bluuebunny/crossref_metadata_2025 huggingface dataset:
Application of the Learning Contract Learning Method to History Learning Activities of Class X Students in Online Business and Marketing at State Vocational High School 1 Pontianak
Authors: Lidia Lidia , Ulfa Maria , Putri Astrini Eka
Published: January 2024

This research was conducted with the aim of knowing the application of the learning contract learning method to the learning activities of class X BDP students at Vocational High School 1 Pontianak. This research is a quantitative research with experimental method. The data source was used by students of class X BDP 1 as the experimental class and class X BDP 2 as the control class. Data collection through questionnaires and documentation. From the results of the research the researchers found that: The implementation of learning history using the learning contract learning method includes planning by determining learning objectives, applying learning contract learning methods and evaluating. Student activities during the learning process showed that students were able to explain material about the origins of their ancestors and conduct group discussions. In the learning process using the learning contract learning method there is an influence on the history learning activities of class X BDP SMK Negeri 1 Pontianak. As for learning activities such as arriving on time, listening to subject matter and having group discussions related to historical material. In this case the learning contract learning method aims to achieve what is planned as well as possible.

Keywords: Learning Menthods, Learning Contract, Activity
Inactivation Effects of Negative Pressures by A Metal Berthelot Technique on Bacteria Solutions
Authors:   Ph.D., Prof., Department of Mechanical Engineering, National Institute of Technology, Nara College, Yamato Koriyama, Japan, Hiro Kazuki , Imanishi Momoko ,   FD, Student, Department of Mechanical Engineering, National Institute of Technology, Nara College, Yamato Koriyama, Japan, Kotake Hiroki ,   FD, Student, Department of Mechanical Engineering, National Institute of Technology, Nara College, Yamato Koriyama, Japan, Fukuoka Hiroshi ,   Ph.D., Prof. Assoc., Department of Mechanical Engineering, National Institute of Technology, Nara College, Yamato Koriyama, Japan, Itsuki Ayuko ,   Ph.D., Prof. Assoc., Department of Chemical Engineering, National Institute of Technology, Nara College, Yamato Koriyama, Japan
Published: January 2024

Bacterial solutions are anticipated to be inactivated under absolute liquid negative pressures much lower in magnitude than positive ones. The pressures, however, have been hard to be produced by experiments because liquids form cavities easily through heterogeneous nucleation. To investigate the anticipation, solutions including two kinds of bacteria, namely Bacillus subtilis and Escherichia coli, were exposed to negative pressures repeatedly by a metal Berthelot tube which was designed newly. Then, numbers of colonies in bacteria which were cultured by a paper strip method and an agar dilute plate one were counted. Numbers of colonies which underwent negative pressures were less than those for non-treatment, and reduction rates of colonies increased with numbers of repetition. It was thought that inactivation effects of negative pressure on bacteria were due to destabilization of kinds of protein constituting the bacteria. Inactivation effects of negative pressure on bacteria will contribute to development of apparatus using ultrasound radiation by considering not only cavitation but also negative pressures without no chemical compound.
Prostitution and Public Policy in Post-Socialist Bulgaria
Authors: Petrunov Georgi
Published: January 2024

The article examines prostitution in Bulgaria, which has become a widespread ‎phenomenon in the post-socialist period when the number of sex workers increases and the places where sex services are offered proliferate. At the same ‎time, the policies towards prostitution remain archaic and inadequate to the ‎new circumstances. ‎The text draws on an empirical base, mixing qualitative and quantitative ‎research conducted in the period 2008-2022. Results of two nationally representative surveys of public opinion on the subject are analyzed. Additionally, ‎reviews of court cases, other documents and Internet forums of clients using ‎paid sex services are discussed. Results from monitoring of specialized police ‎operations related to prostitution are presented.‎ The first part of the text presents the historical development of prostitution ‎in Bulgaria – before socialism and during the communist regime. The second ‎part focuses on the rise of prostitution in post-socialist Bulgaria – development of the sex market is traced; main layers of prostitution and social mobility patterns are analyzed; the role of the third party is discussed. The third part ‎examines the current policies regarding prostitution in Bulgaria. In the concluding section, the article discusses the potential for developing new policies ‎on prostitution in post-socialist Bulgaria.
Isogeometric Analysis in Structural Deformation and Automobile Crash
Authors: Yokoyama Yuta , Nagasaka Kei , Masuda Idemitsu , Sugiyama Hirofumi , Okazawa Shigenobu
Published: January 2024

We evaluate performance of Isogeometric analysis (IGA) for structural deformation and automobile crash. In automobile crash analysis, ensuring the accuracy of the acceleration, velocity and load in time series as well as the deformation behavior is important. To maintain the aforementioned consistency, accurately reproducing the bending and buckling of structural members is indispensable. In this study, we firstly compute the bending and buckling of structural members using IGA and validate its performance by comparing the results with conventional finite element analysis and experiments. In addition, we utilize IGA for the crash analysis of an automobile body.
Lump Sum Contracts in Construction: Benefits, Challenges, and Risk Allocation Strategies
Authors: Rashid Md Redowan
Published: January 2024

