bluuebunny/crossref_metadata_2025 huggingface dataset:
El marketing digital. Factor determinante en la rentabilidad de las empresas en tiempo de Covid-19
Authors: Mackay Castro Clarkent Rubén , Escalante Bourne Teodoro Mauricio
Published: July 2021

El objetivo general de esta investigación se basa en analizar el marketing digital como factor determinante en la rentabilidad de las empresas en tiempo de COVID-19, la metodologia utilizada se basa en un diseño bibliografico de tipo documental. Como conclusion se puede mencionar que con este duro golpe a causa del Coronavirus muchas empresas tuvieron que cerrar sus puertas, generando otros inconvenientes como desempleo, aumentando la tasa de pobreza existente. Sin embargo, debido a estos problemas las empresas que han podido sobrevivir frente a esta situación han buscado alternativas que le permitan surgir, y generar las ganancias necesarias que requieren para cubrir sus compromisos, mantenerse en el tiempo y cumplir con sus objetivos planteados de manera que sigan su nivel competitivo generando fuentes de empleo, se destaquen frente a la competencia y obtengan niveles de rentabilidad adecuados. Es por ello que el marketing digital tiene una alta influencia en el logro de los objetivos de las empresas, ya que los usos de estrategias de marketing digital bien definidas permiten mejorar sus niveles de competencia, mejoran sus ingresos esto siempre y cuando sean utilizadas de manera adecuada.
El Departamento de Ventas como generador de ingresos en las Pymes de Guayaquil, Ecuador
Authors: Bernal Álava Ángel Fortunato , Granoble Chancay Paco Egdon
Published: July 2021

Las pequeñas y medianas empresas del Ecuador (Pymes) dedicadas al comercio en diferentes sectores económicos constituyen una fuente de empleo y productividad para el país. Estas empresas son en su mayoría manejadas de manera informal con diversas fallas en los procesos internoscomo consecuencia de la falta deplanificación, organización y estructuración del Departamento de Ventas que dificultan su rentabilidad y consideración para adquirir fuentes de financiamiento que mejoren la producción y aumento de las ventas. De acuerdo a este contexto, se llevó a cabo una investigación descriptiva con una revisión documental sobre los aspectos básicos y necesarios de la estructura y organización del Departamento de Ventas como generador de ingresos en las Pymes de Guayaquil, Ecuador. Entre los hallazgos se infiere que las reconocidas contribuciones de las Pymes en la economíaecuatoriana no son suficientes para su fácil acceso a fuentes de financiamiento por no cumplir con los estándares de garantías y requerimientos que solicitan la mayoría de las instituciones financieras, quienes limitan sus créditos por su falta de rentabilidad. Por ello, la implementación de técnicas y estrategias de ventas que exalten las cualidades de los productos ofrecidos mejoran el pronóstico de ventas y aumentan ingresos, así como el desarrollo productivo y socioeconómico y rentabilidad de las Pymesen Guayaquil.
Optimización de los niveles de inventario para mejorar los procesos productivos de una organización
Authors: Mackay Véliz Rubén Alberto , Escalante Ramírez Teodoro Antonio
Published: July 2021

Actualmente las empresas tienen que estar al tanto de los cambios constantes en el mercado global debido a los avances tecnológicos, pero también producto de las exigencias de los consumidores como los son la calidad, precios razonables, mejores servicios y atención personalizada. Es por esto, que constantemente éstas están buscando estrategias y métodos más efectivos para producir los mejores productos o para ofrecer los mejores servicios, para lo cual es indispensable tener un óptimo manejo de sus inventarios. El objetivo general de esta investigación estudiar la importancia que tiene la optimización de los niveles de inventario para mejorar los procesos productivos de las organizaciones. Como conclusión se puede mencionar que Los inventarios son útiles ya que prevén la escasez. Siempre será mejor ahorrar productos que dinero en efectivo por la rentabilidad que genera, permite obtener ganancias adicionales cuando hay alzas de precios, entre otros. A pesar de esto, trae como consecuencia una inmovilización de recursos financieros que podrían usarse mejor en otras actividades con mayor rentabilidad, es decir, podría optarse por mejor uso de los recursos financieros y optimizar así las utilidades.
Impacto de la globalización en las estrategias de negocios en las empresas ecuatorianas
Authors:   Universidad Centroccidental Lisandro Alvarado, Barquisimeto, Venezuela, Flores María , Flores Jackeline ,   U.E. Adventista Profesor “Clímaco Girón”, Barquisimeto, Venezuela
Published: July 2021

Las organizaciones hoy en día deben enfrentar numerosos cambios producto de la globalización y la dinámica existente en los procesos tanto internos como externos de las empresas. Deben procesar grandes cantidades de información para poder lograr cumplir sus objetivos y metas, esto se logra a través de aspectos como la innovación, creatividad, crecimiento, competitividad y la toma de decisiones El objetivo general de la investigación se basa en analizar el impacto de la globalización en las estrategias de negocio de las empresas ecuatorianas. La metodología utilizada se basa en un diseño bibliográfico de tipo documental. Como conclusion se puede mencionar que La globalización es pieza fundamental en el desarrollo de los países, sin embargo muchos poseen limitantes que no permiten el desarrollo a cabalidad de nuevas estrategias para lograr llegar al nivel máximo de sus capacidades, tal es el caso de Ecuador que a pesar de los grandes pasos logrados aun está en proceso de desarrollo para implementar la tecnología necesaria y lograr mayores beneficios económicos así como estabilidad económica, política y social Son variados los cambios que surgen producto de la globalización y a su vez permiten que las empresas logren adaptar tecnologías en sus procesos productivos, esto es señal de que su personal debe estar preparado intelectualmente para el manejo de las nuevas tecnologías y poder aprovechar al máximos estas innovaciones que darán fruto trayendo consigo beneficios económicos, rentabilidad, eficiencia y aprovechamiento de los recursos existentes.
Manejo adecuado de la atención al cliente para lograr satisfacción y fidelidad
Authors: Rojas León Cevero Rómulo , Calderón Fernández Paúl César
Published: July 2021

