bluuebunny/crossref_metadata_2025 huggingface dataset:
Manajemen Strategik Pondok Pesantren Dalam Upaya Membentuk Santri Yang Berkarakter
Authors: Hasanudin Hasanudin , Kusnawan Dadang , Sadiah Dewi
Published: September 2020

Penelitian ini bertujuan untuk menemukan kejelasan tentang formulasi strategi, implementasi strategi, dan evaluasi serta pengendalian strategi pada Pondok Pesantren Al-Masthuriyah dalam upaya membentuk santri yang berkarakter. Metode yang digunakan pada penelitian ini adalah metode deskriptif dengan pendekatana kualitatif. Pengumpulan data dilakukan dengan teknik observasi, wawancara, dan dokumentasi sehingga data dapat terkumpul dan dianalisis dengan baik. Penelitian ini menemukan bahwa manajemen strategik Pondok Pesantren Al-Masthuriyah telah diterapkan sesuai dengan tahap-tahap manajemen strategik, yaitu formulasi strategi yang didasarkan pada hasil analisis SWOT, kemudian dituangkan dalam keputusan strategi-strategi yang menjadi nilai jual inti pondok pesantren. Implementasi strategi telah berjalan dengan baik, yaitu dengan melaksanakan program-program yang tersusun, serta penerapan tata tertib santri. Evaluasi dan pengendalian strategi dilkaukan secara terus menerus oleh pimpinan, pengurus, dan karyawan dengan agenda dan jenis rapat yang berbeda. Akhirnya dari seluruh tahapan manajemen strategik yang telah ditetapkan dapat disimpulkan bahwa manajemen strategik pada Pondok Pesantren Al-Masturiyah telah dijalankan dengan baik dan menunjukan keberhasilan yang cukup signifikan dalam upaya membentuk santri yang bekarakter.

This study aims to find clarity about strategy formulation, strategy implementation, and evaluation and strategy control at Al-Masthuriyah Islamic Boarding School in an effort to form santri with character. The method used in this research is descriptive method with a qualitative approach. Data collection is done by observation, interview, and documentation techniques so that the data can be collected and analyzed properly. This study found that the strategic management of Al-Masthuriyah Islamic Boarding School has been applied in accordance with the stages of strategic management, namely the formulation of strategies based on the results of the SWOT analysis, then poured into decisions on strategies that are the core selling points of Islamic boarding schools. The implementation of the strategy has been going well, namely by implementing structured programs, as well as the application of the santri code of conduct. Strategy evaluation and control are carried out continuously by leaders, management and employees with different agendas and types of meetings. Finally, from all the stages of strategic management that have been determined, it can be concluded that the strategic management at Al-Masturiyah Islamic Boarding School has been carried out well and has shown significant success in the effort to form students with character.
MSDM Pondok Pesantren
Authors: Saefulloh Ahmad , Zulkarnaen Fisher , Sadiah Dewi
Published: September 2020

ABSTRAK

Penelitian ini bertujuan untuk mengetahui bagaimana implementasi manajemen sumber daya manusia pondok pesantren pagelaran II sumedang, dan mengetahui bagaimana hasil kinerja santri di pondok pesantren pagelaran II sumedang.Metode yang digunakan dalam penelitian ini adalah metode deskriptif, pengumpulan data dilakukan dengan menggunakan teknik observasi, studi dokumentasi dan wawancara.Hasil Penelitian ini menemukan bahwa peran manajemen sumber daya manusia dalam mengoptimalkan kinerja santri di pondok pesantren pagelaran II sumedang yang diawali dengan pengolaan dalam bentuk fungsi perencanaan dan operasional yang baru.Terutama pengrekrutan jajaran assatidz yang berdedikasi dan berpendidikan tinggi masuk ke pondok pesantren pagelaran II. Sehingga keberlangsungan pesantren akan berinovasi dan pengendalian selalu sesuai dengan perkembangan zaman. Sehingga dapat disimpulkan bahwa manajemen sumber daya manusia di pondok pesantren pagelaran II sumedang telah dijalankan dengan baik dan menunjukan keberhasilan dalam upaya menyiapkan insan kamil.

ABSTRAK

It aims to know how to implementation of human resources management hut pesantren by fire ii, and find out How did santri's performance result in the pesantren pagelaran 2 Sumedang. The method used in this study is a descriptive method, data collection is done using observation techniques, a documentary study and debriefing. This study found that human resource management's role in optimizing santri's performance in pondok pesantren pagelaran 2 Sumedang. That begin with processing in the form of new planning and operational functions. Particularly recruits for the dedicated, highly educated assatidz went into the pagelaran 2 Sumedang. So martial arts have continued to innovate and control always conforms to the development of The Times. So it is inadmissible that the human resources management at pesantren pagelaran 2 sumedang has been well run and show that is successful in preparing for the perfect human being.
Go WILD, Not WEIRD
Authors: Newson Martha , Buhrmester Michael , Xygalatas Dimitris , Whitehouse Harvey
Published: September 2020

