bluuebunny/crossref_metadata_2025 huggingface dataset:
Educación; Ciudad y escuela
Authors: Coll César
Published: September 2021

En esta entrevista le hemos pedido una reflexión sobre las relaciones entre ciudad, educación y escuela ante el nuevo milenio, y también, obviamente, como ve la implantación de la reforma educativa en estos momentos y cuáles son sus problemas y retos.
Proyecto Educativo Intitucional. Gestión y autonomía en Santa fé de Bogotá.
Authors: Pérez Jesús Hernando , Cárdenas Martha , Gamba Pedro Lucas
Published: September 2021

Hoy más que nunca, se reqiere mirar la institución escolar como una organización, que aprende y se transforma permanentemente. Y no hay que tenerle miedo a las propuestas del mundo académico y empresarial que han dedicado su vida a investigar cómo funcionan las organizaciones, a entender el por qué algunas de ellas tienen mucho éxito mientras que otras fracasan en su gestión. Abri la institución escolar significa también abrirla a este mundo académico en desarrollo: el de la gestión en general.
Autonomía institucional: reto del fin del siglo
Authors: Ardila Pedraza Amparo
Published: September 2021

La autonomía escolar no es el paso a la anarquía, es el paso a la responsabilidad social de todos los estamentos con la formación de la generación acual y de las venideras. Le compete a la comunidad educativa ser el motor de una nueva concepción de academia, que le permita ser competitiva en una sociedad que avanza a pasos vertiginosos en el desarrollo de las comunicaciones, de la ciencia y de la tecnología.
El maestro y su formación: del devenir moderno al devenir contemporáneo
Authors: Martínez Boom Alberto , Unda Bernal María del Pilar
Published: September 2021

Ser de otro modo implica entender al maestro como sujeto de saber, reconocer que lleva a cabo su práctica en el marco de su compromiso ético con la cultura y que en las prácticas pedagógicas diarias no se reproducen mecánicamente los modelos formales de la pedagogía, sino que ocurren diversos procesos que ponen en juego otros elementos distintos a aquellos que fueron atribuidos al oficio de maestro por la carrera docente, por la capacitacón o por el poder.
Formación ciudadana en los últimos tres gobiernos de Bogotá
Authors: Saénz Obregón Javier
Published: September 2021

Este trabajo muestra algunos resultados del estudio sobre las estrategias pedagógicas utilizadas por los tres últimos gobiernos de Bogotá para la formación de ciudadanos por fuera de las instituciones educativas. Contextualiza espacialmente las prácticas de formación ciudadana desde el Estado en Colombia y analiza los tres escenarios que se han defi nido en la última década: el de la escuela como lugar delimitado, el ámbito extra-escolar y la política del actual gobierno de Bogotá, para plantear la entrada en un debate de fondo para defi nir una acción como virtuosa.
Poder, política y políticas modos de empoderamiento del maestro
Authors: González Forero Ana María
Published: September 2021

Este artículo explora algunas diferencias entre poder, política y políticas, nociones que se han convertido en lugares comunes del sector educativo colombiano. El artículo sugiere los lugares naturales del quehacer docente, como espacios políticos para los maestros, como antiguos y nuevos escenarios para el empoderamiento: el aula, la investigación y la política pública educativa.
The European Union and Brexit Dilemma – A very British Problem?
Authors: Engel Annegret
Published: September 2021

This paper discusses the key legal issues arising from the constitutional conceptions of both the EU and the UK in the latter’s withdrawal process. It argues that the adherent Brexit dilemma is mainly the result of the UK’s non-codified constitution on the one hand, exposing legal uncertainty over institutional procedures, regional involvement, or the precise status of international law. Nevertheless, the EU’s composition of the withdrawal process as defined in Article 50 TEU has also caused confusion during the negotiations of the withdrawal agreement, the future EU-UK relationship, as well as the possibility of revocation. Due to its unprecedented nature, the several uncertainties and flaws inherent in this case have consumed valuable time and resources which could have otherwise been used more efficiently in order to ensure a smooth and orderly departure from the EU.
The Workload of the European Court of Human Rights: A Back-Door to Becoming a Constitutional Court of Europe
Authors: Grozdanovski Damjan
Published: September 2021

The workload of the European Court of Human Rights has been one of its main concerns, and having in mind that justice delayed is justice denied – it has been justifiably so. In order to deal with the backlog of pending cases before the Court the Convention mechanism has been subject to change on several occasions, with the first significant change occurring in 2010. It is undisputed that these changes affected the way in which the Court deals with cases, but have they also affected the very nature of the Court? The aim of this article is to provide an overview of these changes, and an analysis of the effects that these changes had on the nature of the Court and on the protection of human rights in Europe.
Patterns of Federalism in EU Macroeconomic Policy
Authors: Jennerheim Josefin
Published: September 2021

The purpose of the article is to discern the pattern of federalism in EU macroeconomic governance and seek explanations for the strengthening of the framework in this regard. The article operates in a constitutional perspective, adopting a multidimensional approach in order to fulfil the purpose. These approaches have in common that they regard issues of legal power, resulting in a structure of five criticalaxes related to the nature of the Union’s competence in macroeconomic governance. More precisely, withinthese dimensions, the nature of the exercise of legal power, its constitutionality and its implications for the allocation of power between the Union and the Member States are explicated. This thematized presentation is sought to make effective the unearthing of a pattern of federalism. Lastly follows a discussion on the direction of the EU institutional practices in macroeconomic governance and the underlying causes for this development. In addition to drawing on the conclusions on the questions basing the article, this discussion will also feature thoughts on the recent battle between the Commission and theItalian government as regards the latter’s national budget.
The Long-Awaited Trade Deal Between the EU and the UK – Expectations and Realities
Authors: Engel Annegret
Published: September 2021