El objetivo general de esta investigación se basa en encontrar las alternativas o estrategias que permitan al proveedor cumplir con las exigencias o necesidades del cliente, para que su organización sea sostenible, rentable y eficiente en el tiempo. Lo que muestra que la preocupación por mantener la fidelidad y la satisfacción del cliente, siempre han estado presentes dentro de las estrategias de las empresas, mas, sin embargo, deben estar conscientes que los tiempos y las tecnologías cambian y evolucionan, por tanto, las necesidades también. La metodología cuantitativa descriptiva aplicada, arrojo resultados que demuestran que el cliente quiere y necesita que se le atienda con dedicación, y se le tomen en cuenta sus sugerencias o quejas para el mejoramiento del servicio o producto recibido, garantizando con ello su fidelidad a través de su satisfacción. Sin embargo, de acuerdo a los resultados y análisis realizados, se puede concluir que frases como “El cliente siempre tiene la razón”, “Dígame que necesita y se lo buscamos”, “Usted ordena y yo obedezco”, entre otras, igualmente utilizadas para agradar al consumidor, nos demuestran que esas estrategias verbales son efectivas en el manejo adecuado de la atención al cliente, produciendo éxito en la satisfacción y fidelidad de este, para con el proveedor del servicio o producto, ya que regresan a recibir el servicio o adquirirlo nuevamente.
Los conflictos empresariales y el clima organizacional
Authors: Mirabal Sarria Yamilet
Published: July 2021

Las empresas actualmente atraviesan por cambios constantes, producto de las exigencias de la globalización y la economía, y el capital humano también está en constante evolución y mejora, con el propósito de lograr cumplir los objetivos de la organización y a la vez satisfacer sus necesidades económicas y desarrollarse como excelentes profesionales dentro de la empresa donde laboran, sin embargo para que esto suceda de manera óptima deben existir ciertas condiciones y que las habilidades de cada trabajador sean mayores a las fallas presentes. El objetivo general de esta investigación se basa en el análisis de los conflictos empresariales y la manera que influyen en el clima organizacional así como la forma de controlarlos y evitarlos a futuro. La metodología utilizada se basa en un análisis bibliográfico documental. Como conclusión se puede indicar que los conflictos por ser naturales en el ser humano son casi inevitables dentro de cualquier contexto e incluso en las organizaciones, sin embargo es necesario comprender la intensidad del conflicto para poder establecer estrategias reglas y normativas que permitan poder controlarlos, y evitarlos en la medida de las posibilidades.
Gender Discrimination Underlying in Higher Education in Universities
Authors: Liu Liangfei
Published: July 2021

Since ancient times, sexism has existed in all aspects of people's lives. Women have always been at the bottom of society. Even upper-class women also have to abide by the principle of " obeying father at home, obeying husband after getting married, and obeying son after the husband died" as the social ethics. After the founding of new China, the idea that "women hold up half the sky" gradually spread. On the whole, the social status of Chinese women has been greatly improved. But sexism is still rife. Especially in colleges and universities, the underlying sexism on campus, in its "normal" form, is ignored. In view of this phenomenon, the author conducts in-depth exploration in the hope of attracting people's attention.
Mental Health of People in State Quarantine during COVID-19 Situation in Thailand
Authors: Charoensuk Sukjai , Mokekhaow Kanyawee , Channarong Duanphen , Sonpugdee Chariya
Published: July 2021

When the COVID-19 outbreak spread across the globe, Thailand was the first country to report a COVID patient outside of China. We conducted a cross-sectional descriptive study to examine the mental health condition and the risk factors associated with the mental health problems of people in state quarantine. Our study sample included 4,069 people who were in state quarantine in the eastern region of Thailand. We administered a stress assessment test, a depression screening questionnaire, a suicidal risks screening tool and a COVID-19 anxiety screening scale, which were developed by the Department of Mental Health, Thailand. We found that most people in state quarantine reported a moderate level of COVID-19 anxiety, a mild level of stress, and no current risk of suicide. The risk factors associated with stress were female gender (OR = 2.290, p < 0.001, 95% CI [1.687, 3.109]) and having chronic diseases (OR = 2.443, p < 0.001, 95%CI [1.720, 3.470]). The factor associated with depression was female gender (OR = 1.380, p < 0.001, 95%CI [1.201, 1.586]). The factors associated with risks for suicide were female gender (OR = 2.059, p < 0.001, 95%CI [1.553, 2.729]) and having chronic diseases (OR = 2.128, p < 0.001, 95%CI [1.510, 2.998]). The factors associated with COVID-19 anxiety were female gender (OR = 1.469, p < 0.001, 95%CI [1.294, 1.669]) and having chronic diseases (OR = 1.329, p = 0.011, 95%CI [1.066, 1.657]). A system to screen for mental health problems and rapid assistance offered to people in state quarantine who are at risk of mental health problems are recommended to reduce the severity of the problems.
Complementary and Alternative Medicine Use among Gynaecological Cancer Patients in Enugu, South-East Nigeria
Authors: Ajah Leonard Ogbonna , Ifezuoke Dickson Tochukwu , Ajah Monique Iheoma , Nwankwo Theophilus Ogochukwu , Ezeome Ijeoma Victoria , Umeh Uchenna Anthony , Agu Polycarp Uche
Published: July 2021

INTRODUCTION: The high cost and associated adverse effects of conventional therapy make the patients seek complementary and alternative medicine. Complementary and alternative medicine use may contribute to the delay the patients have before seeking orthodox care.

