bluuebunny/crossref_metadata_2025 huggingface dataset:
Knowledge and Practice of Pap Smear and Vaccination Regarding Human Papillomavirus Among Female Medical Students in Karachi, Pakistan
Authors: Zaidi Tafazzul Hyder , Zafar Mubashir , Memon Sobia , Tufail Mehrunnisa , Sattar Aqsa , Bajaj Parshant , Mukhtar Shahreen , Sufiyan Muhammad Sufiyan , Masood Ahmad
Published: November 2021

Background: Cervical cancer is the leading cause of women’s death in developing countries. The change in the epidemiological trends has been attributed to mass screening with the help of a Pap smear. Objectives: This study aimed to determine the knowledge level and practice regarding a Pap smear and human papillomavirus (HPV) vaccination among female medical students in Karachi, Pakistan. Methods: In this cross-sectional study, 147 participants were selected through multistage stratified random sampling. The knowledge level was categorized as adequate if the participants answered 60% of the items. Questionnaire validity was determined through Cronbach’s alpha value (α = 0.69). Binary logistic regression was applied to determine the factors associated with the knowledge level among the students. A confidence interval (CI) of 95% was considered with a margin of error of 5% and a P-value of 0.05 as statistically significant. Results: Most students (60.5%) had adequate knowledge regarding a Pap smear and HPV vaccination. Only 3.4% of the students underwent a Pap smear test. The most common factors contributing to the knowledge level were marriage (OR = 2.98; 95% CI: 1.23 - 11.09; P = 0.003), first academic year of students (OR = 10.78; 95% CI: 1.03 - 12.01; P = 0.046), family history of cancer (OR = 2.76; 95% CI: 1.34 - 7.90; P = 0.004), and family income less than < 100000 Pakistani Rupee (OR = 5.45; 95% CI: 2.09 - 9.06; P = 0.005). Conclusions: Being medical students studying in the first academic year, family history of cancer, and family income less than 100000 Pakistani Rupee had significant effect on knowledge gap about a Pap smear and HPV vaccination. There is a need for an increased level of knowledge in this regard by addressing the risk factors contributing to the knowledge level.
Do This in Remembrance of Me
Authors: Batt J. Daniel ,   Marquette University Press
Published: November 2021

Written 136 years apart, Melville’s Moby Dick and Morrison’s Beloved explore the scriptural tension between the material and spiritual. Against two different American landscapes, each work explores incarnation as both manifestations of the divine and the Word given flesh—two uniquely separate functions. Throughout the stages of Queequeg’s and Baby Suggs life, and other characters, as well, the stages of archetypal incarnation are expressed amongst two distinct populations, similar first in their need for incarnated divinity. Ultimately, these incarnations ask us to see the divine in our physical bodies, now—new bodies for new Words.
TRADUÇÃO, ADAPTAÇÃO CULTURAL E VALIDAÇÃO DA MUNRO SCALE PARA PORTUGUÊS DO BRASIL
Authors: Sousa Cristina Silva
Published: November 2021

RESUMO Objetivo: traduzir, adaptar e validar a Munro Scale aos pacientes brasileiros no perioperatório. Método: estudo metodológico realizado em seis etapas: tradução, síntese, retrotradução, adaptação por comitê de especialistas, pré-teste, validação do instrumento. O comitê de especialistas foi composto de sete enfermeiros. Para os testes psicométricos, foram selecionados 39 pacientes no pré-teste e 75 na validação, mensurados o alfa de Crobanch, coeficiente de correlação intraclasse, e índice de validade de conteúdo, consistência interna com teste de Friedman e validade concorrente com correlação de Spearman entre a Munro Scale e ELPO. Resultados: o alfa de Cronbach foi 0,82, índice de correlação intraclasse 0,75, índice de validade conteúdo dos juízes 0,89 na fase da adaptação. No pré-teste o alfa de Cronbach foi 0,91, índice de correlação intraclasse 0,91, a consistência interna (p <0,0001) e validade concorrente no intraoperatório (0,38; p= 0,018). Na validação, o alfa de Cronbach foi 0,86, índice de correlação intraclasse 0,86, consistência interna (p=0,000) e validade concorrente no intraoperatório (0,30; p= 0,010). Conclusão: A Munro Scale foi traduzida, adaptada e validada, com boa validade e confiabilidade e apresenta-se como um instrumento confiável para mensurar o risco de lesão por pressão no perioperatório.
APRENDIZAGEM BASEADA EM PROBLEMAS NO ENSINO REMOTO: VIVÊNCIAS DE ESTUDANTES DE ENFERMAGEM NA PANDEMIA COVID-19
Authors: Rodrigues Paula Sales , Marin Maria José Sanches , Souza Aline Pereira , Grandin Gabriela Martins , Almeida Karina Roberta Vieira de , Oliveira Carolina Saab Rocha de
Published: November 2021