Reliance on convenience samples for psychological experiments has led to the oversampling of Western, Educated, Industrialized, Rich, and Democratic (WEIRD) populations (Henrich et al. 2010a). Our analysis of academic articles from six leading psychology journals revealed a significantly lower but still very high percentage of studies from European and English-speaking nations (92%), compared to a decade ago (95%), largely due to more studies from Asia (6%). Further analysis of four cognitive science of religion (CSR) journals showed how a more representative field is possible (67% from the Western and Other region), with proportionately more studies in Latin America (4%) and Africa (7%) than psychology (<1% each). Thanks to its interdisciplinary nature, CSR is in a good position to address “WEIRD” problems and may be able to offer psychology methodological and epistemological tools that involve diversifying sample populations, increasing ecological validity, capturing the causes and consequences of cultural variation, and developing novel methodologies. Despite the challenges, we encourage more researchers to embrace the lessons offered by CSR’s history of global and interdisciplinary research. Where WEIRD identifies the populations we need to stop privileging, conducting work that is not just Worldwide, but also In Situ, Local, and Diverse (WILD) is what researchers themselves can aspire to. Just as nineteenth century “armchair anthropologists” were replaced by generations of ethnographers who went out into the real world to study human variation, so modern day psychologists need to conduct experiments outside the lab with suitably heterogeneous populations.
Adaptable Conversational Machines
Authors: Lubis Nurul , Heck Michael , van Niekerk Carel , Gašić Milica
Published: September 2020

In recent years we have witnessed a surge in machine learning methods that provide machines with conversational abilities. Most notably, neural‐network‐based systems have set the state of the art for difficult tasks such as speech recognition, semantic understanding, dialogue management, language generation, and speech synthesis. Still, unlike for the ancient game of Go for instance, we are far from achieving human‐level performance in dialogue. The reasons for this are numerous. One property of human‐human dialogue that stands out is the infinite number of possibilities of expressing oneself during the conversation, even when the topic of the conversation is restricted. A typical solution to this problem was scaling‐up the data. The most prominent mantra in speech and language technology has been “There is no data like more data.” However, the researchers now are focused on building smarter algorithms — algorithms that can learn efficiently from just a few examples. This is an intrinsic property of human behavior: an average human sees during their lifetime a fraction of data that we nowadays present to machines. A human can even have an intuition about a solution before ever experiencing an example solution. The human‐inspired ability to adapt may just be one of the keys in pushing dialogue systems toward human performance. This article reviews advancements in dialogue systems research with a focus on the adaptation methods for dialogue modeling, and ventures to have a glance at the future of research on adaptable conversational machines.
EN ÜST GELİR PAYI-BÜYÜME İLİŞKİSİ: AŞAĞI SIZDIRMA EKONOMİSİ
Authors: ARDA ÖZALP Leyla Firuze
Published: September 2020

Aşağı
sızdırma ekonomisinde, yüksek eşitsizlik seviyelerinin daha fazla ekonomik
büyüme yol açacağı iddia edilir. Bu görüşe göre, üst gelir gruplarına yönelik
daha fazla gelir akışının daha ekonomik büyümeye yol açacağı ve bu nedenle
“eşitsizlik” in toplumdaki herkes için faydalı olacağı ifade edilmektedir. Bununla
birlikte, Stiglitz (2014), pastadan zengin sınıfına daha fazla pay verilmesinin
pastayı büyütmediğini, aksine ekonomik büyümenin eşitsizliğin arttığı
dönemlerde yavaşladığını belirtmiştir. Bu çalışmada da bu noktadan
hareketle eşitsizliğin alternatif bir ifadesi olan üst gelir kesiminin gelir
içindeki payı ile ekonomik büyüme arasındaki ilişki analiz edilmek istenmiştir.
1980-2016 dönemini kapsayan panel veri analizinde 17 farklı ülkeye ait bir veri
seti kullanıyoruz ve ampirik sonuçlarımız (1) eşitsizlikle ekonomik büyüme
arasında uzun vadeli bir ilişki olduğunu ve (2) ekonomik büyümenin üst gelir
diliminde biriken daha fazla gelir nedeniyle zarar gördüğünü gösteriyor.
Collection, Packaging and Cold Shipping of Fresh Non-Islet Pancreatic (Acinar) Tissue v1
Authors: Islet Distribution Program Integrated
Published: September 2020

This SOP defines a standardized method for packaging and cold shipping of research quality, fresh Non-Islet Pancreatic (Acinar) Tissue (NIPT) to approved investigators of human isolated islet preparations, for use in the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) sponsored research in the Integrated Islet Distribution Program (IIDP). This protocol is written to assist the participating islet isolation centers and investigators who are part of this program. Note: This SOP was developed by the IIDP with assistance from Dagmar Klein, PhD, at University of Miami who has been working with acinar since 2011 when it became clear, as far as shipping and culture was concerned, that protease inhibitors must be used in the medium otherwise the tissue will digest itself.
Scale-dependent Fractal Analysis (ver. 0.1) v1
Authors: I Schaefer Ethan
Published: September 2020

This protocol supports scale-dependent fractal analysis of input geometries by the divider method. Those geometries should be 2D lines (or more precisely, linestrings). For each such geometry, the protocol generates three plots: fractal dimension vs. representative scale, goodness of model fit vs. representative scale, and an example "Richardson plot" of measured length vs. rod length (for a single representative scale). This protocol is archived in association with the following preprint: Schaefer, E. I., Hamilton, C. W., and Neish C. D. (2020), "Reexamining the potential to classify lava flows from the fractality of their margins", Earth and Space Science Open Archive (https://www.essoar.org/).
Development of Algorithm of Surgical Treatment Choice in Patients with Cataract and Asteroid Hyalosis
Authors: Korotkikh S. A. , Grinev A. G. , Sviridova M. B. , Danilov A. M.
Published: September 2020

The method of phacovitrectomy can be used for surgical treatment of patients with cataract and asteroid hyalosis. However, there is still a topical question in the choice of surgical treatment taking into account the completeness of the posterior hyaloid membrane (PHM) detachment.