OBJECTIVES: To determine the prevalence, pattern, factors responsible for complementary and alternative medicine use and if complementary and alternative medicine use causes delay in seeking orthodox care among gynaecological cancer patients in Enugu.

MATERIAL & METHODS: A pretested, semi-structured interviewer-administered questionnaire -based cross-sectional survey of 396 eligible gynaecological cancer patients recruited from both University of Nigeria Teaching Hospital, Enugu and Enugu State University of Science and Technology Teaching Hospital, Enugu between January, 2018 and June, 2020. The data was analyzed using the statistical package for social sciences version 23 (IBM SPSS, Chicago, IL).

RESULTS: The mean age of the respondents was 57.3 years and it ranged from 41 to 77 years. Cervical cancer (76%) was the most common type of gynaecological cancer. A total of 283(71.5%) of the respondents used complementary and alternative medicine. Herbs (65%) were the most common type of complementary and alternative medicine used. Majority (56.9%) of complementary and alternative medicine users rarely used it. A total of 178(62.8%) complementary and alternative medicine users presumed that it would cure them while 105 (37.1%) presumed that it would relieve the symptoms of their cancer. However, 197 (69.6%) complementary and alternative medicine users stated that there was no actual benefit from its use. The low educational status has a statistically significant influence on complementary and alternative medicine use among the respondents(P-value=<0.0001). Complementary and alternative medicine use had a significant influence on delay to seek orthodox care among the study participants (P-value=<0.0001). Majority (84.5%) of the doctors, caring for the patients, were not aware of the patients’ use of complementary and alternative medicine.

CONCLUSION: Complementary and alternative medicine use among gynaecological cancer patients is high in Enugu. It also delays their presentation for orthodox care. Female education and public sensitization on the effect of complementary and alternative medicine use is necessary to curb this trend.
IFRS 16 - Impact on the Assets of the Major Airlines Operating in Brazil
Authors: Suzuki Tofanelo Renan Eidy , Nunes Rodolfo Vieira , Willrich Sales George André
Published: July 2021

The article aims to study the impacts that the adoption of IFRS 16 will have on the financial position, that is, what will be the impact on the total value of assets of airlines operating in the Brazilian market. It is evident that the new accounting of aircraft acquired through operating leases, an essential tool for any company in the sector, is fully in line with the essence of the operation. Therefore, the authors structured the methodology through a comparison of indicators between 3 companies in the Brazilian airline industry, together with data collection through accounting information obtained in explanatory notes on future payments of operating leases. The findings show that, with IFRS 16, there were significant changes in the indebtedness indicators of companies, due to the significant changes in the accounting of assets, affecting the capital structure and profitability of companies.
Reviewer Acknowledgements for Network and Communication Technologies Vol. 6, No. 1
Authors: Lee Bruce
Published: July 2021

Reviewer Acknowledgements for Network and Communication Technologies Vol. 6, No. 1, 2021.
A Preliminary Measure of Teachers’ Occupational Well-Being in Baku Schools and Contextual Factors Affecting It
Authors: Molina Fuenzalida Álvaro Javier
Published: July 2021

Teachers’ occupational well-being is the work-related aspect of teacher’s well-being. This study investigates the levels of occupational well-being of Baku school teachers and the factors that may influence them. The studied indicators of occupational well-being are self-efficacy, job satisfaction, psychosomatic symptoms, and social relations (among colleagues, principals, and students), and the studied contextual factors are school type, classroom size, gender, age, experience, and education. A quantitative questionnaire based on an OECD instrument was implemented among 100 participants to assess their levels of occupational well-being and compare the above-mentioned contextual factors. The data showed positive levels of the participants’ occupational well-being, the teacher-student relations were notoriously strong, and the teacher-principal relations were significantly low. The classroom size and teachers’ educational level showed the most notorious differences in occupational well-being, while the quality of teachers’ relation with their principal was a predictor of job satisfaction and self-efficacy. The most frequent psychosomatic symptom among the participants was fatigue, which showed some differences across groups. The minor participation of male teachers did not allow for the analysis of the data based on gender. More details and other findings, as well as implications for research and practice, are discussed.
Gozareshhayi az Enqelab-e Mashrutiyyat-e Iran [Reports on the Iranian Constitutional Revolution] Mohammad Amin Rasulzadeh (trans. Rahim Ra’isniya, introduction by Kaveh Bayat) (1998). Tehran, Iran: Shirazeh, 360 pages. ISBN 964-6578, 228
Authors: Siegel Evan
Published: July 2021

