bluuebunny/crossref_metadata_2025 huggingface dataset:
Medication resistant tuberculosis: multi drugresistant and extensively drug resistant
Authors: Bereda Gudisa
Published: February 2022

Medication-resistant tuberculosis is a considerable across-the-board public health challenge that menace’s the substantial advance made in tuberculosis heedfulness and precluding in current decades. Multidrug-resistant tuberculosis is caused by organisms that are resistant to the consummate effective anti-tuberculosis medications (isoniazid and rifampicin). Tuberculosis organisms resistant to the antibiotics used in its treatment are extendedly and happen in entire countries studied. Medication resistance noticed as a sequence of insufficient treatment and once tuberculosis organisms obtain resistance they can disseminate from person to person in the similar way as medication-sensitive tuberculosis. Multidrug-resistant tuberculosis sequences from either infection with organisms which are previously medication-resistant or perhaps advance in the program of a patient's treatment. Rifampicin-resistant tuberculosis is caused by bacteria that do not answered to rifampicin, one of the consummate influential anti- tuberculosis medications. These patients necessitated multidrug-resistant tuberculosis treatment. Extendedly medication-resistant tuberculosis is a figure of tuberculosis caused by organisms that are resistant to isoniazid and rifampicin (i.e. multidrug-resistant tuberculosis) as well as every fluoroquinolone and any of the second–line anti- tuberculosis injectable drugs (amikacin, kanamycin or capreomycin). Extendedly medication-resistant tuberculosis can elaborate when second-line medications are used incorrectly or wrongly managed and upon become ineffective.
Migrating Techniques from Search-based Multi-Agent Path Finding Solvers to SAT-based Approach
Authors: Surynek Pavel , Stern Roni , Boyarski Eli , Felner Ariel
Published: February 2022

In the multi-agent path finding problem (MAPF) we are given a set of agents each with respective start and goal positions. The task is to find paths for all agents while avoiding collisions, aiming to minimize a given objective function. Many MAPF solvers were introduced in the past decade for optimizing two specific objective functions: sum-of-costs and makespan. Two prominent categories of solvers can be distinguished: search-based solvers and compilation-based solvers. Search-based solvers were developed and tested for the sum-of-costs objective, while the most prominent compilation-based solvers that are built around Boolean satisfiability (SAT) were designed for the makespan objective. Very little is known on the performance and relevance of solvers from the compilation-based approach on the sum-of-costs objective. In this paper, we start to close the gap between these cost functions in the compilation-based approach. Our main contribution is a new SAT-based MAPF solver called MDD-SAT, that is directly aimed to optimally solve the MAPF problem under the sum-of-costs objective function. Using both a lower bound on the sum-of-costs and an upper bound on the makespan, MDD-SAT is able to generate a reasonable number of Boolean variables in our SAT encoding. We then further improve the encoding by borrowing ideas from ICTS, a search-based solver. In addition, we show that concepts applicable in search-based solvers like ICTS and ICBS are applicable in the SAT-based approach as well. Specifically, we integrate independence detection, a generic technique for decomposing an MAPF instance into independent subproblems, into our SAT-based approach, and we design a relaxation of our optimal SAT-based solver that results in a bounded suboptimal SAT-based solver. Experimental evaluation on several domains shows that there are many scenarios where our SAT-based methods outperform state-of-the-art sum-of-costs search-based solvers, such as variants of the ICTS and ICBS algorithms.
THE USE OF CHILD SOLDIERS IN ARMED CONFLICT
Authors: Kearen Bell  , David Abrahams
Published: February 2022

The use of the child soldier is by its very nature contradictory. It is therefore not surprising that the law pertaining to and providing protection for the child soldier is uncertain and often vague. The object of this article is to analyse the use of child soldiers in armed conflict, so as to ascertain the complete situation surrounding the child soldier. The relevance of such an examination lies in the fact that the continued dissemination and awareness of this situation will ensure that further preventative and protective measures aretaken, thereby ensuring that the rights of the child soldier are afforded and implemented in a manner consistent with the child’s best interests. The first part of this article serves essentially as a prologue, defining a “child soldier” and highlighting the context in which the analysis of the use of child soldiers will occur. The second part exposes the consequences of participation in armed conflict, whilst exploring some of the encouraging factors of war which contribute to the emergence of the phenomenon of child soldiering.In law regarding to the child soldier is both analysed and ascertained next, whereafter the full legal position in regard to the child soldier is obtained through the consideration of customary international law. The penultimate part of this article deals with the enforcement and implementation of the law pertaining to the child soldier. The relevance of NGOs and international humanitarian organisations is considered, and recommendations posed by the ICRC are referenced. The conclusion serves to condense the findings of this article, so as to ensure concisely that the full position in relation to the child soldier in armed conflict becomes apparent.
THE LAW OF DELICT AND PUNITIVE DAMAGES
Authors: J Neethling
Published: February 2022