Lump sum contracts are specific contracts used in the construction industry to give owners financial certainty and decrease risk while incentivizing contractors to finish projects on schedule and within budget. This article discusses the usage of lump sum contracts in construction projects, covering the types of projects appropriate for lump sum contracts, critical considerations for entering a lump sum contract, and the tender and preliminary expenses involved. The article also covers lump sum contracts' benefits and drawbacks and how owners and contractors allocate risk. Finally, the difficulties of implementing lump sum contracts, such as potential disagreements over scope changes and quality issues, are investigated. In general, lump sum contracts can be a valuable tool for managing construction projects, but their execution necessitates careful planning and collaboration to ensure successful completion.
Comparison of Mental Nerve Block With Lingual Infiltration and Inferior Alveolar Nerve and Lingual Nerve Block for Extraction of Mandibular Anterior Teeth
Authors: Srinivasan Manthra , John Rubin S
Published: January 2024

Aim: the main aim of this study is to compare the onset of effectiveness of mental nerve block with lingual infiltration and inferior alveolar nerve block on patients visiting dental hospital for extraction of mandibular anterior teeth. Materials and methods: The study was set in a clinical setting. This was a randomized controlled double-blind cross study, where 25 subjects received two treatments at an interval of at least 1 week in a within a dental hospital.Inferior alveolar nerve block and lingual nerve block injection is given with 2mL lignocaine 2% with 1:2,00,000 epinephrine was administered for the right side. Mental nerve block along with lingual infiltration of the corresponding tooth was given with 2mL lignocaine 2% with 1:2,00,000 epinephrine was administered on the left side.Visual analogue scale (VAS) was used in this study, which consists of a scale with range of 0-10 pain severity on which 0 indicated absence of pain and 10 the worst pain possible. The patients were asked to give scores corresponding to his/her pain, after IANB, mental nerve block and lingual infiltration and these scores were recorde.Results: From the results we can see that patients gave scores between 3-4, stating that they had moderate pain during extraction after administration of IANB (54%) (graph 2) and VAS scores of 0-1 were given by patients, which is suggestive of no pain during extraction after administration of Mental nerve block and lingual nerve infiltration (62%)Conclusion: Within the limits of the study we can conclude that mental nerve block along with lingual infiltration is an effective way to completely and quickly anaesthetise the central incisor to the 1st premolar region.
Effectiveness interactive digital modul physics (IDMP) based interactive lecture demonstration of concepts vector
Authors: Wibowo Firmanul Catur , Awaliyah Siti Rubihatul , Nasbey Hadi , Rustana Cecep E , Darman Dina Rahmi , Ahmad Nur Jahan , Costu Bayram , Prahani Binar Kurnia , Samsudin Achmad
Published: January 2024

This research explores the effectiveness of Interactive Digital Module Physics (IDMP) for additional teaching materials in vector concepts. The IDMP which was developed according to the ADDIE model and its implementation uses the Interactive Lecture Demonstration (ILD) learning model. A total of 65 participants were students enrolled in a Basic Physics course at a university in a special area in the central district of Indonesia. The instrument used to validate the IDMP uses a scale of 1-5 and has a scoring rubric and processing effectiveness data using technique Cohen's D formula. The intervention group was given training assignments in using ILD-based IDMPs while the control group was given ILD-based assignments only. The results of this study obtained data that the intervention group was significantly better than the control group, found there was no significant increase. Cohen's D score in the intervention group had a large impact on the control group of 1.17 with a 95% confidence interval. Furthermore, they get learning experience by providing feedback that the course material using ILD-based IDMP can challenge students to learn independently.
Development of Life Skill in Problem-Based Learning in Early Childhood
Authors: Pratiwi Indy Ari
Published: January 2024

This research aimed to develop teaching materials that can help students develop life skills in learning by using a problem-based learning approach. A research and development approach with the development stage of Dick and Carey, ADDIE. The subjects who used teaching materials in this study were early childhood education teachers and the objects were students aged 5-6 years at RA Mentari and TK IT Al-Muttaqin. This teaching material contains concepts and hands-on activities, included 1) social skills, 2) hygiene and health skills, and 3) financial management skills. The results of expert validation for all items in the instrument show a number above the critical r of 0.30 which means that the teaching material is feasible both in content and systematically. The effectiveness test results obtained from the t count of 3.501 so it can be concluded that the teaching materials that have been developed are suitable for students to use to develop life skills in problem-based activities
ANALYZING HOSPITAL ADMISSION RATE FOR DISEASES OF THE CIRCULATION SYSTEM AMONG POST-WORKING AGE POPULATION IN THE RUSSIAN FEDERATION
Authors:   Federal Research Institute for Health Organization and Informatics of the Ministry of Health of the Russian Federation, Moscow, Russia, Shlyafer Sofia , Shikina Irina ,   Federal Research Institute for Health Organization and Informatics of the Ministry of Health of the Russian Federation, Moscow, Russia
Published: January 2024

