bluuebunny/crossref_metadata_2025 huggingface dataset:
Analysis of the Possibility of Improving the Performance of Clinch-Riveted Joints by Increasing the Depth of the Rivet Press during the Microalloyed HX340 Steel Sheet Joining Process
Authors: Boda Łukasz , Mucha Jacek , Witkowski Waldemar
Published: January 2024

The forming mechanism of clinch joints, for various materials arrangement, using a punch and a rigid die, is well known. The basic technological parameter of the process is the parameter X – the minimal thickness of the embossment. Usually, the lower the X parameter, the greater the joint interlock. This paper presents the possibility of forming a pressed joint for two 1.5 [mm] thick sheets made of HX340 steel. The joint was formed using an additional deformable steel rivet with a hardness of 400HV1. Different values of rivet pressing below the initial surface of the upper sheet were chosen: 0, 0.15, 0.30, 0.45 and 0.60 (in [mm]). The punch positioning accuracy was 0.01 [mm]. For the mentioned rivet pressing distances, forming tests were performed using an ‘‘SKB’’ die with three die depths: 1.45, 1.60 and 1.75 (in [mm]). Observations and measurements of the characteristic geometric dimensions of the interlock were made. Furthermore, the strength of the clinch-riveted joints was analysed. The greater the rivet pressing distance, the larger the interlock parameters. Furthermore, depending on the size of the rivet pressing distance, different failure mechanisms of the lap joint were observed in the tensile shear tests.
Determination of ASR in Concrete Using Characterisation Methods
Authors: Doğruyol Murat
Published: January 2024

Alkali-Silica Reaction (ASR), which develops over time into a harmful internal reaction in concrete, produces a harmful gel due to the reaction between the reactive silica in the aggregate and the alkalis of the pore solution. Due to the multi-scale nature of this long-term phenomenon, understanding its mechanism in concrete structures remains difficult to assess. Accelerated Mortar Bar Testing (AMBT) ASTM C1260 is among the commonly used methods to understand ASR formation in a short time. In this study, the chemical characterisation of concretes produced from volcanic rock type basalt aggregate was compared with the chemical characterisation of ASR concretes after AMBT was applied. In addition, 20% FA was substituted into the concrete to investigate the effect of fly ash (FA) on ASR. Specimens with limestone aggregate (PL), basalt aggregate (BBC) and 20% basalt aggregate with fly ash substitution instead of cement (BBC20FA) were prepared for the investigation. Scanning electron microscopy (SEM), energy dispersive X-ray spectrometry (EDX), X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FT-IR), thermogravimetric analysis (TGA) and differential thermal analysis (DTA) techniques were used to characterise the morphology and analytical composition of the concretes. It was determined that basalt aggregate does not cause ASR and its use with fly ash increases the strength and durability of concrete.
The Effect of Irrigation and Fertilization on the Qualitative Indices of the Planting Material, for Some Plum Species, with the Aim of Obtaining a Sustainable Fruit Trees Production, in the Pedo-Climatic Conditions of Romania
Authors: Venig Adelina , Stănică Florin
Published: January 2024

The purpose of the research was to obtain information about the necessity and efficiency of the application of localized irrigation to some qualitative indices of plum trees in the nursery, against the background of different fertilization treatments. The expected results to be obtained by applying differentiated rules of irrigation and fertilization will consist in obtaining a healthy, vigorous fruit tree planting material, increasing production in the nursery. With fruit trees in the nursery, as with all cultivated plants, the growth process depends to the greatest extent on the climate and soil conditions available to them. The use of fertilizers in tree culture becomes necessary to renew the reserve of nutrients consumed by plants or leached in depth, then to improve the physical condition, the chemical composition, and the overall state of fertilization of the soil. It is necessary to intervene every year, in several rounds, with fertilizations that ensure, on the one hand, the achievement of a certain level of production, and on the other hand, a certain level and ratio of nutritional elements by returning the amounts of elements easily accessible nutrients extracted with the harvest to be able to maintain, in this way, the fertility of the soil in accordance with the age of the plantation and the level of production. The two varieties of plum studied were Stanley and Cacanska Lepotica, two valuable varieties for the quality of the fruit. During the research, the fertilization treatments had the highest contribution (34.50 %) on the stem diameter, compared to irrigation (20.67 %) and respectively the variety (5.63 %), considering that the variety did not significantly influence the increase in diameter of the grafted trees.
Elucidating the role of KojR in transcriptional regulation of carbon metabolism for kojic acid biosynthesis in Aspergillus oryzae
Authors: Mizutani Tomoka , Oka Hiroya , Goto Riko , Tsurigami Ryoga , Maruyama Jun-ichi , Shimizu Motoyuki , Kato Masashi , Nakano Hideo , Takaaki Kojima
Published: January 2024

DNA-binding transcription factors are broadly characterized as proteins that bind to specific sequences within genomic DNA and modulate the expression of downstream genes. This study focused on KojR—a transcription factor involved in the metabolism of kojic acid, which is an organic acid synthesized in Aspergillus oryzae and is known for its tyrosinase-inhibitory properties. However, the regulatory mechanism underlying KojR-mediated kojic acid synthesis in remains unclear. Hence, we aimed to obtain a comprehensive identification of KojR-associated genes using genomic Systematic Evolution of Ligands by Exponential enrichment (gSELEX-Seq) and RNA-Seq. During the genome-wide exploration of KojR-binding sites via gSELEX-Seq and identification of KojR-dependent differentially expressed genes (DEGs) using RNA-Seq, we confirmed that KojR directly regulates kojT, as was previously reported. We also observed that kojA expression, which may be controlled by KojR, was significantly reduced in a ΔkojR strain. Notably, no binding of KojR to the kojA promoter region was detected. Furthermore, certain KojR-dependent DEGs identified in the present study were associated with enzymes implicated in the carbon metabolic pathway of A. oryzae. This strongly indicates that KojR plays a central role in carbon metabolism in A. oryzae.
Extended Cleavage Specificity of Two Hematopoietic Serine Proteases from a Ray-Finned Fish, the Spotted Gar (Lepisosteus oculatus)
Authors: Valentini Paolo , Akula Srinivas , Alvarado-Vazquez Abigail , Hallgren Jenny , Fu Zhirong , Racicot Brett , Braasch Ingo , Thorpe Michael , Hellman Lars
Published: January 2024