In two recent case-law dicta, one of the Constitutional Court, it was made perfectly clear that there is no room in the South African law of delict for awarding punitive damages. In Dikoko v Mokhatla (2006 6 SA 235 (CC) 263) Mokgoro J expressed it as follows:“Equity in determining a damages award for defamation is ... an important consideration in the context of the purpose of a damages award, aptly expressed in Lynch [1929 TPD 974 at 978] as solace to a plaintiff's wounded feelings and not to penalise or deter people from doing what the defendant has done. Even if a compensatory award may have a deterrent effect, its purpose is not to punish. Clearly, punishment and deterrence are functions of the criminal law. Not the law of delict ... In our law a damages award thereforedoes not serve to punish for the act of defamation. It principally aims to serve as compensation for damage caused by the defamation, vindicating the victim's dignity, reputation and integrity. Alternatively, it serves to console.” A similar approach is also apparent from Seymour v Minister of Safety and Security (2006 5 SA 495 (W) 500), where Willis J stated unequivocally that it “is trite that the primary function of awards for damages under the actio injuriarum is to compensate the victim for his or her injuriae, and is not exemplary”.It is, however, debatable whether this view accurately reflects the position in positive law, or, if it does, whether the de lege ferenda approach in our law should not be different. Under South African law there is consensus that the actio legis Aquiliae, in terms of which patrimonial damages may be claimed, and the action for pain and suffering aimed at non-patrimonial damages for bodily injuries, have purely compensatory functions - punitive damages are thus completely out of the question. But not so in the case of the actio iniuriarum which is traditionally directed at solatium (solace money) or (personal) satisfaction (sentimental damages) for an iniuria – that is, the wrongful and intentional infringement of an interest of personality.
THE ADMISSIBILITY OF EXTRA-CURIAL STATEMENTS BY A NON-TESTIFYING ACCUSED
Authors: BC Naudé
Published: February 2022

Section 219 of the Criminal Procedure Act 51 of 1977 determines that “no confession made by any person shall be admissible as evidence against another person”. Section 219 deals with the situation where an accused has made a confession that also incriminates a co-accused. The parts which incriminate the co-accused are inadmissible. Even indirect usage of a confession against someone other than the declarant is prohibited.Section 219 does not deal with the admissibility of statements that are considered to be vicariously made.The Constitutional Court recently dealt with the admissibility of extra-curial statements by a non-testifying accused that incriminate a co-accused in S v Molimi (2008 2 SACR 76 (CC)). The case came before the Constitutional Court by way of an application for leave to appeal against the judgment and order of the Supreme Court of Appeal in S v Molimi (2006 2 SACR 8 (SCA)).
THE MOMENT OF DEATH: LAW, SOCIETY AND SCIENCE
Authors: Andra le Roux-Kemp
Published: February 2022

To determine the moment of death is very important for various purposes in medico-legal practice. The moment of death may not only assist and be regarded as valuable evidentiary material in criminal investigations but it is also important in the context of organ transplantation, questions regarding euthanasia, insurance claims, the termination of a marriage or business partnership as well as in the legal domain of succession. A diagnosis of death is furthermore important and necessary for society to commence with religious and/or traditional rituals, burials etcetera. In order to determine the exact moment of death, however, is not an easy task, least of all a very simple and straightforward undertaking as Prof Christiaan Barnard suggested by asserting that a person is dead when the doctor says that the person is dead!  To determine the exact moment of death, a definition of death is required as well as a standard to diagnose death – diagnostic criteria. This note will show that what initially may be regarded as general medical and legal requirements as well as basic semantics when referring to a definition of death, a concept of death and the criteria for the purposes of diagnosing death, is actually a very complicated, multifaceted and unsettled area of debate. The focus of this note will be on the moment of death in the broader context of medico-legal practice and with specific reference to the amendments made by the National Health Act 61 of 2003 in this regard. Owing to the vast scope of the topic, the note will highlight the main debates regarding the moment of death, the definition for death and criteria for determining death. The basic principles and comments on recent developments in this particular area of medical law will also be discussed.
ADVANCED AGE AS A MITIGATING FACTOR
Authors: Marita Carnelley  , Shannon Hoctor
Published: February 2022

The sentencing of an offender is not determined in a vacuum. Certain guidelines and principles have been developed that should be applied in every case: the circumstances of the case; the severity of the crime; mitigating and aggravating factors regarding the offender; the interests of society; and the purposes of sentencing specifically deterrence, prevention, rehabilitation and retribution, as well as mercy. The focus of this note is only on a single aspect of the sentencing equation, specifically the extent to which the advanced age of the offender constitutes a possible mitigating factor. Although much has been written regarding youthful offenders, very little jurisprudence exists on the impact of age on persons on the opposite side of the age spectrum. This can be partly attributed to the fact that the elderly in general commit fewer crimes and that there are fewer appeals noted and reported on as age has been taken into consideration during sentencing. The note commences with an overview of the common law, proceeds to a discussion of the South African sources and concludes with a brief comparison with the approach adopted in the Zimbabwean, English and Australian jurisdictions with regard to sentencing older offenders.
CANCELLING AN INSTALMENT SALE OF LAND Merry Hill (Pty) Ltd v Engelbrecht 2008 2 SA 544 (SCA) Van Niekerk v Favel 2008 3 SA 175 (SCA)
Authors: Henk Delport
Published: February 2022