Mohammad Amin Rasulzadeh’s Journalism

Mohammad Amin Rasulzadeh (1884-1954) was a prominent journalist and political activist from the present-day Republic of Azerbaijan who would also become the first head of the Azerbaijani National Council. He apparently got his start in journalism, contributing to Hemmat, a magazine sponsored by Muslim socialists and other progressives. In the one surviving article from that period which illustrates his political outlook, he writes, in the floral and colorful style of his early years, about four people, a nationalist, a democrat, a reactionary, and a progressive, and how it is only by them joining hands and avoiding division that anything will be accomplished.
One of the first of his journalistic campaigns was healing the wounds opened by the Armenian-Muslim massacres of 1905, which he blamed on the Russian imperial bureaucracy. However, the Armenian left-nationalist Dashnaks did not escape reproach for betraying socialism by engaging in nationalist provocations. He also campaigned for European-style reading rooms to raise the level of culture among the Muslims.
Reduction in Emergency Department Presentations in a Regional Health System during the Covid-19 Pandemic
Authors: Mann Edana , Swedien Daniel , Hansen Jonathan , Peterson Susan , Saheed Mustapha , Klein Eili , Munjuluru Ajit , Scheulen James , Kelen Gabor
Published: July 2021

Introduction: Nationally, there has been more than a 40% decrease in Emergency Department (ED) patient volume during the coronavirus disease 2019 (Covid-19) crisis, with reports of decreases in presentations of time-sensitive acute illnesses. We analyzed ED clinical presentations in a Maryland/District of Columbia regional hospital system while health mitigation measures were instituted.

Methods: We conducted a retrospective observational cohort study of all adult ED patients presenting to five Johns Hopkins Health System (JHHS) hospitals comparing visits from March 16 through May 15, in 2019 and 2020. We analyzed de-identified demographic information, clinical conditions, and ICD-10 diagnosis codes for year-over-year comparisons.

Results: There were 36.7% fewer JHHS ED visits in 2020 compared to 2019 (43,088 vs. 27,293, P<.001). Patients 75+ had the greatest decline in visits (-44.00%, P<.001). Both genders had significant decreases in volume (-41.9%, P<.001 females vs -30.6%, P<.001 males). Influenza like illness (ILI) symptoms increased year-over-year including fever (640 to 1253, 95.8%, P<.001) and shortness of breath (2504 to 2726, 8.9%, P=.002). ICD-10 diagnoses for a number of time-sensitive illnesses decreased including deep vein thrombosis (101 to 39, -61%, P<.001), acute myocardial infarction (157 to 105, -33%, P=.002), gastrointestinal bleeding (290 to 179, -38.3%, P<.001), and strokes (284 to 234, -17.6%, P=0.03).

Conclusion: ED visits declined significantly among JHHS hospitals despite offsetting increases in ILI complaints. Decreases in presentations of time-sensitive illnesses were of particular concern. Efforts should be taken to inform patients that EDs are safe, otherwise preventable morbidity and mortality will remain a problem.
Are Smaller Emergency Departments More Prone to Volume Variability?
Authors: Nourazari Sara , Harding Jonathan , Davis Samuel , Litvak Ori , Traub Stephen , Sanchez Leon
Published: July 2021

Introduction: Daily patient volume in emergency departments (ED) varies considerably between days and sites. Although studies have attempted to define “high-volume” days, no standard definition exists. Furthermore, it is not clear whether the frequency of high-volume days, by any definition, is related to the size of an ED. We aimed to determine the correlation between ED size and the frequency of high-volume days for various volume thresholds, and to develop a measure to identify high-volume days.

Methods: We queried retrospective patient arrival data including 1,682,374 patient visits from 32 EDs in 12 states between July 1, 2018–June 30, 2019 and developed linear regression models to determine the correlation between ED size and volume variability. In addition, we performed a regression analysis and applied the Pearson correlation test to investigate the significance of median daily volumes with respect to the percent of days that crossed four volume thresholds ranging from 5–20% (in 5% increments) greater than each site’s median daily volume.

Results: We found a strong negative correlation between ED median daily volume and volume variability (R2 = 81.0%; P < 0.0001). In addition, the four regression models for the percent of days exceeding specified thresholds greater than their daily median volumes had R2 values of 49.4%, 61.2%, 70.0%, and 71.8%, respectively, all with P < 0.0001.

Conclusion: We sought to determine whether smaller EDs experience high-volume days more frequently than larger EDs. We found that high-volume days, when defined as days with a count of arrivals at or above certain median-based thresholds, are significantly more likely to occur in lower-volume EDs than in higher-volume EDs. To the extent that EDs allocate resources and plan to staff based on median volumes, these results suggest that smaller EDs are more likely to experience unpredictable, volume-based staffing challenges and operational costs. Given the lack of a standard measure to define a high-volume day in an ED, we recommend 10% above the median daily volume as a metric, for its relevance, generalizability across a broad range of EDs, and computational simplicity.
Effectiveness of Mechanical Chest Compression Devices over Manual Cardiopulmonary Resuscitation: A Systematic Review with Meta-analysis and Trial Sequential Analysis
Authors: Sheraton Mack , Columbus John , Surani Salim , Chopra Ravinder , Kashyap Rahul
Published: July 2021

Introduction: Our goal was to systematically review contemporary literature comparing the relative effectiveness of two mechanical compression devices (LUCAS and AutoPulse) to manual compression for achieving return of spontaneous circulation (ROSC) in patients undergoing cardiopulmonary resuscitation (CPR) after an out-of-hospital cardiac arrest (OHCA).

Methods: We searched medical databases systematically for randomized controlled trials (RCT) and observational studies published between January 1, 2000–October 1, 2020 that compared mechanical chest compression (using any device) with manual chest compression following OHCA. We only included studies in the English language that reported ROSC outcomes in adult patients in non-trauma settings to conduct random-effects metanalysis and trial sequence analysis (TSA). Multivariate meta-regression was performed using preselected covariates to account for heterogeneity. We assessed for risk of biases in randomization, allocation sequence concealment, blinding, incomplete outcome data, and selective outcome reporting.