At long last, the EU and the UK have struck an agreement on their new relationship defining future trade and cooperation across the Channel. However, expectations and realities do not always meet and so it is in the particular case here. The TCA is not an ordinary international trade agreement, as it contains distinct features which may disappoint those expecting a CETA-style deal. In addition, Brexit has the potential of developing into a never-ending story as the TCA by no means puts an end to the debate. Many questions remain unanswered which will have to be dealt with in the following years or otherwise run the risk of creating further divergence in the longer term, ultimately undermining the entire agreement and keeping the threat of a ‘no deal’ scenario alive.
Evaluating the Efficiency of Heat and Power Systems by the Data Envelopment Analysis Method
Authors: Pokushko M. , Stupina A. , Medina-Bulo I. , Dresvianskii E. , Stupin A. , Kuzmich R. , Ruiga I. , Korpacheva L.
Published: September 2021

The article describes the Data Envelopment Analysis (DEA) method and the main features of its application. The main problems of heat and power systems are described, which are addressed by the DEA method of efficiency assessment presented in the article. The approbation of this method is presented at the objects of the centralized municipal heat supply system of the fuel and energy complex: boiler houses and heat and power plants. 9 objects were analyzed according to four input indicators: available heat capacity, installed heat capacity, heat consumption for own needs, fuel consumption. Also, the efficiency of the system was evaluated according to two output indicators: the release of thermal energy to the grid and the mass of the emission. As a result of the analysis and calculations made, it was revealed that 5 objects have the maximum possible efficiency indicator equal to 1, that is, they function as efficiently as possible. 4 objects of the centralized municipal heat supply system have an efficiency indicator less than 1. Accordingly, improvements are required for the operation of the above Decision-Making Units (DMU)s. These objects have deviations in terms of the inputs and outputs of the actual data and those obtained using the DEA method. Based on the calculations obtained for these 4 objects, the article provides recommendations for changing the quantitative values of their input and output indicators. For example, for object number 2, it is recommended to reduce the installed heat capacity in the grid by 72.57%, without changing the available heat capacity and fuel consumption. Reduce the heat consumption for your own needs by 69.383%. In addition, it is recommended to increase the supply of thermal energy to the grid by 6,034%, and reduce the mass of emission by 11.5%. Specific measures have also been developed to modernize the studied objects in order to achieve the recommended indicators of inputs and outputs. The research results presented in the article are of scientific and practical interest and can be used to improve the efficiency of heat and power systems facilities
Gunshot Injury in Neck; Suicide or Homicide?
Authors: Anil Garg1  , Shakshi Sharma  , Yogendra Malik  , Yogesh Kumar Vashist  , Pawan Mittal  , Gaurav Sharma  , Bhavya Kalra
Published: September 2021

Forensic investigation of a gunshot related death can be a challenging process .When ascertaining the mannerof death, the forensic expert should be careful, as, attempts are not uncommon to disguise homicides assuicides. Abnormal and unusual location of gunshot wound adds to this suspicion. The case under discussionhighlights the role of a forensic expert in the ascertainment of the manner in firearm deaths. The deceasedwas a criminal who was absconding and when his where about were revealed to the investigating agency, hewas followed to arrest but, upon reaching the spot in the sugarcane fields, there was exchange of fire and hisdead body was found with the weapon lying near him. A thorough complete autopsy and detection of gunpowder residue on hands lead to the unfolding of this mystery.
Comprehensive Analysis of Blood Transfusion in Paediatrics Patients admitted at Dhiraj Hospital
Authors: Ashu Dogra
Published: September 2021

Back Ground:- Audit of transfusion practices in pediatric patients was performed to study indications ,clinical profile and whether transfusions were in accordance to guidelines.Objective:- to perform audit of transfusion practices , in order to study appropriate and inappropriate usageof different blood components in pediatric population.Results:- In present study it was observed that out of 62 packed red cells transfusions 35(56.45%) transfusionswere found to be inappropriate. Among FFP transfusions out of 55 transfusions 11(20%) transfusions wereobserved as inappropriate . Most of inappropriate transfusions had bleeds but normal coagulogram.Among Platelet transfusions , three (16.6%) platelet transfusions, out of 18 transfusions were inappropriateand transfused mainly to raise the platelet count.Conclusion:-Most frequently transfused blood components are red cells in pediatrics . Inappropriatetransfusion of blood components hinders the utility of this valuable resource , Thus it becomes necessary toconduct regular audit of blood component transfusion for optimum utilization.
Ecological Analysis of Success of TB Treatment and Its Related Factors in Indonesia in 2019
Authors: Alfons Deristo Lega  , Hario Megatsari  , Shrimarti Rukmini Devy
Published: September 2021

