bluuebunny/crossref_metadata_2025 huggingface dataset:
Phenytoin toxicity as a forgoer of schizophrenia like psychosis: a case report
Authors: Dihingia Prasanta , Jha Anshu Kumar
Published: June 2019

This is a case report describing the toxicity of phenytoin overdose. It is very uncommon to find an anti-epileptic drug causing psychosis and till date only a few studies have found such a co-relation. A psychiatric patient was admitted in our department of medicine with the complain of ingestion of 30 tablets of phenytoin. On examination he was found to have auditory and visual hallucinations. He was restless and had an ill sustained concentration. First and foremost, thing was to stop the prescribed phenytoin tablets and sedate the patient with haloperidol and promethazine. Then, he was switched over to Levetiracetam 500 mg i.v. thrice daily, Clobazam 10 mg once daily and Resperidone 3 mg twice daily. On investigation we found serum phenytoin level >40 mg/dl. This was sufficient to support our diagnosis as after stopping the drug his symptoms improved. There have been case reports of epileptic patient presenting with psychosis but usually after 10-15 years, unlike our case. In our case this time period was reduced to 12 hours as there was a triggering factor present. So, if a known epilepsy patient develops psychosis, the drug history should be given a big importance and if required serum phenytoin level should be assessed to come to the diagnosis of “phenytoin induced schizophrenia like psychosis.
A rare and independent association of Right Atrial Myxoma with Immune Thrombocytopenic Purpura
Authors: R. Karthik Raman , Palanisamy Vijay Anand , Ravikumar Mithun Sundararaja , Moses Jeswin , Pandian Sivakumar , Sethuratnam Rajan
Published: June 2019

Primary tumours of the heart are rare and the most common benign ones are myxomas.  The clinical features are varied and include a myriad of presenting symptoms like embolic, constitutional, cardiac and also symptoms due to obstruction. Right atrial myxomas are very rarely seen when compared with left atrium. Such myxomas independently co existing with Immune Thrombocytopenic Purpura (ITP) is even rarer and we now present one such case in with right atrial myxoma was associated with ITP and was managed surgically. This case emphasises the fact that ITP can co-exist with myxoma and should be borne in mind when treating such patients surgically.
A rare triad of diabetic ketoacidosis, hypertriglyceridemia and acute pancreatitis: a case report
Authors: Kumar Manoj , V. Vijayavarman , Kumar Pawan , Das Arindam
Published: June 2019

Diabetic ketoacidosis (DKA), Acute Pancreatitis and Hypertriglyceridemia are an unusual and infrequent presentation of Diabetes. Hypertriglyceridemia leading to acute pancreatitis is most commonly encountered in poorly controlled Diabetics. In this case report we have described a young Type 1 Diabetic female presenting with Diabetic Ketoacidosis and hypertriglyceridemia induced Pancreatitis (HTIP). The proposed mechanism is triglyceride excess is hydrolyzed by pancreatic lipase resulting in the formation of excess free fatty acids. Excess free fatty acids cause acinar cell injury and capillary leakage in pancreatic vascular beds. Hyperlipasemia frequently occurs in DKA without an underlying acute pancreatitis. Half of the patients with HTIP have falsely low or normal serum Amylase. Imaging is required to confirm the diagnosis of pancreatitis. So, high degree of suspicion is required to diagnose this unusual presentation of diabetes.
Contributing factors for intestinal parasitic infection in children: a study of Nepal
Authors: Das Rajesh Kumar , Mahato Pradip Kumar , Neupane Prabin
Published: June 2019

Background: Intestinal parasitic diseases are common health problems among children in Nepal. The presence of these diseases is an indication of poor hygienic practices. So our objective is to find out the factors that are responsible to cause such infections in our study population.Methods: This is a cross-sectional study to find the causes of parasitic intestinal infection in children. Stool specimens were collected from children below 15 years and studied by microscopy method to detect the causative organisms of infection.Results: Among the sample size of 305, 154 (50.5%) cases were found microscopically positive for parasitic diseases. Age and sex-wise study did not show the significant relationship (P>0.05) for infection. Entamoeba histolytica and Giardia lamblia had higher prevalence i.e., 18.03% (55/154) and 16.06% (49/154). Likewise, infection was higher in children using untreated water sources and municipal water. Many children with unsanitary habits like not washing hands properly before and after eating meals and after using toilet and nail biting habits developed more positive infection. The relationship in this case was significant (P<0.05).Conclusions: Thus, the contributing factors for intestinal parasitic infection in children are lack of hygienic practices among children. Such habits can cause ingestion of infective parasites in the intestine which eventually causes diseases.
Factors associated with the level of compliance of nurses in universal precaution application
Authors: Sofiana Liena , Ayu Suci Musvita , Sundari Dewik
Published: June 2019