RESUMO Objetivo: compreender a percepção dos estudantes de Enfermagem frente ao processo tutorial remoto no período de isolamento social decorrente da COVID-19. Método: trata-se de pesquisa qualitativa na modalidade compreensiva e interpretativa, fundamentada nos pressupostos da hermenêutica dialética, a qual busca contextualizar o discurso dos atores, as suas compreensões e autenticidades. O estudo foi realizado a partir de entrevistas com 22 estudantes da segunda série do curso de Enfermagem de uma instituição pública do interior de São Paulo, Brasil, de setembro a dezembro de 2020. Resultados: dos 22 estudantes entrevistados, 21 se identificaram como sendo do sexo feminino, com idades entre 19 e 24 anos e, em sua maioria, residindo com familiares no período da pandemia. Identificaram-se quatro temáticas na análise da percepção desses estudantes frente ao processo tutorial remoto: a dinâmica do processo tutorial remoto; as limitações impostas às atividades no domicílio; os incômodos da pandemia; e a falta de recursos institucionais e de momentos de convivência. Conclusão: o processo tutorial remoto configura-se como essencial para a continuidade da aprendizagem dos estudantes de Enfermagem. Identificou-se, porém, a falta de efetiva integração com a prática profissional e entre os integrantes do processo e a inadequação dos recursos do domicílio. Depreende-se que a repentina alteração da ordem estabelecida levou ao enfrentamento dos desafios e contribuiu para novas aprendizagens.
VERDADE, CONHECIMENTO, JUSTIFICAÇÃO E NEGACIONISMO: IMPLICAÇÕES PARA A CIÊNCIA DA ENFERMAGEM
Authors: Guimarães Gilberto de Lima , Goveia Vania Regina , Mendoza Isabel Yovana Quispe , Correa Allana dos Reis , Guimarães Mariana Oliveira , Chianca Tânia Couto Machado
Published: November 2021

RESUMO Objetivo: apresentar reflexões epistêmicas acerca da verdade, do conhecimento, da justificação e do negacionismo na elaboração do conhecimento científico para a Ciência da Enfermagem. Método: trata-se de estudo reflexivo de natureza teórico-filosófica. Resultados: a pesquisa na Enfermagem é recente, sendo observada a partir da segunda metade do século XX. Indicam-se cinco aspectos para a análise, a saber: a) a verdade e alguns de seus aspectos filosóficos; b) o conhecimento científico e sua singularidade epistêmica; c) a análise tradicional tripartite do conhecimento e alguns de seus problemas; d) as dificuldades contemporâneas sobre o conhecimento científico - o negacionismo; e) uma síntese para a Ciência da Enfermagem. Conclusão: é necessário que os pesquisadores tenham solidez ante os fundamentos epistemológicos para que possam garantir a coerência e a consistência do conhecimento científico produzido. O pesquisador da área da Enfermagem deve estar cônscio de todos os meandros epistêmicos que cercam a produção do conhecimento científico, pois disso depende a sua validade. Reconhece-se que a atitude negacionista é danosa à cultura ocidental, pois se funda na recusa e no desprezo ao lógos como elemento de promoção da vida humana.
Prediction of energy consumption in the leadwell v-40 it CNC machining center through artificial neural networks
Authors: Rodriguez-Cabal M.A. , Gonzalo Ardila , Rudas Sebastián
Published: November 2021

Energy consumption in machining processes has become a problem for today's manufacturing industry. The use of neural networks and optimization algorithms for modeling and prediction of consumption as a function of the cut-off parameters in processes of this type has aroused the interest of research groups. The present work used artificial neural networks (ANN) to predict the energy consumption of a Leadwell V-40iT® five-axis CNC machining center, based on experimental data obtained through a factorial experimental design 53. ANN was programed in Matlab®. From the study was concluded that the depth per pass (Ap) is the variable that has the most influence on the prediction model of energy consumption with a 77% of relative importance, while the feed rate is the least relevant with 9% of importance.
Prevalence of traditional cardiovascular risk factors for coronary artery disease and elevated fibrinogen among active military personnel in Republic of Serbia: A cross-sectional study
Authors: Pandrc Milena , Ratković Nenad , Perić Vitomir , Stojanović Maja , Kostovski Vanja , Rančić Nemanja
Published: November 2021

Background: It is well known that less than 1% of the population achieves ideal cardiovascular health, and 65% of patients do not have their conventional risk biomarkers under control. Military service has its own particularities that may contribute to cardiovascular risk. Methods: To define the preventive strategy goals, we analysed the prevalence of traditional cardiovascular risk factors for coronary artery disease and elevated fibrinogen among active military personnel in the Republic of Serbia. Results: The cross-sectional study included 738 individuals older than 20 years, mostly between 31 and 40 years old. The mean value of SBP for the whole group was 122.39± 9.42 mmHg, and for the DBP, it was 79.94±6.56 mmHg. Among active military personnel, 72.7% (533) had prehypertension, and 13.8% (101) was hypertensive. Both body mass and BMI index among the observed age subgroups were found to increase with the age of the patients and cholesterol values. HDL cholesterol values also differed statistically significantly between age subgroups, with the proportion of individuals with HDL less than 1.5 mmol/L in all subgroups being about 85%, the only in the 41-50 age group was lower, 76.4%. LDL cholesterol and the proportion of individuals who had LDL 3.5 increases with the age of patients, and an identical trend was recorded with triglycerides. With ageing, fibrinogen levels increased. Conclusions: Those findings considering cardio and cerebrovascular risk factors would help create a new approach for primary prevention for these categories of individuals.
Study on impact of silver nanoparticles synthesized using aqueous extract of Ganoderma applanatum on thyroid and lipid parameters of albino rat
Authors: Dandapat Sukumar , Srivastava Rohit , Sinha Manoranjan Prasad
Published: November 2021

Se estudió el impacto de SNP cargadas con extracto de Ganoderma applanatum sobre el perfil tiroideo y lipídico de rata. Las SNP (diámetro medio 58,77 nm; potencial zeta - 3,8) mV se analizaron mediante DLS. La microespectroscopía de infrarrojo con transformada de Fourier proporcionó un pico de transmisión amplio y elevado a 3248,12 cm-1, que indica la carga bioquímica del extracto de G. applanatum en la superficie de los SNP. No se observó mortalidad ni cambios de comportamiento en la prueba de toxicidad aguda. El grupo-1 recibió 1 mL de agua destilada, el grupo-2 y el grupo-3 recibieron 200 mg kg-1 y 400 mg kg-1 de nanopartículas respectivamente. Una dosis de 400 mg kg-1 de SNPs mostró una mayor actividad hipertiroidea e hipolipidímica en comparación con el control y la dosis de 200 mg kg-1.