Significance: The fact of population ageing, including the associated rise in cardiovascular diseases, leads to a higher care seeking by people of post-working age and, as a result, an increase in the number of hospital admissions. The analysis of admission rate makes it possible to evaluate advanced cases and severity of conditions associated with the admission to hospital. The purpose of the study is to analyze dynamics in changes in the indicator of admission rate for diseases of the circulatory system among post-working age population in the Russian Federation. Material and methods. The composition of post-working age patients with diseases of the circulatory system and individual nosologies discharged from hospital was analyzed according to the federal statistical observation form No. 14 “Information on activities of departments of medical organizations providing inpatient care” for the period 2010-2021 (divided into two periods due to the changed retirement age). Research methods included: statistical, analytical. Results. In 2010-2019 in the Russian Federation, the highest increase in admission rate was registered for other heart diseases - 2.4 times including a 2.64-fold rise in fibrillation and atrial flutter cases, an 80.8% increase in past myocardial infarction, a 25.9% increase in hypertensive heart disease, a 20.2% rise in cerebrovascular diseases, including a 28.6% rise in other cerebrovascular diseases. Over a decade, the admission rate for all diseases increased from 269.7 to 294.1 per 1000 post-working age population (women aged 55+, men aged 60+) (by 9.1%), including a rise in diseases of the circulatory system from 105.3 to 107.5 per 1000 population of the corresponding age (by 2.1%). The share of admissions for diseases of the circulatory system among post-working age population in the structure of all diseases decreased from 38.9% to 36.5%. The admission rate among post-working age population in 2020-2021 increased from 77.6 to 78.35 per 1000 population of the corresponding age (women aged 56+, men 61 +). Conclusion: In 2010-2019, the admission rate for diseases of the circulatory system increased by 2.1%. The share of the discharged patients admitted for emergency care due to diseases of the circulatory system increased from 43.65 to 53.0%. During the second period under study (2020-2021), the indicator of admission for diseases of the circulatory system increased by almost 1.0% with a slight decrease in the share of the discharged patients admitted for diseases of the circulatory system from 60.2 to 58.7%.
ANALYZING PREVALENCE OF MAIN RISK FACTORS AMONG HEALTH PROFESSIONALS
Authors:   Izhevsk State Medical Academy of the Ministry of Health of the Russian Federation, Izhevsk, Russia, Povolotskaya Nataliya ,   Republican Center for Public Health and Medical Prevention, Izhevsk, Russia, Shkatova Elena ,   Izhevsk State Medical Academy of the Ministry of Health of the Russian Federation, Izhevsk, Russia
Published: January 2024

Significance of the topic of the performed study is substantiated by the fact that activities of health professionals are determinative in providing high-quality specialized medical care. Analysis of risk factors among health professionals and their prevalence are of great importance in terms of developing measures to minimize them and, as a result, determine the quality of health care provided. The purpose of the study is to analyze risk factors among health professionals while performing their professional duties. Material and methods: survey of health professionals according to a specially developed questionnaire, and statistical processing of the results obtained. Results: the analysis determined frequency of the most typical risk factors among health professionals with due regard to individual characteristics (age, gender, professional experience). The most pronounced risk factors among health professionals included: high blood pressure, abdominal obesity, and low physical activity. Scope of application. Development of recommendations to reduce the impact of risk factors associated with professional activities of health specialists on well-being and health, which will indirectly affect the quality improvement of medical care.
DYNAMICS IN THE NUMBER OF NURSING STAFF IN PUBLIC MEDICAL ORGANIZATIONS OF THE RUSSIAN FEDERATION IN 2018-2022
Authors:   Federal Research Institute for Health Organization and Informatics of the Ministry of Health of the Russian Federation, Moscow, Russia, Latyshova Alla , Ivanova Maisa ,   Federal Research Institute for Health Organization and Informatics of the Ministry of Health of the Russian Federation, Moscow, Russia
Published: January 2024

Significance. Nursing staff play an important role in health care delivery. Specialists with secondary medical education provide "independent" medical care at rural health posts and stations (departments) of emergency medical care. Consequently, the density of such staff affects both the care availability and quality, substantiating the relevance of the study of staffing of health facilities with nurses. The purpose of the study. To analyze dynamics in the number of nurses in health facilities of the Russian Federation in 2018-2022. Material and methods. Statistical materials "Resources and activities of medical organizations" on the number of nursing staff in health facilities in the Russian Federation, federal districts and constituent entities of the Russian Federation for the period from 2018 to 2022 were used. When calculating indicators, methodological recommendations of the Ministry of Health of the Russian Federation were used. Analytical and statistical methods were used in the research process. Calculations were performed using Excel 2019 spreadsheets. Results. The results of the analysis of the number of nurses for the last five years show a 6.5% decline. In the Russian Federation, there are significant territorial differences in the number of nursing staff per population (per 10,000 population), which can be traced throughout the entire period under study. It has been revealed that the average age of nurses in the country as a whole equals to 42.62 years. Conclusion. A study on key indicators characterizing the staffing level has shown that the number of nursing staff in the country as a whole in 2022 decreased by 6.5% compared to 2018. However, 34 constituent entities of the Russian Federation report the value of 90.0 or higher per 10,000 population, which is optimal. The indicator of staffing of full-time positions with individuals decreased to 71.5%, with a secondary employment ratio of 1.3. Analysis of dynamics of the average age of nursing staff over a five-year period showed a 0.93 year increase. Scope of application. The study results can be of interest to health officials, practitioners, residents and graduate students of medical universities.
DYNAMICS IN MORTALITY BY MAIN CLASS OF DEATH CAUSES IN THE OMSK REGION IN 2014-2021
Authors:   Omsk State Medical University of the Ministry of Health of the Russian Federation, Omsk, Russia, Sabaev Alexander , Pasechnik Oksana ,   Omsk State Medical University of the Ministry of Health of the Russian Federation, Omsk, Russia, Sukonchik Anna ,   City Clinical Hospital of Emergency Medical Care No. 1, Omsk, Russia
Published: January 2024

