fue implementado como parte del Proyecto de investigación “La seguridad y el servicio informático en el Gobierno Provincial del Carchi (Ecuador) y las Alcaldías Municipales de Pasto, Ipiales y Túquerres (Colombia)”. Las prácticas mostraron la intercepción de sesión a un usuario que se encuentra conectado a la máquina virtual de Centos utilizando Telnet, que es un protocolo que permite acceder a otra máquina y utilizarla remotamente desde la máquina virtual de Windows 7. Kali Linux fue utilizada como el atacante y realizó un escaneo de la red, aplicando “un envenenamiento” para luego acceder a la conexión, probando así la facilidad con la que se puede hacer la sustracción de sesión a los usuarios que se encuentran conectados, por lo que se recomendó usar protocolos de encriptación de los encabezados para que no sea tan fácil acceder a la conexión de la víctima.
cultura tributaria en el sector artesanal: caso centro de negocios y servicios artesanales Sarumaky Yachay, Ibarra-Ecuador
Authors: Fernández Badillo María Eugenia , Torres Farinango Jimena Elizabeth , Santillán Narváez María Dolores , Jaramillo Cruz Verónica Gisella
Published: January 2021

La cultura tributaria se relaciona con la forma en que los contribuyentes realizan oportunamente la declaración y pago de impuestos al Estado. En general; no existe actualmente un índice o procedimiento a seguir para medir la misma porque se basa en una percepciónn social en cómo están establecidos estos impuestos en la sociedad. La cultura tributaria es uno de los mecanismos que contribuye en la efectividad de los sistemas de recaudación tributaria. El objetivo principal de este estudio es identificar los elementos que inciden en la cultura tributaria de los socios que conforman la Asociaciónn “Sarumaky- Yachay”, a través de un análisis documental, descriptivo-exploratorio, que permita conocer la realidad de los aspectos tributarios del sector. Los resultados demuestran que un gran número de socios no dispone de RUC para realizar sus actividades comerciales (53%), el 22% menciona que dispone RISE, de igual manera el 22% afirma que es contribuyente no obligado a llevar contabilidad y el 3% se encuentra registrado con RUC como persona natural obligada a llevar contabilidad. Otro resultado importante que evidenció esta investigación, es que la principal razón por la  que los socios cancelan sus impuestos, es para evitar multas y sanciones con un 59%, el 25% lo hace porque considera que es deber cívico y el 13% considera que al no pagar los impuestos comete un delito.
Uso de técnicas geofísicas para la optimización del uso del suelo en actividades agrícolas
Authors: Pérez Richard , Ruiz Joseline
Published: January 2021

En los últimos años las técnicas geofísicas han ganado un papel preponderante en la agricultura por lo cual este trabajo busca ser una ayuda para introducir al uso de técnicas geofísicas en el estudio de suelos agrícolas por lo cual se menciona los tres métodos más utilizados los cuales son el resistivo, la resistividad, la inducción electromagnética (EMI) y el radar de penetración de tierra (GPR), luego se muestra un ejemplo de la aplicación de un estudio de inducción electromagnética donde se observa que existe una alta correlación de susceptibilidad magnética (SMH) obtenida del estudio de inducción electromagnética y el contenido de contenido organico del suelo (SOM). El uso de técnicas geofísicas en la agricultura es una herramienta más para optimizar la actividad agrícola.
Porque o OKR (Objectives and Key Results) não funciona em minha empresa
Authors: Daher Junior Elias
Published: January 2021

OKR – Objectives and Key Results é uma metodologia de gestão de métricas que já demonstrou sua efetividade em diversas organizações de classe mundial como Google, Linkedin, Microsoft, Uber e muitas outras: seu principal atributo é o foco ostensivo em resultado e em relevância. Desta forma, consegue medir com extrema facilidade, o progresso em direção aos objetivos estratégicos. Entretanto, nem sempre as implementações alcançam o pleno potencial da ferramenta. Este artigo aborda os principais desafios deste framework, os equívocos que as empresas cometem e o modo para superá-los, com base na Literatura e nos estudos de caso. Não é difícil conhecer a estrutura do OKR, bem como suas melhores práticas. O maior desafio consiste na implementação.
Is Information Content a Single, Static Quantity?
Authors: Fernandez Jorge
Published: January 2021

Before information may be measured it must first manifest as a specific kind of information, and that manifestation always occurs within a fixed context. If any critical element of the context is changed, the information that is manifested also changes. The implication of that is significant: information is \emph{not} a single, static entity but instead is a variable, dynamic entity that acquires fixed definition only within a context.
A Response to Clunn's Axioms of Morality
Authors: Miller J R
Published: January 2021

This is a brief critique of Clunn's foundationalism which grounds moral decision making in what he calls the three fundamental axioms of existence, consciousness, and identity. It shows how his precommitments create at least three incoherencies wherein a priori is a posteriori, individuality is an illusion, and objective morality is subjective. For Clunn's moral philosophy to offer practical value, these internal conflicts must be resolved.
The Impact of Curiosity on Counselors’ Social Justice Identity
Authors: Baker Emily , Messerschmitt-Coen Shelby , Haag Granello Darcy
Published: January 2021

The role of counselors has expanded to emphasize social justice principles and community action, encouraging social justice to become infused with counselor’s professional identity. As a result, counselor educators are examining strategies for promoting the social justice identity of students and new professionals. Curiosity has been positioned as theoretically related to the concept of social justice. The current study investigated the relationship between counselor curiosity with social justice identity across three domains (self-efficacy, interest, and commitment) in a sample of 124 counselors and counselor trainees. Results indicated that three types of curiosity (specific, diversive, and competence) predicted each domain of social justice identity. Strategies to incorporate counselor curiosity into social justice pedagogy are discussed.