bluuebunny/crossref_metadata_2025 huggingface dataset:
Characterization of Peat Water Electrocoagulation Flocs from Sarawak Southern Region
Authors: Rahman Nazzeri Abdul , Linus Allene Albania , Jol Calvin Jose , Jalal Nur Syahida Abdul , Shahanney Wan Wafi , Baharudin Nooranisha
Published: March 2024

Sarawak located in Borneo is endowed with the vast availability of peat water sources, particularly for the state southern region. Several investigations have shown that electrocoagulation treatment with aluminium electrodes is feasible to treat peat water in which the quality is comparable to the National Water Quality Standard (NWQS). Even though electrocoagulation treatment is feasible to treat peat water, the characteristics of peat water electrocoagulation flocs have not been reported. As such, this study aims to investigate the characteristics of the electrocoagulation flocs from peat water derived from the Sarawak southern region by using batch electrocoagulation treatment. The objectives of this study are to conduct an experimental study analysis of and identify the minerals on the electrocoagulation flocs along with operating energy cost analysis of peat water batch electrocoagulation treatment. Consequently, this study has found that reaction time and current density affect the production of flocs in which the amount of flocs increases with the increasing reaction time and current density. The flocs produced are found to consist of a large fraction of oxygen (O), carbon (C), iron (Fe), and aluminium (Al) along with a small fraction of potassium (K), magnesium (Mg), calcium (Ca) and Silicon (Si). The presence of Al observed in the flocs is due to the aluminium hydroxide generated during the electrocoagulation process. The total operating cost for peat electrocoagulation with a current density of 5A and reaction time of 20 minutes is about RM0.31 per m3. As a result, the electrocoagulation of peat water process is able to treat peat water as well as produce flocs in which earth elements and heavy metals could be recovered.
Development of Compact Medical Aspirator with IoT Applications
Authors: Muthukumaran V. , Balaji Selvaraj , Senthilkumar K.M. , Sivasubramaniyan A.V. , Shiva Kumar K.P. , Bharathi R. Tamil
Published: March 2024

The medical aspirator is a suction device that operates pneumatically (pump). It is an electrically powered machine that is used in hospitals, health care centers and ambulance for a variety of purpose. It is quite heavy, more expensive and serves a variety of functions. The need for a new device necessitates that it should be compact, easily transportable, portable and which can be used for tele-medication. As a result, a medical aspirator is designed with minimum size, weight and portability to mobilized, an aesthetic design, and idea of planning the machine in a shoulder bag, making it easier for nurse and attendants to carry it and treat their patients in a long-term situation. The new design is an optimized variant of the currently available aspirator, as it can perform all functions without any limitation or drawbacks. As a result, the primary goal of the work is to design an aesthetic and compact medical aspirator to serve for the medical treatment.
Characterization of Fluoroacrylate Palm Oil Polyurethane (FPOPU) with Different Synthesis Methods Using Fourier-Transform Infra-Red (FTIR)
Authors: Mohamad Isa Mohamad Ismail Bin , Binti Mustapha Siti Noor Hidayah , Bin Roslan Rasidi
Published: March 2024

In this study, fluoroacrylate palm oil polyurethane (FPOPU) was synthesized with different synthesis methods. FPOPU was synthesized stepwise starting with the synthesis of acrylated epoxidized palm oil (AEPO) by a reaction of acrylic acid (AA) and triethylamine (TEA) as the catalyst. Then, palm oil polyurethane (POPU) was formed by the reaction of AEPO with isophorone diisocyanate (IPDI) and hydroxyethyl acrylate (HEA) as an end cap agent. POPU was further added with 1,6 hexanediol diacrylate (HDDA), trimethyloltripropane triacrylate (TMPTA), and heptafluorodecyl methyl-metacrylate (HDFDMA) monomers to form FPOPU. FPOPU synthesis methods were studied by manipulating the sequence of chemicals added, temperature, and mixing time of POPU. The FPOPU mixture was finally cast onto a silicone mold with 1 mm thickness and cured under UV radiation at 120 seconds. Based on the analysis, pre-mixed IPDI with HEA at 60°C for 15 min followed by the addition of AEPO at 60°C and further mixed for 3 hours (Method 2) shows the complete formation of the urethane chain. It is proven by the existence of NH peak at 3500 cm-1 and the disappearance of NCO peak at the range of 2200-2500 cm-1 indicating the NCO functional group has completely reacted with OH group in AEPO. The addition of fluorination also can be proved by the existence of CF stretching at 1012 cm-1. This study provides information regarding comparison between the synthesis method of FPOPU.
The Effect of Two Etching Solutions NaOH and KOH on Registration Properties and Etching of Polymer CR-39 Detectors
Authors: Munshed Aqmur Sadoon , Ibrahim Ahmed Abed
Published: March 2024