Chapter II of the Alienation of Land Act 68 of 1981 (“the Act”) governs instalment sales of land (as defined in the Act) where the purchase price is payable in more than two instalments over a period longer than 12 months. The Act affords the purchaser special protection, given the risks arising from instalment sale transactions. Perhaps the biggest risk is that the owner of the land may be sequestrated prior to transfer of the property to the purchaser, after the latter has paid the owner a portion of the purchase priceby way of a deposit and/or instalments. At common law this would leave the purchaser with no more than a concurrent claim for damages against the insolvent estate, should the trustee decide to abandon the sale: Glen Anil Finance (Pty) Ltd v Joint Liquidators Glen Anil Development Corp Ltd (1981 1 SA 171 (A)). Special provision is therefore made in the Act to safeguard the purchaser’s interests in the event of the owner’s insolvency. But there are also a number of other equally serious risks, including the unexpected implementation of a payment acceleration clause, cancellation of the agreement or a claim for damages, all of which could, depending on the wording of the agreement, be triggered by an isolated (even unknown) breach of contract on the part of the purchaser.
A TALE OF ATTEMPTED MURDER AND HIV … S v Nyalungu 2005 JOL 13254 (T) “
Authors: Suhayfa Bhamjee
Published: February 2022

The South African Law Commission (as it was then – hereinafter “SALC”) was commissioned to investigate various aspects of the law as it related to HIV/AIDS. In its 5th and final report (Project 85, 5th Interim Report on Aspects of the Law Relating to AIDS – The Need For A Statutory Offence Aimed At Harmful HIV-Related Behaviour, April 2001 – hereinafter “SALC 5th report”), it dealt with “harmful (ie unacceptable) sexual behaviour by a person with HIV or AIDS that could transmit HIV or expose others to HIV, current measures available to address such behaviour and whether there is a need for statutory intervention” (viii of the executive summary of the report). This note considers the SALC’s recommendations in this regard and the reality that there have been no reported cases of successful prosecution under the common-law crimes for the wilful transmission of HIV, but that the case in point shows a willingness on the part of the courts to accept that such behaviour is dire and will be punished albeit under the guise of some “lesser” offence. Whether the decision is S v Nyalungu ([2005] JOL 13254 (T) (unreported)) has/will made/make it a less daunting task to prosecutecrimes involving allegations of the wilful transmission of HIV/AIDS is yet to be seen.
REKTIFIKASIE (EN KONDONASIE?) VAN VERKEERDELIK-ONDERTEKENDE TESTAMENTE Giles NO v Henriques [2007] 4 All SA 1409 (C)
Authors: Francois du Toit
Published: February 2022

Ondanks die statiese beeld van die erfreg (De Waal “The Social and Economic Foundations of the Law of Succession” 1997 Stell LR 162) kom Suid-Afrikaanse howe tog van tyd tot tyd voor ‘n res nova op dié regsgebied te staan. Die vraag wat regter Goliath in Giles NO v Henriques [2007] 4 All SA 1409 (C) moes beantwoord, het nog nie tevore voor ’n Suid-Afrikaanse hof gedien nie (par [30]): is rektifikasie moontlik ten opsigte van testamente wat die wense van die betrokke testateurs korrek verwoord, maar deur die “verkeerde” testateurs onderteken is?
Intravenous immunoglobulin: A potential treatment for the post-acute sequelae of SARS-Cov-2 infection?
Authors: Reznik Sandra , Tiwari Amit , Ashby Charles
Published: February 2022

Following the recovery from an initial infection with SARS-CoV-2, a recent meta-analysis of almost 1 million patients worldwide suggested that an estimated 43% of patients had experienced a variety of sequelae [1].  Furthermore, numerous studies indicate that patients can develop somatic, musculoskeletal, neuropsychiatric, cardiovascular, dermatologic, renal, hepatic and gastrointestinal manifestations that are heterogeneous and vary in intensity and duration (for up to 12 months) [2,3]. The CDC has defined this phenomenon as “long-term symptoms that might be experienced weeks to months after primary infection with SARS-CoV-2, the virus that causes COVID-19 [4]” and proposed designations for this syndrome have included long covid, long chronic covid syndrome, chronic covid, post-COVID-19 syndrome, post-acute covid-19 syndrome and long – haulers [5]. On Feb. 23, 2021, Dr. Francis Collins indicated that the persistent symptoms that occur in patients after recovery from the initial infection could be designated, post-acute sequelae of SARS-CoV-2 (PASC), which we will use in this article. Currently, there is no clear or agreed upon definition or diagnostic criteria for PASC. PASC is most likely a post-infectious illness similar to that reported by patients that had long - term sequelae that persisted for up to 14 months after infection with SARS-CoV-1 or the Middle Eastern respiratory SARS virus (MERS) [6]. 