Background: Tuberculosis is a direct infectious disease caused by TB germs (Mycobacterium Tuberculosis).Indonesia is ranked third in the world, with the largest incidence of tuberculosis after China and India, with845,000 cases or 315/100,000 in 2019. The study was intended to analyze the coverage of treatment of allcases, the percentage of poor people by province and the ratio of public health centre per sub-district in theprovince to the success of tuberculosis treatment in all provinces in Indonesia in 2019.Methods: The ecological approach is carried out using secondary data from the Ministry of Health of theRepublic of Indonesia in the form of Health Profile of the Republic of Indonesia in 2019 and Data andInformation: Health Profile of Indonesia in 2019. Data from 34 provinces in Indonesia related to the successrate of TB treatment, the coverage of treatment of all TB cases, the percentage of poor people by provinceand the ratio of public health centre per sub-district in the province using cross tabulation.Results: The results showed that the success rate of TB treatment in Indonesia in 2019 was in the moderatecategory in line with the coverage of all TB cases, the percentage of poor people by province and the ratio ofpuclic health centre per sub-district in the province which is also in the moderate category.Conclusion: Efforts to monitor and record cases and treatment of TB patients need to be improved toimprove TB treatment coverage. Improving the economy of the community and equalizing the availabilityof public health centre are also very important to improve the success of TB treatment.
Administrative Sanctions for Hospitals Which Grant Permission for Forced Taking the Corpse of Suspect Covid-19 Patients
Authors: Asmuni
Published: September 2021

This study is intended to analyze the bodies of suspect Covid-19 patients in the Covid-19 Protocol and theresponsibilities of the perpetrators of forcibly taking the bodies of Suspect or Probable patients in criminallaw. This research is a juridical normative research, which is focused on studying the application of normsin positive law by combining legal materials which are secondary and primary legal materials. The approachtaken is a statue and a conceptual approach. Based on the results of this study it can be concluded that thepatient’s body is a suspect Covid-19 body, it must be treated like the Covid-19 body until there is a resultfrom the swab test to fulfill the rights of the body, the responsibility of the perpetrator of forced taking of thesuspect / probable patient’s body in criminal law, among others sentenced to a criminal sentence on the basisof Article 5 of Law No. 4 of 1984 concerning Outbreaks of Infectious Diseases with the threat of one yearin prison or a fine of up to Rp. 100,000,000 (One Hundred Million Rupiah).
Association of Serum Vitamin D Levels on Response Therapy in Patient Lung Adenocarcinoma Advanced with Targeted Therapy
Authors: Devy Trianne Putri  , Isnu Pradjoko  , Anita Widyoningroem
Published: September 2021

Objective: This study aimed to analysis the associated of serum vitamin D levels and response therapyin advanced lung adenocarcinoma patient after used TKIs. Methods: This study was an observationalanalytic study. The subjects where patient with advanced lung adenocarcinoma who received tyrosine kinaseinhibitors (TKIs) for 3 months at Dr. Soetomo general hospital Surabaya from July to March 2021 who metthe inclusion and exclusion criterias. The independent variable in this study are the serum levels of vitaminD and response therapy objective (RECIST criteria) as the dependent variable. Results: The results ofstastitical analysis showed that there was no significant associated of serum vitamin D levels and responsetherapy (p>0.05). Patient insufficiency with partial response had a greater number than patient sufficiencywith partial response. The mean of vitamin D levels in patient with progressive disease was the highest.Conclusion: Although the serum levels of vitamin D in lung cancer was lower but in this study showed thatthere was no significant associated of serum vitamin D levels and response therapy in patient advanced lungadenocarcinoma with tyrosine kinase inhibitors.
Association between Fatigue Level with Disease Severity in Myasthenia Gravis Patients
Authors: Dimas Pambudi  , Fadil  , Muhammad Hamdan
Published: September 2021

Background: Fatigue is a common symptom and has a greater effect on daily living of myasthenia gravis(MG) patients than has muscle weakness. Latest evidence suggested that fatigue in MG negatively impactdisease severity. The relationship between fatigue level with disease severity has never been explored in MGpatients. Aims. The study aimed to determine the association between fatigue level and disease severity inmyasthenia gravis patients at Dr. Soetomo Public Hospital Surabaya. Method. A cross-sectional was usedin this research. Participants of the research were patients with myasthenia gravis in Neurology Clinic, Dr.Soetomo Public Hospital Surabaya. The period of data collection was from April to June 2021. Fatigue levelmeasured with Fatigue Severity Scale (FSS) questionaire and disease severity measured with MyastheniaGravis Composite (MGC) score. Data analysed using SPSS version 22.0 with significances of p <0.05.Results. There were 37 participants consisted of 14 males and 23 females. Mean age of participants 45,03± 11,69. Mean age of onset was 40,38 ± 12,60. The mean FSS was 4,02 ± 1,93 and mean MGC was 5,24 ±5,64. From all participants, we found that about 24 patients (64,9%) showed severe fatigue and 22 patients(58,5%) have severe disease status. The Chi-Square correlation test analysis indicates a significant associationbetween FSS mean score and MGC mean score (p = 0.009, OR at 6,750) 95% CI (1,51-30,16). Conclusion.There was an association between fatigue level and disease severity in myasthenia gravis patients.
Diagnostic Accuracy of Mri Compared to Cct in Patients with Brain Metastases
Authors: Firas Salim Daoud Karomy
Published: September 2021