The solid – state nuclear track detector (SSNTDs) CR-39 can be used to study the different factors for alpha particle. Alpha particle is very dangerous inside the human body so the study its very important. In this article, we investigated the impact of two different etching solutions (NaOH and KOH)) on registrations properties, diameter D, track Diameter growth velocity VD, number of tracks and removal layer thickness of CR-39 nuclear track detector. The two types NaOH and KOH were dissolved in water with varied normality (3,5,7,9,11)N under a temperature of (70±1)°C to create the solution. During the experiment, a source of (α-particles) with a 4MeV energy was used to bombard all detectors (30 Sec). It was found the values of the diameter, number of tracks, removal layer thickness, track Diameter growth velocity VD by using the etching solution (NaOH +water) Solution greater than the values in (KOH + water) solution. the results showed excellent agreement with the outcomes of others who utilized different normalities.
Development of the Obstacle Avoider of Fish Robot
Authors: Muhida Riza , Riza Muhammad , Pratowo Bambang , Muhamad Zein , Cucus Ahmad , Thamrin Taqwan , Sutjipto Agus Geter Edy , Muhida Rifki , Legowo Ari , Safari Mochamad , Santoso Handri
Published: March 2024

The extraordinary swimming capacity of fish in nature makes them unique among Allah's creations. It is extremely difficult for a robotic system to achieve fish-like swimming behaviors, especially in terms of swimming performance. Many fish use their pectoral fins to provide thrust over a wide speed range and to carry out tricky maneuvers. In this paper, we report a robotic fish that can travel forward and backward using its propulsion system. In this report, the creation of a conceptual design for an interactive fish robot took into account a number of factors, including swimming ability, leakage testing, and motion controller. This needed considerable mechanical design work, and the result is a quick-return mechanism for the fish's body. We made the decision to divide the body into the head, body, and tail. In order to create the propulsion system, we employed five servo motors. Finally, controlling the robot's motion is absolutely essential, especially if there is an obstruction in its path. The servo controller, which is located at the fish's head, serves as the primary controller for all of the motors and sensors.
Corrosion Resistance and Thermal Stability Enhancement of Green Layered Clay/Epoxy Coating
Authors: Kabeb Siti Maznah , Hassan Azman , Zulkifli Farah Hanani , Zakaria Farasuraya Che , Rahman Atif Ur
Published: March 2024

A layered clay/epoxy coating was fabricated to investigate the effects of montmorillonite (MMT) and halloysite nanotube (HNT) loading at 0.5, 1.5, and 2.5 parts per hundred resin (phr) on the corrosion resistance and thermal stability of coated mild steel plates. The corrosion study was carried out by Electrochemical Impedance Spectroscopy (EIS) and Tafel polarization. The |Z|0.1Hz value, Rct, and Rp of the layered/clay epoxy coatings containing 1.5 phr of HNT and MMT exhibited the best anticorrosion performance compared to other clay content levels. The |Z|0.1Hz value for the epoxy coating filled with 1.5 phr of MMT (M1.5) is 2.132 × 109 Ω·cm², while it is slightly higher for H1.5 coatings, i.e., 2.629 × 109 Ω·cm². Water absorption trends were consistent with EIS and Tafel polarization studies. The presence of highly compatible nanocontainers clay reduced the total free volume and promoted cross-linking, enhancing anticorrosion performance. Thermal Gravimetry Analysis (TGA) showed that a 1.5 phr loading of MMT in layered/clay epoxy coating demonstrated better thermal stability than a coating embedded with HNT. This improvement can be attributed to the barrier effect of MMT, which retards the diffusion of oxygen molecules into the coating.
A Novel Powder Addition Method for Improving Tensile Strength of Polylactic-Acid Prepared by Using Fused Filament Fabrication (FFF)
Authors: Pratama Juan , Wijaya Rahman , Salim Urip Agus , Suyitno Suyitno , Arifvianto Budi , Saptoadi Harwin , Mahardika Muslim
Published: March 2024

Although Fused Filament Fabrication (FFF) technology has gained popularity and is used extensively since the last decade, the low mechanical properties of the resulting product have been recognized as the major limitation of this technique. The anisotropic nature of the printed products due to the layered structure and many cavities that are present inside the printed parts are among the main causes of this problem. In this study, the powder addition reinforcement (PAR) method had been developed by introducing reinforcing powder into the polylactic acid (PLA) as the base material during the printing process so that nozzle clogging can be avoided and powders can be placed between the layers. In this work, iron oxide nanoparticles (Fe2O3) were used as a reinforcing powder. The addition of this powder was carried out by using two methods, namely brushing and compressed air-assisted techniques. The results showed that the compressed-air assisted technique demonstrated better results in terms of mechanical properties. In this case, the tensile strength of the composite with the compressed-air assisted technique was higher by 28.95% than that of the PLA and by 5.53% - 25.2% than that of the brushing method. Finally, this study showed that the compressed air-assisted method is the potential to be developed in the future as a powder addition reinforcement technique in the FFF process.
Identification of Waste Potential from Maritime Activity - Incorporating Polyethylene Cables into Building Construction
Authors: Barboza Rochelne , Daruari Harish , Rocha Antonieta , Carvalho Miguel A. , Mendonca Paulo
Published: March 2024