Impact of silver nanoparticles loaded with Ganoderma applanatum extract on thyroid and lipid profile of rat were studied. Synthesized SNPs (Average diameter 58.77 nm; -13.8 mV zeta potential) were analysed by dynamic light scattering analysis. Fourier transform infrared spectroscopy provided broad and high transmission peak at 3248.12 cm-1 which indicates the loaded biochemical of the G. applanatum extract on the surface of SNPs. No mortality and behavioural changes were observed in the Acute toxicity test. Group-1 received 1 mL distilled water, group-2 and group-3 received 200 mg kg-1 and 400 mg kg-1 nanoparticles respectively. A 400 mg kg-1 dose of SNPs showed increased hyper thyroid and hypolipidimic activity as compared to control and 200 mg kg-1 dose.
El Quijote y el estoicismo
Authors: Pozuelo Calero Bartolomé
Published: November 2021

¿Alcanzó al Quijote el resurgimiento del estoicismo, tan influyente en la cultura de su tiempo? El artículo rastrea la presencia de muchas de sus principales ideas en la novela: la bipartición entre espíritu y cuerpo y, consiguientemente, la división entre individuos espirituales y terrenales; las cualidades del espíritu: inalterabilidad de ánimo (constantia), paciencia, virtud, libertad; las pasiones y afectos terrenales: cólera, esperanza y miedo; la consideración expresa de la divina providencia; la autonomía de la moral; la visión de la adversidad como benéfica. La conclusión es que, al menos en la creación de sus personajes, Cervantes parece utilizar el ideal humano estoico como paradigma de altura moral.

To what extent was Don Quixote influenced by the resurgence of Stoicism, which was so influential in the culture of that time? This article traces the presence of many of the principal ideas of Stoicism in the work: the separation between body and spirit and consequently the differentiation between spiritual and earthly individuals; the qualities of the spirit: the inalterability of mood (constantia), patience, virtue, freedom; the earthly passions and emotions: ire, hope and fear; divine providence, autonomy of morals; the idea of adversity as positive. One can conclude that when presenting his characters, Cervantes, at least, uses the Stoic human ideal as a model of high moral ground.
Identifying and estimating cybersecurity risk for enterprise risk management
Authors: Quinn Stephen , Ivy Nahla , Barrett Matthew , Feldman Larry , Witte Greg , Gardner R K
Published: November 2021

This document supplements NIST Interagency or Internal Report 8286, Integrating Cybersecurity and Enterprise Risk Management (ERM), by providing additional detail regarding risk guidance, identification, and analysis. This report offers examples and information to illustrate risk tolerance, risk appetite, and methods for determining risks in that context. To support the development of an Enterprise Risk Register, this report describes documentation of various scenarios based on the potential impact of threats and vulnerabilities on enterprise assets. Documenting the likelihood and impact of various threat events through cybersecurity risk registers integrated into an enterprise risk profile helps to later prioritize and communicate enterprise cybersecurity risk response and monitoring.
S’appuyer sur la « féminité » pour l’emporter en campagne
Authors: Pilote Anne-Marie , Montreuil Arnaud
Published: November 2021

Le Québec a vécu lors des élections générales d’octobre 2018 un « moment paritaire enchanté », où la construction d’un discours fondé sur la valeur ajoutée des femmes à la démocratie est apparue profitable chez les candidates et les chef·fe·s de parti, et ce, grâce à la mobilisation d’acteurs extérieurs au champ politique (groupes de femmes, médias, sondeurs). À partir d’une analyse d’un corpus médiatique couvrant les six mois précédant les élections, cet article montre que les propos tenus par les candidates et les chef·fe·s de parti sur les « qualités typiquement féminines » des politiciennes et leur capacité à « faire de la politique autrement » participent d’une stratégie d’argumentation qui réduit les femmes à leur rôle de genre. Alors que les conditions sociales et politiques en présence les y encourageaient fortement, la mise en valeur de la « féminité » s’est imposée comme une contrainte supplémentaire pour les candidates, qui, pour entrer dans un univers (encore) largement dominé par les hommes, devaient répondre aux attentes liées à la fois à leur genre et à leur profession.
¿Cómo comunicamos el nuevo modelo turístico?
Authors:   Universitat Oberta de Catalunya, Compte Marc
Published: November 2021

En los últimos años, la sostenibilidad ha ido ganando reconocimiento social y político gracias a la Agenda 2030 y a los 17 objetivos de desarrollo sostenible (ODS) de Naciones Unidas, fundamentales para garantizar un mundo futuro que sea sostenible en lo medioambiental, lo económico y lo social.
CSRR-DGS Bandpass Filter Based on Half Mode Substrate Integrated Waveguide for X-Band Applications
Authors: Fellah B. , Cherif N. , Abri M. , Badaoui H.
Published: November 2021