Read more in PDF: https://www.bjbms.org/ojs/index.php/bjbms/article/view/6901/2437
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Authors: Keto Max Reviews TruuBurn
Published: February 2022

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[RETRACTED] TruuBurn Keto Max Review [Celebrities Top Pick] Adele Weight Loss Journey v1
Authors: not provided teniaslores
Published: February 2022

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Covid-19 vaccination and pregnancy. A protocol for a systematic review of maternal and neonatal outcomes v1
Authors: Kontovazainitis Christos-Georgios , Mitsiakos Georgios , Katsaras Georgios
Published: February 2022

THIS IS A PROTOCOL FOR A SYTEMATIC REVIEW DOWLOAD THE ATTACHED FILE (PDF) TO VIEW THE COMPLETE PROTOCOL. Registration: Our protocol was submitted to the International Prospective Register of Systematic Reviews (PROSPERO). However, due to delays regarding the assessment of the protocol, no registration number is yet available. This protocol is drafted based on the updated Preferred Reporting Items in Systematic Reviews and Meta Analyses (PRISMA) guidelines. Authors Dr. Christos-Georgios Kontovazainitis (C-GK), MSC Dr. Georgios Mitsiakos (GM), MD, PhD Dr. Georgios Katsaras (GK), MD, MSC Affiliations: 2nd Neonatal Department and Neonatal Intensive Care Unit (NICU), Aristotle University of Thessaloniki, Papageorgiou Hospital, Ring Road Nea Efkarpia, 56403, Thessaloniki, Greece Corresponding author: Dr. Christos-Georgios Kontovazainitis 2nd Neonatal Department and Neonatal Intensive Care Unit Aristotle University of Thessaloniki Papageorgiou Hospital, Ring Road Nea Efkarpia 56403, Thessaloniki, Greece Tel: 0030 694 538 3092 Email: ckontova@auth.gr Author contributions: C-GK, GM and GK drafted the manuscript. C-GK, GM and GK contributed to the development of the selection criteria, the risk of bias assessment strategy and data extraction criteria. C-GK developed the search strategy. GM provided expertise on neonatology field. C-GK provided expertise on the field of obstetrics-gynaecology. All authors read, provided feedback and approved the final manuscript of this protocol. Financial support, funding sources: The authors declare no source of institutional or external financial support in relation to this work.
Value foundations of experiencing stress and adaptation of students: Cross-cultural study
Authors: Koltunov E. I. , Gryazeva-Dobshinskaya V. G. , Dmitrieva Ya. A. , Markina N. V. , Zhi J. , Naboichenko E. S.
Published: February 2022

Introduction. Present work is dedicated to an urgent problem that has emerged as a result of a global trend – an increase in the number of young people moving to other countries in search for a higher education, which often leads to stress during the process of cultural adaptation.

In the current research, the authors conducted a comparative analysis of the normative and individual values of students from China and Russia, studying at the Russian university. The relevance of the research is based on the existing need for distinguishing psychological resources that could be helpful in the process of cultural adaptation and experiencing stress during the contact with the new cultural environment. Value foundations are considered as one of such potential resources, capable of affecting process of experiencing stress and adaptation.

Theaimof the present article was to conduct a cross-cultural analysis of the normative and individual values of students from China, who experience stress and adapt to stressful situations in a new culture, and students from Russia studying with them.

Methodology and research methods.The research uses a comparative analysis of values of different cultures and a complex analysis of value foundations in the context of experiencing stress and adaptation to stressful situations among migrant students.

Resultsandscientifinovelty.In the course of the research, it was found out that values corresponding to the cultural specifi of the native countries of the students (China and Russia) are statistically more pronounced among students with a low level of stress. Among students with a high level of stress, values, which are not that part of the normative of their native culture, are more pronounced. Hedonistic values hamper the process of cultural adaptation both for Russian and Chinese students. A comprehensive study of the relationship between adaptation to stressful situations and stress experience revealed the groups of students with a cross-cultural specifi

of the value foundations for experiencing stress. The data obtained both correlate with the existing studies of changes in values of students from China and Russia, and provide a basis for further research in the direction of studying stress and adaptation among students from both countries.

Practical significance.The research results can be used in the analysis of stress exposure among students from Russia and China and the subsequent development of adaptational strategies. The discovered specificities of cultural value foundations could be employed to form potential resources of preadaptation to stressful situations among student youth.
Satisfaction with remote teaching in Thai higher education
Authors: Fuchs K. , Karrila S.
Published: February 2022

Introduction. Emergency remote teaching (ERT) is meant to be a temporary shift from the normal modes of contact teaching. Such transition was imposed during the global pandemic in the spring of 2020, and higher education was required to shift entire curricula online in an attempt to curb the spread of the virus while maintaining continuity of its services. The disruptive overnight change and conversion of entire courses to ERT caused concerns, not only to the educators but also to the students who had little time to adapt to the new circumstances.

Aim. The aim of the study was to examine student perceptions with regard to remote teaching during the global pandemic COVID-19. Moreover, the study aimed to identify attributes, which students deem as the most important during emergency remote teaching.

Methodology and research methods. This mixed-method case study expands earlier research addressing those concerns, and adds to the body of knowledge by investigating how ERT is currently – during the second year of the pandemic – perceived by undergraduate students in Northeastern Thailand. Responses from a self-administered survey were collected and analysed (n = 363). Based on descriptive analysis, it was decided to conduct 12 unstructured interviews to investigate particular findings more thoroughly. An importance-performance rating matrix was used to determine the perceived satisfaction by the undergraduate students.