Brain metastasis is one of the most common diagnoses encountered by neurologists, neurosurgeons,radiologists, and oncologists. The aim of this article is to review imaging modalities used in the diagnosis andfollow-up of brain metastases. Through the use of various imaging techniques more accurate preoperativediagnosis and more precise intraoperative planning can be made. Post-treatment evaluation can also berefined through the use of these imaging techniques. MRI without and with contrast is the imaging modalityof choice in evaluating patients with suspected metastases.28 Head CT is often performed at the initialscreening or in an emergency setting to exclude hemorrhage. MRI, however, is superior to CT either withoutor with contrast in the detection and evaluation of metastases. Metastatic lesions can generally be evaluatedwith routine contrast MRI studies. Higher dosing of contrast agents, magnetization transfer technique, andhigher field strength magnets increase sensitivity.Typical characteristics of metastases, including multiplicity, location, and signal characteristics, togetherwith clinical history, are often sufficient to suggest the diagnosis of metastatic intracranial disease. In thesetting of more complex cases or solitary brain metastases, advanced MRI techniques and PET will aid inreaching a diagnosis
Lungs’ Microscopic Patterns of Vessels in Patients Deceased with or by SARS-CoV-2 Infection
Authors: Francesco Lupariello  , Francesca Vairano  , Giuliana Mattioda  , Federica Mirri  , Alessandro Gabriele  , Giancarlo Di Vella
Published: September 2021

Background: Even If Specific mechanisms are not completely understood, several studies highlightedSevere Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) ability to alter vascular homeostasis.In the literature, multiple reports of microscopic pulmonary findings of vascular structures in patientsdeceased by or with SARS-Cov-2 infection are available. Nevertheless, the scientific literature lacks asystematic analysis of these findings. Methods: the authors realized a systematic review of the literature inorder to identify common microscopic patterns representative of pulmonary vascular damage: useful datafor pathologists in clinical and forensic settings. The research yielded 23 articles (79 total cases). Quali/quantitative analysis was carried out. Conclusion: the review allowed to identify vascular thrombosis(especially in lesser caliber vessels) as common microscopic pattern. The recurrence of this pattern wasconfirmed by scientific literature data which demonstrate SARS-CoV-2 ability to interfere with coagulationcascade. Other meaningful microscopic findings were also discussed, even if their low frequency in studypopulation did not allow to define them as common
Eccentric Exercise Decrease Blood Glucose Level and Improve Protein Level of Glucose Transporters in Diabetic Mice Muscle
Authors: Handoko Adelia  , Purwanto Bambang  , Mustika Arifa
Published: September 2021

Background: Previously, eccentric exercise improved on blood glucose level better than concentric andisometric exercise. The improvement of blood glucose level was resulted from higher glucose uptakeactivity, particularly at the muscles. Unfortunately here isn’t yet information whether it is facilitated byglucose transporter type 1 or glucose transporter type 4.Objectives: The aim of the present study was to investigate the effect of eccentric activity on glucosetransporter type 1 and glucose transporter type 4 in gastrocnemius muscle of streptozotocin-induced diabetesmellitus mice.Methods: Diabetic mice were grouped randomly into 4 groups (7 mice each group). Two groups wereobserved during fasting and others were observed during post prandial. Single bout of eccentric activity wasgiven by downhill running on 10o degree decline treadmill. The protein level of glucose transporters weremeasured using monoclonal antibody in ELISA protocol. Blood glucose level was measured on fasting andpost prandial using colorimetric protocol of EASY TOUCH app.Result: Glucose levels (fasting and post prandial) of eccentric group were significantly lower than isometricgroup. Consistently, protein level of glucose transporters (type 1 and type 4) were significantly higher thanisometric group. Type-4 glucose transporter level was higher than type-1 glucose transporter, found in calfmuscle.Conclusions: single bout of eccentric exercise on downhill running improve blood glucose level due to bothGLUT-1 and GLUT-4 protein levels improvement.
The Determinant of the COVID-19 Psychosocial Burden inWest Java Province - Indonesia
Authors: Hario Megatsari  , AgungDwi Laksono  , Yeni Tri Herwanto  , KinantyPutri Sarweni  , NidyaEka Putri  , Estiningtyas Nugraheni  , Mursyidul Ibad
Published: September 2021

Background: West Java is one of Indonesia’s provinceswith a large and dense population, making itvulnerable to quarantine or restrictions related to COVID-19.The study aims to analyze the determinants ofthe COVID-19 psychosocial burden in West Java Province, Indonesia.Methods:The author collected data by online survey until it gets 653 respondents. The study reviewedpsychosocial burdens by worries level. The study built the worries based on anxiety in five daily aspects:economic, religion, education, work, and social aspects. Six independent variables were involved in theanalysis, including age, gender, marital status, education, employment status, and religion. In the final stage,the study carried out a multivariate test using binary logistic regression.Results:The results found that women were 0.544 times more likely than men to experience high worries(OR 0.544; 95% CI 0.330 - 0.896). Men are more likely than women to experience the psychosocial burdenof COVID-19.Higher education has a probability of 0.405 times compared to secondary education toexperience high worries (OR 0.405; 95% CI 0.240 - 0.685). Higher education levels are a protective factoragainst the psychosocial burden of COVID-19 in West Java Province, Indonesia.Conclusion:The study concluded that there are two determinants of the COVID-19 psychosocial burden inWest Java, Indonesia. Both are gender and education status.
Death Analysis of 10 Major Diseases Before and During COVID-19 Pandemic in Papua Province, Indonesia, 2020
Authors: Hasmi  , Dolfinus Y. Bouway  , Yacob Ruru
Published: September 2021