Currently, the Azores face a significant problem due to the existence of a large quantity of marine debris derived from fishing activities and gear. This issue represents a threat to the social and environmental aspects of the region. The lack of adequate disposal of this waste produced by the fishing industries is leading to a disruption of the ecosystem. A broad study within the scope of the Azores Ecoblue project in partnership with the Regional Government of the Azores aims to quantify/parameterize and qualify waste from fishing gear. Focused on analyzing the possibility and opportunity of creating a source of revenue for the Region from these raw materials used by the stakeholders identified by a research project called Azores Ecoblue. This survey is being carried out with the aim of identifying adversities related to materials, resulting in the proposal of solutions, involving the recycling and transformation of the polymer, Polyethylene, typically used in mooring cables on fishing vessels. It is essential to raise awareness of the need to reconsider the collection of waste with sustainable potential and relevance in the social and economic context of the region. Polymer identification and characterization was performed in an attempt to address the problem at the source. In addition to identifying the material, this research focuses on characterizing its thermal properties. The development of a construction system composed of reused cables, to be included in a demonstrative prototype, was developed and is presented in this article, emphasizing the importance of implementing sustainable solutions to address the issue of marine litter on the Azorean coast and promote the circular economy.
Study on Influence of Core Structure on Catalytic Converter Performance Using CFD
Authors: Muthukumaran V. , Balaji Selvaraj , Senthilkumar K.M. , Navaneethan M. , Mano D. Deva Jebas
Published: March 2024

In recent years, as the automotive industry is growing, one of the major hope for future vehicles is to meet emissions regulations. Automobiles pollute the air, and clean-air laws have made Catalytic Converters a legal requirement because they convert harmful pollutants from an engine's exhaust into cleaner emissions. The device works with the principle of a catalyst, something that causes or speeds up a chemical reaction without itself being changed. But the presence of a catalytic converter increases the exhaust back pressure which has an indirect effect on the engine efficiency ie engine efficiency decreases, thus increasing fuel consumption. The performance of a catalytic converter is substantially affected by the flow distribution inside the substrate, a uniform flow distribution can increase its efficiency, lower the pressure drop and optimize engine performance. The flow distribution in a catalytic converter assembly 15 is governed by the geometry configurations of the inlet and outlet cone section, the substrate, and exhaust gas compositions, and therefore a better design of the catalytic converter is very important. This Project deals with the fundamental understanding and study of complex processes taking place involving fluid flow, pressure, and velocity profiles in the catalytic converter using ANSYS WORKBENCH 2022 R1. The main objective of our analysis is to determine the most effective and optimum design of a Catalytic Converter
Finite Element Analysis of Solid and Hollow Roller Bearings to Predict the Influence of Contact Factors on Cage Slip
Authors: Arthanari Selvaraj , Manivannan Chandru , Palanisamy Senthilkumar , Ponnan Parandaman
Published: March 2024

This study examines the influence of contact factors such as bearing deformation, contact width and contact pressure on cage slide in cylindrical roller bearings. A cylindrical shaped roller bearing test setup is designed in order to determine the operating speed of bearing components under varying working circumstances. Solid and hollow roller bearings are analyzed using finite element technique, and the contact parameters are obtained. The cage slip obtained by experimental work is correlated with the contact parameters of hollow and solid shaped roller bearings. The specific load acting on solid rollers at various angular positions and the corresponding bearing deflection are obtained by FEA and the bearing run out is estimated. A new methodology is developed for deriving the contact mechanics of hollow roller to predict contact pressure and contact width from the roller deflection. The effect of hollowness on these parameters is derived and the corresponding cage slip is correlated. The effect of hollowness on bending and resultant stresses is obtained by numerical and analytical methods to correlate the stability of hollow roller bearing with the percentage of hollowness.
Silica Fume-Red Mud Based Geopolymer Stabilized Organic Soil
Authors: Choudhury Rezaul Islam , Hussain Monowar
Published: March 2024

Organic soil presents significant challenges for construction due to its unsuitability as a soil type, often necessitating stabilization using conventional agents like cement. The Silica Fume (SF)-Red Mud (RM) binder mix emerges as a promising alternative stabilizer due to its low carbon footprint coupled with its superior strength-enhancing properties. In this study,we explore the feasibility of employing SF-RM based geopolymer to stabilize organic soil. To activate the collected samples, a solution of sodium hydroxide (NaOH) with molarity (M) of 6, 9, and 12 were utilized, as well as binder (SF + RM) proportions of 10%, 20%, 30%, and 40% relative to dried organic soil and alkali-to-binder (A/B) proportions of 0.5, 0.7, and 0.9, respectively. The experimental results reveal that a variety of factors, including NaOH molarity, A/B proportions, pH, and curing duration, have an effect on the unconfined compressive strength (UCS) of treated organic soil. The best combination was obtained with a binder concentration of 30%, a NaOH molarity of 9M, and an A/B proportion of 0.7. After 28 days of curing, the UCS of the treated organic soil (1714 kPa) was found to be 168 times that of the untreated organic soil (10.2kPa). Further, the production of compounds such as aluminium silicate, sodium aluminosilicate, and potassium aluminosilicate, which have been found by X-ray diffraction (XRD) research, can be ascribed to the increase in strength. Furthermore, when subjected to analysis through Field Emission Scanning Electron Microscopy (FESEM), it becomes evident that these items play a pivotal role in filling the voids within the soil-binder composite. As a consequence, they facilitate the creation of a more smoother, compact and denser structure.
Structural and Geochemistry of Air Piau Gold Mineralisation in Kelantan, North-East Peninsular Malaysia
Authors: Ahmad Aminuddin Muhammad Irman Khalif , Endut Zakaria , Setiawan Nugroho Imam , Warmada I Wayan , Yonezu Kotaro
Published: March 2024