Results and scientific novelty. The study identified that the students largely view ERT as inferior compared to traditional classroom teaching. Students claimed both lack of social interactions with peers and inability to seek academic support as the primary reasons. This study informs educators about student perceptions and preferences during these extraordinary circumstances of uncertain duration.

Practical significance. The current research presents the recommendations that aim to provide institutions and educators with practical guidance on how to tackle the outlined issues.
Clinical risk index of babies-II versus score for neonatal acute physiology-II in predicting mortality and morbidity in preterm babies
Authors: Madabhushi Siddharth , Naik Suhail A. , Shah Mubashir H.
Published: February 2022

Background: The measurement of severity of illness using scoring systems is an important aspect in predicting mortality and morbidity in intensive care units which in turn can help in optimizing the limited healthcare resources in developing countries. The primary objective was to determine the correlation between clinical risk index of babies-II (CRIB-II) and score for neonatal acute physiology-II (SNAP-II) scores while the secondary objective was to identify which among them is superior in predicting mortality and morbidity in preterm neonates.Methods: The components of CRIB-II and SNAP-II scores were recorded prospectively over a period of 1 year in preterm very low birth weight (VLBW) babies and receiver-operating-characteristics (ROCs) were plotted for comparison. Correlation between CRIB-II and SNAP-II was examined by Pearson technique. The ability of CRIB-II and SNAP-II scores to correctly predict mortality, was assessed by calculating ROCs and their associated area under the curve (AUC).Results: Thirty nine neonates with a mean birth weight of 994.10 grams (SD±273.45 grams) and mean gestational age of 28.07 weeks (SD±2.29 weeks) were included in this study. The mean value of CRIB-II score and SNAP-II score was 8.54 (SD±4.67) and 9.82 (SD±8.93) respectively with a Pearson coefficient of 0.483 showing a modest correlation. CRIB-II (AUC 0.909) showed greater discrimination than SNAP-II (0.869) as a predictor of mortality. However, both the scores have poor discrimination when it comes to predicting neonatal morbidity.Conclusions: CRIB-II with its simplicity, need for uncomplicated variables and minimal time to generate a score for prediction of mortality and morbidity could be a useful tool in a busy neonatal intensive care unit (NICU).
The rate of endoscopic observation of the major duodenal papilla can be increased by simple guideline
Authors: Chung Hwe Hoon , Park Joo Kyung , Lee Kwang Hyuk , Lee Jong Kyun , Lee Kyu Taek
Published: February 2022

Background: Ampullary lesions are being detected with increased frequency with the growing use of esophagogastroduodenoscopy. However, it is uncertain how frequently endoscopists properly visualize the major papilla in routine clinical practice. This study was undertaken to determine the actual rate of observing the major papilla by endoscopists and if there is a room for improvement in visualizing the duodenal major papilla when performing esophagogastroduodenoscopy.Methods: This was a single-center, prospective, randomized study involving 3,088 consecutive patients referred for diagnostic esophagogastroduodenoscopy at tertiary-care referral center between September and November 2010. Six fellows-in-training in the study group attempted to visualize the major papilla up to three times, while six fellows-in-training in the control group performed endoscopy in a standard fashion.Results: The overall observation rate was significantly higher in study group (975 of 1070 [91.1%]) than in control group (624 of 1022 [61%], p<0.001). “Complete observation” was achieved in 68.2% of the cases in study group compared to 45.0% of the cases in control group (p<0.001). The total procedure time was slightly, but significantly longer in the study group (5.82±2.38 min versus 5.52±2.11 min, p=0.003).Conclusions: The rate of observing the major papilla for endoscopists is not as high as expected in routine clinical practice; however, the rate of observing the major papilla might improve significantly through application of additional effort with but a modest increase in procedural time.
A comparative study of intrathecal morphine v/s nalbuphine along with bupivacaine in laparoscopic gynaecological procedures
Authors: Gupta Surabhi , Goyal Vigya , Sachdev Sudhir , Jethava Durga , Jethava Dharamdas
Published: February 2022

: To compare the pain score of intrathecal morphine v/s nalbuphine along with bupivacaine in laparoscopic gynaecological procedures under general anaesthesia.

: A prospective, comparative, randomized, double blinded, hospital based study was conducted among patients undergoing elective laparoscopic gynaecological procedures. After explaining the study to the selected patients, they were randomized into two groups of 30 each with the use of sealed envelope method i.e. group M (100 µg morphine + 2 ml bupivacaine) and group N (400 µg Nalbuphine + 2 ml bupivacaine). The primary objective of our study was to compare the pain intensity which was done by visual analogue scale (VAS). Any side-effects in the form of post-operative hypotension, bradycardia, respiratory depression, nausea, vomiting and pruritus were recorded and included as secondary objectives. With the help of SPSS version 24, difference between the continuous and categorical variables was analysed using t and chi square test respectively.

: There was no significant difference among both groups with respect to motor blockade score. Mean VAS after extubation and 3 hour was comparable among both the groups, but at 6, 12 and 24 hour, it was comparatively more in group N as compared to group M, though statistically insignificant. Pruritus was revealed in 10% and 0% of the subjects among group M and N respectively.