The extended cleavage specificities of two hematopoietic serine proteases originating from the ray-finned fish spotted gar (Lepisosteus oculatus) have been characterized using substrate phage display. The preference for particular amino acids at, and surrounding the cleavage site was further validated using a panel of recombinant substrates. For one of the enzymes, the gar granzyme G, a strict preference for the aromatic amino acid Tyr was observed at the cleavable P1 position. Using a set of recombinant substrates showed that the gar granzyme G had a high selectivity for Tyr, but also with lower activity cleaving after Phe but not after Trp. The second enzyme, gar DDN1, instead showed a high preference for Leu in the P1 position of substrates. This latter enzyme also showed high preference for Pro in the P2 position and Arg in both P4 and P5 positions. The selectivity for the two Arg residues in positions P4 and P5, suggest a highly specific substrate selectivity of this enzyme. Screening of the gar proteome with the consensus sequences obtained by substrate phage display for these two proteases resulted in a very diverse set of potential targets. Due to this diversity, a clear candidate for a specific immune function of these two enzymes cannot yet be identified.
Antisera developed against the recombinant gar enzymes were used to study their tissue distribution. Tissue sections from juvenile fish showed expression of both proteases in cells in Peyer´s patch-like structures in the intestinal region, indicating they may be expressed in T or NK cells. However, due to the lack of antibodies to specific surface markers in the gar, it has not been possible to specify the exact cellular origin. A marked difference in abundance was observed for the two proteases where gar DDN1 was expressed at higher levels than gar granzyme G. However, both appear to be expressed in the same or similar cells, having a lymphocyte-like appearance.
A representação do ensino do autocuidado pelo professor de educação física
Authors: Oliveira Maicon Douglas de , Fischer Marta Luciane
Published: January 2024

A representação dos professores de educação física sobre do ensino do autocuidado na escola, bem como os pressupostos bioéticos que têm sido utilizados na prática profissional se constituíram dos objetivos desta pesquisa. Para tal, foi conduzido um estudo quali e quantitativo de ordem transversal, por meio um questionário online respondido por 122 professores de escolas públicas e privadas e uma entrevista semiestruturada com 11 docentes. Os resultados demonstraram que os profissionais vêm atuando no ensino do autocuidado, indo de encontro com os parâmetros estabelecidos pela BNCC. Os princípios e valores comuns na Bioética vêm balizando essas ações e contribuindo para a promoção de saúde. Logo, para que a inclusão do autocuidado resulte em ações concretas de promoção de saúde global é importante a apropriação do saber técnico e do embasamento dos pressupostos bioéticos.
The Dark Side of the Moon: An Ever-Fragmenting Discipline and Turkish IR in “the Outer Periphery”
Authors: ÖZDEMİR Haluk
Published: January 2024

A recent debate has emerged in the literature about a need for more global
International Relations (IR), one which is truly international, to be worthy of its
name. This paper outlines the multi-dimensional fragmentation in IR, which has
prevented the emergence of a genuinely integrated and global discipline, and
created a context in which the periphery cannot make original contributions to
the core. The main purpose of this paper is to point out the major obstacles for
such original contributions that emanate from the periphery itself. Aside from
the general core-periphery fragmentation in the discipline, the periphery is
collapsing within itself. From that perspective, the core and the periphery look
more integrated, while the real division is between the periphery and the outer
periphery. The outer periphery, while mostly invisible to the core, has real effects
in IR practice, yet its nature and problems are not looked upon or handled by
the current literature. Based on this observation, and using the Turkish example,
four major problems of the outer periphery that affect the periphery and curtail
its potential for original contributions are identified: (1) apathy towards western
IR; (2) conspiracy theorizing; (3) chronological historicism; and (4) the outer
periphery’s influence on the mainstream periphery. After discussing these
problems, it is concluded that the periphery can make contributions to the core
only after it has helped the outer periphery solve its problems, and integration
within the periphery is achieved. Only then can original contributions of the
periphery to a truly international IR be possible.
Regresi Logistik Ordinal untuk Memodelkan Predikat Lulusan Perguruan Tingggi
Authors: Fathurahman M. , Orvanita  , Darnah
Published: January 2024