Patients and methods: the study involved 24 patients (24 eyes) with cataract and asteroid hyalosis. The average age of patients was 72.9 years, out of the total number of men — 11, women — 13. Pre-and postoperative diagnosis of all patients included standard methods of investigation, as well as optical coherence tomography performed on the Cirrus HD-OCT 400, Carl Zeiss, Germany. Pre-and postoperative subjective satisfaction was assessed using a validated visual Function Qusetionnaire 14 ophthalmological questionnaire. Patients were divided into 3 groups. In the first group of patients, cataract phacoemulsification with posterior chamber lens implantation and total three-port vitrectomy through a flat part of the ciliary body were performed. In the second patients’ group, cataract phacoemulsification with posterior chamber lens implantation and subtotal vitrectomy through posterior capsulorexis were performed. In the third group of patients, cataract phacoemulsification with posterior chamber lens implantation was performed. All operations were performed with the help of ophthalmic systems Infinity Vision System (Alcon, USA) and Constellation Vision System (Alcon, USA).

Results: in the first day after the operation, all patients noted improvement in visual acuity and quality of life, but more significant improvement was noted in patients of the first and second groups.

Conclusion: analysis of the results of surgical treatment, questionnaire survey, preoperative diagnosis allowed to develop an algorithm for choosing the method of surgical treatment in patients with cataract and asteroid hyalosis, taking into account the state of PHM.
Рhotopic Negative Response for Testing the Function of Inner Retina: Registration Requirements and Comparison in the Eyes with Natural Pupil Width and in Conditions of Drug Mydriasis
Authors: Kotelin V. I. , Kirillova M. O. , Zueva M. V. , Tsapenko I. V. , Zhuravleva A. N. , Kiseleva O. A. , Bessmertny A. M.
Published: September 2020

Purpose: To evaluate the possibility of registration of the photopic negative response (PhNR) without pupil dilatation in healthy individuals to determine the dysfunction of neurons of the inner retina.

Methods: 12 healthy persons (23 eyes) aged 24 to 40 years were examined. Refraction anomalies did not exceed 0.5 diopters. A PhNR was evaluated in photopic ERGs recorded on a blue background with red flashes of four intensities (0.375, 0.75, 1.5, 3.0 cd·s/m2) using the RETIport/scan21 (Roland Consult). First, ERG was recorded with the natural pupil (3.5 ± 0.2 mm). Then, the recording was repeated after drug mydriasis (average pupil size 8.7 ± 0.1 mm).

Results. In eyes with natural pupil width, in comparison with drug mydriasis, PhNR amplitudes in responses to weakest stimuli (0.375 cd·s/m2) were significantly reduced. The effect of pupil size on the PhNR amplitude from a baseline was virtually absent in responses to higher strength flashes. This phenomenon can be associated with an irregular distribution of light over the retina with small pupil size, the effect of which is maximal in responses to weak flashes. For the maximal brightness stimuli (3.0 cd·s/m2), differences were found between groups of non-dilated and dilated pupils in the amplitudes of the b-wave and PhNR from the b-peak, which may reflect a decrease in the number of stimulated photoreceptors during ganzfeld stimulation when the pupil is not dilated.

Conclusion. The effect of pupil size on the parameters of the PhNR was most significant in the ERG with minimal flash strength and it decreases in responses to flashes of higher brightness. If it is necessary to record the ERG without drug mydriasis, especially in screening studies, it is recommended to limit the protocol to estimate the PhNR from a baseline in responses to maximal flashes, and use the relative parameter — the amplitude ratio of PhNR/b. Keywords: photopic negative response, electroretinography, pupil width
Мethod of Functional Treatment of Refractive Amblyopia in Children Using Alternating Presentation of Stereo Stimules
Authors: Rychkova S. I. , Likhvantseva V. G.
Published: September 2020

The research is devoted to one of the most urgent problems of modern ophthalmology — the search for new approaches to creating effective methods of functional treatment of refractive amblyopia using computer technologies.

The purpose of the work is to evaluate the effectiveness of computer technology with consistent use of alternating and non-alternating modes of presentation of stereostimulars in the functional treatment of refractive amblyopia in children.

Patients and methods. 105 patients with refractive amblyopia at the age of 7 to 17 (on average 11.45 ± 0.3) years were observed. Refraction was hypermetropic in 31 (29.5 %) children, myopic in 62 (59 %) and mixed astigmatism was detected in 12 (11.5 %) children. The visual acuity of the best-seeing eye was on average 0.76 ± 0.01, that of the worse-seeing eye was 0.68 ± 0.02, and that of the binocular eye was 0.77 ± 0.01. In the study on synoptophore, all children had normal correspondence of the retina with the fusion reserves, which were significantly reduced. The character of vision was binocular in all children, but the presence of stereo vision on the Fly test was detected in 96 (91.4 %) children, and on the Lang test only in 73 (69.5 %) children. Functional treatment was performed using computer programs with sequential use of modes of alternating and non-alternating presentation of stereo stimuli with certain characteristics.

