bluuebunny/crossref_metadata_2025 huggingface dataset:
Reforming the Holy Name: The Afterlife of the IHS in Early Modern England
Authors: Davis David J.
Published: November 2021

This article challenges the prevailing understanding of the Holy Name of Jesus as largely a Roman Catholic representation in early modern England. Although the Holy Name was attacked intermittently by Protestant iconoclasts, the article uses both visual and literary texts to set out a more nuanced relationship between the symbol and the broader religious culture of the period. As a symbol, the IHS served as a polysemous representation in a period of religious turmoil, creating not only multiple meanings but also multiple contexts in which the symbol could be found. The article both addresses the reasons why scholars tend to see the IHS as a particularly Catholic symbol and demonstrates the continued importance of the Holy Name in Protestant devotion.
Impacts of polyols and temperature on the micellization, interaction and thermodynamics behavior of the mixture of tetradecyltrimethylammonium bromide and polyvinyl alcohol
Authors: Sultana Sharmin , Al Mamun Abdullah , Aktar Shahina , Mahbub Shamim , Yusuf Kareem , Alothman Asma A. , Wabaidur Saikh M. , Rana Shahed , Islam Md Ataul , Hoque Md. Anamul
Published: November 2021

Herein, the aggregation manner of the mixture of polyvinyl alcohol (PVA) and tetradecyltrimethylammonium bromide (TTAB) was performed in polyols (glucose, maltose and galactose) media over 300.55–320.55 K temperatures range with 5 K interval through conductivity measurement method. The micelle formation of TTAB + PVA mixture was identified by the assessment of critical micelle concentration (CMC) from the plots of specific conductivity (κ) versus TTAB concentration. The degree of micelle ionization (α), the extent of bound counter ions (β) as well as thermodynamic properties (

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,

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0

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and

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) of TTAB + PVA systems have been estimated. The CMC values reveal that the micelle formation of TTAB + PVA mixture experience an enhancement in the manifestation of polyols. The values of free energy of micellization (

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0

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) are negative for the TTAB + PVA system in aqueous polyols media, suggesting a spontaneous aggregation phenomenon. The

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and

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values of TTAB + PVA systems direct that the PVA molecule interacts with TTAB through the exothermic, ion-dipole, and hydrophobic interactions. The thermodynamic properties of transfer were also determined for the move of TTAB + PVA mixture from H2O to water + polyols mixed solvents. The values of compensation temperature (T
c) and intrinsic enthalpy gain (

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0
,
∗

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) were evaluated and discussed for the studied system.
Strength and Conditioning Program Design Considerations for Law Enforcement Officers
Authors: Dawes Jay , Lentine Tim , Johnson Quincy , Lockie Robert , Orr Rob
Published: November 2021

Many essential occupational tasks performed by law enforcement officers are physically demanding. There are numerous challenges with developing and maintaining physical fitness within this population. These challenges can lead to a steady decline in health and fitness over the occupational life span and have a devastating impact on officer safety and wellness. The purpose of this column is to discuss physical training program considerations when working with law enforcement professionals and provide potential solutions to these barriers.
Importance of Muscle Strength in Chronic Heart Failure
Authors: Souza Wallace Machado Magalhães de , Nascimento Pablo Marino Correa , Vieira Marcelo Carvalho
Published: November 2021

Chronic heart failure (CHF) is a complex syndrome characterized by dyspnea, exercise intolerance, and quality-of-life impairment. The compensatory physiological mechanisms of this disease may promote muscle wasting and reduction in muscle strength, which are independent predictors of mortality. Therefore, the evaluation of muscle strength in patients with CHF is essential for the prognosis of the disease and the evaluation of interventions. Besides that, strategies to increase muscle strength should be performed to improve this outcome.
11+ Dance: A Neuromuscular Injury Prevention Exercise Program for Dancers
Authors: Kolokythas Nico , Metsios George S. , Galloway Shaun M. , Allen Nick , Wyon Matthew A.
Published: November 2021

Epidemiological studies over the past decade indicate high injury prevalence in preprofessional ballet (76%) and professional contemporary and ballet dancers (60–69%). Injuries can have detrimental effects both for the dancers and the dance company. Most injuries are in the lower limb and reported as the gradual onset of overuse. Professional dance companies have reduced injury incidence and severity through the implementation of comprehensive injury audit programs and proactive exercise prescription. Injury prevention research in dance is scarce, and there has been no intervention targeting dance injuries. This article describes the development of 11+ Dance, an injury prevention training program designed for dancers, based on current evidence and best practice on injury prevention in sports. It is a 25–30-minute neuromuscular-based training program focused on strength, balance, and jumping/landing technique, with special attention to ankle, knee, and hip alignment. The high prevalence of injuries reported in the different styles of dance suggests that implementation of an injury prevention program is both the plausible and ethical action to take for all levels of performance.
Brief Review of Methods to Quantify High-Speed Running in Rugby League: Are Current Methods Appropriate?
Authors: Bennett Thomas , Marshall Phil , Barrett Steve , Malone James J. , Towlson Chris
Published: November 2021