Some of the co-morbidities that may cause death in COVID-19 patients include: hypertension, diabetes,lung disease, heart disease and malaria. People with the disease have a high death rate when they becomeinfected with COVID-19. The aim of this study is to analyze the deaths of the top 10 diseases in the PapuaProvince prior to and during the COVID-19 pandemic. The research method used in this study is a mixmethod. The research was conducted in Papua Province and Yowari Regional Hospital, Jayapura Regency,from September to November 2020. The informants were the Head of the Provincial Health Office and threeheads of the COVID-19 epicenter of the Health Office. Quantitative samples were taken from patients whodied between January 2020 and June 2020, namely 87 cases of death. A sample of 87 people was obtainedusing a total sampling technique. Data gathering techniques are secondary data and in-depth interviews. Theresults showed an increase in the number of deaths in the top 10 diseases before and during COVID-19,with an increase of 71 percent. The cause of the increase in death rates before and during the COVID-19pandemic was due to a misconception of health and illness, as well as to the behavior of people who werelate to go to health services. Death from heart failure was the main cause of death. At Yowari RegionalHospital, Jayapura Regency, people who died from the top 10 diseases before COVID-19 were aged 26-45years, i.e. 11 people (34.4 percent). Meanwhile, the majority were 46-65 years old during the COVID-19pandemic, i.e. 18 people (32.7 percent). Promotional and preventive efforts are the strategy of the localgovernment (Health Department) to reduce deaths from the top 10 diseases during the COVID-19 pandemic.
Regional and Gender Differences in the Cephalic Index among South Indian and North-East Indian Population
Authors: Mebin Wilson Thomas  , Santhosh Kareepadath Rajan
Published: September 2021

Background: Cephalic index has a wide range of scope in personal identification, plastic surgery, andorthodontics and in identifying the differences in race and ethnicity. The present research is an attempt toidentify the difference in the cephalic index in association with region and gender in a sample of total 300participants (South Indians, 150 and North East Indians, 150), with an equal number of males and females.Standardized spreading caliper was used to measure the head breadth and head length of each participant.Measurement of cephalic index was obtained using the equation; maximum cranial breadth/maximumcranial length multiplied by 100.Results: The baseline of the cephalic index of the participants from South India were approximated as 76.47,with a range of 71.27 to 81.67. The baseline of the participants from North East India can be approximatedas 84.16, with a range of 80.34 to 87.98. The baseline indicated that participants from South India are moremesocephalic, and from North East India are more brachycephalic. Mann-Whitney U test indicated thatthere is a significant regional difference in the cephalic index. There is no significant gender difference.Conclusion:Generalization regarding the regional difference in cephalic index can be made by comparingthe present results with the previous findings. The results contribute to forensic, anthropological, and clinicalliterature.
Effect of the National Early Warning Score Education Program on Nurses’ Knowledge at an Emergency Hospital
Authors: Mohamed Naeem Badr  , Nahla Shaaban Khalil  , Ahmed Mohamed Mukhtar
Published: September 2021

Aims and Objectives: To determine the effect of a designed program about the National Early WarningScore on nurses’ knowledge at an emergency hospital. Background: The Early Warning Score has beendeveloped as a tool for early detection of patients’ deterioration. However, its implementation has not beenoptimal due to the lack of knowledge and understanding of EWS among staff nurses. Design: Pre-test/posttestquasi-experimental research design. Methods: A convenient sample of 34 nursing staff working at theinpatient unit at an emergency hospital was included in the education program. Results: The current findingsrevealed that all nurses (100 %) (34) had an unsatisfactory knowledge level pre-educational program. Whilenurses’ knowledge level post-educational program showed, most of them (97.1 %) (33) had a satisfactoryknowledge level. And there was a highly significant statistical difference between pre-test and post-testof knowledge (p <0.001). Moreover, nearly half of the nurses (50.2 %) answered knowledge questionsincorrectly pre-educational program, while post-educational program, the majority of them (91.6%) answeredknowledge questions correctly. Conclusion: After implementing an educational program regarding NationalEarly Warning Score, The emergency care nurses’ knowledge was markedly improved.
Unusual Complication of Abdominal Pseudocyst Following Cystoperitoneal Shunt in Posterior Cranial Fossa Arrachnoid Cyst
Authors: Prastiya Indra Gunawan  , Rahadian Indarto Susilo
Published: September 2021

Abdominal pseudocyst is a rare complication reported of VP shunt surgery. Here, we report a 10-monthsoldboy with abdominal distension following cystoperitoneal (CP) shunt procedure for the fossa posteriorarrachnoid cyst. The diagnosis was based on the clinical symptoms and abdominal USG. Infection andallergic reaction was considered as the underlying cause. The CP shunt was removed to atrioventricularshunt and it resulted in a good response. Abdominal pseudocyst should be considered whenever there isabdominal distension following VP/CP shunt.
Diuretic treatment in chronic heart failure
Authors:   Universitatea de Medicină şi Farmacie „Carol Davila“, Bucureşti, DIACONU Camelia C. ,   Spitalul Clinic de Urgenţă Floreasca, Clinica de Medicină Internă, Bucureşti, BĂLĂCEANU Alice ,   Universitatea de Medicină şi Farmacie „Carol Davila“, Bucureşti,   Spitalul Clinic de Urgenţă Sf. Ioan, Clinica de Medicină Internă, Bucureşti, IANCU Mihaela Adela ,   Universitatea de Medicină şi Farmacie „Carol Davila“, Bucureşti,   Disciplina Medicină de Familie
Published: September 2021