The formation of the Air Piau Gold Deposit in North-East Peninsular Malaysia due to Permo–Triassic subduction and collision between Sibumasu and East Malaya blocks and resulted in several phases of deformation, contraction, and metamorphism. Kinematic and petrography study of quartz veins in Air Piau area observed whether following the foliation of metamorphic rock or crosscut the foliation. Early generation of veining system in Air Piau follow the host rock foliation (V1). Meanwhile the later formation of the hydrothermal vein has a cross-cutting relationship with foliation (V2). Some veins observed were sheared and brecciated (V3). Positive correlation between Au and As concentration that can be characterized these deposit formed at mesozonal zone. V3 vein type showed the brecciated texture of vein indicates the brittle structure deformation. The conceptual model of orogenic gold, this type of V3 vein can be classified as epizonal zone. Regionally, the Air Piau gold deposit shares geologically similarities (in term of tectonic setting, geological structures controlled, host rock, ore gechemistry) with many other sediment/metasediment- hosted, orogenic gold deposits in Peninsular Malaysia such as Tersang, Selinsing and Penjom. Furthermore, Air Piau gold deposit characteristics as discussed before supported the theory related with orogenic/mesothermal gold from various researchers However, a number of inferences on classified Air Piau gold deposit model as orogenic gold deposit remains speculative in the absence importance data like ore geochemistry data (Hg, Sb and Te element concentrations) and fluid inclusion data.
Characteristics of asthmatic children with Mycoplasma pneumoniae infection in Vietnam
Authors: Bui Nghia Quang , Mai Cuong Thi Kim , Nguyen Nguyet Kim , Nguyen Thang , Duong Linh My
Published: March 2024

Introduction: Mycoplasma pneumoniae is regarded as an involved factor in refractory asthma exacerbations. The link between Mycoplasma pneumoniae infection and asthma is not fully understood, particularly regarding clinical and paraclinical characteristics.Objectives: To determine the frequency of Mycoplasma pneumoniae infection in asthmatic children, identify clinical and paraclinical characteristics along with clinical management in children aged 6 to 15 years at Can Tho Children's Hospital, Vietnam.Method: From March 2019 to April 2021, 124 patients participated in a cross-sectional study that was done. Mycoplasma pneumoniae was detected using an immunoglobulin N (IgM) serology test.Results: Mycoplasma pneumoniae-IgM serology was positive in 32.3% asthmatic children. IgM-positive individuals had significantly greater percentages of accessory respiratory muscle contraction, coarse crackles, fever, and increased heart rate. Mycoplasma pneumoniae infection occurred in 42.3% of children who were hospitalized for the first time and had asthma diagnosis. Mycoplasma pneumoniae infection and the severity of acute asthma exacerbations had a positive association (p<0.05). A longer hospital stay (6.74±1.91 days) and a higher exacerbation recurrence rate (32.4%) were observed in the IgM-positive group (p<0.05). Conclusions: Mycoplasma pneumoniae infections were highly prevalent in asthmatic children. Severity of acute asthma exacerbations, first-time asthma diagnosis, and recurrence of asthma exacerbation were significantly associated with Mycoplasma pneumoniae infection.
Spectrum of complications in blood culture positive enteric  fever in children aged 1-15 years: A 10-year-experience from a tertiary care centre in Eastern India
Authors: Halder Partha Pratim , Ranjit Parinita , Das Barnali Ghosh , Dey Sarkar Subhajit
Published: March 2024

Background: Enteric fever is caused by Salmonella enterica serovar typhi and Paratyphi A, B and C. Blood culture is the gold standard for diagnosis, but is not always feasible due to logistical issues. This may delay definite diagnosis and treatment resulting in increased complications.Objectives: To document the spectrum of complications involving different organ systems in blood-culture positive enteric cases  Method: This was a single centre retrospective observational study conducted in the Institute of Child Health (ICH), Kolkata, India. The study period was from January 2013 to December 2022. Children aged 6 months to 15 years, admitted in ICH, with a history of fever of any duration, whose blood culture revealed Salmonella species were included. Clinical symptoms, complications and the outcome of treatment were noted. Data were statistically analysed using SPSS software.Results: Around one third of the total study population presented with complications. Age group of 5-10 years was the most vulnerable for the infection and its complications. Central nervous system (CNS) involvement, hepato-biliary involvement and gastrointestinal (GI) involvement were the common complications.Conclusions: Enteric fever involved a broad spectrum of complications involving the CNS, hepato-biliary system and the GI system.
Do vitamin D levels affect forced expiratory flow 25-75 among children with asthma?
Authors: Anand Veena , Joseph Susy , Yadev I. P.
Published: March 2024

Background: Previous reports of association between vitamin D levels and pulmonary function based on forced expiratory volume in one second (FEV1) and ratio of FEV1 to forced vital capacity (FEV1/FVC) gave mixed results. Forced expiratory flow 25-75 (FEF 25-75) is considered a sensitive parameter in children as it is effort independent.Objectives: To assess the correlation between serum vitamin D levels and pulmonary function parameters in children with asthma.Method: This cross-sectional analytic study was conducted at the paediatric respiratory clinic of a tertiary care referral hospital. Children aged 6-12 years, having asthma, on controllers with good compliance and under regular follow-up were enrolled.Results: Mean serum vitamin D level (16.8± 6.69ng/ml) was low and deficiency was seen in 36 (72%) children with asthma. Positive correlation (r=0.41) was seen between serum vitamin D levels and predicted FEF 25-75%. Univariate analysis between vitamin D and FEF 25-75 showed decreased vitamin D levels were associated with significantly low FEF 25-75 (p<0.001). In multivariate linear regression analysis after adjustment for age and sex, the relationship was direct and significant (R2=0.18, p<0.05) but for FEV1 the relationship was not significant (R2=-0.034, p=0.336).Conclusions: Vitamin D levels showed direct and significant relationship with FEF 25-75 outcome in children with asthma.
Low-level laser therapy as an adjuvant in the treatment of erythema multiforme of the oral mucosa: a case report
Authors: Melo de Lima Morais Thayná , Silva Sara Maria Santos Dias da , Da Silva Peralta Felipe , Kitakawa Dárcio , Saito Nogueira Marcelo , das Chagas e Silva de Carvalho Luis Felipe
Published: March 2024