Logistic regression is an alternative model that can model the relationship between a categorical response variable and one or more categorical, continuous predictor variables, or a combination of categorical and continuous predictor variables. Based on the number of categories in the response variable, the logistic regression model consists of a dichotomous logistic regression model and a polychotomous regression model. The dichotomous logistic regression model is a logistic regression model that has two categories in the response variable and has a Bernoulli distribution. In comparison, the polychotomous logistic regression model is a logistic regression model that has three or more categories and a multinomial distribution. The polychotomous logistic regression model is divided into two models, namely the multinomial logistic regression model and ordinal logistic regression. This research aims to examine ordinal logistic regression modeling and its application to the predicate of graduates of the undergraduate program at the Faculty of Mathematics and Natural Sciences, Mulawarman University (FMIPA UNMUL) for the 2020 graduation period. The results of the research show that the factors that have a significant influence on the predicate of graduates of the FMIPA UNMUL undergraduate program are gender and admission route. Female graduates of the FMIPA UNMUL undergraduate program have a greater chance of achieving satisfactory and very satisfactory predicates compared to achieving a cum laude predicate. Graduates of the FMIPA UNMUL undergraduate program who are accepted through the SMMPTN admission route have a lower chance of achieving satisfactory and very satisfactory predicates compared to achieving a cum laude predicate.
DEMOGRAPHIC AGEING: ASSESSMENT OF THE RUSSIAN ELDERLY WELLBEING INDEX IN THE IRKUTSK REGION
Authors:   Irkutsk State Medical University of the Ministry of Health of the Russian Federation, Irkutsk, Russia, Gaidarov Gaidar , Alekseevskaya Tatyana ,   Irkutsk State Medical University of the Ministry of Health of the Russian Federation, Irkutsk, Russia, Sofronov Oleg ,   Irkutsk State Medical University of the Ministry of Health of the Russian Federation, Irkutsk, Russia, Kindrat Dmitry ,   Irkutsk State Medical University of the Ministry of Health of the Russian Federation, Irkutsk, Russia
Published: January 2024

Significance. The study presents results of the analysis of the wellbeing of the post-working age population and analysis of the processes of demographic ageing in the Irkutsk region. The authors have carried out a comprehensive analysis of the well-being of the post-working age population in dynamics using an integral index - the Russian Elderly Wellbeing Index. The analysis of ageing processes was carried out using special indicators of population ageing among male and female populations. The purpose of the study is: to provide a comprehensive characterization of demographic ageing and socio-economic wellbeing of the post-working age population of the Irkutsk region. Material and methods. The study of wellbeing of the post-working age population covered 2014-2020, while the study of the processes of demographic ageing was confined to the period from 2000 to2020. The authors used forms and indicators of the Federal State Statistics Service of the Russian Federation as sources of information to develop database, and data of the Rosstat’s survey «Comprehensive monitoring of living conditions» as a source of subjective data for the study. In the course of the study, the authors have tested the methodology for assessing the Russian Elderly Wellbeing Index in healthcare at the level of a constituent entity of the Russian Federation. Results. The processes of population ageing which are formed mainly due to the female population are on within the territory of the Irkutsk region. This is evidenced by the calculated values of special ageing coefficients. Gender differences in ageing persist throughout the study period. In dynamics, the Russian Elderly Wellbeing Index showed multidirectional trends. The indexes of the groups of indicators "economy", "society", "regional space" slightly decreased, while the index of the "health" group increased. The change in the final value showed the index growth. Conclusion. Against the background of the population ageing, the Russian elderly wellbeing index made it possible to determine peculiar features of changes in the well-being of the post-working age population.
El ingenioso hidalgo don Quijote de la Mancha | Miguel de Cervantes Saavedra, ed. Diego Martínez Torrón, Sevilla, Renacimiento, 2020, 2 vols. 980 y 1024 pp.
Authors: López Pastor Beatriz
Published: January 2024

Reseña: El ingenioso hidalgo don Quijote de la Mancha | Miguel de Cervantes Saavedra, ed. Diego Martínez Torrón, Sevilla, Renacimiento, 2020, 2 vols. 980 y 1024 pp.
Giro cultural de la memoria. La Guerra Civil a través de sus patrones narrativos | Patricia Cifre-Wibrow, Berlín, Peter Lang, 2022, 314 pp.
Authors: Sánchez Zapatero Javier
Published: January 2024

Reseña: Giro cultural de la memoria. La Guerra Civil a través de sus patrones narrativos | Patricia Cifre-Wibrow, Berlín, Peter Lang, 2022, 314 pp.
En el taller de la Liberata. Sobre la revisión del Canto XVIII
Authors: Russo Emilio
Published: January 2024

El artículo pretende reconstruir las etapas finales de la composición de la Gerusalemme liberata de Torquato Tasso, profundizando en la escritura de una serie de octavas del canto XVIII, cuya edición crítica se brinda aquí, a partir del manuscrito autógrafo conservado en Ferrara (Biblioteca Ariostea, II 475). En virtud de dicho análisis,se proponen también consideraciones generales con vistas a una nueva edición crítica del poema.
Premisa para una Filología de autor aplicada a textos del Siglo de Oro
Authors: Baldissera Andrea , Bonilla Cerezo Rafael , Pintacuda Paolo , Tanganelli Paolo
Published: January 2024

Premisa al monográfico
Incendio mineral | María Ángeles Pérez López, epílogo de Julieta Valero, Madrid, Vaso Roto Ediciones, 2021, 85 pp.
Authors: Balcells Doménech José María
Published: January 2024

Reseña a: Incendio mineral, María Ángeles Pérez López, epílogo de Julieta Valero, Madrid, Vaso Roto Ediciones, 2021, 85 pp.
Dos monedas: el yo femenino y la otredad en el viaje como parte del bildungsroman en el cómic
Authors: Escandell Montiel Daniel
Published: January 2024

El presente artículo aborda el cómic Dos monedas (2019) de Núria Tamarit, que gira en torno al proceso de maduración de la adolescente Mar durante su estancia en Senegal. Luego de exponer las características propias de la autoficción en el cómic de autora, procuraremos demostrar cómo esta novela gráfica rehúye dicho recurso, aun basándose en varios episodios de la biografía de la valenciana. En segundo lugar, sondeamos la instrumentalización de la protagonista para presentar la obra como un Bildungsroman que reflexiona sobre el viaje y la otredad no solo como proceso de maduración y rito de paso liminoide, sino también como reivindicación de África.
“Arte puro, viejo y moderno”: Federico García Lorca y los Títeres de Cachiporra de 1923, fiesta centenaria de tradición y vanguardia para la renovación teatral
Authors: Martín Barrachina Antonio
Published: January 2024