: Our results conclude that the analgesic efficacy of nalbuphine is comparable to morphine, but nalbuphine provides a better safety profile than morphine especially related to pruritus.
Comparing intrathecal 1% 2-chloroprocaine and 0.5% bupivacaine for patients undergoing saddle block in daycare surgeries with respect to recovery and home readiness: A prospective double blind randomised study
Authors: Gowda Vansuma S R , Krishna K  , Shivakumar G  , Archana BN  , Somsundar R G
Published: February 2022

Preservative free 2-chloroprocaine seems to be a better alternative to lidocaine and bupivacaine for day care procedures, because of its short duration of action. This study was designed to compare 2-chlorprocaine with low dose bupivacaine for saddle block in elective perineal surgeries on day care basis in terms of recovery and home readiness.

To compare 1% 2- chloroprocaine with 0.5% bupivacaine with respect to time taken to obtain discharge criteria from post-anaesthesia care unit (PACU) to post-operative ward, from hospital to home and time taken for ambulation and micturition.

This is a prospective, randomized, double blind, parallel group clinical study, conducted on ASA class I and II patients undergoing elective perineal surgeries on daycare basis in MIMS teaching hospital, Mandya.

After obtaining approval from institutional ethical committee, a total of 100 patients were enrolled in this study. Saddle anaesthesia was achieved with 7.5 mg 0.5% hyperbaric bupivacaine (Group B, n = 49) or 1% 2- chloroprocaine 40 mg (Group C, n = 50). After completion of surgery, patients were monitored in PACU and postoperative ward using modified Aldrete’s score and PADSS. After discharging, patients were contacted at 24 hours and followed up for 7 days via telephone to assess potential complications of saddle block.

Data analysis was done using IBM SPSS version 20. Chi-square test, Fisher’s exact test and independent t-test were used to compare the variables. P value of <0.05 is considered statistically significant.

Mean time required to attain discharge eligibility from hospital in Group B was 296.24 min and Group C was 213.3 min with a difference of 83 mins (P < 0.001). Mean duration of time spent in PACU in Group B was 105.18 min and Group C was 27.22 min (P < 0.001). Time to unassisted ambulation and micturition was also significantly lower in Group C. None of the patient in both study groups required additional analgesia in the intraoperative period. However, 26% patients in Group C experienced more pain in the post-operative period compared to Group B (4%) (P = 0.04).

Chloroprocaine provides satisfactory anaesthesia with advantage of faster regression of block, early ambulation and micturition, and thus early discharge from the hospital.
Study of the effects of dexmedetomidine on hemodynamic parameters and extubation quality in patients undergoing ENT surgery under general anaesthesia
Authors: Kumar Anjali , Lele Smita
Published: February 2022

In ENT surgeries most of the cases are done under general anaesthesia and should be extubated smoothly. If a patient is lightly anesthetised, tracheal and laryngeal irritation can stimulate reflex responses during extubation like bucking, gagging, breath holding, laryngospasm, pulmonary oedema. Alpha 2-Adrenergic agonists are used for their sympatholytic, sedative, anaesthetic sparing and haemodynamic stabilizing properties. We aimed to study the extubation quality and hemodynamic parameters of dexmedetomidine undergoing ENT surgeries under general anaesthesia.

This observational study included 100 patients undergoing ENT surgery under general anaesthesia, between 18 to 60yrs. Patients were divided into group P (n=50) and group PD (n=50). A standard general anaesthesia technique according to the Ent operation theatre protocol were followed for all patients. For maintenance group P received inj.Propofol 4mg/kg/hr and group PD received inj. Propofol 4mg/kg/hr and inj. Dexmedetomidine infusion 0.5ug/kg/hr as a standard protocol. Respective infusions were stopped at the start of skin closure. Heart rate, systolic blood pressure and diastolic blood pressure were recorded at the time of extubation and at 1,3,5. minutes till 30 minutes after extubation. Quality of extubation was evaluated using 5-point rating scale (extubation quality score) at extubation.

The mean heart rate in the group P was 92/min while in the group PD was 75/min. The mean systolic blood pressure in the group P was 116mmhg while in the group PD was 108mmhg. The mean diastolic blood pressure in the group P was 85mmhg and 67mmhg in group PD (P<0.001). 11 patients of group p got extubation quality score of 2 while 41 cases of group PD got a score of 2(P<0.001).

InjDexmedetomidine provides stable hemodynamic parameters during extubation and provides better extubation quality score.
A comparative study of intranasal dexmedetomidine and intranasal midazolam for premedication - A prospective randomized double-blind study in children posted for tonsillectomy
Authors: Nagarajan Girimurugan , Sekar Pavithira , Srinivasan Navaneetha Krishnan , Kumar Prem , Kumar Harish
Published: February 2022

Preanesthetic medication in paediatric patients is well known to be a challenge for anaesthesiologists. Premedication in paediatric population helps to produce a relaxed state with reduced anxiety and increased compliance as well as to ease separation from parent and allowing the patient to tolerate and co-operate with the necessary procedure. Our aim is to do a comparation of dexmedetomidine and midazolam given via intranasal route in children posted for tonsillectomy as premedication.