Background: The highest prevalence of surgical wound infections in NurHidayah Hospital occurred in 2014 which is at 2.80%. This was because nurses’ compliance in using PPE and hand washing was still low and the culture for reporting needle puncture events had not been implemented so that the number of nurses who were punctured was still unknown. Meanwhile, the lowest prevalence of surgical wound infections occurred in 2016 amounting to 0.76%, this happened because the compliance of nurses in using PPE was quite high and the incidence of needle puncture reached 0 (zero) but compliance in hand washing was still low.Methods: This study was a quantitative study with an observational analytic method with a cross sectional design. The variables in this study were knowledge, attitudes, working period, training and nurse compliance in the application of universal precaution with the number of respondents 46 nurses. The research instruments used were questionnaires and observation sheets. The data analysis was conducted using chi square test and fisher test.Results: Factor associated with the level of nurse compliance in universal university application was attitudes (0.000), while factors not related to the level of nurse compliance in the application of universal precaution include knowledge (0.124), years of service (0.657) and training (0.098).Conclusions: There is a relationship between attitudes and levels of nurse compliance in implementing universal precaution in NurHidayah Hospital. There is no relationship between knowledge, work and training with the level of nurse compliance in the application of universal precaution at NurHidayah Hospital.
Epidemiology of preoperative hyperglycaemia among patients undergoing surgery at a tertiary health care facility of Eastern India
Authors: Banerjee Souvik , Kumar Rakesh , Basu Debasis
Published: June 2019

Background: With about 425 million patients globally and 72.9 million patients in India, diabetes mellitus (DM) is one of the global health emergency of 21st century. Perioperative hyperglycaemia is reported in 20-40% of patients undergoing general surgery. A substantial body of literature demonstrates a clear association between perioperative hyperglycaemia and adverse clinical outcomes. This study aims to find out the frequency of preoperative hyperglycaemia and factors influencing it among patients undergoing surgery at a tertiary health care hospital of Eastern India.Methods: This Institution based, cross-sectional, observational study was conducted among study subjects who were operated at IQ City Medical College and Multispecialty Hospital, Durgapur, India during January-February 2019. Relevant medical records were reviewed to collect data regarding clinic-social data. Estimation of fasting plasma glucose (FPG) has been done as per World Health Organization (WHO) guidelines. Hyperglycaemia was defined and classified as per American Diabetes Association (ADA). Anthropometric measurements were taken as per standard WHO protocols.Results: A total 158 study subjects participated in study. The mean age and mean FPG of the study subjects was 42.63±12.95 years and 103.3±17.37 mg/dl respectively. As per the ADA criteria, 58.9% had normal FPG, 24.0% had impaired fasting glucose (IFG) and 17.1% had diabetes. Out of total 27 T2DM patients, 22 (13.9%) were known cases of T2DM and 5 (3.2%) were undiagnosed. The frequency of preoperative hyperglycaemia i.e. sums of IFG and diabetes was found to be 41.1%. Increasing age, male gender and overweight and obesity significantly influenced the occurrence of preoperative hyperglycaemia.Conclusions: The prevalence of preoperative hyperglycaemia among patients undergoing surgery is higher than the prevalence of hyperglycaemia among non surgical patients. Routine HbA1C should be done in all surgical patients to differentiate between chronic undiagnosed hyperglycaemia and stress hyperglycaemia.
Effect of saphenous vein space packing in conventional varicose vein surgery
Authors: P. B. Thrishuli , K. J. Shashank , S. R. Divakar , Kamath Akshata
Published: June 2019

Background: Varicose veins are common. The prevalence has been variously reported from as little as 2% to over 20% in population studies. Management of varicose vein disease has changed drastically over the past decades. Since its introduction, surgery has gone through several stages of evolution until the method of ligation with stripping eventually became and remained the standard for a long time. The objective was to study the effect on Saphenous vein space packing in conventional varicose vein surgery on intra-operative bleeding and post-operative patient recovery.Methods: A prospective comparative study was conducted in JSS Hospital, Mysuru from August 2016 to October 2018. A total of 60 patients were selected for the purpose of the study based on the inclusion and exclusion criteria. The patient was passed on post operative day 2, 4, 7 and 30. The study population was divided into 2 groups, Group 1: 30 patients undergoing varicose vein surgery with packing and Group 2: 30 patients undergoing traditional varicose vein surgery without packing.Results: On pre-operative evaluation of GSV diameter, the mean diameter was found to be 8.20±2.3 mm in the conventional group and 7.30±1.82 mm in vein packing technique. The pain was found to be more in conventional group than Saphenous vein packing technique and score was found to statistically significant between the two groups on day 2 and 4.Conclusions: Saphenous vein space packing is an easy, economical and effective way of reducing post-operative pain in conventional varicose vein surgery.
An assessment of factors responsible for diarrhoea deaths of under five children in rural and urban settings of India
Authors: Singh Om Prakash , Singh Jatinder Bir , Mishra Dushyant , Dutta Abhik
Published: June 2019

Background: Very little scientifically based information is available on cause-specific mortality rates of diarrhoea among all regions and populations wherein an inequitable proportion exits in low-income households, which have fewer resources and less knowledge to manage burden than high-income households. The strategic purpose of the study is to identify gaps in care seeking in order to make changes in approach to address these gaps either directly by working with the community and by doing area specific advocacy to improve service delivery through government channels.Methods: The study was conducted in nine locations (6 rural and 3 urban) of India. The ethical and confidentiality parameters of conducting verbal autopsies were followed and random sampling methodology was adapted.Results: Respondents of our study attributed 22% deaths to diarrhoea. From the study, it is revealed that children who passed stool for 5 or more number of times in a day are more likely to die 1.5 times than the children who passed stool for 3 times a day. Children having diarrhoea for 5 days or more than 5 days are more likely to die 1.6 times in comparison to the children who have had diarrhoea for 3 days. Approximately seven of the ten children died within five days of treatment.Conclusions: Information on diarrheal diseases, its determinants in India and preventive and control strategies in light of recent developments need to be reviewed for better planning and organization of health services within the community.
Knowledge of newborn care practices among caregivers attending immunization clinic at a tertiary care centre of Lucknow: a cross-sectional study
Authors: Singh Sujata , Yadav Kriti , Choudhary Ranjana
Published: June 2019