Cien años después, la fiesta celebrada el 6 de enero de 1923 en la casa de la familia García Lorca puede considerarse un hecho excepcional dentro de la historia del teatro español contemporáneo. Como conmemoración del acontecimiento, este artículo procura explicar su alcance para la renovación teatral acaecida durante la Edad de Plata. Se enmarca primero su lugar en la trayectoria lorquiana, rastreando el proyecto del Teatro Cachiporra Andaluz y los planteamientos que rigen su diálogo con la tradición. Se reconstruye después el desarrollo de aquella sesión, atendiendo a sus distintos elementos, su importancia y su sentido a la luz del contexto renovador.
Estudios sobre literatura contemporánea | Antonio Carreira, Sevilla, Renacimiento, 2022, 420 pp.
Authors: Laskaris Paola
Published: January 2024

Reseña de Estudios sobre literatura contemporánea | Antonio Carreira, Sevilla, Renacimiento, 2022, 420 pp.
Textos inéditos e inconclusos de Miguel Hernández (Estudio y edición) | Carmen Alemany Bay (ed.). Jaén, Editorial Universidad de Jaén, 2022, 378 pp.
Authors: Olmo López José
Published: January 2024

Reseña de Textos inéditos e inconclusos de Miguel Hernández (Estudio y edición) | Carmen Alemany Bay (ed.). Jaén, Editorial Universidad de Jaén, 2022, 378 pp.
Discurso autobiográfico y proyección del yo en el cómic femenino en español (1970-2023)
Authors: Padilla Aguilera Tania , Touton Isabelle
Published: January 2024

Presentación del monográfico Discurso autobiográfico y proyección del yo en el cómic femenino en español (1970-2023)
To Compare Isobaric Thoracic Spinal Anesthesia Versus General Anesthesia in Laparascopy Cholecystectomy
Authors:   Postgraduate 3rd Year Resident, Department of Anesthesiology, LN Medical College and Research Centre, Bhopal 462042, Madhya Pradesh, India., Kumbhare Nivedika , Dubey Anuj ,   Associate Professor, Department of Anesthesiology, LN Medical College and Research Centre, Bhopal 462042, Madhya Pradesh, India., Mishra Chandra Sekhar ,   Associate Professor, Department of Anesthesiology, LN Medical College and Research Centre, Bhopal 462042, Madhya Pradesh, India., Yadav Vinay ,   Postgraduate 3rd Year Resident, Department of Anesthesiology, LN Medical College and Research Centre, Bhopal 462042, Madhya Pradesh, India., Chakravarty Nupur ,   Professor and Head, Department of Anesthesiology, LN Medical College and Research Centre, Bhopal 462042, Madhya Pradesh, India.
Published: January 2024

Background: The laparoscopic cholecystectomy procedure is typically carried out under general anesthesia, but regional techniques, such as low thoracic isobaric spinal anesthesia, have been used to manage patients with significant medical problem like coexisting systemic disease, who are deemed to be high risk in general anesthesia. Segmental spinal anesthesia has great outcomes in terms of post-operative discomfort, the need for analgesics, relatively fewer complications, and shorter hospital stays. Thus the aim of this study to avoid and minimize the risk of general anesthesia who does not have any significant comorbidity. So it might be a substitute for a standard laparoscopic cholecystectomy. Material and Methods: Total 60 adult patient with ASA1 & I I, 18-60 years, with normal coagulation profile, is divided into 2 groups. Group IS (Isobaric) - given 2.5 ml of isobaric preservative free bupivacaine 0.5% (levobupivacaine) + 0.5 mg of Fentanyl at T9-T10/T10-T11 into sub arachnoid space. Group GA – given general anesthesia using propofol, fentanyl citrate and atracurium besylate. After intubation, ventilation was controlled and balanced anesthesia was continued with isoflurane. After completion, neuromuscular block was anatagonized neostigmine methylsulfate and glycopyrrolate at the end of surgery. Results: Isobaric spinal anesthesia showed good control in intraoperative as well as postoperative pain control as compared to general anesthesia. In few patients, there were minor degrees of nausea, vomiting, abdominal pain, shoulder pain, patient anxiety or itchng which were treated with standard medication like fentanyl and midazolam. All patients can resume oral intake on the day of surgery. Conclusions: In conclusion, this study provide evidence that segmental spinal anesthesia can be used in place of general anesthesia in healthy individuals also.
Impact of Misophonia on Anxiety and Depression Among Intensive Care Unit Patient: A Survey
Authors:   Professor and Head, Dept. of Anaesthesiology and Critical Care, Melmaruvathur Adhiparasakthi Medical and paramedical Institute, Tamil Nadu-603319, India., Thangavelu Swarnalingam , Chandran Ramya ,   Assistant Professor, Dept. of Physiotherapy, Melmaruvathur Adhiparasakthi Medical and paramedical Institute, Tamil Nadu-603319, India., Divakaran A. ,   Professor and Head, Dept. of Physiotherapy, Melmaruvathur Adhiparasakthi Medical and paramedical Institute, Tamil Nadu-603319, India.
Published: January 2024