Significance. Mortality is one the most important statistical indicators characterizing level of sanitation. This demographic indicator is one of the most common in international health statistics. Of particular interest to health authorities are mortality rates from individual causes. Mortality rate from individual causes depends on prevalence of specific nosological forms of diseases and their lethality. The purpose of the study was to analyze rates and dynamics in mortality in the Omsk region by main class of death causes for the period from 2014 to 2021. Material and methods. Statistical processing of the research materials used methods of alternative (intensive indicators) and graphical analysis; indicators of dynamic series were calculated. Results. During the period from 2014 to 2021, the Omsk region registered a 35% increase in the crude death rate. Diseases of the circulatory system remained the leading cause of death in the Omsk region. Mortality from diseases of the nervous system increased 2.6 times. The COVID-19 pandemic is associated with a high mortality in the region in 2020, followed by a 3.2-fold increase in 2021, ranking second after diseases of the circulatory system. A decrease in mortality was recorded in the classes "Infectious and parasitic diseases" (by 18.8%), "Neoplasms" (by 7.1%), "Diseases of the respiratory system (by 29.0%), "Diseases of the digestive system" (by 10.4%), and "Accidents, injuries, poisoning" (by 29.1%). Conclusion. Statistically significant positive changes were registered during the analysis of dynamics in mortality due to infectious diseases, neoplasms, respiratory diseases, digestive diseases, and external causes. In the region, mortality due to diseases of the circulatory system was characterized by a stable trend and high rates. Negative trends have been noted in the dynamics in mortality associated with COVID-19, and diseases of the nervous system. A significant increase in mortality due to these causes apparently determines the negative trends in the medical and demographic component of the current development of the Omsk region.
Pengolahan Sampah Organik Menjadi Pupuk Kompos Dengan Menggunakan Keranjang Takakura
Authors: Supriyadi Supriyadi
Published: January 2024

Pengelolaan sampah selama ini di Desa Wadungasih, menjadi persoalan serius. Hal ini berdasarkan hasil observasi bahwa masyarakat Wadungasih mayoritas pekerja pabrik. Secara geografis Desa Wadungasih berada di daerah kawasan industri, serta keberadaan pasar dekat balai desa Wadungasih, yaitu pasar kasih yang setiap pagi, malam berjualan. Pengelolaan sampah salama ini, hanya dibuang di tempat pengolahan sampah terpadu (TPST) yang sudah berdiri sejak lama, dimana sampah yang tidak bisa didaur ulang akan dibuang ke kecamatan Jabon dengan menggunakan truk sampah. Desa Wadungasih juga memiliki bank sampah non organik, antara lain: botol, palstik, buku, kaleng, pecah beling, sepatu, dan sandal.
0.5% Lignocaine vs 0.5% Lignocaine with Dexmedetomidine for Bier’s Block: A Comparative Study
Authors:   Assistant professor, Department of Anesthesiology, Mahadevappa Rampure Medical College, Kalaburagi, Karnataka 585105, India., Joshi Vikas , Yahya Mohammed ,   Associate Professor, Department of Anesthesiology, Mahadevappa Rampure Medical College, Kalaburagi, Karnataka 585105, India.
Published: January 2024

Background: Intravenous regional anesthesia (IVRA) was introduced into clinical practice by August Bier in 1908. This form of analgesia is ideally suited for emergencies, where patient is with full stomach or suffering from other diseases that contraindicates general anaesthesia, moreover the feasibility and simplicity of execution of this method, its effectiveness and its lack of any side effects have been gratifying. IVRA is particularly suitable for day care surgeries as it requires minimal preparation and premedication. Dexmedetomidine, a stereoisomer of medetomidine is a highly selective alpha 2 adrenergic agonist and has been shown to decrease anesthetic requirements by upto 90% and to induce analgesia in rats, volunteers and patients. The present study was designed to evaluate the quality, onset and recovery of IVRA with 0.5mcg/kg dexmedetomidine added to 3mg/kg of 0.5% lignocaine. Methods: After institutional approval and informed consent, 60 ASA 1 and 2 volunteers, were taken into the study. In Group A 30 patients were randomly allocated to receive IVRA for upper limb with 3mg/kg for 0.5% lignocaine; in Group B 30 patients randomly received IVRA of upper limb with 3mg/kg of 0.5% lignocaine with 0.5mcg/kg Dexmedetomidine. The onset and recovery of sensory block were tested in six sites of the forearm and hand, determined by pin prick, touch and cold. The cuff was released after 45 minutes. The onset of complete motor block was also assessed and any symptoms after cuff de!ation were recorded. Usual haemodynamic monitoring was used. Results: The speed of onset of sensory and motor block was higher in Group B than in Group A (p<0.05). The recovery of sensory and motor block was prolonged in Group B than in Group A (p<0.05). The tourniquet pain occurred signi#cantly later in Group B as compared to Group A. There were few incidence of bradycardia in Group B. Conclusion: Addition of 0.5mcg/kg of Dexmedetomidine as an adjuvant to Bier’s Block effectively enhances the anesthesia and post-operative analgesia obtained with lignocaine. The low dose of Dexmedetomidine was effective and did not cause any major side-effects.
A Study on Complications of Magnesium Sulphate as an Adjunct to Ropivacaine Versus Plain Ropivacaine in Local Subcutaneous Infiltration for Postoperative Analgesia
Authors:   Assistant Professor, Department of Anesthesiology, Raichur Institute of Medical Sciences, Raichur, Karnataka 584102, India., Siddartha Myakala , Raghavendra P G ,   Assistant Professor, Department of Anesthesiology, Raichur Institute of Medical Sciences, Raichur, Karnataka 584102, India.
Published: January 2024