Background: Essential newborn care (ENC) provides for an opportunity to assess the infant’s growth and development and counsel mothers regarding proper newborn care. Acquainting the caregivers with knowledge pertaining to dangers signs, hygienic practices, feeding, weaning, health and nutrition including growth and behaviour of children, might affect the rearing of their children. Therefore the present study aims to study the knowledge of caregivers in relation to newborn care.Methods: A descriptive cross sectional study was conducted among the caregivers attending the immunization clinic in a tertiary care centre (King George's Medical University) in Lucknow between January- March, 2016. A pretested and structured interview questionnaire was used to collect data and analysis was done using SPSS ver 16.0.Results: In Majority (75%) of the caregivers the knowledge regarding ENC was found to be average. Only 4% of the caregivers had good knowledge of ENC. Among the variables the association of knowledge of ENC and age of the caregiver< 30 years, general caste, level of education of the caregiver of high School and above, middle socioeconomic status, female sex of the newborn, birth order of 2 or more, >4 ANC visits and new born care not discussed in the VHND being conducted in the area were found to be statistically significantly.Conclusions: On the whole, the results of our study indicated that most of the caregivers were having unsatisfactory knowledge of child care practices. The present scenario can be improved through enhancing information education and counselling activities, training of health workers and mothers focusing on newborn health care practices.
Access to sanitation and risk of developing urinary tract infections among women from low socio-economic settings
Authors: Kawade Rama , Radkar Anjali , Thadathil Abhilash , Thakur Deepa
Published: June 2019

Background: Poor sanitation facilities are root cause of many health problems of people residing in slums. The present study estimates the prevalence of urinary tract infections (UTI) and identifies factors associated with an increased risk of UTI among women.Methods: A cross-sectional study was conducted among 616 women aged between 18 to 60 years residing in 33 slums across four cities in Maharashtra, India. Data related to individual characteristics of women, housing condition, access to sanitation facilities, behaviors adopted by the women that could lead to UTI and an episode of symptomatic UTI in the previous one month were recorded through structured questionnaire. Logistic regression analysis was performed to find out risk factors for UTI among women.Results: The prevalence of UTI was found to be 19.6%. The prevalence was higher among young women aged upto 30 years (23.2%). In absence of individual toilet, women had adopted certain behaviors such as urine holding (21.3%), modify dinner to avoid toilet use at night (26.6%) and avoid intake of liquids (10.7%) to reduce frequency of visits to toilet. All these behaviors were significantly associated with UTI. Multiple logistic regression indicated that UTI was strongly and independently associated with age (OR=1.64, 95%CI: 1.08, 2.47), no access to bathroom (OR=2.21, 95%CI: 1.08, 4.49) and avoid intake of liquids (OR=2.70, 95%CI: 1.53, 4.75) (p<0.05).Conclusions:Behavior modifications by women to adjust with restricted use of place of urination may affect their health and increase the likelihood of developing UTI. Younger women are more at risk of developing UTI.
Breast cancer: knowledge, attitude and practices among undergraduate female students at a government college in Koppal, Karnataka
Authors: Nimbannavar Smita M. , Mane Vijaykumar P.
Published: June 2019

Background: Breast cancer is the second most common malignancy in general and most common cancer among women in both the developed and developing countries. Its incidence is on the raise due to increased life expectancy of people, increased urbanization and adoption of unhealthy lifestyles. An awareness of brest cancer and its presentation is essential among women for detection at an early stage and timely treatment for better prognosis. The objective of the study was to assess knowledge, attitudes and practices towards breast cancer among female students in the study setting.Methods: A descriptive study was conducted for duration of 3 months from July 2018 to September 2018 among female students at a degree college in Koppal city, Karnataka. A total of 396 students were included and data was collected using a pre tested and semi structured questionnaire after taking an informed consent. Data thus obtained was entered and analyzed using Microsoft Office Excel 2013.Results: More than 80% of study participants had heard about breast cancer in the present study but their knowledge on its various aspects was limited. More than half were positive in their attitude believing that they are not at risk of breast cancer and were willing to practice breast self-examination (BSE) in future but only 5.28% of them admitted to have done BSE in the past. Most common source of information about disease was school in the present study.Conclusions: The present study demonstrated KAP gap among graduate female students which needs to be tackled through proper educational interventions.
A study of knowledge and behaviour regarding blood donation among medical college students of Ajmer, Rajasthan, India
Authors: Meharda Bharat , Keswani Mahesh , Choudhary Pradeep Kumar , Mehra Ankit
Published: June 2019