Background: Misophonia is a disorder were certain sounds triggers the emotional and physiological responses of the particular individual. Studies states that it is caused by increased autonomic nervous system activity to particular sounds leads to irritation, anger and anxiety and reduces the tolerance capacity to particular sounds which leads to anxiety and depression. This study deals about impact of misophonic on hospital related anxiety and depression among intensive care unit patients. Method: 43 patients fulfil the inclusion criteria and they were surveyed initially whether they have disturbance to particular sound in intensive care unit after a week of admission and they were noted as misophonic sounds and their disturbance level were scored with Amsterdam misophonia scale A-MISO-S. On the same day patients were scored for hospital anxiety and depression questionnaire (HADS). Participants were participated through direct interview on bedside. Scoring was done based on the method given in the questionnaire. Result: Subjects were categorized into five different age groups. Young adult (17-30), middle aged adulty (31-45), old adults (46-64), youngest old (65-74), middle old (75-84). The result shows that middle aged adult and old adult experiences highest level of anxiety, depression and misophonia with mean value of (18±0.53, 18.5±0.92 and 20.8±3.04) and (16±0.70, 16.38±0.85 and 16.23±1.16) where as, young adult around (13.6±0.86, 14±0.86 and 13.5±4.12). The least amount of depression was experienced by individuals with age more than 65. Conclusion: From the result it concluded that misophonia is directly related for anxiety and depression in intensive care unit patient. The significant difference in misophonia between anxiety and depression indicates that early management of symptoms or identification of psychological stress among intensive care unit patients is needed to prevent future complications.
Hypokalemic Periodic Paralysis: A Case Report
Authors:   Second year postgraduate, Department of Anesthesiology, Sri Devaraj URS Medical College, SDUAHER, Kolar 563101, Karnataka, India., Kushal Sonnappa Marappa , Sunand Ankitha ,   Assistant professor,  Department of Anesthesiology, Sri Devaraj URS Medical College, SDUAHER, Kolar 563101, Karnataka, India., Vasantha Naga Seshu Kumari ,   Associate professor, Department of Anesthesiology, Sri Devaraj URS Medical College, SDUAHER, Kolar 563101, Karnataka, India., Madhusudhana Ravi ,   Professor, Department of Anesthesiology, Sri Devaraj URS Medical College, SDUAHER, Kolar 563101, Karnataka, India.
Published: January 2024

Introduction: Hypokalemic Periodic Paralysis is one form of Periodic Paralysis, a rare group of disorders that can cause sudden onset weakness. Although rare, Periodic paralysis must be differentiated from other causes of weakness and paralysis so that the proper treatment can be initiated quickly. Case Report: A 72 year-old elderly male presented to the emergency room with sudden onset of paralysis. He had no respiratory or swallowing difficulty and was able to move his neck and facial muscles. Neurologic exam revealed flaccid paralysis bilateral lower extremities which involved the proximal and distal muscles. Sensation was intact but deep tendon reflexes were slightly diminished to 3 out of 4 throughout. RFT deranged with serum creatinine level of 1.7 (0.6- 1.2mg/dl), potassium level of 1.6 (3.5–5 mmol/L), magnesium level of 0.9 (1.3-2.1meq/l). Electrocardiogram revealed bradycardia and left axis deviation. Two hours after initiation of intravenous potassium replacement, the patient's neurologic symptoms started resolving. The patient was diagnosed with Hypokalemic Periodic Paralysis and was started on calcium channel blocker for control of blood pressure. He was discharged home with an appointment to follow up. Conclusion: Periodic Paralysis should be kept in mind when a patient comes with sudden onset weakness or paralysis, especially when other diseases have been ruled out. It can be life threatening if the treatment is improper, but intervention and subsequent correction of potassium abnormalities can clear the symptoms completely. The underlying etiology should be searched properly to avoid recurrence or persistence of the paralysis.
Heat Stroke in a COVID-19 Field Hospital
Authors:   Associate Consultant, Department of Emergency Medicine, Holy Family Hospital, Mumbai 400050, Maharathra, India., Vajifdar Farzin , Pavrey Renaldo ,   Lead Consultant & Head, Department of Emergency Medicine, Prince Aly Khan Hospital, Mumbai 400010, India.
Published: January 2024

Heatstroke is a medical emergency warranting critical, time sensitive interventions. Due to its infrequent occurrence inside medical facilities, and symptoms overlapping with other commonly seen conditions in an emergency setting, the recognition of heatstroke is often undermined. With the ongoing SARS CoV-2 pandemic, Several makeshift field hospitals have been set up in Mumbai, India. Heatstroke is not a common occurrence in patients infected by the SARS CoV-2 virus. More so, it is almost never anticipated in hospitalized individuals. Our case report aims to highlight the unusual presentation of a heat illness occurring inside a field hospital dedicated to managing Coronavirus disease (COVID-19). We hope to sensitize the clinician to this rare event, and subsequently aim towards preparedness and mitigation for the future strategizing of such field hospitals.
Spontaneous Subcutaneous Emphysema and Pneumomediastinum in Young Male Adult
Authors:   Junior consultant, Department of Emergency, Ramkrishna Care Hospital, Raipur 492001, Chhattisgarh, India., Chowdhury Apurva , Singh Santosh Kumar ,   Head of department,Department of Emergency, Ramkrishna Care Hospital, Raipur 492001, Chhattisgarh, India., Vaja Uvesh ,   Senior Consultant, Department of Emergency, Ramkrishna Care Hospital, Raipur 492001, Chhattisgarh, India.
Published: January 2024