Results: A total of 15 studies (n = 18474), including six RCTs, two cluster RCTs, five retrospective case-control, and two phased prospective cohort studies, were pooled for analysis. The pooled estimates’ summary effect did not indicate a significant difference (Mantel-Haenszel odds ratio = 1.16, 95% confidence interval, 0.97 to 1.39, P = 0.11, I2 = 0.83) between mechanical and manual compressions during CPR for ROSC. The TSA showed firm evidence supporting the lack of improvement in ROSC using mechanical compression devices. The Z-curves successfully crossed the TSA futility boundary for ROSC, indicating sufficient evidence to draw firm conclusions regarding these outcomes. Multivariate meta-regression demonstrated that 100% of the between-study variation could be explained by differences in average age, the proportion of females, cardiac arrests with shockable rhythms, witnessed cardiac arrest, bystander CPR, and the average time for emergency medical services (EMS) arrival in the study samples, with the latter three attaining statistical significance.

Conclusion: Mechanical compression devices for resuscitation in cardiac arrests are not associated with improved rates of ROSC. Their use may be more beneficial in non-ideal situations such as lack of bystander CPR, unwitnessed arrest, and delayed EMS response times. Studies done to date have enough power to render further studies on this comparison futile.
Utilization of Point-of-care Echocardiography in Cardiac Arrest: A Cross-sectional Pilot Study
Authors: Wolfe Yanika , Duanmu YouYou , Lobo Viveta , Kohn Michael , Anderson Kenton
Published: July 2021

Introduction: Point-of-care (POC) echocardiography (echo) is a useful adjunct in the management of cardiac arrest. However, the practice pattern of POC echo utilization during management of cardiac arrest cases among emergency physicians (EP) is unclear. In this pilot study we aimed to characterize the utilization of POC echo and the potential barriers to its use in the management of cardiac arrest among EPs.

Methods: This was a cross-sectional survey of attending EPs who completed an electronic questionnaire composed of demographic variables (age, gender, year of residency graduation, practice setting, and ultrasound training) and POC echo utilization questions. The first question queried participants regarding frequency of POC echo use during the management of cardiac arrest. Branching logic then presented participants with a series of subsequent questions regarding utilization and barriers to use based on their responses.

Results: A total of 155 EPs participated in the survey, with a median age of 39 years (interquartile range 31-67). Regarding POC echo utilization, participants responded that they always (66%), sometimes (30%), or never (4.5%) use POC echo during cardiac arrest cases. Among participants who never use POC echo, 86% reported a lack of training, competency, or credentialing as a barrier to use. Among participants who either never or sometimes use POC echo, the leading barrier to use (58%) reported was a need for improved competency. Utilization was not different among participants of different age groups (P = 0.229) or different residency graduation dates (P = 0.229). POC echo utilization was higher among participants who received ultrasound training during residency (P = 0.006) or had completed ultrasound fellowship training (P <0.001) but did not differ by gender (P = 0.232), or practice setting (0.231).

Conclusion: Only a small minority of EPs never use point-of-care echocardiography during the management of cardiac arrest. Lack of training, competency, or credentialing is reported as the leading barrier to use among those who do not use POC echo during cardiac arrest cases. Participants who do not always use ultrasound are less likely to have received ultrasound training during residency.
Randomised Controlled Trial Assessing Head Down Deep Breathing Method Versus Modified Valsalva Manoeuvre for Treatment of Supraventricular Tachycardia in the
Emergency Department
Authors: Lim Hoon Chin , Seah Yi-En Clara , Iqbal Arshad , Tan Vern Hsen , Lai Shieh Mei
Published: July 2021

Introduction: Supraventricular tachycardia (SVT) is commonly encountered in the emergency department (ED). Vagal manoeuvres are internationally recommended therapy in stable patients. The head down deep breathing (HDDB) technique was previously described as an acceptable vagal manoeuvre, but there are no studies comparing its efficacy to other vagal manoeuvres. Our objective in this study was to compare the rates of successful cardioversion with HDDB and the commonly practiced, modified Valsalva manoeuvre (VM).

Methods: We conducted a randomised controlled trial at an acute hospital ED. Patients presenting with SVT were randomly assigned to HDDB or modified VM in a 1:1 ratio. A block randomisation sequence was prepared by an independent biostatistician, and then serially numbered, opaque, sealed envelopes were opened just before the intervention. Patients and caregivers were not blinded. Primary outcome was cardioversion to sinus rhythm. Secondary outcome(s) included adverse effects/complications of each technique.

Results: A total of 41 patients were randomised between 1 August, 2018–1 February, 2020 (20 HDDB and 21 modified VM). Amongst the 41 patients, three spontaneously cardioverted to sinus rhythm before receiving the allocated treatment and were excluded. Cardioversion was achieved in six patients (31.6%) and seven patients (36.8%) with HDDB and modified VM, respectively (odds ratio1.26, 95% confidence interval, 0.33, 4.84, P = 0.733) . Seventeen (89.5%) patients in the HDDB group and 14 (73.7%) from the modified VM group did not encounter any adverse effects. No major adverse cardiovascular events were recorded.