Background: Blood is specialized body fluid in humans that delivers necessary substances such as nutrients and oxygen to the cells and transports metabolic waste products away from that same cells.Methods: The study was conducted among undergraduate medical students of J.LN. Medical College, Ajmer, Rajasthan, India in March 2019. It was a descriptive cross‑sectional study among 1st professional MBBS students.Results: The study participants included age range of 17-20 years. 96 (78.04%) study participants were knows blood group “O” is a universal donor and 94 (76.42%) were know blood group “AB” is universal recipient. majority of study participants 48 (45.28%) not donate due to fear of procedure.Conclusions: Role of health care personnel and medical students of a medical college for blood donation are pivotal.
Prevalence of gestational diabetes mellitus and associated risk factors amongst antenatal women attending urban health centre of Rajkot City, Gujarat
Authors: Nimavat Nirav K. , Dadwani Roma S. , Kartha Girija P.
Published: June 2019

Background: Prevalence of gestational diabetes mellitus (GDM) vary widely depending on the region of the country, dietary habits, and socio-economic status. This study was undertaken to determine the prevalence of GDM and risk factors associated with it, in women attending an antenatal care (ANC) clinic at urban health training center in Rajkot city, Gujarat.Methods: This study enrolled women, with estimated gestational age between 24 and 28 week, attending UHC in Rajkot. After informing, women who consented to participate were given a standardized 75 g oral glucose tolerance test (OGTT). A proforma containing general information on demographic characteristics, socio-economic status, education level, parity, family history of diabetes and/or hypertension was filled up. Diabetes in pregnancy study group India (DIPSI) criteria for 75 g 2-h OGTT was used for diagnosing GDM.Results: Total of 366 women participated in the study and GDM was diagnosed in 36 (9.8%) women. Age, parity, BMI, family history of DM and hypertension were accessed and found to be not significant. History of hypertension in previous pregnancy was statistically significant with occurrence of GDM in present pregnancy.Conclusions: The prevalence of GDM was found to be 9.8 per cent in a UHC, Rajkot. Appropriate interventions are required for control of GDM and modifications of risk factors.
An evaluation of compliance with the cigarettes and other tobacco products act 2003 in Koppal district, Karnataka
Authors: Mane Vijaykumar P. , Yenkanaik Yuvaraj Bhanot , Dhanapur Shankrappa , Yallammanavar Sangappa , Sreenivasamurthy Rashmi
Published: June 2019

Background: Tobacco is a major risk factor for a number of diseases affecting all age groups. One person dies every six seconds due to tobacco use and up to half of current users will eventually die of a tobacco-related disease. Government of India has enacted cigarette and other tobacco products act (COTPA) in the year 2003 to control tobacco use. The objective of study was to estimate the level of compliance to selected sections (4 to 9) of COTPA (cigarette and other tobacco products – prohibition of advertisement and regulation of trade and commerce, production, supply and distribution) act, 2003 in Koppal district, Karnataka.Methods: The present study was a cross sectional study conducted as an independent evaluation of COTPA act 2003 in Koppal district as per National Tobacco Control Program guidelines. Cluster sampling technique was used for sample selection and sample consisted of 158 public places, 102 educational institutional, 87 shops/ sell points and 60 tobacco products. Data entry and analysis was done using microsoft office excel 2013.Results: The prevalence of compliance to section 4, 5, 6A, 6B, 7, 8 and 9 of COTPA act 2003 in Koppal district were 80.3%, 96.5%, 98.9%, 64.8%, 53.3%, 63.3% and 50% respectively.Conclusions: Compliance level was poor especially in relation to display of health warnings on tobacco products which needs to be tackled through strict enforcement of the existing laws.
Clinico-pathological profile of nasopharyngeal carcinoma at Muhimbili National Hospital, Dares Salaam, Tanzania
Authors: Abraham Zephania Saitabau , Massawe Enica Richard , Ntunaguzi Daudi , Kahinga Aveline Aloyce , Yahaya James Joseph , Mithe Siwillis Elizabeth
Published: June 2019

Background: Nasopharyngeal carcinoma (NPC) is an uncommon malignant tumor which has been reported invariably and cases have been encountered in Tanzania. Though rare they are associated with potential morbidity and mortality. The aim of this study was to characterize the clinico-pathological profile of such neoplasm in our set up.

Methods: A retrospective review of 25 cases from hospital archives for 3 consecutive years was done where all patients with a histopathologically confirmed diagnosis of NPC were recruited. Data was analyzed using SPSS version 21.

Results: Of the 25 eligible cases, 15 (60%) were males and 10 (40%) were females. Age range was 15-70 years. The peak age was 30-50 years in males and 50-59 years in females. Highest incidence was in the 5th decade. The commonest presenting features were cervical lymphadenopathy (92%) epistaxis (80%), hearing loss (80%) and nasal obstruction (76%) while the least common feature was seizures (4%). Histologically, undifferentiated carcinoma (76%) was the commonest variant while the least common one was differentiated non keratinizing squamous cell carcinoma (8%). Identifiable risk factors were consumption of salted smoked fish (80%), tobacco use (60%), alcohol intake (52%) and occupational exposure to wood dust (32%). Majority of patients (80%) were diagnosed with advanced stage of the disease (Stage IV).