Introduction: Local anaesthesia have been employed during the operation as an adjuvant to anaesthesia or to alleviate postoperative pain. Local anaesthetic is injected to block the nerves before cutting the skin at the beginning of the operation, or after closing the skin at the end. Subcutaneous infiltration of bupivacaine microcapsules prolongs analgesia in humans for up to 96 h, and pre surgical infiltration of levobupivacaine significantly decreases the intensity of postsurgical pain, especially for the first 12 h, thereby reducing analgesic consumption. Methodology: The minimum samplesize required for the study per group is 23. We have considered 30 patients per group for better statistical representation. A total of 60 patients were included in the study. Results: None of the patients suffered from bradycardia, hypoxaemia, respiratory depression, skin rash or incision site excessive redness nor was there any evidence of infection. The incidence of sedation and pruritis was similar in both groups with no statistically significant difference. Conclusion: The incidence of nausea and vomiting was infact lower in group B as compared to group A. This could be explained by the lesser use of rescue analgesic agent in group B since Inj tramadol itself is associated with increased incidence of nausea and vomiting.
Levobupivacaine vs Ropivacaine in Spinal Anesthesia for Lower Abdominal and Lower Limb Surgeries: A Comparative Study
Authors:   Associate professor, Department of Anesthesiology, Mahadevappa Rampure Medical College, Kalaburagi, Karnataka 585105, India., Yahya Mohammed , Joshi Vikas ,   Assistant professor, Department of Anesthesiology, Mahadevappa Rampure Medical College, Kalaburagi, Karnataka 585105, India., Makandar Abdul Azim ,   Junior Resident, Department of Anesthesiology, Mahadevappa Rampure Medical College, Kalaburagi, Karnataka 585105, India.
Published: January 2024

Background: Till recently Bupivacaine 0.5% Heavy was the only drug used for spinal anesthesia after the discontinuation of Lidocaine’s intrathecal use. The last few years, its pure S (-) enantiomers, ropivacaine and levobupivacaine, have been introduced into clinical practice because of their lower cardiac and central nervous system toxic effects. This study was performed to compare the anesthetic efficacy and safety of the ropivacaine and levobupivacaine, in patients undergoing lower abdominal and lower limb surgery. Methods: 60 patients of ASA physical status I–II between the ages of 20–60 years, scheduled for spinal anesthesia were prospectively enrolled in our randomized controlled trial. They were divided into 2 groups, R and L, of 30 pts each. 3.0ml (15mg) of 0.5% isobaric ropivacaine in study group R and 3.0ml (15mg) of 0.5% isobaric levobupivacaine in study group L was given. Results: The mean Time of onset sensory blockade and Time of onset of Motor Blockade was significantly high in Group R as compare to Group L, whereas mean Duration of sensory blockade, mean Duration of motor blockade and mean Duration of analgesia were significantly less in Group R as compare to Group L (P<0.001). Conclusion: Intrathecal administration of either 15 mg ropivacaine or 15 mg levobupivacaine was well-tolerated and provided similar, effective anesthesia for lower limb and lower abdominal surgery. Intrathecal ropivacaine may prove useful when surgical anesthesia of a similar quality but of a shorter duration is desired.
Anesthesia for Brachytherapy: A Review
Authors:   Professor and head, Department of Anesthesiology, Pain Medicine and Critical Care, Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu 600044, India., .. Kala , Elizabeth Tanya ,   Junior resident, Department of Anesthesiology, Pain Medicine and Critical Care, Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu 600044, India.
Published: January 2024

Radiotherapy is a commonly employed and an important modality of treatment for cancer with about 50 % of the patients receiving radiotherapy during their course of treatment.1 Two major categories for the application of radiation are external beam radiation and brachytherapy.1 Brachytherapy is derived from the greek word brachys meaning “short distance”.2 Brachytherapy is administered by inserting a radiation source inside a specific cancer site which needs anesthesia, analgesia and muscle relaxation. The theory behind brachytherapy is to deliver low intensity radiation over an extended period to a relatively small volume of tissue covering the tumour area and sparing the surrounding normal tissue. The demand for anesthesia in brachytherapy is increasing nowadays. Anesthetic management is crucial because it poses a number of challenges for the anesthesiologist. Patients for brachytherapy are often elderly and are high risk patients with multiple co morbidities, brachytherapy for head and neck malignancy may pose the problem of difficult airway, to achieve a stable position of the applicators and implants immobilization is essential.3 Brachytherapy often has an unpredictable procedural duration. Transportation of the anesthetized patients to different radiological suite is a typical challenge.3 Various modalities of anesthesia employed include general, spinal, combined spinal epidural anesthesia and local anesthesia with sedation. Anesthesiologist play a major and an important role in the ongoing challenge to provide an optimal treatment conditions for brachytherapy.
Comparative Evaluation between Ropivacaine versus Ropivacaine with Dexmedetomidine in Ultrasound Guided Parasagittal Brachial Plexus Approach in Upper Limb Orthopedic Surgeries
Authors:   Professor, Department of Anaesthesiology, Rajarajeswari Medical College and Hospital, Bangalore, Karnataka 560074, India., GS Karthik , R Sudheer ,   Professor, Department of Anaesthesiology, Rajarajeswari Medical College and Hospital, Bangalore, Karnataka 560074, India., KB Mahima ,   Junior Resident, Department of Anaesthesiology, Rajarajeswari Medical College and Hospital, Bangalore, Karnataka 560074, India., K Hosalli Shivasharn ,   Junior Resident, Department of Anaesthesiology, Rajarajeswari Medical College and Hospital, Bangalore, Karnataka 560074, India., . Rangalakshmi ,   Professor and Head, Department of Anaesthesiology, Rajarajeswari Medical College and Hospital, Bangalore, Karnataka 560074, India., P Nivedha ,   Junior Resident, Department of Anaesthesiology, Rajarajeswari Medical College and Hospital, Bangalore, Karnataka 560074, India.
Published: January 2024