Conclusion: Both the head down deep breathing technique and the modified Valsalva manoeuvre appear safe and effective in cardioverting patients with SVT in the ED.
Quality Improvement Initiative to Increase Rate of and Time to Post-intubation Analgesia in the Emergency Department
Authors: Imhoff Bryan , Wagner Samuel , Howe Kelly , Dangers Jonathan , Nazir Niaman
Published: July 2021

Introduction: Intubation and mechanical ventilation are common interventions performed in the emergency department (ED). These interventions cause pain and discomfort to patients and necessitate analgesia and sedation. Recent trends in the ED and intensive care unit focus on an analgesia-first model to improve patient outcomes. Initial data from our institution demonstrated an over-emphasis on sedation and an opportunity to improve analgesic administration. As a result of these findings, the ED undertook a quality improvement (QI) project aimed at improving analgesia administration and time to analgesia post-intubation.

Methods: We performed a pre-post study between January 2017–February 2019 in the ED. Patients over the age of 18 who were intubated using rapid sequence intubation (RSI) were included in the study. The primary outcome was the rate of analgesia administration; a secondary outcome was time to analgesia administration. Quality improvement interventions occurred in two phases: an initial intervention focused on nursing education only, and a subsequent intervention that included nursing and physician education.

Results: During the study period, 460 patients were intubated in the ED and met inclusion/exclusion criteria. Prior to the first intervention, the average rate of analgesia administration was 57.3%; after the second intervention, the rate was 94.9% (P <0.01). Prior to the first intervention, average time to analgesia administration was 36.0 minutes; after the second intervention, the time was 16.6 minutes (P value <0.01).

Conclusion: This QI intervention demonstrates the ability of education interventions alone to increase the rate of analgesia administration and reduce the time to analgesia in post-intubation patients.
The Effect of Crystal Dependence on Brain Activity Related to the Perception of Pleasure Using fMRI
Authors: Yoonessi Ali , Batouli Seyed Amir Hossein , Ahmadnezhad Iman , Soltanian-zadeh Hamid
Published: July 2021

Background: Addiction is currently one of the problems of human society. Drug abuse is one of the most important issues in the field of addiction. Methamphetamine (crystal) is one of the drugs that has been abused in recent decades. Methods: In this case-control study, 10 individuals aged 20 to 40 years old with at least 2 years of experience of methamphetamine consumption without any history of drug use or other stimulants from clients and drug withdrawal centers in Tehran City, and 10 healthy volunteers were selected. Age, social status, and economic status of addicts were included in the fMRI apparatus, and 90 selected pleasurable, non-pleasurable, and neutral images (IAPS) were displayed by the projector through an event-related method. The playback time of each photo was 3 s, and after this process, the person outside the device, without the time limit selected the enjoyable and unpleasant images. Results: The results showed that there was no significant difference between the groups in terms of age, alcohol use, and smoking history (P < 0.05). There was no significant difference in terms of the age at first use between members of the methamphetamine-dependent group. Also, the methamphetamine-dependent group showed more brain activity in their pre-center and post-center gyrus than the normal (control) group. Conclusions: According to the results obtained in this study, in general, it can be concluded that there are some areas in the brain of addicts that are activated when watching pleasant photos, while these areas are not active in the brains of normal people.
Differences in the Brain Cortical Thickness and Area of Different Lobes Between Fetuses with Intrauterine Growth Restriction and Controls Based on 3-Tesla Magnetic Resonance Imaging (MRI)
Authors: Moradi Behnaz , Shirazi Mahboobeh , Alibeigi Nezhad Zohreh , Seyed Saadat Nazanin , Hashemi Hassan , Kazemi Mohammad Ali , Gity Masoumeh , Rahmani Maryam , Ghanaati Hossein
Published: July 2021

Background: Intrauterine growth restriction (IUGR) is a major factor in long-term perinatal morbidity and is associated with abnormal fetal brain development; however, its pattern of brain involvement remains unknown. Objectives: This study aimed to investigate the effect of IUGR on the brain parenchyma. Patients and Methods: Forty-two women with IUGR pregnancy and 28 women with normally grown fetuses at 28 - 38 weeks of pregnancy underwent 3-tesla magnetic resonance imaging (MRI). Cortical thickness was assessed in four regions and corrected by the biparietal diameter/2. Also, the whole brain surface area (WBA) was measured, and the areas of six brain regions were calculated and corrected by WBA. Results: In the IUGR group, the cortical thickness in the insula and temporal lobe was significantly thinner than the control group (0.034 vs. 0.043 and 0.036 vs. 0.047, respectively; P < 0.05); these fetuses also showed significantly reduced WBA (P = 0.028). The corrected brain areas were not significantly different between the groups, except for the corrected areas of the cerebellum and the hippocampus, which increased in the IUGR group as compared to the control group (0.147 vs. 0.130 and 0.017 vs. 0.0125, respectively; P < 0.05). Conclusion: In the IUGR fetuses, significantly thinner insular cortex and temporal lobe cortex and smaller WBA were found compared to the control group. Among different brain regions, the cerebellum and the hippocampus were less affected by growth restriction in the antenatal period.
Evaluation of Celiac Disease Prevalence Among Patients with Refractory Hypothyroidism: A Cross-sectional Study
Authors: Alavinejad Pezhman , Shahbazian Hajieh Bibi , Jahanshahi Alireza , Faramarzi Mohamad , Shokati Eshkiki Zahra
Published: July 2021