In this paper, a half mode substrate integrated waveguide (HMSIW) bandpass filter using defected ground structure cells (DGS) is proposed. By using the periodic square CSRR resonant properties of DGS according to design requirement, an X-band band-pass filter is designed and analyzed to meet compact size, low insertion loss, and high rejection. The simulation results obtained by CST in X-band show that the proposed filter is characterized by a large transmitted bandwidth of about 1.38 GHz from 13.03 to 14.41 GHz. The higher simulated insertion loss is about −2.6 dB and the lower return loss is about −34 dB. The proposed filter size is 9.50 × 38.00 mm2 which make it a compact component. The structure is optimized using CST simulator. For the proposal validation, the simulation results is compared by HFSS. The simulation results are in good agreement for the   two simulator.
Prevalence of Vitamin D Deficiency and its Associated Risk Factors on Osteoarthritis: A Cross-sectional Survey
Authors: Kundur Ramadevi , Itumalla Ramaiah , Abdel-Rahman Eitimad Hashim , Althawainy Malak Saad
Published: November 2021

Introduction: Vitamin D Deficiency (VDD) and several other metabolic factors are known to be involved in the aggravation of Osteoarthritis (OA). A better understanding of the role of these metabolic factors and diseases is required to alleviate the OA progression. Aim: To analyse the prevalence of VDD in OA patients and its correlation with co-morbidities such as diabetes, hypertension (HT), Cardiovascular Disease (CVD) and acidity and also to assess the effect of Body Mass Index (BMI) and increasing age on the developmental process of OA. Materials and Methods: A cross-sectional survey was undertaken during September 2018 to March 2019 in King Khaled, King Salman and Hail General Hospitals located in Ha’il province of Kingdom of Saudi Arabia (KSA). The study included 501 participants of OA patients that visited these hospitals. Data pertaining to the variables in this study such as diabetes, HT, cardiovascular problems, vitamin D and calcium deficiency, acidity and anthropometric details was obtained using a structured questionnaire. Data analysis was done using descriptive statistics and Pearson’s correlation with the statistical program SPSS version 21. Results: VDD, calcium deficiency and acidity were the most prevalent factors observed in the patients. Vitamin D and calcium deficiency was observed to be higher in females than males. VDD significantly correlated to diabetes, HT, acidity and age, both in females and males. Cardiovascular disease and BMI correlated with VDD only in males but not in females. BMI showed positive correlation with HT in males (p<0.01) but not females, and also correlated with age (p<0.01) irrespective of gender. Conclusion: The study concluded that VDD is more prevalent in females than males in Ha’il region. It is correlated to variables such as diabetes, HT, acidity, BMI and increasing age, which are identified as risk factors contributing to the progression of OA.
The Used of Natural Anesthetic Materials Nutmeg Seed Oil in the Transportation of Sumatran Fish Fingerlings (Puntius tetrazona)
Authors: Lili Walim , Wahyudin Muhamad Fikri , Suryana Asep Agus Handaka , Haetami Kiki
Published: November 2021

The low survival rate in Sumatran fish fingerlings transportation is a problem related to metabolic disturbances that cause death. The addition of nutmeg seed oil in the transportation medium is expected to reduce the rate of respiration and metabolism, so that fish mortality can be minimized. The purpose of this study was to determine the effective concentration of nutmeg seed oil to maintain the highest survival rate of Sumatran fish fry transported during treatment and to analyze its effect on induction time and recovery time. This research was carried out from January to March 2021 in the Ciparanje wet laboratory, Faculty of Fisheries and Marine Sciences, Padjadjaran University. This research was conducted experimentally using a factorial randomized group design (FRGD) consisting of two factors, namely the concentration of four levels (0.03, 0.06, 0.09 ml/L and control) and duration of three levels (3, 5, and 7 hours) which was repeated three times. This research uses a closed transportation system. Parameters observed were induction time and conscious recovery time of test fish, post-transportation and post-maintenance survival for 7 days and water quality consisting of temperature, DO, pH, and ammonia. The results showed that the effective nutmeg seed oil for the anesthesia of Sumatran fish fry transported was 0.03 ml/L with a transportation duration of 3 hours because it had an induction time of 08:07, recovery time of 02:41 and postoperative survival rate. transportation by 98.33% and post-maintenance for 7 days by 91.49%. Temperature parameters are 22.7oC, DO is ±10.3 mg/L, pH is ± 6.83 and ammonia is ±0.0010 mg/L.
A Study to Compare the Efficacy of Back Strengthening Therapy in Patients with Lower Back Pain on Analgesics to that of those on Placebo in a Tertiary Care Hospital in Chennai
Authors: Nehaapriya R. , Vasudevan Damodharan , Gunalan K.
Published: November 2021

Aim: Isometric and Core strengthening exercises for lower back pain provides relief to patients, whereas combing it with analgesics also provides relief of pain, thereby in this study the efficacy of isometric and core strengthening exercises alone is evaluated.

Method: A cross-sectional study involving 200 subjects was conducted in the OPD of department of Orthopaedics, Saveetha Medical college and hospital. Assessment of lower back pain was done using ODI (Oswestry Disability Index) among patients receiving Isometric and Core strengthening exercises with and without analgesics for a period of 3 months.