This study was conducted in 100 patients of 6 to 12 years posted for tonsillectomy. Patients were randomly allocated into Group M and D. Patient in group M (50) received 0.2mg/kg of midazolam administered intranasally as nasal drop using 1ml insulin syringe and similarly group D (50) received 1µg/kg of dexmedetomidine administered intranasally as nasal drops using 1ml insulin syringe. Sedation score, Anxiolysis score, mask induction score, post-operative agitation score was assessed.

Satisfactory sedation was achieved by 86% and 68% of patient in dexmedetomidine and midazolam respectively p (0.03). Satisfactory mask induction was achieved by 84% and 70% of patient in dexmedetomidine and midazolam respectively p (0.09). In terms of post op agitation score there is no difference in both the group p (0.30). During the time between administration of pre op drugs and initiation of anaesthesia, no patient seems to develop hypotension, hypoxia or any other life-threatening complication

In our study we concluded that in terms of decreasing anxiety at parental separation both dexmedetomidine and midazolam were found to be equally effective. However, Intranasal dexmedetomidine produced superior sedation scores at separation and induction compared to oral midazolam in paediatric patients.
Evaluation of postoperative analgesic efficacy of dexmedetomidine as adjuvant with ropivacaine in ultrasound guided adductor canal block in patients undergoing unilateral Total Knee Replacement
Authors: Kumar Abhijit , Chattopadhyay Animesh , Parashar Preeti , Kohli Amit , Teckchandani Chhavi , Gupta Lalit
Published: February 2022

The aim of anaesthesia in Total knee replacement (TKR) is to provide adequate analgesia and early ambulation. The recent success of adductor canal block in providing post-operative analgesia and achieving early ambulation has evoked interest in studying the effects of local anaesthetic agents and various adjuvants.

This study was a randomized three arm parallel group comparative study conducted in a tertiary care center in India on 135 patients undergoing unilateral total knee replacement under spinal anaesthesia. After completion of the surgery, the adductor canal block was performed with ultrasound guidance at mid-thigh level in all three groups. In group A, 20 ml 0.375% ropivacaine was only used but in group B and C Dexmedetomidine was added to ropivacaine (total volume of 20 ml; 0.375%) at a dose of 0.25 µg/kg and 0.50 µg/kg respectively. The primary outcome of the study was to compare duration of analgesia after the adductor canal block.

Duration to rescue analgesia (in hours) was significantly longer [Group A: 15.71±4.87; Group B: 16.44±6.21; Group C: 19.78±5.57 (p=0.014)] and total opioid (24 hours tramadol needed in mg) consumption [Group A: 60.00±13.94; Group B: 52.22±18.80; Group C: 33.33±13.95 (p=0.033)] was significantly lower in Group C. NRS scores both at movement and rest were significantly lesser in Group C at 18 and 24 hours timepoints. Patient satisfaction was significantly higher in Group C with 46.67% patient reporting better than expected peri-operative experience (p=0.022).

The addition of dexmedetomidine, 0.5 µg/kg to 0.375% ropivacaine in adductor canal block results in longer duration of analgesia, less 24 hours opioid consumption, better motor strength and better patient satisfaction without any adverse effect after unilateral total knee replacement surgery.
Perioperative management of Wolff–Parkinson-White syndrome – A case series
Authors: Kumar Prem , Manidas Robin
Published: February 2022

Wolff-Parkinson-White (WPW) syndrome is a type of pre-excitation syndromewhere part of cardiac ventricles are activated too early by virtue of an accessory pathway, that directly attaches atria and ventricles, thereby allowing electrical activity to bypass AV node, thus leading to episodes of tachycardia which can be either asymptomatic or may present with dyspnoea on exertion or with palpitation. As it’s a rare condition, we report 3 cases of WPW Syndrome which adds more evidence to the current literature. The anaesthetic management can be challenging and has to be customized to the nature of the surgery and the patient to avoid life-threatening tachyarrhythmias.

Perioperative management of WPW syndrome is challenging and requires good pre-operative planning and adequate preparation for intraoperative and post-operative period.
Anaesthetic management of a parturient with Takayasu’s arteritis coming for emergency caesarean section
Authors: Shalini A  , Srinivas V Y  , Bharadwaj Nagashree J
Published: February 2022

Takayasu’s arteritis (TA) also known as pulseless disease is a rare disease that involves aorta and its main branches. It can cause inflammatory reaction of tunica media and adventitia of the arteries involved causing stenosis, occlusion or aneurysm., Anaesthesia for caesarean section in a parturient with Takayasu’s arteritis is complicated by associated hypertension, end organ dysfunction, stenosis of major blood vessels and overall vasculopathy.

The optimal anaesthetic management in a parturient with Takayasu’s arteritis is controversial, but avoidance of regional anaesthesia has been recommended by some authors because of the risk of hypotension and the subsequent need for vasopressors., We herein report the use of general anaesthesia in a term parturient with Takayasu’s arteritis coming for emergency Lower segment caesarean section (LSCS).
Anesthetic implications in Poland syndrome
Authors: Sharma Keerty , Kumar Neera Gupta , Arya Mona , Kumar Rakesh , Gupta Lalit
Published: February 2022

: Poland Syndrome (PS) is a rare birth defect described as unilateral absence of pectoralis major, pectoralis minor, serratus anterior and external oblique muscles and upper limb anomalies. It is also associated with variable thoracic muscle, chest wall and lower limb deformities. Dextrocardia, diaphragmatic hernia, liver and GIT anomalies, renal agenesis have also been reported in literature. In addition, there is association of PS with patient’s susceptibility to malignant hyperthermia (MH). For patients requiring general anesthesia, special preparation and execution are recommended.