Erythema multiforme is an autoimmune condition that can affect the skin and mucosa. Oral lesions initially present with edema and progress to superficial erosions with pseudomembrane formation. The most recommended treatment is the use of corticosteroids; however, low-level laser therapy can be effective in the treatment of erythema multiforme. We report a case of erythema multiforme in the oral mucosa treated with low-level laser therapy. A 73-year-old woman using alendronate for osteoporosis, losartan, and puran T4 with extensive ulcers on the upper and lower lips. The clinical diagnosis was erythema multiforme. The proposed treatment was 0.05% clobetasol propionate in gel, 3 times a day, and seven sessions of low-level laser therapy on alternate days. Low-level laser therapy significantly improved the erythema multiforme of the oral mucosa, offering the patient a non-invasive approach with no side effects.
A Cross Cultural Perspective of Adherence for Racial/Ethnic Minority Women with HIV, Living in the United States
Authors: Duthely Lunthita , Villar-Loubet Olga , Akurati Sneha , Sanchez Covarrubias Alex
Published: March 2024

HIV persists as a global public health tragedy, as more than 36 million lives have been lost to HIV/AIDS. A diagnosis of HIV can be treated as a chronic disease, for those who adhere to their medication regimens and other health recommendations. However, for racial/ethnic minorities living in the United States, many of whom face a multitude of barriers, adherence to medications and medical appointments can be a challenge. For racial/ethnic minority women, specifically, gender roles, HIV stigma, racism, inconsistent access to healthcare, financial and food insecurity are just a few of the barriers they experience, which may interfere with their ability to adhere to medical treatment. For immigrant women, low language literacy, which is linked to health literacy, may further exacerbate these lives where staff and services provide culturally and linguistically competent services. This paper reports parts of a larger mixed-methods inquiry. The goal is part of larger study to develop an intervention for racial/ethnic minority women with HIV, living in the Southeastern region of the United States.
More Than Yes and No: Predicting the Magnitude of Non-Invariance Between Countries from Systematic Features
Authors: Karl Johannes , Fischer Ronald
Published: March 2024

Measurement Invariance has long been the cornerstone of cross-cultural comparisons. Nevertheless, over time a research tradition has developed in which invariance tests are applied with the stated end goal of finding invariance between measures and an implicit view that non-invariance is a barrier to cross-cultural research. In the current paper we aim to challenge this view and urge researchers to consider non-invariance critically not as barrier, but as opportunity for cross-cultural research. Specifically, we show how invariance effect sizes of items can be used to understand psychometric distances between countries and formulate novel hypotheses on cultural differences. Using a previously published dataset on the cross-cultural comparability of subjective happiness from 59 countries, we show how invariance effect sizes can be used to detect problematic items and variables which shape the psychometric similarity of countries. Focusing on item differences, we showed that negatively worded items are performing markedly worse in cross-cultural comparisons and that this effect is exacerbated if countries are linguistically distant. Additionally, we showed that country level variables such as GDP or environmental factors such as temperature can be used to cluster similarities in psychometric functioning, creating novel possibilities to systematize sources of non-invariance on a granular level.
Comparison of lung aeration loss in open abdominal oncologic surgeries after ventilation with electrical impedance tomography-guided PEEP versus conventional PEEP: a pilot feasibility study
Authors: Karthik A. R. , Gupta Nishkarsh , Garg Rakesh , Bharati Sachidanand Jee , Ray M. D. , Hadda Vijay , Pahuja Sourabh , Mishra Seema , Bhatnagar Sushma , Kumar Vinod
Published: March 2024

Background: Existing literature lacks high-quality evidence regarding the ideal intraoperative positive end-expiratory pressure (PEEP) to minimize postoperative pulmonary complications (PPCs). We hypothesized that applying individualized PEEP derived from electrical impedance tomography would reduce the severity of postoperative lung aeration loss, deterioration in oxygenation, and PPC incidence.Methods: A pilot feasibility study was conducted on 36 patients who underwent open abdominal oncologic surgery. The patients were randomized to receive individualized PEEP or conventional PEEP at 4 cmH2O. The primary outcome was the impact of individualized PEEP on changes in the modified lung ultrasound score (MLUS) derived from preoperative and postoperative lung ultrasonography. A higher MLUS indicated greater lung aeration loss. The secondary outcomes were the PaO2/FiO2 ratio and PPC incidence.Results: A significant increase in the postoperative MLUS (12.0 ± 3.6 vs 7.9 ± 2.1, P < 0.001) and a significant difference between the postoperative and preoperative MLUS values (7.0 ± 3.3 vs 3.0 ± 1.6, P < 0.001) were found in the conventional PEEP group, indicating increased lung aeration loss. In the conventional PEEP group, the intraoperative PaO2/FiO2 ratios were significantly lower but not the postoperative ratios. The PPC incidence was not significantly different between the groups. Post-hoc analysis showed the increase in lung aeration loss and deterioration of intraoperative oxygenation correlated with the deviation from the individualized PEEP.Conclusions: Individualized PEEP appears to protect against lung aeration loss and intraoperative oxygenation deterioration. The advantage was greater in patients whose individualized PEEP deviated more from the conventional PEEP.
A young boy with a rare tumor presenting as an upper gastrointestinal bleed
Authors: Jain Ajay K. , Jain Suchita , Ware Sandeep
Published: March 2024