Results. As a result of the course of treatment, the number of children with stereo vision increased from 96 (91.4 %) to 105 (100 %) on the Fly test and from 73 (69.52 %) to 97 (92.4 %) on the Lang test. In addition, there was a significant increase in visual acuity (on average, up to 0.96 ± 0.01 for the best-seeing eye, up to 0.9 ± 0.01 for the worse-seeing eye, and up to 0.97 ± 0.01 binocularly). There was also an increase in positive fusion reserves by 1.5 times and negative reserves by 1.3 times.

Conclusion. Visual training with computer programs that provide the consistent use of modes of alternating and non-alternating presentation of stereo stimuli with certain characteristics is an effective way of functional treatment of refractive amblyopia in children, allowing to increase monocular and binocular visual acuity, improve the performance of fusion reserves and improve the state of stereo vision.
Impact of Eye Drops Instillation of Antihypertensive Drugs on the Refractive Power of the Cornea
Authors: Belov D. F. , Nikolaenko V. P.
Published: September 2020

Purpose: to assess effect of eye drops instillation on the refractive power of the cornea and potential intraocular lens (IOL) power calculation errors appearing related within.

Patients and methods. There were 478 patients divided in 3 groups: 1st — patients without glaucoma and topical treatment (n = 325); 2nd — individuals with primary open angle glaucoma (POAG) on treatment (n = 122); 3rd — patients with POAG and previous trabeculectomy (TE) without using eye drops (n = 31). For each patient keratometry was performed by IOL-Master 500. Mean preoperative keratometry and corneal astigmatism were compared within IOL calculation error received by Barrett Universal II formula 1 month after phacoemulsification (PE).

Results. Mean keratometry was significantly (p < 0.001) less (0.6 D) at the 1st group (44.00 ± 1.96 D) versus 2nd group (44.6 ± 1.76 D). Cancellation of topical eye drops due to TE leads to insignificant decline of corneal curvature (from 44.6 ± 1.76 D to 44.1 ± 1.59 D). There was no any difference in corneal astigmatism level between study groups (0.92 ± 2.23 D, 0.8 ± 0.59 D and 0.86 ± 0.50 D for groups respectively) as like as no distinction in IOL calculation error in these groups (–0.08 ± 0.57 D, –0.06 ± 0.6 D and 0.003 ± 0.61 D). However, men have more flatter cornea (43.6 ± 1.98 D) than women (44.4 ± 1.80 D) (p < 0.001). Mean keratometry at the age group 60–74 years was less (43.7 ± 2.3 D) than at 75–90 years (44.4 ± 1.54) (p = 0.002).

Conclusion. Patients with coexistent cataract and glaucoma on treatment require special attention in IOL calculation. To avoid keratometric errors it is recommended to prescribe lubricants and change hypotensive eye drops to preservative-free analogs to form a stable tear film.
Сlinical Case of Macular Hole Recurrence after Surgical Treatment with Platelet-Rich Plasma
Authors: Cherepov D. V. , Goziev S. J.
Published: September 2020

Purpose: presentation of a clinical case of an idiopathic macular hole (IMH) recurrence after its successful closure augmented with platelet-rich plasma (PRP) and the results of repeated surgical treatment.

Methods. The patient underwent clinical examination and optical coherence tomography (OCT) of the retina before and after surgical treatment. А 2-stage surgical treatment of the left eye with an interval of 7 days: phacoemulsification (PE) followed by microinvasive vitrectomy with Internal limiting membrane peeling (ILM) and closure with the use of PRP. The patient was discharged with improved visual acuity and closure of the macular hole (MH). After 2 weeks vision deterioration was noted by the patient in the operated eye. Clinical examination revealed macular edema (ME) and recurrence of MH. Topical steroid eye drops were used to no avail, with increase of ME and MH via OCT control. Revision of the vitreal cavity augmented with PRP was performed.

Results. In follow-up a complete closure of the MH, resolution of ME and improvement in visual acuity after repeated surgery was confirmed.

Conclusions. A case of recurrent MH after primary closure with PRP is described. The case suggests a possibility of clinical improvement after repeated MH closure augmented with PRP. The causes and mechanisms of the recurrence of MH are still not clear. Despite the positive results of surgery subsequent OCT retina examination is necessary.
Are routine post drain removal chest x-rays necessary after oesophagectomy?
Authors: Aboul-Enein Mohamed Saad , Knight William R. C. , Foley Daniel , McKnickle Luke , Carter Harrison , Gossage James A.
Published: September 2020

Background: Routine chest X-rays (CXR) are often performed following the removal of chest drains placed during oesophagectomy. CXRs are costly and inconvenient for the patient, often being performed out of working hours. The aim of this study was to evaluate whether routine CXR is necessary following drain removal or if CXRs should only be performed when indicated by the clinical status of the patient.Methods: This was a retrospective study of oesophagectomies performed at a single high volume centre. Routine post chest drain removal CXRs were analyzed and compared to baseline post-operative CXRs. The clinical status of the patient before and after chest drain removal was recorded.Results: 188 patients were identified. 111/188 (59%) had a pleural effusion or pneumothorax on their baseline post-operative CXR. Abnormal findings on post drain removal CXR were common with 72/188 (38.3%) patients having a new or worse pleural effusion or pneumothorax. Only, 5.6% (11/188) of these patients actually developed clinical signs after chest drain removal. Of these, only 2.1% (4/188) required chest drain re-insertion. No patients underwent intervention without showing clinical deterioration. No re-intervention was prompted by CXR finding alone.Conclusions: Routine CXR following chest drain removal is unnecessary. It is safe to only perform CXRs on patients who develop clinical signs.
A comparative study of laparoscopic technique versus open repair for inguinal hernia
Authors: Anilkumar B. U. , Shyam Sharvari , Manohar S.
Published: September 2020