Conclusions: Findings from this study correlate with what has been reported elsewhere. Clinicians should have a higher index of suspicion in diagnosing NPC to enable early referral and prompt treatment of such malignant neoplasm.
Endoscopic cerebrospinal fluid leak repair: how we do it
Authors: Patel Kalpesh , Gugliani Abhishek , Vishwakarma Rajesh
Published: June 2019

Background: Cerebrospinal fluid (CSF) rhinorrhoea is characterized by a defect in the barriers which separate the subarachnoid space from sinonasal tract resulting in the leakage of watery fluid from the nose. Management of CSF rhinorrhoea is by both conservative and/or surgical approach. Transnasal endoscopic method has become the preferred surgical method for the repair of CSF leak because of less complication as compared to the open approach. To evaluate the results of patients who underwent endoscopic repair of CSF rhinorrhoea over a period of 5 years at BJ Medical College, Civil Hospital, Ahmedabad.

Methods: 118 patients were included in this retrospective study who underwent CSF leak repair by nasal endoscopy over a period of 5 years between 2011-2016 in the department of ENT at BJ Medical College, Civil Hospital, Ahmedabad. As per review of the records, these patients were diagnosed with CSF leak on the basis of their history, clinical examination, and radiological investigations. Materials used for the repair were fat, fascia lata, fibrin sealant, and/or vascular flap.  

Results: Primary surgery was successful in 110 (93%) of cases. In 8 (7%) cases, there was a recurrence of leak which was managed by either conservative management (5 cases, 4%) or by re-exploration (3 cases, 3%).

Conclusions: Transnasal endoscope is an important tool for the evaluation and subsequent treatment of CSF rhinorrhoea. Endoscopic repair of CSF rhinorrhoea is safe, effective, has a low complication rate and has almost completely replaced the open technique.
Thyroglossal duct cyst: myriad presentations
Authors: Meenakshi S. , Rajasekar M. K.
Published: June 2019

Background: Thyroglossal duct cysts are the most common midline neck swellings. They are routinely treated by surgeons with simple excision.

Methods: We present a retrospective study of a series of 30 cases operated in our hospital over a period of five years and the challenges faced during investigations, surgery and postoperative period. All patients were clinically diagnosed as thyroglossal duct cysts. The diagnosis confirmed with USG Neck and FNAC of the swelling. CECT NECK was used to delineate the normal thyroid and patients were subjected to Sistrunk procedure under general anesthesia.

Results: The outcome of all cases was good with one case being a revision surgery and another case going in for delayed healing due to infection. All patients were healthy with no complaints postoperatively.

Conclusions: This study validates the Sistrunk surgery as the best method of excision to avoid recurrences. This article highlights the variant presentations of this cyst in our institution and the challenges we faced in diagnosis, during surgery and later as well.
Efficacy of intratympanic injection of dexamethasone in the treatment of subjective idiopathic tinnitus
Authors: Shetty Sandeep , George Ammu , Chandrashekar Shilpa , Prakash Bhadravathi Ganesh
Published: June 2019

Background: To study the efficacy of intratympanic injection of dexamethasone in cases of subjective idiopathic tinnitus.

Methods: Prospective interventional study at the Department of ENT, JSS Medical College and Hospital, Mysore, in which 45 patients diagnosed clinically as subjective idiopathic tinnitus, for a duration of 2 years from October 2016 were included in the study. The patients were subjected to 3 intratympanic injections of dexamethasone once in a week for 3 weeks.  They received a 0.5 ml intratympanic injection of 4mg/ml dexamethasone solution. After topical anaesthesia, using a 2 ml syringe and a spinal needle no. 22, the assigned solution was administered under direct vision using an endoscope in the postero- inferior quadrant of the tympanic membrane. They were followed up at the end of 1 and 3 months from the last injection. Tinnitus handicap inventory was repeated during the follow up and was compared to the value at presentation.  

Results: There was a statistically significant improvement in the THI at the first follow up compared with the baseline THI. Whereas there was no statistically significant change in improvement rate from the 1st follow up to the 2nd follow up (p=0.7), however there is decrease in the improvement, which means the improvement is temporary, and starts reverting by the second visit to some extent.

Conclusions: It was observed that the improvement in the tinnitus was for a short term after intratympanic injection of dexamethasone.
Clino-radiological and functional outcome of intra-articular distal radius fractures treated with volar locking plate system
Authors: Rao Mohan , Gupta Siddharth , Jayasankar P. V. , Yadav Vinit , Williams Sudhakar
Published: June 2019

Background: No uniform consensus exists to decide type of fixation for unstable distal radius fractures. The objective of the study is to evaluate the patients on regular follow up for radiological & functional status. We evaluated the effectiveness and outcomes of unstable distal radius fractures treated with locking plates.

Methods: The study design was prospective observational study. 36 patients with distal radius fractures deemed unsuitable for conservative management underwent ORIF with a volar locking plate. The evaluation methods were clinical examination, DASH score and PRWE score. Patients were followed up from minimum of 2 weeks to 6 months. This data was analysed in MS excel and SPSS software version 19.0 for testing the association between different variables by using the chi-square tests.

Results: The mean age of patients was 45 years with male preponderance. As per DASH score 17 patients had zero score implying no disability. In the remaining 19 patients score ranged from 4 to 24 with a mean of 11 indicating good outcome. PRWE score was best in 17 patients and worst in zero patients.