Spontaneous pneumomediastium refers to the presence of air in the mediastinum without any obvious cause. It is an uncommon condition occurring due to alveolar rupture as a result of increased intrathoracic pressure. In this report, we present a case of Subcutaneous Emphysema and Spontaneous Pneumomediastium. Although there are several causes responsible for this condition, it is extremely rare to occur spontaneously with no prior trauma or Predisposing factors, especially in older age groups.
Comparison of Norepinephrine & Terlipressin vs Norepinephrine Alone for Management for Septic Shock
Authors:   Department of Emergency Medicine, Gujarat Adani Institute of Medical Science, Bhuj, Kutch-370001, Gujarat, India., Navlekar Madhav , Mehta Harshil ,   Assistant Professor, Department of Emergency Medicine, Gujarat Adani Institute of Medical Science, Bhuj, Kutch-370001, Gujarat, India.
Published: January 2024

Introduction: Sepsis is a clinical syndrome that has physiologic, biologic, and biochemical abnormalities caused by a dysregulated inflammatory response to infection. The present study aimed to estimate the dose of injection of norepinephrine in micrograms/ kg/min after 12 hours of starting the vasopressor infusion to keep an MAP of above 65 mm Hg. Materials & Method: The study was done for the period of two years. Patients who were 18 years and above; who were diagnosed with septic shock during their ICU course and whose relatives gave informed written consent were included in the study. Result: Total of 12 patients were lost during the study period and so in total 100 patients were enrolled for the study. Both the groups were comparable with respect to the MAP (p = 0.655). The norepinephrine dose in group I vs group II at 12 hours was found to be 0.163 ± 0.089 vs 0.396 ± 0.18 μg/kg/min (p <0.001). Reduction in blood lactate concentration in 12 hours was significantly higher in group I [1.479 ± 1.46] than group II [0.08 ± 1.50] mmol/L (p = 0.002). Increase in the urine output of the patients in 12 hours in Group I [0.72 ± 0.44] than group II [0.47 ± 0.460] mL/kg/hour (p = 0.001). Conclusion: A low-dose continuous infusion of terlipressin may have a significant role in ensuring better organ perfusion, preventing renal injury, and improving the SOFA score of the patients when used in adjunct to norepinephrine, early in the management of septic shock.
Comparative Evaluation of Levobupivacaine and Levobupivacaine with Dexmedetomidine in Infraumbilical Surgeries
Authors:   Assistant professor, Department of Emergency Medicine, Gujarat Adani Institute of Medical Science, Bhuj, Kutch-370001, Gujarat, India., Mehta Harshil , Navlekar Madhav ,   Associate Professor, Department of Emergency Medicine, Gujarat Adani Institute of Medical Science, Bhuj, Kutch-370001, Gujarat, India.
Published: January 2024

Background and Aim: Spinal anesthesia is a widely used technique providing faster onset with effective and uniformly distributed sensory and motor block. Due to decreased cardiovascular and central nervous system toxicity, levobupivacaine is a good alternative for spinal anesthesia. Present study was done to compare the effects of adding of dexmedetomidine to levobupivacaine in prolonging the analgesia produced by epidural levobupivacaine alone in patients undergoing infraumbilical surgeries. Material and Methods: A prospective study was carried out which included 100 adult patients between the age group of 20 and 65 years of physical status American Society of Anesthesiologists Classes I and II who underwent infraumbilical surgeries. Group L patients received 3 ml (15 mg) of 0.5% isobaric levobupivacaine + 0.3 ml normal saline while Group LD patients received 3 ml (15 mg) of 0.5% isobaric levobupivacaine + 0.3 ml (3 μg) dexmedetomidine. The two groups were compared with respect to the onset and duration of sensory and motor block and hemodynamic stability. Results: In Group LD, increase in VAS was observed at 210 min and the first dose of rescue analgesia was given at 5th h postoperatively. The second dose of recue analgesia was given at 12th h and the third dose was given at 21st h. Postoperative VAS scores at different time intervals were significantly lower in Group LD than Group L, thus indicating superior analgesia. The time of request of the first dose of rescue analgesia was delayed in Group LD and the difference in the two groups was highly significant (P < 0.001). Conclusion: Epidural administration of dexmedetomidine with levobupivacaine hydrochloride 0.5% results in faster onset of sensory and motor blockade compared to levobupivacaine hydrochloride 0.5% alone. Dexmedetomidine as an adjuvant to levobupivacaine hydrochloride 0.5% provides superior quality of analgesia without any significant hemodynamic instability.
Pericardial Tamponade in Infant with upper Respiratory Tract Infection
Authors:   First year trainee, Department of Emergency Medicine, Max Super Speciality Hospital, Shalimar Bagh, Delhi 110088, India., Mitra Manas , Rajpal Bumika ,   First year resident, Department of Emergency Medicine, Max Super Speciality Hospital, Shalimar Bagh, Delhi 110088, India., Rawat Anita ,   Senior consultant, Department of Emergency Medicine, Max Super Speciality Hospital, Shalimar Bagh, Delhi 110088, India., Datta Kishalay ,   Director and HOD, Department of Emergency Medicine, Max Super Speciality Hospital, Shalimar Bagh, Delhi 110088, India.
Published: January 2024

Infectious pericarditis is a rare phenomenon in the era of antibiotics and vaccines. The number of patients with Haemophilus influenzae are rising (in rare cases) and commonly affect the adult population. Haemophilus influenzae is rarely seen in children due the advancement of vaccination. We describe a case where a 1 year infant suffering from cardiogenic shock, its management in the emergency room.
Devic’s Disease: The Confusing CNS Disease
Authors:   Resident, Department of Emergency Medicine, Max Hospital, Shalimar Bagh 110088, New Delhi, India., Althaf Shebin , Khanal Manoj ,   Associate Director, Department of Neurosciences, Max Hospital, Shalimar Bagh 110088, New Delhi, India., Rawat Anita ,   Senior consultant, Department of Emergency Medicine, Max Hospital, Shalimar Bagh 110088, New Delhi, India., Datta Kishalay ,   Director and HOD, Department of Emergency Medicine, Max Hospital, Shalimar Bagh 110088, New Delhi, India.
Published: January 2024