Results: There is no significance difference in the reduction of pain among group A who received analgesics along with isometric and core strengthening exercises and group B who received only isometric and core strengthening exercises.

Conclusion: Isometric and core strengthening exercises alone is as effective as its combination with analgesics.
Evaluation of Blood Pressure and Heart Rate Variability during Different Phases of Menstrual Cycle
Authors: Srigopika T. , Sridevi G. , Preetha S.
Published: November 2021

Introduction: Every month, between puberty and menopause, a woman’s body goes through a number of changes to get it ready for a possible pregnancy. This series of hormone-driven events is called the menstrual cycle. A woman’s menstrual cycle is divided into three phases- proliferative phase, secretory phase and menstrual phase.  The hormonal surge during each phase causes profound effects on the cardiovascular system as well. However, previous research reported conflicting results in this concept. Thus the controversial statements associating blood pressure and heart rate variability with menstrual cycle promoted this research.

Objective: The aim of this study is to evaluate the blood pressure and heart rate variability during different phases of the menstrual cycle.

Materials and Methods: 20 healthy women belonging to the proliferative, secretory and menstrual phase of the menstrual cycle were analyzed for autonomic functions tests using systolic blood pressure, diastolic blood pressure, pulse rate and heart rate variability.

Results: It showed that there was a statistically significant increase in systolic blood pressure, diastolic blood pressure, and pulse rate during the secretory phase. There was an increase in heart rate variability during the menstrual phase but this was statistically insignificant.

Conclusion:  The study concluded that there were significant changes in blood pressure during the secretory phase and pulse rate and insignificant increase in heart rate variability during the menstrual phase. Thus, the study also concluded that sympathetic nervous activity in the secretory phase is significantly greater than in the proliferative phase, whereas parasympathetic nervous activity is predominant in the proliferative phase.
The Role of Hyperhomocysteinemia in the Pathogenesis of Thromboocclusive Diseases
Authors: Yusupov Ibragim Abdulganievich , Akaeva Mubarik Dziyaudinovna , Stepanova Natalia Yurievna , Slysarenko Nikita Vladimirovich , Gaidarbekov Omar Ruslanovich , Saidov Eldar Abdurahmanovich , Dudugova KhavraAdamovna , Dikieva Zaytun Said-Magomedovna , Maslova Alina Yuryevna
Published: November 2021

Homocysteine is a sulfur-containing non-proteinogenic amino acid that is an intermediate product of methionine metabolism. With excessive accumulation of homocysteine in the body, a state of hyperhomocysteinemia occurs, which has attracted the attention of doctors since the middle of the last century and received a serious impetus for research after the publication of data on the role of hyperhomocysteinemia in the pathogenesis of thromboocclusive diseases. To date, there are more than 7.5 thousand scientific papers devoted to the study of hyperhomocysteinemia, monothematic international conferences on clinical and therapeutic aspects of hypermonocysteinemia are held every year. In the Russian Federation, a detailed study of the role of homocysteine and its side effects in excess is of particular interest due to the prevalence of cardiovascular pathologies (according to statistics of the Ministry of Health of Russia-49.27% of deaths of Russians fall on this cohort of diseases). This is an important fact in Russian medicine, which deserves close attention from researchers and scientists.
A Study of D-Dimer Levels in Acute Febrile Non Covid Conditions in a Tertiary Care Hospital
Authors: Sylvia S. Caroline , Vinoth S.
Published: November 2021

Introduction: Acute undifferentiated febrile illness (AUFI) is caused by a multitude of diverse pathogens, with significant morbidity and mortality in the developing world. This study aims to highlight the gaps in our understanding of  the various differential diagnosis of acute febrile illness  and their prognostic outcomes. In this study, We used d-dimer levels to arrive at a differential diagnosis in acute febrile illness and also used it as a biomarker of disease severity and prognostic outcome.

Materials and Methods: A prospective study was conducted at medicine department, Saveetha  medical college and hospital, Thandalam, India  for a period of 3 months from January 2020 - March 2020. Patients who presented to the medicine outpatient department with symptoms of acute febrile illness with non specific symptoms were registered after getting written consent in the study. The plasma concentration of D -dimer levels ,prothrombin time , APTT from which INR were measured. The duration of hospital stay of patients in study was recorded. The data collected was entered into an excel sheet and analysed using SPCC software.

Results: A total of 50  patients with acute febrile illness were enrolled in the study. Out of which 37 patients (74./. of patients)  were found to have elevated D dimer levels.

These 37 patients with elevated D – dimer levels required longer duration of hospital stay, reflecting the need for more days for recovery.
Knowledge and Attitude of Primary School Teachers Regarding Early Identification and Management of Learning Disability
Authors: Koshy Betty , Gamit Nikita , Fernandes Aarohi , Chouhan Devraj Singh
Published: November 2021

Introduction: In India, 1% to 19% of the total students have Learning Disability. Learning disability may vary from person to person and is incurable but can be controlled if diagnosed earlier. Teachers play a vital role in its identification.

 Aims: Assessing the Knowledge and Attitude of primary school teachers regarding early identification and management of Learning Disability.

Study Design: The study design is Descriptive cross sectional design.

Place and Duration of Study: selected school at Tapi District, Gujarat, between 2020 – 2021.

Methodology: The research was carried out by using Quantitative research approach and on 150 primary school teachers. The non probability sampling technique was used. The tool includes socio demographic variables, Knowledge questionnaire and Attitude scale.