We describe an interesting upper gastrointestinal endoscopy image of a mass seen in the stomach of a 19-year-old boy who presented to us with an upper gastrointestinal bleed without any history of pain or illness in the past and was diagnosed as a primitive neuroectodermal tumor or Ewing’s sarcoma of the stomach.
Correlation between acne and insulin resistance; experience from central India
Authors: Srivastava Prachi R. , Khare Jaideep , Saxena Animesh , Jindal Sushil
Published: March 2024

ABSTRACT

Introduction:

Acne is a common dermatological condition primarily seen in teenage and adolescent patients and is a major concern for cosmological issues. Along with environmental factors, the proliferation of basal keratinocytes in the sebaceous-pilosebaceous unit, abnormal desquamation of follicular corneocytes, and metabolic abnormalities play a significant role in the pathogenesis of acne development.

Aim:

To study the causal relation between acne vulgaris and insulin resistance by calculating Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) and identify the relation between insulin resistance and the severity of acne.

Materials and Methods:

This was a retrospective study, where the data of patients with persistent Acne Vulgaris who were referred to the Endocrine department for evaluation of the hormonal and metabolic causes for acne vulgaris were analysed. The patient’s clinical records were evaluated in whom there was no significant hormonal or metabolic abnormality identified known to cause persistent acne were included after proper consent and HOMA-IR was calculated.

Results:

Of several patients with persistent acne, 150 patients were included in our study with the male-to-female ratio was 23:27. The mean age of patients was 33.2 years. The mean HOMA-IR in our acne patients was 1.62 ranging from 0.9-3.7. Sixty four (42.67%) patients had HOMA-IR more than 2.0, thereby suggesting insulin resistance.

Conclusion:

Our study suggests the prevalence of insulin resistance in 42.67% of patients with acne, thereby providing the possibility of use of insulin modifiers as an adjunct acne treatment and stratifying the possible risk of metabolic syndrome in patients with acne. Also recommended is the control of dietary factors and lifestyle modification for the management of acne with insulin resistance.
Assessment of acceptability of black wheat flour products and factors affecting it among Anganwadi beneficiaries and workers: A mixed-method prospective observational study
Authors: Bharti Bhavneet , Garg Monika , Nadda Anuradha , Anand Abha , Kapoor Neha , Malhotra Nidhi
Published: March 2024

ABSTRACT

Introduction:

Malnutrition is very common in India and black wheat might be an acceptable solution to this problem. The aim of the study was to assess acceptability of black wheat flour products and factors affecting it among Anganwadi beneficiaries and workers.

Materials and Methods:

This was a mixed-method prospective observational study. All the family members enrolled for supplementary nutrition and Anganwadi workers/helpers of three randomly selected Anganwadi centers were taken in the study. For qualitative data, in-depth interview was done, and for quantitative data, 9-point hedonic scale was administered. Braun and Clarke’s six-phase data analysis framework was used for qualitative data.

Results:

A total of 16 pregnant females, 14 lactating females, 16 children, 2 Anganwadi workers, and 3 Anganwadi helpers participated in the study. Thematic analysis of the data revealed five significant themes. It included characteristics of black wheat flour, the process of making the product (experience of making the product), family acceptability, availability, and hygiene. Participants expressed that the black color appearance is one of the negative influencers in the acceptability of black wheat flour. Most of the participants liked the taste as well as the texture. However, kneading, rolling, and puffing were more challenging than traditional wheat flour. On the hedonic scale, the mean rank of acceptability is lowest for color (3.03), followed by puffing (3.49) and highest for texture (4.87) and taste (4.60).

Conclusion:

Our study results revealed that black wheat is acceptable to the Anganwadi beneficiaries and workers.
Reproductive healthcare seeking behaviour of women of the reproductive age group in an urban resettlement area of district Gautam Buddh Nagar in Uttar Pradesh, India
Authors: Barua Kabita , Gohar Meraj , Mahajan Harsh , Srivastava Shalini
Published: March 2024

ABSTRACT

Background:

Reproductive tract infections (RTIs) and gynaecological morbidities constitute a significant proportion of morbidities in women of the reproductive age group.

Objective:

To find out the proportion of reproductive age group women in an urban resettlement colony having the symptoms of gynaecological morbidities and RTI/sexually transmitted infection (STI) and to explore the healthcare seeking behaviour of the women during such ailments.

Materials and Methods:

A community-based cross-sectional study was conducted from January to June 2023 among 317 females aged 15 to 49 years in an urban resettlement area of Gautam Buddh Nagar district in Uttar Pradesh. Statistical analysis used included descriptive statistics and Chi-square test. SPSS 23 was used for data analysis.