Heart failure is a major public health problem in developed countries. Many of the clinical manifestations of heart failure are due to congestion and fluid retention, therefore diuretic therapy occupied for a long time an important place in the management of these patients. All diuretics increase the excretion of water from the body, each of the classes of diuretics achieving this effect in a distinct manner. Given the magnitude of their effect, loop diuretics are the central pillar of diuretic therapy in many patients with heart failure. Resistance to diuretic therapy is one of the management issues for medical science, which is looking for solutions.
Fine tuning in neuraxial subarachnoid anesthesia
Authors:   Department of Anesthesiology Intensive Care (ATI I) Clinical University Hospital, “Carol Davila” University of Medicine and Pharmacy, Bucharest, PENES Ovidiu , VALEANU Emilia ,   Intern resident
Published: September 2021

The spinal anesthesia, a category of neuraxial anesthesia, is commenced in the lumbar spine, where the local anesthetic (LA) is injected into cerebrospinal fluid (CSF) to anesthetize the spinal nerves. This technique is most frequently used for analgesia and/or anesthesia for different forms of lower extremity, lower abdominal, pelvic, and perineal procedures. Preoperative evaluation that includes a medical history and anesthesia-directed physical examination should be performed for every patient who undergo any type of anesthesia. Focus should be made on the preoperative evaluation, when spinal anesthesia is considered, to prevent medical conditions that may alter the physiologic response to spinal anesthesia or increase the risk of complications and the baricity influences of the anesthetic distribution within the subarachnoid space.
The role of hemodynamic parameters in chronic heart failure diagnosis in children
Authors:   Department of Pediatrics, “Nicolae Testemitanu” State University of Medicine and Pharmacy  Chisinau, the Republic of Moldova, GROSU Victoria
Published: September 2021

Despite the achievements in this field in recent years, concerning the chronic myocardial dysfunctions, pathogenesis, diagnosis and treatment management, the chronic heart failure continues to hold preeminence in the structure of cardiovascular complications and remains now one of the leading causes of invalidity of young contingent and infant mortality, presenting one of the most pressing public health problems. This requires looking for new methods of noninvasive early diagnosis with application of modern laboratory and investigational tests facilitating the identification in preclinical stages of chronic myocardial dysfunctions (CMD) by assessment of new biomarkers of myocardial injury. Objectives of the study. Hemodynamic parameters changes estimation in the evolution of chronic heart failure in children. Material and methods. The study included 233 patients with chronic heart failure, of which 78 were children and adolescents aged 10-17 years with CMD secondary to arterial hypertension. The diagnosis of arterial hypertension was established according to the ESA (European Society of Cardiology, 2009) recommendations, but the assessment of clinical manifestations of chronic heart failure was evaluated according to NYHA (New York Heart Association classification). The estimation of hemodynamic parameters was performed using echocardiography method using “Ultramark-8” (US device A) under Mand Doppler. Obtained results. In patients with arterial hypertension the types of concentric hypertrophy of left ventricular myocardial index mass (IMMVS) -59.2±14.2 and relative LV wall thickness (GRPVS) -0.46±0.22 cm were assessed. It is important to note that the study assessed the type of eccentric hypertrophy with IMMVS 66.4±7.6 and 0.44±0.25 cm GRPVS. Concentric geometric remodeling variant noted IMMVS average value of 48.4±4.2 and GRPVS- 0.44±0.21 cm. Identification of LV hypertrophy, increased GRPVS, IMMVS increase, the MMV based on echocardiographic examination of the heart reveals the geometric performance called “pathological remodeling” which actually confirms the occurrence of chronic myocardial dysfunction in patients with CHF secondary hypertension. Conclusions. Early identification of changes of cardiac performance parameters (MMV, IMMVS, GRPVS, HVS) under the conditions of the persistent tensional over estimation, reveals the early development of types of early myocardial pathological left ventricular remodeling and facilitates the options and diagnostic criteria of the heart remodeling in children with CMD secondary arterial hypertension in order to choose a selected pathogenetic treatment.
Correlation between global statistics and Romanian prevalence of rethinopathy of prematurithy (ROP)
Authors:   C.M.D.T.A. Roma, POPESCU Daniela ,   Universitatea de Medicină şi Farmacie „Carol Davila“, Bucureşti, MATEI Dumitru ,   Universitatea de Medicină şi Farmacie „Carol Davila“, Bucureşti,   Institutul Naţional pentru Sănătatea Mamei şi Copilului „Alessandrescu-Rusescu“, Bucureşti
Published: September 2021

The active discovery of risk factors among pregnant women could lead to a decrease in premature births in Romania which are currently above the European average – 9% over 6.5%. Low addressability of the population towards primary medicine constitutes a major risk factor for premature birth. Unwanted pregnancy prevention among teenagers may become a priority from an economic standpoint or when one considers the social impact of a premature newborn. Daily costs for taking care of a premature baby are extremely high, the European average being somewhere around 100 euro/day. Therefore, given the impact and severe nature of ROP, it is highly recommended that a deep and careful research of risk factors, their rate of prevalence and a specific individualization of their causes be performed in order to establish the main areas of prevention. Assuring an analysis of adjustable factors corroborated with the importance of early discovery of retinopathy allow for a thorough evaluation of possible prognostic factors. Underlining the risk factors currently found on modern literature, a retrospective study has been made, which backs these conclusions. The basis for monitoring is represented by the clinical charts in IOMC (“Alessandrescu-Rusescu” National Institute for Mother and Child, Bucharest).
Endothelial dysfunction assessment in healthy smokers
Authors:   Universitatea de Medicină şi Farmacie „Carol Davila“, Bucureşti, TICARĂU Adriana , MATEI Dumitru ,   Universitatea de Medicină şi Farmacie „Carol Davila“, Bucureşti,   Institutul Naţional pentru Sănătatea Mamei şi Copilului „Alessandrescu-Rusescu“, Bucureşti
Published: September 2021