Background: Ropivacaine has been used for brachial plexus block because of its safety profile. Dexmedetomidine is one of the adjuvants added to Ropivacaine as it is known to potentiate sensory and motor blockade. Aim: Our aim was to compare and assess the effectiveness of adding Dexmedetomidine as an adjuvant to 0.75% ropivacaine in supraclavicular brachial plexus block using parasagittal approach for duration of analgesia primarily. Onset and duration of sensory and motor blockade were also the variables compared. Materials and methods: A prospective single blinded randomized comparative clinical study was carried out among in eighty patients of ASA Grade I and II between the ages of 20-60yrs, scheduled for elective upper limb orthopedic surgeries involving the forearm under supraclavicular brachial plexus block using parasagittal approach. Group R received 20ml of 0.75% ropivacaine along with 1ml of normal saline while Group RD received 20ml of 0.75% ropivacaine along with 0.5mcg/kg dexmedetomidine constituted to 1ml. Sensory, motor blockade & analgesic efficacy was determined. Statistical Analysis: Student t-test was used for demographic and hemodynamic data analysis. Unpaired t-test was used for evaluation of data which consisted of onset, duration of sensory and motor blockade along with duration of analgesia. The results were statistically significant if p-value <0.05. P-value <0.001 was considered highly significant. Results: Duration of analgesia lasted longer in Group RD (991.09 ± 16.34) when compared to Group R (542.57 ± 18.37). Onset time for sensory and motor blockade were rapid in Group RD (7.71 ± 1.23, 13.66± 1.03) when compared to Group R (10.14 ± 1.00, 18.60 ± 1.54). Duration of sensory blockade was prolonged in Group RD (780.26 ± 31.43) when compared to Group R (455.57± 20.28). Duration of motor blockade was also enhanced in Group RD (725.57 ± 25.18) when compared to Group R (397.74 ± 24.92). Conclusion: Addition of Dexmedetomidine to Ropivacaine provided superior analgesia along with faster onset and longer duration of sensory and motor blockade.
Relationship between Preoperative Maternal Abdominal Circumference Measurement and the Level of Sensory Block in SAB in Cesarean Section : Prospective Observational Study
Authors:   Professor and Head, Department of Anesthesia, Bangalore Medical College and Research Institute, Fort Road, Bangalore 560004, Karnataka, India., R Ramachandraiah , N Rao Vyshnavi ,   Post Graduate, Department of Anesthesia, Bangalore Medical College and Research Institute, Fort Road, Bangalore 560004, Karnataka, India.
Published: January 2024

Background and aims: Inferior venacaval compression during pregnancy causes extradural venous engorgement which may reduce the lumbar cerebrospinal fluid volume. A subsequent greater cephalad spread of sensory block is observed. We hypothesized that maternal abdominal circumference measurement can reflect the compressive effect of uterus and investigated the relationship between maternal abdominal circumference and the level of sensory block, the maximum level of sensory block, incidence of hypotension, nausea, vomiting, requirement of ephedrine in term parturients undergoing cesarean section under spinal anasethesia. Methods: Abdominal circumference of 40 term parturientswere measured before performing subarachnoid block. 0.5% hyperbaric bupivacaine (2ml, 2.2ml, 2.4ml) was injected into L3-L4 subarachnoid space according to parturients height .The level of sensory block was assessed at various time intervals. The statistical tests applied were Onewayanova, product moment correlation and independent sampleT Test. Results: The correlation coefficient between abdominal circumference and the level of sensory block was significantly positive at various time intervals (p<0.05) following spinal anesthesia. There was a positive correlation between abdominal circumference and highest level of sensory block. No significant correlation was found between abdominal circumference and incidence of hypotension, requirement of ephedrine, nausea and vomiting after spinal anaesthesia (p>0.05).There was a significant positive correlation between BMI and the level of sensory block (p<0.05). Conclusion: Parturients with greater abdominal circumference value have a higher level of sensory blockade after spinal anaesthesia. Abdominal circumference cannot predict the incidence of hypotension, nausea, vomiting and the dose of ephedrine required.
Comparison of Efficacy of Two Different Dose Regimens of Intravenous Dexmedetomidne for Awake Transnasal Fibreoptic Intubation
Authors:   Post Graduate Resident, Department of Anaesthesiology, Sri Devaraj Urs Medical College, R L Jalappa Hospital, SDUAHER, Tamaka, Kolar, Karnataka 563101, India., V D Sandeep , N Kiran ,   Professor, Department of Anaesthesiology, Sri Devaraj Urs Medical College, R L Jalappa Hospital, SDUAHER, Tamaka, Kolar, Karnataka 563101, India.
Published: January 2024