Results: No teacher have excellent knowledge i.e 0.00% regarding Learning Disabilty. 59.33% have good knowledge and 40.66% teachers are poor in knowledge regarding Learning Disability. 96.66% teachers have positive attitude towards children having Learning Disability while 3.33% teachers have negative Knowledge. There is positive correlation between Knowledge and Attitude. There is significant association of knowledge with age and classes allotted at p< 0.05. There is significant association of Attitude with classes allotted at p< 0.05.

Conclusion: Majority of the teachers have good Knowledge and most of them have positive attitude towards the children with Learning disability.
Thyromental Height - As a Predictor of Difficult Laryngoscopy
Authors: Gothandaramalingam Harivarshan Velusamy , Vittobaraju Muralidharan
Published: November 2021

The fundamental responsibility of the anaesthesiologist and one of the most important steps in anaesthesia practice is the intubation and maintenance of the airway. The integral part of pre-anaesthetic evaluation to recognize a potentially difficult airway is the airway assessment. There are multitude of bedside screening tests which are helpful to predict a difficult airway but the accuracy is doubtful. Thus, pointing out a single reliable predictor of difficult intubation is important. Accordingly, this study aims to evaluate the practicality of thyromental height test alone as a sole predictor of difficult laryngoscopy in our present population. Ethical clearance was obtained and after taking an informed consent, a randomised prospective observational study was conducted on 315 adult patients who were posted for elective surgical procedures under general anaesthesia with endotracheal intubation. On the day before the surgery, airway was assessed and Thyromental height (TMHT) was measured. Laryngoscopy was performed intra-operatively and Cormack Lehane’s grading was noted. The evaluation of the accuracy of thyromental height in predicting difficult laryngoscopy was done by comparing the preoperative assessment data and laryngoscopy findings. In our study, the mean thyromental height observed was 5.4cm. Thyromental height at cut off of 50mm had a high negative predictive value of 94.1% and high sensitivity of 72.5%, but with low specificity of 64.2% (P value 0.000). When the cut off was emended to 48mm, sensitivity of the test decreased to 56.2% and specificity increased to 79.8% (P value 0.002).The conducted study demonstrates the usefulness of thyromental height. It substantiates the good sensitivity of thyromental height for predicting difficult intubation. But, the validation will require further studies in more diverse patient population.
A Case Report of Silent Cervical Spondylosis with Neck Pain
Authors: Zoting Mayuri , Uttamchandani Shivani , Deshmukh Mitushi , Wadhokar Om C.
Published: November 2021

Background: Cervical Spondylosis, commonly known as Cervical Osteoarthritis, is a kind of degenerative osteoarthritis of the joints between the spinal vertebrae's and the neural foramina. It's a condition characterized by changes in the cervical bones, discs, and joints as a result of regular aging wear and tear. Spondylosis of the cervical spine is most common in 40s and 50s.

Case Presentation: A 65 years old male came to physiotherapy department with complaints of pain in left upper limb and neck and weakness in his left upper back muscles and unilateral since 2 months. Clinical impression showed cervical non radiculopathy. X-ray of cervical spine revealed osteophytosis and narrowed inter- vertebral space, seen in C6 and C7 cervical vertebral bodies with straightening of cervical spine. Cervical Distraction and compression test was positive.

Conclusion: A well planned physical therapy intervention has shown significant improvement in cases with cervical spondylosis in relieving the symptoms and improving quality of life.
The Prevalence of using Prescribed & Unprescribed “Roaccutane (Isotretinoin)” among Females Riyadh, Saudi Arabia: A Cross Sectional Study
Authors: Mahmoud Mahmoud A , Almohaini Reem A. , Assiri Raghad A. , Alkhatabi Reema A. , Alobaishi Reema S. , Alharbi Rola F.
Published: November 2021

Aims: To determine the prevalence of using prescribed and unprescribed Isotretinoin and to assess knowledge of its adverse effects among females in Riyadh, SA.

Study design:  cross-sectional study.

Place and Duration of Study: online questionnaire collected throughout two months by distributing the questionnaire via. social media platforms.

Methodology: We included 385 female patients (age range 15-45 years) use Roaccutane (Isotretinoin) with or without prescribed.  Statistical analysis was performed using Rv 3.6.3. Counts and percentages was used to summarize the distribution of categorical variables and data. Chi-square test was used to estimate the association between categorical variables. Hypothesis testing was performed at a 5% level of significance.

Results: 568 respondents completed the questionnaire. Of these, 440 were from Riyadh. The majority of respondents were aged 15 – 20 (46.4%) and 21 – 25 (35.2%). Knowledge regarding some side effects of Roaccutane was significantly higher in respondents who reported using Roaccutane than those who did not. Knowledge of dry and cracked lips as a side effect was significantly higher in users (91.9%) than non-users (73.1%). Similarly, knowledge regarding dry eyes, depression, continuous thirst, nose dryness, bleeds, and effect of Roaccutane on liver biochemical profile, lipid profile, and bones was higher in users than non-users, regarding the teratogenic effect of Roaccutane was insignificantly different between groups.