Results:

There was a prevalence of 65.3% of at least one self-reported symptom suggestive of RTI/STI or gynaecological morbidity among the respondents. Among the symptomatic respondents, 54.1% were found to seek treatment. Among the reasons given for not seeking treatment in any health facility, the majority (83.1%) responded ‘lack of awareness that the problem needed medical treatment’ and ‘stigma related with the problem’ to be the main reasons.

Conclusion:

The reproductive healthcare seeking behaviour was found to be inadequate, with only 54.1% of symptomatic respondents seeking treatment. Enhanced health awareness sessions can be planned in the short term, and skilled communicators within or outside of the health system in the long term may be deployed to disseminate information in the community regarding sexual and gynaecological morbidities in reproductive age group women and their timely intervention.
The 2021 Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) guidelines and the outpatient management: Examining physician adherence and its effects on patient outcome
Authors: Orozco Ricardo J. , Rodriguez David , Hunter Krystal , Roy Satyajeet
Published: March 2024

ABSTRACT

Background:

Chronic obstructive pulmonary disease (COPD) is a common preventable illness that carries a large global economic and social burden. The global initiative for chronic obstructive lung disease (GOLD) guidelines has been utilized as a global strategy for the continued COPD diagnosis, assessment, and treatment. We aimed to determine if the adherence to the 2021 GOLD guideline directed management influenced outcomes.

Materials and Methods:

Retrospective medical records review of adult patients with COPD, who received care in our office during the entire year of 2021. Patients managed as per the 2021 GOLD guidelines were compared with those who received usual care.

Results:

Among 242 patients, 171 (70.7%) were GOLD management adherent (GA) and 71 (29.3%) were GOLD non-adherent (GNA). Certain comorbidities were associated with higher frequencies in the GA group, such as allergic rhinitis (63.2 vs. 18.3%; P < 0.001), coronary artery disease (55.9 vs. 38.0%; P = 0.011), GERD (63.2 vs. 32.4%; P < 0.001), anemia (38.6 vs. 19.7%; P = 0.004), malignancy (34.5 vs. 19.7%; P = 0.023), and immunodeficiency (12.3 vs. 1.4%; P = 0.007). There was no significant difference in the mortality between the GA and GNA groups (5.3 vs. 9.9%; P = 0.254). Although the frequency of number of exacerbations was greater in the GA group, the difference in the mean number of exacerbations was not statistically significant (0.39 ± 1.08 vs. 0.39 ± 1.14; P = 0.984).

Conclusion:

We found no significant difference in the patient outcomes, such as number of exacerbations of COPD and mortality, when comparing the 2021 GOLD guideline adherent versus GOLD guideline non-adherent management of COPD.
Case report: The role of hypertension retinopathy graduation in the management of systemic cardiovascular disease
Authors: Kosteva Kathryn , Kaufman Evan J. , Kinch Alicia
Published: March 2024

ABSTRACT

Moderate to severe hypertensive retinopathies are more likely to correlate with uncontrolled blood pressure in all ages. Mild microvascular changes are expected with natural aging and are therefore more concerning in patients younger than 40. Risk assessment is subsequently determined based on blood pressure measurements and patient symptoms. The goal of this paper is to discuss current opinions regarding the role of grading hypertensive retinopathy in the risk assessment of systemic cardiovascular disease in the context of a clinical case. Management and referral recommendations for clinicians will be summarized. Emergent referral for hospital-based care is indicated in any patient with severe hypertensive retinopathy; pregnant women with moderate hypertensive retinopathy; patients younger than 55 with blood pressure greater than Grade 2; any patient with blood pressure greater than grade Severe; any patient with symptoms of chest pain, headache, dyspnea, or dizziness; and any patient with a symptomatic retinal plaque.
A nuanced exploration delving into malignant melanomas occurring in unexpected and less common anatomical locations
Authors: Sinha Reena , Osama Md Ali , Rabab Shadan , Jaiswal CP
Published: March 2024

ABSTRACT

Malignant melanoma originates from melanoma cells, which derive from the neuroectoderm of the ectodermal mucosa. The chameleonic presentation of malignant melanoma, its often asymptomatic nature, the rarity of the lesion, the grim prognosis, and the imperative for highly specialized treatment are critical factors that merit careful consideration. Herein, we report a compilation of five cases of malignant melanomas occurring at unusual anatomical locations, which were initially misdiagnosed, which on careful analysis with the use of immuno-histochemical stains were correctly diagnosed as malignant melanoma.
Analysis of leadership and team management skills of middle-level healthcare managers of Valsad district, Gujarat
Authors: Patel Neha A. , Nayak Sunil N. , Bariya Bhaveshbhai R. , Patel Mehulkumar N.
Published: March 2024

ABSTRACT

Background:

The healthcare managers need to develop the managerial skills and use it for better healthcare delivery. A manager requires leadership skill to empower employees and motivate them to work in an efficient manner to achieve organizational goal. Motivating employees/subordinates and developing positive attitude toward them is one of the crucial skills that the leader needs to develop. The way health team works as a unit affects the outcome and needs good leader. With this background, the current study tends to explore the managerial skills of middle-level managers.

Objectives:

1. To assess the leadership and team management skills of middle-level managers and 2. To find out motivational factors used by managers.

Materials and Methods:

A cross-sectional study was conducted among district-level healthcare managers and medical officers. Data collection was performed via semistructured and scale-based questionnaire and analyzed using Microsoft office excel.