Conclusions: The fixation of unstable distal radius fractures with volarly applied locking plates without bone grafting and prolonged immobilisation is an effective method & hence has gained worldwide acceptance and is highly recommended.
Functional outcome of elastic intramedullary nailing of forearm fractures in children using pin leverage technique
Authors: Jhan Alamgir , Jan Wazir Fahad , Dharamshaktu Ganesh Singh , Bhalla Tajinder , Rasool Saika , Nippuleti Anoop
Published: June 2019

Background: There is a recent trend towards elastic intramedullary nailing in fixation of pediatric forearm bone diaphyseal fractures. But in children we should always attempt closed reduction and immobilsation in a moulded plaster cast. Irreducible, open fractures and those that get redisplaced in moulded plaster cast need operative fixation with intramedullary nailing. Our aim was to know the outcome of tens nailing in such fractures.

Methods: We studied functional and radiological outcome of elastic intramedullary nailing by pin leverage technique in forearm fractures in 34 children. The study was done at a tertiary care centre in Uttrakhand, India from May, 2016 to July, 2018. Inclusion criteria were closed forearm fractures; diaphyseal fractures; age 1 to 19 years. Exclusion criteria were open type 2 and type 3 Gustillo-Anderson fractures; metaphyseal, epiphyseal forearm fractures; age >19 years; pathological fractures.

Results: Closed reduction and percutaneous pin leverage technique for reduction was successful in all but 4 patients where limited open reduction was used for reduction of fracture fragments. All fractures united radiologically between 7 to 13 weeks with mean distribution of 9.2 weeks. For functional outcome we used modified Price and Daruwala’s score. 28 patients showed excellent results and 6 patients showed good results. All our patients had radiological union in mean of 9.2 weeks (7-13 weeks).

Conclusions: Fixation with intramedullary TENS nailing is an effective and affordable way of treating patients in paediatric age group.
A prospective study on surgical management of neglected Montaggia fracture in children without annular ligament repair
Authors: Nayak Satya P. , Panda Chandan K.
Published: June 2019

Background: Monteggia fracture presenting after 4 weeks of injury termed as neglected monteggia fracture.There are many options for management of this fracture. The present study was planned with objective to assess clinical outcome of patients who were treated with a specific technique of ulnar osteotomy without annular ligament repair.

Methods: This prospective study was conducted in Department of Orthopaedics MKCG Medical College and Hospital, Berhampur from July 2015 to April 2018 where 15 patients of neglected monteggia fracture were operated with specific technique of ulnar osteotomy without annular ligament repair. Participants were followed up and at end point they were evaluated for pain, stability, and disturbance of daily and sporting activities. Function was assessed using elbow performance score. Data collected were analyzed in SPSS (version 16.0).

Results: Mean age of study participants was 7.3 year and male constituted majority (60%). There were 11 children with Bado type I, 3 with type II and one with type III injury. The mean time from initial injury was 8.8 months. All had limited range of movements of forearm and elbow. All patients had regular follow up for 9 months to 24. In 53.3% flexion arc was improved. The mean flexion arc was increased by 20 degree and pronation-supination arc was reduced by 20 degree.

Conclusions: The present study revealed that osteotomy in neglected monteggia fracture brings stability of elbow joint and this surgical management of neglected monteggia fracture without annular ligament reconstruction had good outcome. Annular ligament reconstruction is not always necessary.
Caries sicca: tuberculosis of glenohumeral joint
Authors: Goel Varun , Sharma Pankaj Kumar , Jain Jalaz , Yadav Umesh , Devgan Ashish , Bhardwaj Neha
Published: June 2019

Tuberculosis is quite common in India. Shoulder tuberculosis although rare among the skeletal tuberculosis needs to be kept in mind for diagnosis and proper treatment of cases of Carries Sicca. Twenty year old female presented with non traumatic pain in right shoulder with severe restriction of shoulder Range of Movements (ROM), not responding to treatment. On detailed examination turned out to be a case of Caries Sicca. Thorough debridement along with sufficient immobilization and Anti Tubercular Treatment (ATT) gives excellent results. High suspicion is needed to diagnose the cases of Carries Sicca. Early diagnosis and proper treatment gives wonderful results. Only ATT with or without immobilization and debridement are sufficient enough in majority of cases.
Isolated teres major rupture in an amaturer volleyball player
Authors: Opondo Everisto A.
Published: June 2019

Isolated lesions to the teres major muscle are extremely rare. These injuries have been report in cases reports only due to the rarity of these injuries. I report the case of an amateur volleyball player who suffered an isolated injury to the teres major while volleyball for recreational purposes. The clinical presentation was confirmed by clinical examination and MRI scanning. Conservative treatment was chosen and consisted of brief immobilization and analgesics, followed by rehabilitative treatment. The patient recovered quickly from a conservative regime of physiotherapy and analgesics. The results and the data from the literature suggest that non-operative rather than surgical treatment is preferable in isolated lesions to the teres major muscle. 
Pattern of dermatoses in elderly at tertiary care center, Jaipur, Rajasthan, India
Authors: Mehra Ankit , Depan Anju , Meherda Ashok , Bohara Deepak
Published: June 2019

Background: The population of India is currently moving towards and old age structure. The Indian elderly population 60 and older is currently the second largest in the world. During aging, structural and functional changes of the skin system are observed. Among the elderly, the number of cells decreases and the cell-renewing slows down in the epidermis. The skin water retention capacity decreases as well. Social and psychological circumstances also influence skin in old age.