Smoking is a known risk factor for cardiovascular disease, chronic respiratory neoplasms and diseases, and will kill more than one billion people this century, according to the World Health Organization. Smoking induced endothelial dysfunction triggers a new alarm for this social custom, which in connection with metabolic syndrome, who has reached alarming rates of prevalence in recent years, contributes specifically to cardiovascular morbidity and mortality. In this study we aimed to evaluate more parameters of endothelial dysfunction in smokers patients, indicating a high statistical significance of the influence of smoking on arterial stiffness.
Vitamin D and maternal-fetal implications
Authors:   Institutul Naţional de Endocrinologie „C.I. Parhon“, Bucureşti, DUMITRU Nicoleta , BURUIANĂ Andra ,   Institutul Naţional de Endocrinologie „C.I. Parhon“, Bucureşti, PETROVA Eugenia ,   Institutul Naţional de Endocrinologie „C.I. Parhon“, Bucureşti, OLARU Maria ,   Institutul Naţional de Endocrinologie „C.I. Parhon“, Bucureşti, GHEMIGIAN Adina ,   Institutul Naţional de Endocrinologie „C.I. Parhon“, Bucureşti,   Universitatea de Medicină şi Farmacie „Carol Davila“, Bucureşti
Published: September 2021

Vitamin D is a fat-soluble vitamin and a presteroid hormone synthesized in the dermis under UVB rays. In terms of its endocrine functions, it has an important role in mineral homeostasis. Besides these effects, recent studies have found a series of non-calciotropic actions of vitamin D: modulation of autoimmune processes, promoting secretion and insulin action, pulmonary development, inhibition of malignant cells proliferation in various cancers, implications in maternal-fetal pathology. Recent studies have identified the association of vitamin D deficiency in pregnancy with a series of maternal complications (preeclampsia, bacterial vaginosis, gestational diabetes, increased risk of cesarean delivery) and fetal complications (affecting skeletal development and tooth enamel, impaired fetal growth). Also, newborns from mothers with vitamin D deficiency have an increased risk of tetany, hypocalcemia, with or without seizures and an increased susceptibility to respiratory diseases (asthma, bronchiolitis RSV). Conclusions: There is no current consensus on routine screening of vitamin D deficiency in pregnancy, nor the required dosage for vitamin D supplementation in pregnant women. All pregnant women should have a balanced diet and get vitamin D as part of prenatal vitamins. Their purpose is to increase the availability of calcidiol to the fetus and newborn with a beneficial role over the classic effects of vitamin D and possibly over the non-calciotropic ones.
Acute postoperative pain
Authors:   Spitalul Clinic de Urgenţă „Prof. Dr. Agrippa Ionescu“, Bucureşti, BRĂDIŞ Adriana Alexandra , TULIN Adrian Daniel ,   Spitalul Clinic de Urgenţă „Prof. Dr. Agrippa Ionescu“, Bucureşti,   Universitatea de Medicină şi Farmacie „Carol Davila“, Bucureşti, NESTIANU Erick ,   Universitatea de Medicină şi Farmacie „Carol Davila“, Bucureşti, BĂDĂRĂU Ioana Anca ,   Universitatea de Medicină şi Farmacie „Carol Davila“, Bucureşti
Published: September 2021

Acute postoperative pain is a personal unpleasant sensory and emotional experience with negative physiological and psychological effects. Severe acute pain may increase postoperative morbidity and mortality and is a risk factor for chronic pain incidence. We evaluate pain intensity using pain scales. Pain management includes preventive analgesia who interacts and modulates central sensitization response and multimodal analgesia which uses two or more different analgesic mechanisms agents for a superior analgesic effect. Effective pain management provide early postoperative recovery and decrease the incidence of chronic pain.
Teriparatide as option for severe osteoporosis
Authors:   “C.I. Parhon” National Institute of Endocrinology, CARSOTE Mara ,   “Carol Davila” University of Medicine and Pharmacy, Bucharest, GHEMIGIAN Adina ,   “C.I. Parhon” National Institute of Endocrinology,   “Carol Davila” University of Medicine and Pharmacy, Bucharest, RADU Otilia ,   “Carol Davila” University of Medicine and Pharmacy, Bucharest, VALEA Ana ,   Clinical County Hospital, “I. Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca
Published: September 2021