Conclusion: Females in Riyadh are aware of the side effects of isotretinoin, particularly dryness of the skin, eyes, and lips. Yet there is insufficient knowledge regarding its teratogenic effect. Based on the reported results, a few participants obtained Roaccutane without a prescription from the doctor, and some obtained their information from unreliable sources (i.e., friends/relatives). Our results suggest good practice towards the prescription of isotretinoin.
LA QUETE MUSICALE DE L’AUTHENTICITE : UN TRANSFERT SUR L’INOUÏ OU PORTRAIT DES « BAROQUEUX » EN AVENTURIERS DU TIMBRE PERDU
Authors: Vivès Jean-Michel
Published: November 2021

L'auteur de cet article s'attache à décrire les phénomènes psychiques qui ont présidé au mouvement baroque où des musiciens ont tenté de retrouver les sons qui étaient ceux qui avaient vu naître les œuvres interprétées. Il se concentre sur la façon dont l’interprète tente d’approcher un son nouveau, non encore advenu, qu’il appelle le « transfert sur l’inouï ». Il y brosse un portrait des « baroqueux » en aventuriers d’un timbre perdu. Leur désir d’authenticité des interprètes serait celui de réentendre des timbres qui n’avaient plus cours. Il approche les qualités de ce timbre à travers le parallèle entre André Schaeffner et Philippe Beaussant, et à travers eux entre les musiques africaines et l’aventure baroque : présence du bruit, du tremblé ou du trouble dans le son, qui aurait le pouvoir de convoquer au-delà de l'enveloppe sonore la dimension du réel.
EDITORIAL: EM TEMPOS PANDEMÔNICOS A NECESSÁRIA INTERLOCUÇÃO ENTRE DEMOCRÁCIA E PSICANÁLISE
Authors: Maurano Denise , Avril Renata Mattos , Souza Joana
Published: November 2021

No que tange à arte ou ciência de governar a psicanálise só pode ser afeita a políticas não totalitárias, não excludentes, não genocidas, não fascistas. É apenas com essas políticas que a dimensão cidadã, da atividade de um psicanalista pode se comprometer. Pelo fundamento da livre circulação da palavra, no qual a psicanálise foi inventada e prosperou, é em defesa de políticas não totalitárias que faz sentido sua militância nos coletivos diversos nos quais ela se engaja. A abstinência na intimidade da clínica encontra como contrapartida o engajamento na atuação pública. Se assim não for, há que se desconfiar da ética em jogo. Não à toa essa prática da circulação da palavra tem afinidades com a Democracia...
Risk of Infection Associated With Administration of Intravenous Iron
Authors: Shah Akshay A. , Donovan Killian , Seeley Claire , Dickson Edward A. , Palmer Antony J. R. , Doree Carolyn , Brunskill Susan , Reid Jack , Acheson Austin G. , Sugavanam Anita , Litton Edward , Stanworth Simon J.
Published: November 2021

Importance

Intravenous iron is recommended by many clinical guidelines based largely on its effectiveness in reducing anemia. However, the association with important safety outcomes, such as infection, remains uncertain.

Objective

To examine the risk of infection associated with intravenous iron compared with oral iron or no iron.

Data Sources

Medline, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched for randomized clinical trials (RCTs) from 1966 to January 31, 2021. Ongoing trials were sought from ClinicalTrials.gov, CENTRAL, and the World Health Organization International Clinical Trials Search Registry Platform.

Study Selection

Pairs of reviewers identified RCTs that compared intravenous iron with oral iron or no iron across all patient populations, excluding healthy volunteers. Nonrandomized studies published since January 1, 2007, were also included. A total of 312 full-text articles were assessed for eligibility.

Data Extraction and Synthesis

Data extraction and risk of bias assessments were performed according to the Preferred Reporting Items of Systematic Reviews and Meta-analyses (PRISMA) and Cochrane recommendations, and the quality of evidence was assessed using the GRADE (Grades of Recommendation, Assessment, Development, and Evaluation) approach. Two reviewers extracted data independently. A random-effects model was used to synthesize data from RCTs. A narrative synthesis was performed to characterize the reporting of infection.

Main Outcomes and Measures

The primary outcome was risk of infection. Secondary outcomes included mortality, hospital length of stay, and changes in hemoglobin and red blood cell transfusion requirements. Measures of association were reported as risk ratios (RRs) or mean differences.

Results

A total of 154 RCTs (32 762 participants) were included in the main analysis. Intravenous iron was associated with an increased risk of infection when compared with oral iron or no iron (RR, 1.16; 95% CI, 1.03-1.29; I2 = 36%; moderate certainty of evidence). Intravenous iron also was associated with an increase in hemoglobin (mean difference, 0.57 g/dL; 95% CI, 0.50-0.64 g/dL; I2 = 94%) and a reduction in the risk of requiring a red blood cell transfusion (RR, 0.83; 95% CI, 0.76-0.89; I2 = 15%) when compared with oral iron or no iron. There was no evidence of an effect on mortality or hospital length of stay.

Conclusions and Relevance

In this large systematic review and meta-analysis, intravenous iron was associated with an increased risk of infection. Well-designed studies, using standardized definitions of infection, are required to understand the balance between this risk and the potential benefits.
T
lymphocytes: Activation
Authors: Oeste Clara L , Alarcón Balbino
Published: November 2021

T‐lymphocyte activation is triggered by interaction of the T‐cell receptor (TCR) with antigens. Full activation of these immune cells requires three distinct signals: TCR activation, costimulatory receptor engagement (i.e. CD28) and cytokine recognition through their receptors (i.e. IL‐2). The immunological synapse forms at the contact between T lymphocytes and antigen‐presenting cells (APC), providing a platform where receptors form microclusters, thus enhancing cooperative signalling through conformational changes. Initial steps of TCR signalling are transmitted through these conformational changes to induce a recruitment cascade of adaptor proteins, tyrosine kinases, coreceptors or integrins. The distinct signalling pathways activated upon antigen binding to the TCR include Ras/MAPK, PI3K, Rho/Rac or Ca
2+
/calcineurin, among others, as well as negative regulators. All these integrated signals result in T‐lymphocyte progression towards unique proliferative and differentiation patterns that modulate immune responses.