Methods: A cross-sectional study was conducted in out-patient Department of Dermatology, Venereology and Leprosy, Mahatma Gandhi Medical College and Hospital, Jaipur (Rajasthan) for a period of 18 months from January 2016 to June2017. A total of 1100 elderly were included in the study.

Results: Out of 1100 total elderly patients 622 (56.50%) were males and 478 (43.50%) were females. Maximum number of males (322; 29.27%) as well as females (244; 22.18%) belonged to 65-70 years age group. Out of total 3138 diagnosis, the most common physiological changes secondary to aging process were graying of hair (1100; 35.05%) and wrinkling (1100; 35.05%). Out of the total 3256 diagnosis, the relative incidence of benign tumors was maximum (1626; 49.94%).

Conclusions: Good general care of the elderly including nutritional diet, proper clothing, moderate physical activity and personal hygiene will improve many of their dermatoses and help in prevention of cases of dermatitis and infections.
Igualdade de gênero e divisão sexual do trabalho: subalternidades, enfrentamentos e resistências a partir da percepção de mulheres trabalhadoras da cidade de Guarabira/PB
Authors: Alves Clarissa Cecilia Ferreira , Gonçalo Cassia Maria De Souza , Batista Janiele Ferreira , Oliveira Lucas De Lima , Da Costa Marsoniel Felipe
Published: June 2019

The objective of this article is to analyze how women workers linked to commerce perceive the subalternities to which they are conditioned, the individual constraints they have and the forms of resistance they develop in the context of the sexual division of labor. We seek to understand how women’s perception of the sexual division of labor and the forms of mobilization and resistance regarding situations of gender inequality are still rooted in our society. Using the research technique of the semistructured interview, this is a qualitative study, which has the city of Guarabira/PB as locus of the research. It is expected that this study and the results here pointed out may contribute to the understanding of how the women interviewed consider ways of overcoming that gender inequality.
Influência do revestimento comestível à base de fécula de mandioca e óleo essencial na conservação de queijo minas frescal
Authors: Santos Edilene Vieira dos , Cesar Erica Lins , Virginio Gabrieli Vieira , Neto João Ferreira , Santos Carlos Christiano Lima , Sousa Poliana Epaminondas
Published: June 2019

The objective of this research was to evaluate the influence of cassava starch and essential oil for the preservation of the cheese during the refrigerated storage period (± 5 ºC). The treatments were: F1- without addition of coatings; F2 - manioc starch (2.0%); F3 - manioc starch (2,0%) + rosemary oil (0,5%); F4 - manioc starch (2.0%) + rosemary oil (1.0%). Coliforms at 35 ºC and 45 ºC, coagulase-positive Staphylococcus / g, Salmonella sp, molds and yeasts on 0, 14, 28 and 35 days of storage were carried out. All treatments were submitted to sensory analysis with 60 non-trained testers on the seventh day of storage, using a structured hedonic scale of 9 points for the attributes appearance, aroma, color, taste and texture and intention of purchase test. As for physical-chemical parameters, analyzes of moisture, colorimetry, ashes, proteins, fats, carbohydrates, water activity (Aw), acidity and pH were performed. Regarding the physical-chemical characteristics, the control and coated cheeses did not present significant difference in the ash parameter (2.64 ± 0.67, 2.88 ± 0.67) and color analysis (* L, * ae *B). Microbiological results revealed shelf life of up to 14 days for uncoated cheese, while cheeses with coatings remained microbiologically stable up to 35 days of storage and were within the microbiological standards for the evaluated microorganisms throughout storage. The acceptance test with untrained consumers confirmed that the increased samples of rosemary oil showed higher rejection among the tasters and that the sample coated with cassava starch alone did not present sensorial differences in relation to the control. In a way, coatings represent promising technologies for maintaining the quality of minas frescal cheese, working as an additional barrier to post-processing contamination of food.
Análise dinâmica aplicada ao controle de vibrações em protótipo de edifício incorporando molas LMF superelásticas
Authors: Moraes Yuri José Oliveira , Silva Antonio Almeida , Rodrigues Marcelo Cavalcanti , Dos Reis Rômulo Pierre , Moreira Pedro Igor
Published: June 2019

O aumento da flexibilidade de estruturas civis em função de construções cada vez mais altas, esbeltas e com vãos maiores, resulta em uma vulnerabilidade do sistema à ação de cargas dinâmicas de causa humana ou natural. Essas estruturas, quando submetidas a essas forças, podem causar desconforto aos usuários e até seu colapso. Neste contexto, o controle destas vibrações faz-se necessário como forma de garantir ou evitar danos e falhas estruturais ao sistema. No presente trabalho estuda-se a aplicação de um sistema de controle passivo de vibrações através da incorporação de materiais inteligentes, como minimolas de uma Liga com Memória de Forma (LMF) em seu estado de superelasticidade. Numa primeira fase foram realizados estudos de modelagem analítica e numérica do sistema sem os elementos passivos e posteriormente testes dinâmicos experimentais para fins de validação do mecanismo de controle num pórtico de Dois Graus de Liberdade (2GDL), através da incorporação de fios de aço acoplados com as minimolas LMF, visando aumentar o amortecimento estrutural e reduzir a transmissibilidade de deslocamento do sistema. Nesse estudo foi concluído que a incorporação destes elementos pode apresentar resultados bastante satisfatórios para o controle de vibração em estruturas, quando esta é submetida à excitação dinâmica.
The Evaluation of Education Quality Assurance at ‎ SD N Noborejo 01 Using CIPP
Authors: Dwimurtiyanto Budi Yuwono
Published: July 2019