e introduce an original study referring to Romanian population treated with teriparatide (TPT), an anabolic drug for severe menopausal, glucocorticoid and male hypogonadism-related osteoporosis. Primary end point is to analyze the parameters of persons who fulfilled the national criteria of TPT regarding co-morbidities and bone profile. Secondary end point is to reveal the skeleton indices 12 months after TPT (20 μg/day subcutaneous). Informed written consent was signed between July 2015 and June 2016. Out of 21 patients with a mean age of 66.76 years (yrs), except for 2 men, there were menopausal females with av. 21.47 yrs since menopause. 57% had a history of superior digestive condition, another 57% had a chronic thyroid disease and 29% had a non-thyroid autoimmune morbidity. 17 patients were pre-exposed to anti-osteoporotic drugs 4.23+/-3.49 yrs. Number of prevalent fractures was: 3.75+/-2.17 (median 3; min 1, max 9). 42% (N=9) of subjects were followed for 1 year: no new fracture was registered; each patient had at least one DXA site with a BMD (Bone Mineral Density) increase (mean T-score increase of the most affected region was of 0.56+/-0.2 SD); osteocalcin statistically significant elevated from 18.87+/4.22 ng/mL to 42.8+/-16.3 ng/mL (p<0.0005) while CrossLaps went from 0.46+/-0.22 ng/mL to 0.65+/-0.3 ng/mL (p=0.15). Early drop-offs were registered in 2 patients. Based on this original study, patients with severe osteoporosis having a burden of many years of prior therapy or fragility fractures became candidates for TPT. After 12 months, the anabolic window was revealed by high bone remodelling blood markers, especially for osteocalcin.
Primary and secondary prevention of varicose disease in medical practice
Authors:   Universitatea de Vest „Vasile Goldiş“ Arad, JOMPAN Afilon
Published: September 2021

Varicose veins are a common pathology in medical practice, easily diagnosed, with risk factors that can be universally recognized for starting preventive therapeutic measures. Early detection of this pathology in the family doctor's office involving secondary preventive measures and proper management, sometimes in collaboration with a specialist Phlebology, prevents the progression of complications. This study of adults(over 30 years), analyzes 104 people with a prevalence of 17.39% of varicose veins, with different prevalences in sexes, age groups and depending on the risk factors often meet with primary and secondary preventive indications.
The impact of preoperative preparation on postoperative complications in patients with colorectal cancer
Authors:   Clinica Chirurgie II, Spitalul Universitar de Urgenţă Bucureşti, RUSU Octavia Cristina , COSTEA Radu Virgil ,   Clinica Chirurgie II, Spitalul Universitar de Urgenţă Bucureşti,   UMF „Carol Davila“ Bucureşti, POPA Cristian Constantin ,   Clinica Chirurgie II, Spitalul Universitar de Urgenţă Bucureşti,   UMF „Carol Davila“ Bucureşti, NEAGU Ştefan Ilie ,   Clinica Chirurgie II, Spitalul Universitar de Urgenţă Bucureşti,   UMF „Carol Davila“ Bucureşti
Published: September 2021

Colorectal cancer is a frequently encountered disease. In most countries, it represents the second leading cause of cancer death. The treatment with radical intent of this condition is surgical. Objective: Through this study, we want to update some data regarding the impact of nutrition and the preoperative mechanical bowel preparation on postoperative complications, in patients who need surgical treatment for colorectal cancer. Material and Method: Relevant articles in the field, contained in international databases were analysed, with no language exclusion, including clinical trials and meta-analyses performed between 1994 and 2015. Conclusions: Preoperative preparation is particularly important in the postoperative evolution of the patients with colorectal cancer and it is based on several main principles: nutritional support, antimicrobial treatment and mechanical bowel preparation.
CORRELATIONS BETWEEN THE SEVERITY OF CARDIOVASCULAR AUTONOMIC NEUROPATHY AND OTHER COMPLICATIONS IN TYPE 2 DIABETES MELLITUS
Authors:   Department of Neurology, University of Medicine and Pharmacy Targu-Mures, Romania, Motataianu Anca , Bajko Zoltan ,   Department of Neurology, University of Medicine and Pharmacy Targu-Mures, Romania, Maier Smaranda ,   Department of Neurology, University of Medicine and Pharmacy Targu-Mures, Romania, Stoian Adina ,   Department of Patophysiology, University of Medicine and Pharmacy Targu-Mures, Romania, Barcutean Laura ,   Department of Neurology, University of Medicine and Pharmacy Targu-Mures, Romania, Balasa Rodica ,   Department of Neurology, University of Medicine and Pharmacy Targu-Mures, Romania
Published: September 2021

Introduction. Cardiovascular Autonomic Neuropathy (CAN), also known as the “silent killer”, represents a serious complication of diabetes mellitus and is most of the times ignored. This is a highly topical issue, given the increased number of patients diagnosed with type 2 diabetes mellitus (T2DM). The purpose of this study was to determine the association between the severity of CAN and the severity of other microvascular complications, such as diabetic sensory-motor polyneuropathy (DSMP), diabetic retinopathy (DR) and macrovascular complications (carotid and peripheral vascular atherosclerosis) in patients with T2DM. Methods. A total of 149 patients with T2DM were assessed for CAN using the Ewing’s battery of cardiovascular autonomic function tests. The patients were evaluated for diabetic microvascular complications (DSMP, RD), respectively macrovascular complications (carotid atherosclerosis by intima media thickness and peripheral vascular atherosclerosis by ankle-brachial index). Results. Of the 45 patients with intermediate CAN, 35.55% were without DR, 51.11% had non-proliferative DR and 13.33% had proliferative DR. From the 13 patients with severe CAN, 76.92% had non-proliferative DR and 23.07% had proliferative DR. From the 56 patients with subclinical CAN, 26.7% had no DSMP, 48.2% had subclinical DSMP and 25% had clinical DSMP. Of the 45 patients with intermediate CAN, 11.2% had subclinical DSMP and 80% had clinical DSMP. Conclusion. In T2DM we demonstrated that an increase in the severity of cardiovascular autonomic injury is associated with an increase in the prevalence and severity of DSMP and DR, respectively carotid and peripheral atherosclerosis.