Background: The repair of inguinal hernias has seen an evolution over the past few decades and more research on the same is still underway. Though laparoscopy has gained widespread acceptance in today’s era of surgery, there is still a debate between laparoscopic and open hernia mesh repair.  Methods: A randomized prospective study was conducted at a tertiary care teaching hospital to compare laparoscopic hernioplasty and Lichtenstein’s open mesh repair. The study consisted of 70 subjects with unilateral or bilateral inguinal hernia and they were randomly allocated into either group. Various parameters like duration of surgery, intra and post-operative complications, post-operative pain, recurrence, stay in the hospital and resumption of daily activities were compared.Results: Out of the 70 patients, 35 underwent laparoscopic hernioplasty and 35 underwent open hernia repair. The mean operative time for laparoscopic hernioplasty (unilateral 63.44mins, bilateral 123.80mins) was greater than open hernioplasty (unilateral 47.35mins, bilateral 90.42 mins). Post-operative complications, like wound infection, seroma formation and urinary retention were noted more in the open hernioplasty group. The mean pain score for laparoscopic hernia repair was lower than open hernia repair on postoperative day 3 and 7. The average duration of hospital stay was 3.5 days in laparoscopy group and 6 days in open group. The mean duration for resumption of daily activities was 4.8 days following laparoscopic hernioplasty and 8.1 days following open hernioplasty.Conclusions: Laparoscopic hernioplasty is more beneficial than Lichtenstein’s open hernia mesh repair as it is safer, with faster recovery, lesser post-operative complications and reduced morbidity.
A clinicopathological study and management of abdominal tuberculosis
Authors: Majji V. V. Harika , Erabati Santosh Raja , M. Swetha B.
Published: September 2020

Background: Tuberculosis is a major health problem in developing countries. Inspite of considerable advances, abdominal tuberculosis still continues to be of paramount health issue in India, owing to its vague and non-specific presentation challenging the therapeutic skills of present day surgeon. Surgical intervention was frequently used in the past for diagnosis is not necessary and is reserved for complications like obstruction, perforation, fistula, or a mass which does not resolve with medical therapy.Methods: 30 patients admitted in Department of Surgery satisfying the inclusion criteria from November 2015 to October 2017. Patients were selected on a prospective basis.Results: In this study out of 30 patients, 16 patients were treated conservatively with anti- tubercular therapy (ATT) alone and 14 patients underwent surgical treatment. Out of 14 patients, 5 patients were operated on emergency basis and 9 were operated electively. Of the 5 emergency cases, 2 patients underwent resection anastomosis of small bowel, 1 patient underwent adhesiolysis, and 3 patients with hollow viscus perforation underwent perforation closure with peritoneal drainage.Conclusions: Tuberculosis has become a resurgent global problem with increasing numbers of extrapulmonary manifestations, non-specific features of abdominal tuberculosis result in difficulty in establishing a diagnosis, hence prompt initiation of treatment that can be either medical management or a surgical procedure is important to prevent morbidity and mortality associated with it.
Laparoscopic floppy Nissen fundoplication: evaluation of outcome in 34 patients operated without prior oesophageal pH and manometry
Authors: Prasad Dinesh , Kumar Abhishek , Modh Foram , Gehlot Vishnu , Kothari Purva
Published: September 2020

Background: Aim of the study was to evaluate prospectively the outcomes of laparoscopic floppy Nissen fundoplication in cohort of patients with typical symptoms of gastroesophageal reflux disease (GERD) and hiatus hernia without pre-operative 24 hours oesophageal pH and manometry study. Methods: Thirty-four patients with typical symptoms of GERD, from March 2009 to November 2019, were studied. The study was limited to patients with positive findings on upper GI endoscopy done by operating surgeon with typical symptoms (heartburn, regurgitation, and dysphagia) of GERD and hiatal hernia. Laparoscopic Nissen’s fundoplication was performed when clinical assessment suggested adequate oesophageal motility and length. Only 1 patient, who had negative endoscopic findings, underwent a 24-hour pH-monitoring before surgery. Outcome measures included assessment of the relief of the primary symptom responsible for surgery in the early postoperative period; the patient's evaluation of outcome and quality of life after surgery.Result: Laparoscopic Nissen’s fundoplication is an effective long-term treatment for GERD and may be performed in patients with typical symptoms of GERD and hiatus hernia and endoscopic findings suggestive of reflux esophagitis and patient who wants to get rid of life long proton-pump inhibitors (PPI) and antacids medication.Conclusions: Preoperative oesophageal manometry and 24-hour pH monitoring are not mandatory for laparoscopic fundoplication if the patient selection is appropriate but may be required in selected patients with atypical symptoms.
Did general surgeons surgical spectrum changed over time? A retrospective comparative study in a South Indian tertiary care centre between 2009 and 2018
Authors: Gade Veena , Meegada Someswara Rao , Alavala Chakrapani
Published: September 2020