This research is aimed at evaluating the implementation of education quality assurance program at SD N Noborejo 01 using Context, Input, Process, Product (CIPP) model which used evaluation approach using descriptive qualitative method. The research result shows that based on the context evaluation, it has not met the minimal standard of internal quality assurance system set by the government. According to the evaluation result, external quality assurance system is categorized into standard “A” which includes standard of education, teacher and staf, and scoring management that are involved into good category. The aspects of process consist of content standard, process standard, and evaluation standard which are included into good category. In the aspect of product standard category, the passing grade is assesed and results good category. The impact of education quality assurance evaluation at SD N Noborejo 01 are: 1) Output: SD N Noborejo 01 is able to implement the whole cycle of CIIP model and the effectiveness of education quality assurance organization at school; 2) Outcome: the learning process has been implemented based on standard; 3) Impact: the quality culture of SD N Noborejo 01 has been constructed and learning outcome quality has increased.
A reprodução capitalista do espaço por meio da concessão de serviços e as implicações no lazer dos visitantes no Parque Nacional da Tijuca –RJ
Authors: Botelho Eloise Silveira , Maciel Gláucio Glei
Published: July 2019

Este artigo analisa as implicações da concessão de serviços de apoio à visitação do Complexo Paineiras no uso da área de lazer Floresta das Paineiras (Parque Nacional da Tijuca, Rio de Janeiro). É resultante de uma pesquisa de caráter exploratório, que tem como método a análise teórica sobre a reprodução capitalista em áreas protegidas do espaço urbano e, como base para a análise empírica, os resultados de pesquisa conduzida pelo Instituto Chico Mendes de Conservação da Biodiversidade (ICMBio) com os frequentadores da Floresta das Paineiras. Aponta que a implantação do Complexo Paineiras reflete a lógica de reprodução capitalista do espaço que vigora no Rio de Janeiro, motivado, sobretudo, pelos megaeventos. Apesar do estudo do perfil dos visitantes da área de lazer indicar que existe interesse nos serviços oferecidos pela concessionária, o artigo avalia que o processo de transformação do espaço resultante da concessão tende a atribuir um valor de uso ao patrimônio natural (representado pela paisagem natural) e históricocultural (edificação histórica). O artigo defende que o processo pode significar a perda da função pública e social do Parque Nacional como espaço de lazer e de cultura, na medida em que o processo de reprodução capitalista tende a atender às necessidades de uma cidade que se globaliza.
SIMULAÇÃO E ANÁLISE ECONÔMICA DA TRANSESTERIFICAÇÃO DA TRIACETINA VIA CATÁLISE ÁCIDA HETEROGÊNEA COM FOCO NO TIPO DE REATOR E NAS CONDIÇÕES OPERACIONAIS
Authors: Gomes Paula Geovana , Temóteo Rafael Luiz , Silva Faria Wagner Luís , Ávila Rodrigues Fábio , Silva Deusanilde de Jesus
Published: July 2019

Nesse trabalho simulou-se, no programa computacional Aspen Plus, a atividade catalítica da zircônia sulfatada no processo de transesterificação da triacetina e avaliou-se a viabilidade econômica das plantas geradas. Nas simulações realizadas, comparou-se o desempenho dos reatores CSTR e PFR a 150°C e 12 bar com o desempenho dos mesmos em condições de operação mais brandas, em torno de 60°C e 1 bar. Nesse último caso, analisou-se o efeito da implantação de uma corrente de reciclo em cada reator. O preço mínimo de venda (PMV) do acetato de metila foi o parâmetro usado para determinar a planta mais viável. Os resultados mostraram que a configuração com o PFR a 150°C e 12 bar foi a que apresentou o menor PMV, 0,98 USD kg-1, e, portanto, foi a mais economicamente viável. A redução nas condições de operação do PFR gerou os maiores PMVs, já para o CSTR, a redução gerou o segundo menor PMV.
Marketing gubernamental: análisis de su aplicación en los gobiernos locales del Ecuador
Authors: Morejón Santistevan Maryury
Published: June 2019

El presente trabajo se realiza en atención al análisis de escritos realizados por autores, en los que se puede determinar la importancia de la utilización del marketing gubernamental como apoyo primordial para la gestión pública de los gobernantes, en donde se demuestran los planes y estrategias que se ejecutan con la finalidad de cumplir con la plataforma del partido, el propósito de la investigación es dar a conocer la importancia de la comunicación que muestra el marketing en el nivel local de gobierno entre los gobernantes y gobernados, el método que se aplica es el cualitativo de análisis de observación documental y la técnica de la entrevista, obteniendo como resultado que los políticos electos deben de seguir manteniendo el contacto permanente con la ciudadanía, con la intención de que se dé la comunicación que permita integrar a la participación ciudadana, así se llega a concluir que los gobernantes y gobernados deben de seguir interrelacionando como lo hacían en las campañas electorales, todo esto, debe de efectuarse con la ayuda de los medios tecnológicos que facilitan la realización del marketing gubernamental.