Background: The association of celiac disease (CD) with refractory hypothyroidism is a known but less common condition. Objectives: This study aimed to evaluate the prevalence of CD among patients with refractory hypothyroidism and compare the accuracy of different diagnostic procedures of CD in these patients. Methods: During a six-month period, 25 patients with refractory hypothyroidism were included from the endocrinology outpatient clinics of Ahvaz Jundishapur University of Medical Sciences, Khuzestan, Iran. For all the participants, the serological profile of CD, including anti-tissue transglutaminase (anti-tTG), anti-endomysial antibody (anti-EMA), and total immunoglobulin A, was determined, and then they were referred to undergo upper endoscopy and random biopsies from the first and second parts of the duodenum. Results: The average duration of hypothyroidism among the participants was 7 months. In addition, 75% of the patients (n = 19) were female. The mean age values of male and female subjects were 31.3 ± 17 and 34.3 ± 8.5 years, respectively (age range: 17 - 53 years). The average daily dosage of levothyroxine was 285.1 ± 89.9 mg. The most common comorbidities were anemia (72%) and diarrhea (24%). The most frequent serologic findings in these patients were positive anti-tTG (28%) and anti-EMA (16%). The most common results of upper endoscopy were normal mucosa (48%), gastritis (28%), duodenal fissuring (8%), duodenal atrophy (8%), and duodenal erythema (8%). Based on the results of the pathology report, 20% of the patients (n = 5) were diagnosed with CD (mostly marsh 1 and 0 stages). The sensitivity and specificity of tTG were 33 and 87.5%, respectively. The sensitivity and specificity of EMA were 11.1 and 87.5%, respectively. Conclusions: Based on the results of this pilot study, the prevalence of CD among cases with refractory hypothyroidism is higher than that of global reports. Furthermore, routine screening of CD in these patients is highly recommended even with negative serology. The endoscopic view is not adequate for the diagnosis of CD among patients with refractory hypothyroidism. In addition, it is necessary to focus on pathology reports and antibody titer.
Effects of Eight-Week High-Intensity Interval Training on Aerobic Performance, Lipid Profile, and Hematological Indices in Overweight Adolescents
Authors: Sadeghi Jahangir , Monazzami Amirabbas , Taheri Kalani Abdolhossein
Published: July 2021

Background: Research on the effects of interval training on lipid profile and hematological indices is limited. Objectives: Therefore, the purpose of this study was to determine the effects of eight weeks of high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) on aerobic performance, body composition, lipid profile, and hematological indices in overweight adolescents. Methods: Thirty overweight boys (13 - 16 years) participated in this study and were randomly divided into three groups, including the control (n = 10), HIIT (n = 10), and MICT (n = 10) groups. HIIT training (4 × 4-minute) was performed with an intensity of 95 - 85% of maximum heart rate, and MICT training (35-minute) was performed with an intensity of 70 - 60% of maximum heart rate, three sessions per week for eight weeks. Beep test and ELISA technique were used to measure aerobic performance, lipid profile, and hematological indices, respectively. The two-way repeated-measures ANOVA was used to determine the differences with a confidence interval of 95% (α = 0.05). Results: The results showed that except for the variables of glucose, triglyceride (TG), and low-density lipoprotein (LDL), all other variables in the HIIT group had a significant change compared to the pre-test (P < 0.05). Also, the results showed that there was a significant difference between the HIIT and control groups in fat percentage, VO2Max, high-density lipoprotein (HDL), iron, and hemoglobin value (P < 0.05). Conclusions: The results suggest that HIIT training can be as effective as continuous strategy training to reduce the risk factors associated with cardiovascular disease in overweight adolescents.
First Report of Multi-resistant Escherichia fergusonii Isolated from Children Under Two Months of Age in Intensive Care Unit
Authors: Rivera-Galindo Mildred Azucena , Manzanares-Leal Gauddy Lizeth , Caro-Gonzalez Luz Marcela , Santos-Ramirez Erika , Mendieta-Zeron Hugo , Sandoval-Trujillo Horacio , Ramirez-Duran Ninfa
Published: July 2021

Background: Gram-negative bacilli are primarily responsible for the most common pediatric infections. Frequently, Escherichia fergusonii is identified as E. coli because of its close genetic proximity. Objectives: We aimed at the isolation and identification of multi-resistant strains of E. fergusonii, affecting children under two months of age. Methods: Strains were isolated from infectious processes and were identified phenotypically and molecularly. The microdilution method (MicroScan, autoSCAN-4) and the disk diffusion method (modified Kirby Bauer) were used to analyze antibiotic susceptibility. Results: Strains isolated were multi-resistant. Molecular identification provided the correct taxonomic assignment. Escherichia fergusonii strains were wrongly identified as E. coli with the phenotypic identification method. In addition, Pseudomonas aeruginosa and Klebsiella pneumoniae were identified. The best sensitivity results were obtained with Ceftazidime/avibactam and ceftolozane/tazobactam. Conclusions: We provided the first report of isolation and identification of multi-resistant E. fergusonii strains affecting children under two months of age in a neonatal intensive care unit.
Vitamin D Regulatory Effect on Restraint Stress-Induced Changes in Serum Corticosterone and Hippocampus BDNF Levels in the Male Rats
Authors: Sedaghat Katayoun , Choobdar Sara , Bandegi Ahmad Reza , Ghods Zahra
Published: July 2021