Background: General surgery discipline has fragmented into several subspecialties over the past. This division has affected the surgical spectrum of general surgeons. Studies comparing the changes in the general surgeon's work spectrum were done in the ’90s but not in the recent past. Our study aims to compare the surgical spectrum of general surgeons between two time periods in our institute.Methods: We performed a retrospective study comparing the elective surgeries performed by general surgeons in the year 2009 and 2018 in an academic tertiary care centre.Results: There was a 28.9% rise in the total number of elective surgeries (1567 vs. 2020) in our study. There was a significant rise in the mean age of surgical patients (39.7 years vs. 41.9 years) but with no change in M: F ratio (1.7: 1). There was a significant rise in Hernia surgeries and Varicose veins surgeries (p<0.001) along with a rise in anal surgeries (p=0.018). There was a significant decrease in Breast surgeries (p=0.02) and Thyroid surgeries (p<0.001). There was a dramatic rise in the laparoscopic cholecystectomy rate (23.2% vs. 52%) and a fall in the laparoscopic appendectomy rate (26.3% vs. 8%). Open inguinal hernia surgeries were the most common surgeries performed in both the years.Conclusions: There was an increase in the surgical volume for general surgeons but the surgical spectrum has narrowed. We recommend conducting periodic surgical audits in institutions to monitor and maintain the standards of surgeries performed by general surgeons.
Evaluation of mesh fixation versus non-fixation in laparoscopic mesh hernioplasty in inguinal hernias
Authors: Kochar Shubra , Kakkar Dipanshu , Singh Devendra Pal
Published: September 2020

Background: Laparoscopic inguinal hernia repair (LIHR) is usually done by two methods, which vary in approach to the preperitoneal space; transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP). This study aimed at comparing the effect of mesh fixation and non-fixation in terms of operative time, hospital stay, analgesic requirement, complications and cost analysis with respect to fixation device in LIHR.Methods: This prospective randomized comparative study included 60 patients of inguinal hernias admitted to the Department of Surgery at Rajendra Hospital, G.M.C, Patiala from July 2016 to September 2017 (duration of study was 15 months). Cases were divided into two groups by draw of lots with group A as mesh fixation (n=30) and group B as non-fixation (n=30).Results: The results were calculated with chi square test (p value). Results were found to be not significant in two groups in the terms of postoperative analgesia, complications i.e. (intraoperative, postoperative and long term) postoperative hospital stay and time to return for work. The cost of procedure was found to be very high in Group A and results were highly significant (p<0.001).Conclusion: LIHR repair without mesh fixation shows advantages over mesh fixation, which includes significant less cost of surgery, with comparable intraoperative, postoperative and long-term complications (with no increase in hernia recurrence), hospital stay and mean operative time. Hence, our study favours LIHR without mesh fixation a valuable alterative option.
A comparative study of open preperitoneal versus laparoscopic mesh hernioplasty in cases of incisional hernia repair
Authors: Kharadi Ashish , Makwana Vikas , Patel Pranav
Published: September 2020

Background: Incisional hernias repair being done in large numbers there is still not a consensus about the best repair. Very few studies have been done on comparison open and laparoscopic incisional hernia repair.Methods: A prospective, cross-sectional study was undertaken in Department of Surgery of Civil Hospital. The study included total 50 patients, out of which 25 patients underwent open approach and rest of 25 patients, underwent laparoscopic approach. Patients were assigned to both the groups randomly.Results: Pain, duration of post-operative stay, and return to routine work is earlier in patients with laparoscopic repair mainly due to decreased pain, fewer complications, early mobility and faster return of bowel movements. Laparoscopic repair is more expensive and operative time is more as compared to open method.Conclusions: Keeping in view the advantages and limitations of laparoscopic repair, the choice among two surgical modalities should be made on a case to case basis depending on patient preference and characteristics.
Intravenous fluids in acute pancreatitis: a prospective study
Authors: Sony Jithin , Sunny Ann , Rozaria Anthony Prakash
Published: September 2020

Background: Fluid therapy is the mainstay of treatment in the management of acute pancreatitis. Most guidelines recommend aggressive fluid therapy in the initial 48-72 hours. We aimed to compare the occurrence, persistence or worsening of systemic inflammatory response syndrome (SIRS) and occurrence organ failure in patients with acute pancreatitis receiving normal and high volume fluid therapy in the first 24 hours.Methods: This was a prospective observational study. Consecutive adult patients admitted with acute pancreatitis were included in the study. SIRS was defined according to the criteria. Organ failure and local complications were defined according to Atlanta classification. Patients were divided into two groups according to the rate of fluid administered in the initial 24 hours: Normal volume group which received fluids at a rate <150 ml/hour and high volume group >150 ml/hour.Results: A total 60 patients were included in the study with 30 each in the two groups. Persistence or worsening of SIRS at 48 hours was more in normal volume fluid group compared to the high volume fluid group (p=0.076). Organ failure at 48 hours was more in normal volume fluid group compared to the high volume fluid group (p=0.074). Incidence of local complications equal in both group.Conclusions: Our study did not show any statistically significant difference in outcomes in patients with acute pancreatitis receiving normal or high volume fluids in the initial 24 hours. Further multi-centric randomised control trials are required to analyze the outcomes of high and normal volume fluid resuscitation in acute pancreatitis.
Correlation of international prostate symptom score and uroflowmetry in evaluation of benign prostatic hyperplasia
Authors: Anilkumar B. U. , Shyam Sharvari
Published: September 2020