Neuromyelitis optica spectrum is order (NMOSD) is a rare auto-antibody mediated disease of the central nervous system involving the central nervous system. The symptoms should alert the clinician to the diagnosis. Prompt diagnosis in the emergency department plays a crucial role as delay in diagnosis and initiation of management will lead to increased chances of morbidity and mortality. Approximately 80% of NMO patients have auto-antibodies against aquaporin-4, a water channel expressed on astrocytes. In this case report, we discuss a patient with NMO disease, the diagnosis and its management.
A Case of Aneurysmal Sub Arachnoid Hemorrhage Complicated by Nstemi and Acute Pulmonary Edema
Authors:   Senior Specialist, Department of Emergency Medicine, Aster RV Hospital, Bengaluru 560078, Karnataka, India., Kasyap K. Harish , K. S. Harish ,   Head of the Department, Department of Emergency Medicine, Aster RV Hospital, Bengaluru 560078, Karnataka, India.
Published: January 2024

Aneurysmal SAH is a life threatening event which can cause permanent disability, the mortality and morbidity will be increased with associated complications like ACS and Acute pulmonary edema, which are rare complications of aneurysmal SAH. The combination of these three conditions imposes important treatment dilemmas. These patients tend to have electrocardiographic changes along with elevated cardiac biomarkers and neurogenic stress cardiomyopathy and pulmonary edema.
Acute Ascending Paralysis: Time Limited Diagnostic Perplexity
Authors:   Junior Resident, Department of Internal Medicine, Department of Emergency Medicine, KS Hegde Medical Academy, Deralakatte, Mangalore 575018, Karnataka, India., R Rohith Krishnan , SS Vijay Kumar ,   Assistant Professor, Department of Emergency Medicine, KS Hegde Medical Academy, Deralakatte, Mangalore 575018, Karnataka, India.
Published: January 2024

Ascending paralysis is a rare neurological manifestation characterized by progressive weakness that starts in the lower extremities and ascends towards the upper body. GuillainBarré Syndrome (GBS) is a common cause of ascending paralysis and is typically preceded by an infection. We present two case reports, who presented with ascending paralysis, which was initially suspected to be GBS. However, further evaluation revealed an underlying neuropathy contributing to the clinical presentation with a vasculitic etiology. This case highlights the importance of considering alternative etiologies when evaluating patients with ascending paralysis, as over lapping clinical features between GBS and neuropathies can present diagnostic challenges. Early recognition and prompt initiation of appropriate treatment are crucial for favorable patient outcomes.
To Study Correlation between MOD Score and Biomarker Values for Early Prediction of MODS in Suspected Cases of Sepsis Cases in Hospital
Authors:   Consultant & Head, Department of Emergency Medicine, Alchemist Hospital, Panchkula 134112, Haryana, India., Kalra Madhur , Shah Dina J ,   Group Head, Emergency Medicine, Yatharath Super Speciality Hospitals, Noida 201318, Uttar Pradesh, India., Pandey Nalini Bala ,   Consultant, Department of Emergency Medicine, Lok Nayak Hospital, Delhi 110002, India, Singhal Akash ,   Senior Resident, Critical Care, Artemis Hospital, Gurgon 122018, India.
Published: January 2024

Background: Utility of biomarkers in early prediction of multiple organ dysfunction syndrome (MODS) in suspected cases of sepsis presenting to the Emergency Department (ED). Aim and Objectives: To correlate the biomarker values (Pro-calcitonin (PCT), C-reactive protein (CRP), NT-pro BNP and Neutrophil gelatinase associated lipocalin (NGAL) with multiple organ dysfunction (MOD) score and to evaluate their role in early prediction of MODS in suspected sepsis patients presenting to ED. Methods: This is a prospective observational study conducted on 65 patients with suspected sepsis. Patients of 18-65 years presented in the ED with triage complaints of fever, respiratory, urinary and abdominal infections, who were sepsis screen positive on arrival and admitted, were enrolled in the study. They were categorized into two groups: Group 1 (MODS score Positive at 48 or 72 hours) and Group 2 (MOD score Negative). Biomarker values in both the groups and its correlation with MOD score was analyzed. Results: At 48 hours, 40 (61.5%) patients were MODS positive with PCT (Sensitivity 100%, OR-12.6, CI-0.6-255.04, p=0.098), CRP (Sensitivity 100%, OR-27.0, CI-1.44-504.0, p=0.027), NTpro BNP (Sensitivity 82.5%, OR-7.07, CI-2.55-22.16, p=0.0008) and NGAL (Sensitivity 77.5%, OR-82.9, CI-9.7-698.16, p=0.0001) with PPV of NGAL (96.88%) and NT-pro BNP (76.74%) and 100% NPV for PCT and CRP. Conclusion: This study established a good correlation of NT-pro BNP and NGAL with positive MODS score suggestive of and highly predictive of developing MODS in suspected cases of sepsis. The normal value of PCT and CRP on arrival in patients with suspected sepsis rules out MODS even at 72 hours during their hospital stay.
Bilateral Renal Cortical Necrosis following Snake Envenomation: A Comprehensive Case Report and Analysis of the Underlying Pathophysiological Mechanisms and Treatment Approaches
Authors:   Assistant Professor, Department of Emergency Medicine, KS Hegde Medical Academy Deralakatte, Mangalore 575018, India., SS Vijay Kumar , Shekhli Shabbir ,   Assistant Professor, Department of Emergency Medicine, S. Nijalingappa Medical College, Navanagar 587102, Bagalkot, India., Jose Anila ,   Assistant Professor, Department of General Medicine, Sree Narayana Institute of Medical Sciences Chalakka, kunnukara 683594 India.
Published: January 2024