We share our anesthesia management in a child with PS posted for ear reconstruction and described that patients with PS requires special preparation and attention in intraoperative and post-operative period.

In patients of PS requiring general anesthesia adequate preparation must be made keeping in mind not only the anatomical changes but also the much higher possibility of MH in such patients.
Microbiological surveillance of operation theatres of a tertiary care hospital in Mizoram, north eastern part of India: 4 years retrospective analysis
Authors: Hmar Vanlalhmangaihi , Vanlalruati RSC , Khiangte Lalbiakmawia , Vanlalchhanhimi L V , Chongthu Joseph Lalrindika , Hmar Lalhmachhuana , Sailo Lalrinmuani
Published: February 2022

Healthcare associated infections are important cause of patient morbidity and mortality. Microbiological contamination of air and environment in the operation theatres (OTs) are major risk factor for surgical site and other hospital-associated infections.

To identify bacterial colonization of surfaces, equipments and to determine the microbial contamination of air in the OTs of a tertiary care hospital in Lunglei, Mizoram which is in north eastern part of India.

Four years (January 2016 – December 2020) retrospective analysis of a data obtained from routine microbiological surveillance of the OTs.

Surface samples were taken with wet swabs from different sites and equipments, and Settle plate method for air in the OTs. Bacterial species were isolated and identified by conventional method.

The colony forming unit (CFU) count/plate was expressed as CFU/m3 by Omeliansky formula.

The culture positivity rate of surface swab samples was 6.4% (60/937). Bacillus spp. with 45 (67.16%) isolates was the most common baterial isolates. The bacterial CFU/m3 counts of air in the two OTs were in the range of 90 to 166 before fumigation. Staphylococcus aureus with 43(42.16%) was the predominant species obtained and the least common species obtained was Enterococcus faecalis with13 (12.74%). The bacterial CFU/m3 counts of air was one in both the OTs after fumigation.

Settle plate method for air and swabbing technique for surfaces are proved to be valuable techniques in detecting the contamination level in our set up with limited resources.
A retrospective study of predictive value of Gram staining in the diagnosis of urinary tract infection
Authors: Ramalatharani S
Published: February 2022

One of the most common infection among humans is Urinary Tract Infection that almost every person will get atleast once in their lifetime. Timely diagnosis and treatment are necessary to reduce the complications from UTI particularly among patients with comorbidities. Urine culture is considered as the gold standard diagnostic test for UTI, however it is costly and time consuming. In this study we evaluated Urine Gram stain that can be used as screening test that is also cost effective with less turn around time. The Sensitivity, Specificity, Positive predictive value (PPV) and Negative predictive value (NPV) of Urinary Gram stain were assessed with gold standard culture and sensitivity that showed the point-of-care Gram stain and pyuria can be used as rapid diagnostic test for UTI, which can be carried out quickly at low cost.
Evaluation of microbial infections of ear and their susceptibility pattern in a tertiary care hospital
Authors: Kumar P Kennedy , Sunil Anisha , L Somu , Sridharan K S
Published: February 2022

Nearly 0.065-0.33 billion people suffer from ear infections leading to loss of hearing in 60% of them. As the middle ear is in close proximity to the brain, infections can lead to intracranial complications. Inappropriate use of antibiotics in these situations can lead to multi drug resistant bacterial strains. Hence, the knowledge of commonest bacteria causing these infections along with its susceptibility pattern remains a key to unravel the void left in otological microbiome.

: Aretrospective analysis of samples obtained from middle ear infections were analyzed for a period of 4 months (2019) at the Department of Microbiology, SRIHER using Hospital information system. The results of microbiological profile and their susceptibility pattern were tabulated and statistically analyzed.

: Out of 325 samples enrolled, 302 samples grew pathogens(GPC:122,GNB:186, Fungi:17 & 23 of them grew more than 1 pathogen). The microbiological profile of 325 pathogens were: Pseudomonas aeruginosa 41.8%, Staphylococcus aureus 27.6%, CONS 7.6%, Klebsiella pneumoniae 4.6%, Proteus species 4.6%,Candida species 3.3%, Streptococcus species 2.2%,Escherichia coli 1.8%, Aspergillus species 1.8%, Acinetobacter species 1.2%, Enterobacter species 1.2%, Citrobacter species 0.9%, Morganella species 0.6%, Providencia species 0.3%. Multi-drug-resistant strains were seen in 17 of GNB 9.1%(n=186), predominantly in Pseudomonas species 8.8%(n=136). Methicillin resistance among the Staphylococcus species was 22%(n=115), predominantly in CONS 64%(n=25). Pan-drug resistance was not reported.

Based on our study, a total of 43(13.2%) isolates were MDR strains, hence it is imperative to do a culture and sensitivity pattern of ear infections for efficacious management, thereby reducing further complications.