Background: Uroflowmetry is a simple non-invasive technique in evaluating patients presenting with Lower urinary tract symptoms (LUTS), to assess voiding patterns, maximum urinary flow (Qmax), average urinary flow (Qave) and voided urine volume. Uroflowmetry is considered mandatory prior to surgical intervention in diagnosis and assessment of men with LUTS. Correlating the International prostrate symptom score (IPSS) with that of uroflowmetry results will allow a better diagnosis and help in determining more appropriate modality of treatment. Therefore, the purpose of our study is to correlate IPSS and the findings of uroflowmetry in evaluation of Benign prostrate hypertrophy (BPH).Methods: This was a prospective study of 50 patients presenting with LUTS diagnosed with BPH. Patient’s symptoms were initially evaluated by administering a pre-treatment IPSS/Quality of Life Score (QoL) and uroflowmetry. All patients underwent Transurethral resection of the prostate (TURP). A post TURP IPSS/QoL score assessment and uroflowmetry was done. Pre-operative IPSS and uroflowmetry results were correlated using spearman’s correlation coefficient. Outcome of IPSS and uroflowmetry following TURP was assessed in terms of percentage improvement.Results: Statistically significant correlation (p<0.05) was seen between IPSS and uroflowmetry results. No correlation was found between prostate volume and IPSS. Significant improvement in symptom severity (IPSS score) and uroflowmetry results was observed in post TURP patients.Conclusion: IPSS is a valuable tool in the evaluation and grading of LUTS. Correlating both IPSS and uroflowmetry results will help in better diagnosis and management of patients. It can also be concluded that IPSS and uroflowmetry can be used for evaluation and monitoring patients following prostate surgery.
A rare case of discontinuous type splenogonadal fusion in a 13 year old boy: a case report and review of literature
Authors: Jonuzi Asmir , Popović Nusret , Zvizdić Zlatan , Milišić Emir , Bukvić Melika , Sefić Irmina , Džananović Amra , Mesic Amira , Chikha Adisa , Zukanović Amila , Kulovac Benjamin
Published: September 2020

Splenogonadal fusion (SGF) is a rare developmental anomaly in which an abnormal connection between the splenic tissue and gonads or mesonephric derivatives is present. This entity often presents with scrotal mass, inguinal hernia, or cryptorchidism. Less than 200 cases have been reported since it was first described in 1883. It can be of continuous and discontinuous type based on the presence of a band of connecting splenic tissue. Report a rare case of discontinuous type of SGF in an adolescent male presenting as nonpalpable testis. On evaluation, ultrasonography (USG) and magnetic resonance imaging of abdomen and pelvis, his left scrotal testis was atrophied and right intra-abdominal undescended testis. This is the first reported case of SGF from Bosnia and Herzegovina. Laparoscopy was demonstrated to be the only accurate exploratory procedure for the diagnosis and surgical treatment of SGF with non‑palpable testis.
A rare case of Kimura lymphadenpathy in elderly female
Authors: Ganesan Vinayagam , Periyasamy Venkatesh Sadayan , Kannaian Muralidharan
Published: September 2020

Kimura's disease (KD) is a chronic inflammatory disease, a rare variety. It usually presents as non-tender subcutaneous swelling in head and neck region, predominantly in preauricular and submandibular area and is often associated with cervical lymphadenopathy, marked peripheral eosinophilia and an elevated immunoglobulin E (IgE) level. Renal involvement is the only systemic manifestation.4 Nephrotic syndrome is the most common manifestation of renal disease in KD. Diagnosis through Fine needle aspiration cytology (FNAC) is misleading and can easily be mistaken as a malignant disease. So, diagnosis is therefore only established by histopathological examination. The treatment of KD involves one of three major approaches are surgical excision, irradiation, or steroid therapy. Surgical excision is recommended as the treatment of choice but carries recurrence rates of 33-50%. In our study, we are reporting a case of elderly female who presented with left sided cervical lymphadenopathy for which excision biopsy was done and the histopathology examination shown as kimura lymphadenopathy, a rare case.
A rare case of bilateral drain site abdominal hernia: a case report and review of literature
Authors: Sonker Santosh K. , Kujur Lizrose , Agrawal Harsh M.
Published: September 2020

Use of abdominal drain is a tradition used since a long time. These is generally done to prevent or drain any post-operative intra-abdominal collection aiming to reduce morbidity and mortality and early recovery of patient. But drain has its own complication such as drain site infection, drain site hernia. We encountered a case of bilateral drain site hernia in a 55 year old female who was previously operated for perforation peritonitis. Both herniae were repaired successfully with onlay meshplasty. Drain placement has various complications like drain site infection, adhesion's, intestinal erosion, bleeding, anastamotic rupture and drain site hernia. There is greater risk of hernia in patient with poor nutritional status, obesity, ascitis, severe abdominal infection or with persistent cough. It is better to avoid unnecessary placement of drain. If a drain is placed, its removal should be done as early as possible. It is better to close the defect after removal of drain.
Non-recurrent inferior laryngeal nerve: a case report
Authors: Manish Shah Urvin , Subbarayan Boopathi , Subbaraj Saravanakumar , Tirougnanassambandamourty Tirou Aroul , Smile S. Robinson
Published: September 2020