Background and Objectives: Nasal Fibreoptic intubation (NFI) is the recommended technique in patients with difficult airway like facial defects, limited mouth-opening and cervical instability but it requires the patient to be awake. The usage of an ideal sedative agent and stabilizing the intubating condition was essential for this. In this study we compare efficacy of different doses of dexmedetomidine for conscious sedation facilitating NFI. Materials and Methods: This is a prospective, blinded-randomized-trial to correlate the effectiveness of different loading and maintenance doses of dexmedetomidine during NFI on 60 patients, 30 in each group, aged between 20 and 60 years with ASA grade I or II enrolled for elective surgery. All patients received 2 mg Midazolam as premedication before transferring to operating room. Group A patients received Dexmedetomidine 1 mcg/kg I.V bolus slowly over 10 minutes then 0.8 mcg/kg/h as maintenance throughout the procedure. Group B patients received Dexmedetomidine 0.8 mcg/kg I.V. as bolus and 0.2 mcg/kg/h as maintenance dose. Primary outcomes were assessment of sedation level and comfort of each patient by Total Comfort Scale (TCS). The difference in quantitative measures was done using student ‘t’ test and difference in proportions by ‘Chi’ square test. P<0.05 was considered statistically significant. Results: With respect to comfort scores and optimal conditions during NFI, Group A people showed significantly lower scores when compared to Group B. Conclusion: Dexmedetomidine with loading 1μg/kg and higher maintenance dose 0.8μg/ kg/h were better for NFI with better patient tolerance, patient comfort, patient satisfaction, good sedation and preserved upper airway with spontaneous breathing. Key words: Comfort scale; Dexmedetomidine; Fibreoptic intubation.
Comparison of Analgesic Efficacy of Levobupivacaine and Levobupivacaine with Nalbuphine in Inguinal Hernia Surgeries Under Subarachnoid Block
Authors:   Director Professor and Medical Director, Department of Anesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital, Dilshad Garden, Delhi- 110095, India,, Singh Rautela Rajesh , Salhotra Rashmi ,   Professor, Department of Anesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital, Dilshad Garden, Delhi- 110095, India,, Jha Shreshtha ,   Senior Resident, Department of Anesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital, Dilshad Garden, Delhi- 110095, India,
Published: January 2024

Background: Recently there has been an interest to explore the efficacy of nalbuphine as' an adjuvant to local anaesthetic agents. This study was designed to compare its analgesic efficacy when added to levobupivacaine in patients undergoing inguinal hernia surgeries under subarachnoid block. Methods: Fifty patients belonging to ASA I/II, between 18-65 years of age undergoing inguinal hernia repair were randomly allocated to receive subarachnoid block with either 12.5 mg of 0.5% isobaric levobupivacaine (2.5 ml)+ normal saline (0.5 ml) (Group-LS) or 12.5 mg of 0.5% isobaric levobupivacaine (2.5 ml)+ 1 mg nalbuphine (0.1 ml) + normal saline (0.4 ml) (Group-LN). Onset of sensory block, two segment regression time, time of regression to T12, duration of effective analgesia and intensity of motor block were assessed. Results: Onset of sensory block was comparable in the two groups (P=0.774). Time of regression of sensory block to T12 dermatome was 161.09 ± 40.50 min in group LS and 167.50 ± 50.17 min in group LN (P=0.633).The duration of effective analgesia was 177.39 ± 43.53 min in group LS and 183.75 ± 56.69 min in group LN (P=0.669).Motor block parameters were also comparable.More number of patients in group LN had a sedation score of one as compared to group LS. No major side effects were seen. Conclusion: 12.5 mg levobupivacaine with or without nalbuphine is sufficient for conducting inguinal hernia surgeries. Intrathecal nalbuphine 1 mg did not affect the sensory and motor block characteristics of levobupivacaine.
Anaesthetic Management of a Patient with Failing Modified Fontan, Morbid Obesity, Atrial Flutter and OSA posted for RFA-A Case Report
Authors:   Consultant Pediatric, Cardiac Anaesthesia, Glenfield Hospital, University Hospitals of Leicester, Leicester, UK., Paddalwar Snigdha , Singh Sumal Jaswant ,   Consultant Pediatric, Cardiac Anaesthesia, Glenfield Hospital, University Hospitals of Leicester, Leicester, UK.
Published: January 2024

The Classic Fontan has been abandoned these days due to occurrence of rapid and incessant complications. Presence of complications like, morbid obesity, obstructive apnoea, chronic atrial flutter, elevated Fontan pressures as seen in our patient, increases the risk of Anaesthesia manifold times. We report a case of 32 year old male patient with failing modified Fontan and aforementioned complications, posted for radiofrequency ablation under general Anaesthesia.
Comparison between Dexmedetomidine and Buprenorphine as Adjuvants to Isobaric Levobupivacaine in Spinal Anaesthesia for Elective Lower Limb Surgeries
Authors:   Assistant Professor, Department of Anesthesia, Vijaynagar Institute of Medical Sciences, Ballari, Karnataka 583104, India., M H Chandana , Raghavendra P G ,   Assistant Professor, Department of Anesthesia, Raichur Institute of Medical Sciences, Raichur, Karnataka 584101, India.
Published: January 2024