Results:

60% of managers had participative leadership style. Team work skills were fair enough among the managers. 53% of medical officers were freshly appointed with experience of less than one year. The middle-level managers used appreciation of work (41.8%) as major motivator of the team.

Conclusions:

The middle-level healthcare managers have good leadership quality as well as teamwork skills. Appreciation of work is commonly used motivator.
Anisocoria in patients with hyperhidrosis: A case series for the primary care physician
Authors: Sasher Tianna , Bomar Parker , Feuer Daniel , McDonald Lauren
Published: March 2024

ABSTRACT

The differential diagnosis for anisocoria is broad and ranges from benign to life-threatening causes. Often, patients with new onset anisocoria present to their primary care physician, an urgent care center, or an emergency room. As such, it is important for non-ophthalmologist physicians to be familiar with its common causes. We present two cases of pharmacologic anisocoria from Qbrexza (glycopyronnium), a wipe used in the treatment of hyperhidrosis. Identifying this medication as a cause of anisocoria in patients with hyperhidrosis can reduce costs and unnecessary testing. Furthermore, physician education about safer usage can be provided.
Comparison of the efficacy of propranolol versus amitriptyline as monotherapy for prophylaxis of migraine
Authors: Patel Krinaben M. , Popatbhai Kachhadia M. , Xavier Roshni , Aramin Mohammed A. S. , Faris Khalid J. F. , Mateen Mohammed A. , Prajwal Priyadarshi , Marsool Mohammed D. M. , Sheikh Hafsa , Mohamed Esra H. A. G.
Published: March 2024

ABSTRACT

Background:

Approximately 15% of migraine sufferers need preventative medicine because they have more than two episodes each month. Migraine is a regular, persistent condition that frequently makes victims helpless. Numerous drugs from various classes have so far been used in migraine prophylaxis. Their effectiveness is recurrently overshadowed by their side effects because they must be used for a long time, which occasionally necessitates stopping the drug.

Materials and Methods:

In the tertiary care teaching hospital’s department of medicine, a prospective, comparative, open-label study was initiated. Two groups of 80 patients were randomly chosen. For 3 months, the 40 patients in Group A were given a tablet of amitriptyline 10 mg once daily, whereas the 40 patients in Group B were given a tablet of propranolol 20 mg once a day. At the conclusion of the fourth, eighth, and twelfth weeks, the patients’ own self-assessment migraine diary and a 4-point pain scale were used to grade the intensity of the headaches.

Results:

As a result, in Group A, the mean migraine attack severity in periods 1 and 2 was 5.88 2.69 and 5.41 2.48, respectively. In Group B, the mean was 5.15 2.75 in period 1 and 5.66 2.78 in period 2, respectively. The average length of a migraine attack in Group A was 20.30 5.61 h in period 1 and 16.75 5.23 h in period 2. In Group B, the mean was 16.59 3.21 in period 1 and 18.78 5.14 in period 2. Between groups A and B, there was a statistically significant difference.

Conclusion:

The average number of migraine attacks reduced in the amitriptyline and propranolol groups as the treatment duration increased. Amitriptyline is a popular medication with established effectiveness and manageable levels of negative side effects. It is the tricyclic antidepressant that is most frequently used to prevent headaches. When administered for migraine prevention, it generates a quick response within 3 months. Propranolol is less effective than amitriptyline at reducing the frequency, length, and severity of episodes.
Comparison of size of the liver between patients with non-alcoholic fatty liver disease and healthy controls
Authors: Dorostghol Maryam , Gharibvand Mohammad M. , Hanafi Mohammad G. , Motamedfar Azim
Published: March 2024

ABSTRACT

Background:

Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease across all age groups. Limited studies have been conducted to consider the relationship between NAFLD and liver size. This study aimed to compare the size of the liver between NAFLD patients and healthy controls.

Methods:

This case-control study was conducted on NAFLD patients (n = 300), and healthy subjects (n = 300) referred to the Golestan Hospital of Ahvaz from April to August 2021. All individuals underwent ultrasonography examination, and liver size was measured in the midclavicular line. Fatty liver was divided into three grades, I (mild), II (moderate), and III (severe), according to the disease severity. Anthropometric parameters, including age, sex, weight, height, and body mass index (BMI), were recorded. Finally, the size of the liver and its relationship with NAFLD and anthropometric parameters was evaluated.

Results:

Patients had significantly higher weight, and BMI mean values than controls (P < 0.001). In comparison to controls, NAFLD patients had considerably larger livers on average. (149.05 ± 12.60 mm vs. 134.51 ± 12.09; P < 0.001). There was a significant tendency for larger liver size in normal to severe fatty liver patients (P < 0.001). In patients with mild, moderate, and severe NAFLD, the mean liver size was 144.34 ± 11.35, 154.21 ± 10.84, and 158.63 ± 13.45 mm, respectively. The mean liver size in both groups was significantly higher in males than females (P < 0.05). Age (P = 0.037), sex (P < 0.001), height (P < 0.001), BMI (P = 0.008), and steatosis (P < 0.001) were independent variables for predicting the liver size.

Conclusion:

The liver size of persons with fatty liver was substantially more considerable than healthy people. The size of the liver was substantially linked with sex, age, BMI, fatty liver, and hepatic steatosis grade. A straightforward way to predict fatty liver is to use ultrasonography to determine the size of the liver.