Key Concepts

T‐lymphocyte activation is triggered by antigen recognition by TCRs on T cells, giving rise to the immunological synapse.

Costimulatory receptors and cytokines are also required for full activation of T cells.

Conformational changes in clustered TCR at the immunological synapse transmit signals towards coreceptors, tyrosine kinases or adaptors.

Downstream effectors of the TCR include proteins from many signalling pathways, that is Ras/MAPK, PI3K, Rho/Rac or PKCθ, which ultimately modulate transcription factors such as AP‐1, NF‐κB or NFAT.

Activation of diverse signalling cascades through the TCR results in clonal expansion and differentiation of T lymphocytes.

TCR clustering allows for signal regulation by maintaining a spatiotemporal distinction at the immunological synapse between active TCRs and TCRs to be recycled or degraded.
Allergens
Authors: Goodman Richard E , Tetteh Afua O
Published: November 2021

Allergens are proteins or in rare cases, small molecular weight haptens that bind human proteins and induce IgE antibody production. The IgE binds surface FcϵR1 receptors on mast cells and basophils and stimulate release of histamine and other mediators when cross‐linked by allergen. These elicitors stimulate symptoms of allergy intended to expel parasitic worms and skin parasites including the scabies and possibly protection against toxic venoms. Allergen epitopes are segments of the proteins bound by MHCII and T helper cell receptors or by IgE from B cells. The T helper cells direct B cells to produce IgE rather than IgG. Circulating IgE circulates binds FcϵRI receptors on mast cells and basophils. Allergens bound by at least two IgE antibodies causes release of histamine and other mediators causing serum leakage, smooth muscle contraction and diverse symptoms: hives, angioedema, bronchoconstriction, asthma, diarrhoea, hypotension and anaphylaxis. Reactions occur rapidly after contact with allergen. This review discusses common allergens, allergen databases, and risks of allergy.

Key Concepts

Allergy is an adaptive immune response that requires previous immune education.

Antigen‐presenting cells process and present peptides of proteins to T cells to determine specificity.

Antigen specific T cells are important in switching B cells that are making IgM or IgD or in some cases, IgG to switch isotypes to make IgE antibodies.

IgE antibodies bind FcϵRI receptors on mast cells and basophils.

The mast cells and basophils make histamine, tryptase and leukotrienes that are released upon activation and trigger allergic symptoms.

Some IgG antibodies or IgA that recognise the same epitope as the IgE can block IgE binding to allergens.

Immunotherapy with the allergen may help develop tolerance and blocking antibodies that prevent allergic reactions.

Diagnosis of allergy requires careful clinical history, plausibility of exposure and measurement of IgE specific binding as well as clinical reactivity.
Covid‐19: Medical, Social and Psychological Aspects
Authors: Lederman Zohar
Published: November 2021

Prior to 2002, viruses from the coronavirus family were hardly known, mainly causing mild sickness in immunocompetent patients in China. Since then, several pandemics, caused by this family, made it infamous. Covid‐19 is the largest pandemic since the influenza epidemic at the end of the First World War and is likely to change the world as previously known.

Key Concepts

Covid‐19 has affected human health globally both directly and indirectly.

While no one was initially immune to the virus, people were affected to various degrees, such that vulnerable populations were affected to a larger degree.

There will be other pandemics, and we should better prepare for the next one.

Solidarity focuses on our similarities, while justice obliges us to address our differences when they cause health inequity.

Infectious diseases are a major threat to human public health.
Homology in Character Evolution
Authors: Staton Joseph L
Published: November 2021

Homology forms the basis of organisation for comparative biology. Richard Owen's simple definition of homology as the ‘same organ in different animals under every variety of form and function’ takes on new meaning in light of Darwin's concept of descent with modification. The modern study of comparative biology and phylogenetics is grounded in the notion that organisms sharing a greater proportion of homologous (i.e. ‘derived’) characteristics share a more recent common ancestry. Instead of solely being the purview of anatomical study, homology of these characteristics can be applied at the level of molecular evolution, genomic organisation and modern evolutionary developmental biology (‘evo/devo’). Aspects of homology help us formulate hypotheses about the meaning of changes in homologous structures in the inference of evolution of organisms at all levels of biological organisation.

Key Concepts

Darwin's theory of descent with modification restructured Owen's concept of positional similarity.

Ancestral ‘types’ are artificial attempts to combine major lineage features into a single progenitor.

Evolution of traits can be used to assess lineage history through phylogenetics inference at multiple levels: DNA primary sequence, genomic organisation, developmental pathways or gross morphology.

Pattern forming genes can give other insight into the factors leading to shifts in morphology.

Deep homology may elucidate early evolutionary events, but these must be taken in context since such information can be only similar and descent with modification often retools preexisting pathways to be applied in novel ways. Appearance of commonality may be only similarity.