The incidence of Non-recurrent laryngeal nerve (NRLN) is reported to be 0.6%-0.8% on the right side and in 0.004% on the left side. Damage to this nerve during thyroidectomy may lead to vocal cord complications and should therefore be prevented. A middle-aged woman with a nodular goiter who underwent subtotal thyroidectomy for multinodular colloid goiter. We encountered a non-recurrent laryngeal nerve on the right side in a patient during surgery. We were not able to find the inferior laryngeal nerve in its usual position using the customary anatomical landmarks. Instead, it was emerging directly from the right vagus nerve at a right angle and entering the larynx as a unique non-bifurcating nerve. Nonrecurrent inferior laryngeal nerve incidence is very rare, but when present, increases the risk of damage during thyroidectomy. Hence, it is very important to be aware of the anatomical variations of the inguinal lymph node (ILN) and the use of safe meticulous dissection while looking for the nerve during thyroidectomy. The use of Intra-operative neuro-monitoring (IONM) if available in thyroid surgery allows the surgeon to recognize and differentiate branches of the inferior laryngeal nerve (ILN) from sympathetic anastomoses, as well as NRLN during surgery.
Tubular enteric duplication presenting as jejuno-colic fistula in a 38 years old adult
Authors: N. Chandhana Vishal , Ahmed Sameer , Pai B. Srinivas
Published: September 2020

Colo-enteric fistula is a rare entity, malignancy being the commonest cause. Both adenocarcinoma and rarely lymphoma have been known to cause it. Benign jejuno-colic fistulas are mostly secondary to tuberculosis or inflammatory bowel disease. Here we present a case of a young adult male, who presented with altered bowel habits. Colonoscopy and oesophago-gastro-duodenoscopy (OGD) revealed a fistulous tract between the proximal jejunum to the splenic flexure of colon. Surgery revealed a small fistulous connection between the above-mentioned parts of the bowel about 1cm long. Histopathology demonstrated it to have all the layers of the intestinal anatomy, hence indicating a possibility of congenital aetiology, probably enteric duplication of communicating tubular variety.
Synchronous colonic malignancy and tuberculosis: a rare histologic surprise
Authors: Khemchand Agrawal Kavita , Singh Kaptan , Vaiphei Kim , Kaman Lileshwar
Published: September 2020

Coexistence of colorectal cancer and tuberculosis of same site is described in few of case reports. Tuberculosis (TB) is known to involve any part of the body. Intestinal TB accounts for the majority of extra pulmonary TB, ileocecal region being the most common site. TB has been known to be associated with various types of malignancy. The most common association is malignancy and pulmonary TB. However, association of extra pulmonary TB and malignancy at the same site is relatively uncommon. This case report describes synchronous colonic malignancy and tuberculosis on histopathological evaluation of the resected specimen in a 42-year female patient.
A rare and interesting case report of Kikuchi-Fujimoto disease masquerading as tuberculosis
Authors: Mathew Joel Danie , K. Ajithakumari , Ninan Jiby Soosen , Sunny Juby
Published: September 2020

Kikuchi-Fujimoto disease (KFD), or histiocytic necrotizing lymphadenitis, is a rare benign, self-limited condition, probably genetic, that mainly affects young women which often presents with localised lymphadenopathy and fever. Reporting the case of a 17-year-old girl, with a strong family history of tuberculosis, who presented to the surgery OPD with cervical lymphadenopathy and a history of anti-tubercular treatment for the same complaints two years back. An excision biopsy revealed necrotizing histiocytic lymphadenitis suggestive of KFD. Post-operative period was uneventful and patient had spontaneous resolution of her complaints upon follow up. It is quite difficult to make a pre-operative diagnosis of this disease, until the clinician has got a very high index of suspicion especially because of the more common differential diagnoses including extrapulmonary tuberculosis.
Giant non-functioning adrenocortical carcinoma: an unusual tumour presentation
Authors: Potnis Abhishek R. , Boralkar Ajay K. , Rafe Abdul , Jadhav Sarojini P.
Published: September 2020

Adrenocortical carcinoma is a rare tumour with incidence of 1 per million all over the world. Age distribution is bimodal with peaks occurring at 5-20 years and 40-50 years. Tumours greater than 9 cm commonly involve inferior vena cava (IVC) or right side of heart. 80 percent of the carcinomas are functional. We describe a case report of a rare tumour of a non-functioning adrenocortical carcinoma in a 40 year old female having incidence of 0.5/million world over with no extra-adrenal spread at presentation without IVC or right heart involvement in spite of having a large size of 12 cm. Patient underwent successful surgical extirpation with adjuvant radiotherapy with regular follow ups and disease free survival since the surgery. It is imperative to determine hormone levels in symptomatic and asymptomatic patients with adrenal masses. The possibility of adrenocortical carcinoma should not be ruled out in a functioning/non-functioning tumour. All solid incidentalomas on computed tomography (CT)/magnetic resonance imaging (MRI) greater than 5 cm in size should be removed surgically with adjuvant therapy consideration after histopathological reporting.
A rare case of congenital diaphragmatic hernia in adult: an incidental finding during an elective procedure
Authors: Ganesan Vinayagam , Periyasamy Venkatesh Sadayan , Mariappan Gokila
Published: September 2020

Congenital diaphragmatic hernia consists of a defect of the diaphragm that allows the passage of abdominal viscera into the thorax. Congenital diaphragmatic hernia most commonly present in infancy and childhood due to respiratory distress. However, a few of them may escape into adulthood. A very few of these adult cases may be identified during a routine medical checkup for various other reasons without any cardio-respiratory problems. In our case report, we have diagnosed incidentally an asymptomatic left diaphragmatic hernia with cardio-mediastinal shifting in a 38 years old female admitted for left breast fibroadenoma excision during a routine pre-anesthetic check-up and underwent breast surgery without any cardio-respiratory problems.