Background: Levobupivacaine and racemic bupivacaine are equally effective in spinal anaesthesia with less systemic toxicity seen with levobupivacaine. Buprenorphine and Dexmedetomidine now being evaluated as a potential neuraxial adjuvant. This study has been designed to study various effects and any adverse effects of addition of either dexmedetomidine or buprenorphine to 2 ml of 0.5% isobaric levobupivacaine intrathecally for lower limb surgeries. Methods: In this randomized, double-blind prospective study, 60 patients of ASA I and II were randomized into two groups: group LD and LB (n=30). All patients received a drug volume of 2.5 ml containing 2 ml isobaric levobupivacaine (15 mg). They received dexmedetomidine 10 μg (Group LD) or 60 μg of buprenorphine (Group LB) diluted to 0.5 ml with distilled water added to levobupivacaine in the same syringe. Results: It was found that the onset of sensory block upto T10 and motor block is statistically significantly faster in group LD (109.33 and 153.5, in sec) over group LB (133 and 167.67, in sec). The mean time for two segment regression, the mean time to sensory regression to L1, the mean duration of analgesia and the mean duration of motor blockade is significantly prolonged in Group LD (106.67, 322, 343, 330.5, in min) over Group LB (132.67, 259.67, 290.67, 253.34, in min) with p<0.001. Conclusion: 10μg of dexmedetomidine added to local anaesthetic in subarachnoid block has proved to be a better adjuvant in prolonging the sensory and motor blockade intraoperatively and the duration of postoperative analgesia compared to 60μg of buprenorphine, without significant adverse effects. Keywords: Spinal anaesthesia; Levobupivacaine; Buprenorphine; Dexmedetomidine.
A Randomized Comparative Study of Ropivacaine 0.5% in Brachialplexus Block with Adjuvant as Dexamethasone vs Fentanyl
Authors:   Senior Resident, Department of Anesthesiology, Intensive Care and Pain Medicine, Yashoda Hospital, Hyderabad 500073, Telangana, India., Sravani Gurajapu E S , Chandra Sekhar C N ,   Consultant, Head of the Department, Department of Anesthesiology, Intensive Care and Pain Medicine, Yashoda Hospital, Hyderabad 500073, Telangana, India.
Published: January 2024

Background and Aim: Supraclavicular brachial plexus block is a well-known technique of giving analgesia and anaesthesia for upper limb, our study is aimed at comparing the efficacy of dexamethasone 8mg versus fentanyl 50µg in blockade characteristics and postoperative analgesia when added to 0.5% ropivacaine 30 ml in supraclavicular brachial plexus block. During the study we want to compare the sensory and motor block achieved. Methods: This was a prospective randomized double blind study of 60 cases. The selection of patients was carried out randomly, depending on the lists of operations submitted by the surgical team.A written informed consent was obtained from all patients. Groups were Randomized into Ropivacaine+Fentany group (RF) and Ropivacaine + Dexamethasone (RD) groups. Results: Duration of motor blockade was longer in RD group 793.67±75.143 compared to RF group 455.5±27.429. P value was 0.001 which is statistically significant. Duration of sensory blockade was longer in RD group 1181.67±75.59 compared to RF group 508.83. p value was 0.0001 which is statistically significant. Conclusion: Role of Ultrasonography in regional block need not be emphasized, Addition of dexamethasone prolongs the duration of motor block, enhances the duration of analgesia significantly when compared with fentanyl in supraclavicular brachial plexus block and dexamethasone group has 0 VAS scores for longer period compared to fentanyl group. Keywords: Supra clavicular Brachial Plexus; Ultrasound; Ropivacaine; Fentany; Dexamethasone.
Comparative Evaluation of two Doses of Epidural Butorphanol with Bupivacaine for Postoperative Analgesia
Authors:   Consultant, Department of Anesthesiology, Max Hospital Mohali, Punjab 160055. 2Medical Officer, PCMS, Punjab 160062, India., Singh Sukhvir , Kaur Navreet ,   Consultant, Department of Anesthesiology, Max Hospital Mohali, Punjab 160055. 2Medical Officer, PCMS, Punjab 160062, India.
Published: January 2024

Background: Postoperative analgesia is very important to prevent subjective discomfort, early mobilization and shortened hospital stay. Opioids addition to local anesthetics improve the quality of analgesia. Present study was designed to evaluate and compare the duration and efficacy of two different doses of epidural Butorphanol for postoperative analgesia. Patients and Methods: This prospective, randomized double blinded study was conducted on 75 patients in the age group of 20-60 years of either sex, with ASA class I and II scheduled for elective lower limb orthopedic surgeries under combined spinal epidural anesthesia after taking the informed consent and approval from hospital ethical committee. Group allocation, group I (n=25) received epidural 0.25 % bupivacaine, group II (n= 25) patients received 0.25% epidural Bupivacaine and 1 mg Butorphanol, group ΙΙΙ (n= 25) patients received 0.25% epidural Bupivacaine and 2 mg Butorphanol. Postoperatively VAS, sedation score, vitals & side effects were observed. Injections were given on achieving VAS>3. Results: Onset of analgesia was significantly shorter in group III as compare to group II and group I. Duration of analgesia was longest in group ΙII 9.95±0.43 hour which was significantly greater than group I 3.90±0.32 hours and group ΙΙ 6.06±0.26 hours. Postoperative VAS scores at different intervals were lower in group III than group II and group I (group III< group II< group I). Sedation scores were significantly higher in butorphanol group with no major adverse effects. Conclusion: Butorphanol 2 mg with 0.25% bupivacaine appears to be the optimal dose to produce a more rapid onset and longer duration of analgesia with no adverse effects. Keywords: Epidural; Postoperativanalgesia; Butorphanol.