Acute bilateral renal cortical necrosis (RCN) is a rare but potentially lethal form of renal injury that poses a diagnostic and therapeutic challenge for clinicians. The causes of renal cortical necrosis are multi-factorial. Renal cortical necrosis shows a higher incidence in men than women in non-obstetric cases, and its clinical presentation is heterogeneous, ranging from asymptomatic to severe renal failure. In this case report, we describe the clinical course of a patient who presented with acute renal failure following a venomous snake bite and was subsequently diagnosed with renal cortical necrosis. Despite aggressive management, the patient ultimately succumbed to death on the 24th day of admission. The present case highlights the importance of early diagnosis, prompt initiation of appropriate management, and effective prevention of complications in patients with renal cortical necrosis to improve patient outcomes and reduce morbidity and mortality. A timely and accurate diagnosis of renal cortical necrosis is critical for initiating appropriate interventions, and management should aim to address the underlying cause and prevent potential complications.
Effectiveness of Structured Teaching Programme on Knowledge and Attitude Regarding Cervical Cancer Screening among Women attending OPD
Authors:   Student, Department of Nursing, KGMU College of Nursing, Lucknow 226003 Uttar Pradesh, India., . Ramakanti , P John Rashmi ,   Principal, Department of Nursing, KGMU College of Nursing, Lucknow 226003 Uttar Pradesh, India., Agarwal Anjoo ,   Associate Professor, Department of Nursing, KGMU College of Nursing, Lucknow 226003 Uttar Pradesh, India., Lata Suman ,   Clinical Instructor, Department of Nursing, KGMU College of Nursing, Lucknow 226003 Uttar Pradesh, India.
Published: January 2024

Context: Cervical cancer screening is helpful in finding abnormal proliferation of cells in cervix which leads to cervical cancer. Screening of cervical cancer includes cervical cancer which also known as Pap test and some women go through human papilloma virus (HPV) for cervical screening. Cervical cancer usually takes 3-7 years in proliferation of high grade abnormal cells to become a cancer. Cervical cancer screening is helpful in detecting these abnormal changes in the cells of the cervix before they give rise to cancer. Aim: This study was aimed to determine the effectiveness of structured teaching program on knowledge and attitude regarding cervical cancer screening among women attending OPD. Methodology: In this study quasi experimental one group pretest post test design was applied. Convenient sampling technique was used to select the 82 women attending OPD who met the inclusion criteria. Statistical Analysis used: Mean, mean difference, standard deviation, t-test and chi-square. Result: The result revealed that after the intervention the mean and standard deviation of the post test knowledge was 13.08+1.71 being compared to the mean and standard deviation of pre test knowledge 7.33+2.63. It indicates that there was a significant improvement in the level of knowledge of women. The calculated‘t’ value (4.83) on analysis of the data was found to be significant at ‘p’ value 0.05. Conclusion: The study concluded that a structured teaching program was effective in improving the level of knowledge and attitude of women regarding cervical cancer screening.
Sars Cov2 Infection and Vascular Complications during Antepartum Period in Pregnancy
Authors:   Post Graduate Student, Department of Obstetrics and Gynecology, Bharati Vidyapeeth (Deemed University), Pune, Maharashtra 411030, India,, Talathi Manju , Taralekar Vaishali ,   Post Graduate Student, Department of Obstetrics and Gynecology, Bharati Vidyapeeth (Deemed University), Pune, Maharashtra 411030, India,, Gupta Surbhi ,   Post Graduate Student, Department of Obstetrics and Gynecology, Bharati Vidyapeeth (Deemed University), Pune, Maharashtra 411030, India,, Balasaheb Deshmukh Rupeshkumar ,   Statician, Department of Community Medicine, Bharati Vidyapeeth Medical College, Pune, Maharashtra 411030, India.
Published: January 2024

Background: COVID 19 infection is the profanation for the mother in late gestation in respect to vascular complication due to sharing of the same Pathophysiology. Aim: To evaluate the incidence of vascular complications in covid positive mothers in late gestation. Objectives: a. To study the incidence of Preeclampsia, Fetal growth restriction, obstetric Doppler changes in covid positive mothers. b. To correlate the patho physiology of COVID 19 and vascular complication in pregnancy. c. To correlate the clinical and biochemical  ndings of Covid 19 infections with vascular complications in pregnancy. Settings and Design: This was the observational study carried out in a tertiary health care center. Materials and Method:A prospective observational study was conducted with 103 covid positive pregnant women who were presented to the department of obstetrics and gynaecology, Bharati Vidyapeeth deemed university, Pune between June 2020 to May 2021. Covid positive mothers with the onset of vasculopathies and other related complication have been observed. COVID 19 infection and pregnancy vascular pathology have been correlated. Conclusion: In our study, inflammatory markers has been observed significantly raised in covid positive women who were symptomatic with vasculopathies as compared to symptomatic covid positive women without vasculopathies. Clinical Significance:In present Covid era pregnant women are vulnerable to obstetric complications in late gestation as IUGR, Preterm labour with pre mature rupture of membranes, colour Doppler changes, Oligohydramnios, Preeclampsia .It is due to sharing the same patho physiology of Covid 19 and vasculopathies in late period of gestation.