Background: Chronic stress exerts negative effects on cognitive functions through inducing changes in the hippocampus. Brain-derived neurotrophic factor (BDNF) is an essential factor in cognitive functions, which is considerably reduced under chronic stress. 1,25(OH)2 vitamin D plays neuroprotective roles partially by regulating the expression of various neurotrophic factors. Objectives: Since few studies have studied the impact of vitamin D on BDNF levels, we conducted this brief experiment to understand the role of vitamin D in maintaining hippocampal BDNF protein levels by using restraining as a model of chronic stress in rats. Methods: Rats underwent restraint stress 3 h/day for 28 days, during which they received vitamin D (5, 10 μg/kg) or its vehicle (IP, twice weekly). After the stress period, serum corticosterone (CORT) and hippocampus BDNF protein levels were measured. Results: Restraint stress increased serum CORT (P < 0.001) and reduced BDNF protein levels (P < 0.001) as compared to the non-stress group. Vitamin D markedly maintained BDNF levels close to normal (P < 0.001), but did not change CORT levels significantly. Conclusions: This study demonstrated that 3h/day of chronic restraint stress for 28 days boosted serum CORT and declined hippocampal BDNF levels, similar to stronger restraint stress models. Vitamin D maintained BDNF level close to normal in the hippocampus, but it did not affect CORT level significantly.
Evaluation of Tubal Factor in Two Methods of Hysterosalpingography and Laparoscopy in Infertile Women
Authors: Farzaneh Farahnaz , Khodabandehshstan Golbahar , Sarhadi Saeedeh
Published: July 2021

Background: The prevalence of infertility in the world is increasing, and diagnosis of the cause of infertility help to better and faster treatment. Objectives: The aim of this study was to evaluate the detection of tubal factor with hysterosalpingography (HSG) and laparoscopic methods in infertile women referred to Ali ibn-e Abitaleb Hospital. Methods: This descriptive-analytical study was performed on women referred to the infertility clinic of Ali ibn-e Abitaleb Hospital of Zahedan. All patients underwent HSG and laparoscopy on days 6 to 12 of the menstrual cycle. The data were collected using information form and then analyzed by SPSS software. Results: In this study, 142 infertile women were studied. The mean age of the patients was 30.6 ± 5.8 years old. In this study, HSG was normal and abnormal in 57.7% and 42.3% of the patients, respectively. Moreover, laparoscopy was normal and abnormal in 76.1% and 23.9% of the patients, respectively. There was a relative agreement between the results of HSG and laparoscopy (Kappa: 0.326; P < 0.001) so that 67.6% of the patients, who were normal in HSG, were reported normal in laparoscopy and 73.5% of the patients, who were abnormal in HSG, were reported abnormal in laparoscopy. Conclusions: Overall, the results of this study show that there is a relative agreement between HSG and laparoscopy in defining the tubal factor, but since there is no complete agreement between HSG and laparoscopic results, it is recommended to evaluate infertile patients with these two methods that are considered a complement of each other and not as an alternative.
Interpretation of Clinical and Laboratory Findings of Patients with Lupus Nephritis According to the Results of Biopsy
Authors: Soufivand Parviz , Rostamian Abdolrahman , Abbasi Mohammad Reza , Shahbazi Fatemeh
Published: July 2021

Background: There are controversies regarding the diagnosis of lupus nephritis. Also, its clinical manifestations and severity are different from one patient to another. Objectives: The current study aimed to interpret clinical and laboratory features of lupus nephritis according to the results of the biopsy. Methods: Following a retrospective design, 30 patients with lupus, who were candidates for renal biopsy and undergoing kidney biopsy, were studied. Clinical findings (blood pressure and limb edema) and laboratory findings (Cr, ESR, CRP, BUN, C3, C4, CH50, Anti-ds DNA, and hematuria) were gathered. Finally, the diagnostic value of clinical and laboratory findings was interpreted according to the biopsies and the staging of samples in the pathology. Data were analyzed using SPSS. Quantitative variables are displayed using mean and quartiles. Fisher’s exact test was used to compare study groups. Also, independent samples t-test and Levene’s test were used to evaluate variances of quantitative variables. Results: Of 30 cases, 5 had a biopsy of 3 and FSGN. Also, 8 cases were on stages 3 and 4, 9 had a stage of 4 biopsy, and 8 cases were on stage 4 - 5, 5, and 5 - 6. The association between age, Limp edema, ESR, and biopsy was statistically significant (P < 0.05). Conclusions: This study demonstrated the usefulness of clinical and laboratory findings to determine the severity of the disease in the shortest time, mainly due to its easy, non-invasive access and early preparation of the results, which will facilitate the initiation of treatment.
La santidad en el ‘De moribus Ecclesiæ catholicæ’ y en los primeros escritos de san Agustín. Continuidad sin fractura ni futuros perdidos
Authors: Eguiarte Enrique ,   Order of Augustinian Recollects
Published: July 2021

The article discusses St. Augustine’s idea about holiness, and how this idea develops itself through the years. The article focuses on St. Augutine’s Works written before the Confessions, namely mor., an. quant., Gen. adu. Man., uera rel., s. dom. m., c. Adim., exp.prop. Rom., doctr. chr. The article discusses that there is no discontinuity between the Works written before the Confessions and the Works written after.
El «Ciclo de Coré» y la pasión de Cristo en las ‘enarrationes in Psalmos’
Authors: Eguiarte Enrique ,   Order of Augustinian Recollects
Published: July 2021

The article deals with the topic of Christ’s Passion as it is presented in those enarrationes in Psalmos that form the «Core’s Cycle», that is those psalms which are attributed to Core. The article discusses the exegetical explanation that St. Augustine gives of Core’s name, and how this interpretation is linked to Christ’s Passion, underlining the spiritual and ecclesial aspects. It also deals with the linking of these enarrationes with Get’s name and the actual trials as a way of purification for the faithful and also as a mean of self-knowledge.