High-speed running (HSR) has been documented within rugby league to differentiate playing standard and position and often precedes pivotal match events. Practitioners and researchers place importance on HSR because of its inclusion in assessing the demands of training and match play to help prescribe accurate training loads and recovery methods. HSR can be quantified in absolute terms whereby the same threshold speed is applied to all players (e.g., 5.0 m·s−1). Within rugby league, differences in tactical demand, anthropometric, and physical fitness characteristics exist between positions and players, suggesting that absolute HSR thresholds may not be appropriate because of underestimations and overestimations of HSR data. Alternatively, practitioners may individualize the threshold speed to individual players' physical qualities such as peak sprint speed, maximal aerobic speed (MAS), or the speed at which the ventilatory thresholds occur. Individualizing HSR warrants the practitioner to select a valid and practical test to quantify the HSR threshold speed. It is suggested that using peak sprint speed to quantify HSR can produce erroneous interpretation of HSR data while the practicality of specific physiological derived thresholds can be questioned. Implementing MAS to quantify HSR using a set time/distance trial may be the most appropriate approach for rugby league practitioners.
Functional Capacity of Geriatric Patients after Stroke According to the NOSGER Scale. Prospective Studies
Authors: Biercewicz Monika
Published: November 2021

Introduction. In Poland and in other European countries, we are witnessing an increase in the number of elderly (geriatric) people. The psychophysical assessment of the patient and the identification of deficits in his functioning in everyday life are of particular importance. The fitness of the elderly depends on their aging process, lifestyle, environmental, social and psychological factors as well as existing diseases — including neurological ones.Aim. The aim of the study was to perform a functional assessment of geriatric patients after stroke using the NOSGER scale.Material and Methods. The study group consisted of 117 geriatric patients after a stroke, hospitalized in the Department of Geriatrics, CM in Bydgoszcz. The NOSGER scale, the ADL-Katz scale and the Barthel scale were used for functional assessment.Results. The conducted psychophysical assessment of geriatric patients using the NOSGER scale showed that the respondents function the worst in the area of social behaviour — S (M = 15.2) and the instrumental activity of daily living — IADL (M = 14.2). They function best in the area of destructive, disruptive and asocial behaviours — Z (M = 8.1) and in the area of activities of daily living — ADL (M = 9.2). The respondents best cope with activities such as: proper dressing when leaving the house (75.2% of respondents), performing hygienic activities (combing, shaving, make-up) (59.0% of respondents) or keeping order (58.1% of respondents). They are worse at such activities as: control of stool (30.8% of respondents) and urine control (31.6% of respondents). Statistical analysis showed no statistically significant differences (p > 0.05) between the groups as assessed by the NOSGER, ADL-Katz and BI scales. A strong correlation was demonstrated between the assessment of the respondents using the ADL-Katz and Barthel scales (r= –.7128 and r = –.7285), and the NOSGER scale and the area — ADL_NOSGER (r = –.8109 and r = –.8215).Conclusions. Geriatric patients after stroke, as assessed by the NOSGER scale, show moderate disability in the functional area. In most cases, the respondents cope well with such activities as: proper dressing when leaving the house, performing hygienic activities (combing, shaving, make-up) or taking care of order. Conformity was demonstrated in the functional assessment using the ADL_NOSGER, ADL-Katz and Barthel scales. The ADL-Katz scale and the Barthel scale similarly measure the activities of daily living of geriatric patients. (JNNN 2021;10(2):51–57)
Assessment of the Quality of Life in Patients with Multiple Sclerosis
Authors: Kalandyk Halina , Dyndur Jolanta
Published: November 2021

Introduction. Each progressive incurable disease has an impact on the level and quality of life of those affected, on their family, professional and social roles. Multiple sclerosis is an incurable and progressive disease of the central nervous system. The ambiguous course of the disease, the multiplicity of symptoms and the periodicity of relapses and remissions not only have a negative effect on the body, but also have a significant impact on the subjective assessment of life satisfaction.Aim. The main aim of the research was to examine the quality of life among patients suffering from multiple sclerosis.Material and Methods. The study involved 105 patients with multiple sclerosis of the Sandomierz Neurology Center. An original survey questionnaire was used as a research tool.Results. The analysis of the research results showed that the highest percentage of the respondents suffered from a relapsing-remitting form, mostly young people diagnosed between the ages of 21 and 40. Patients complain of many symptoms related to individual symptoms (movement, sensory, vegetative disorders, visual disturbances). Limitations resulting from physical disability create many problems in the lives of patients. The research shows that their quality of life decreased along with the deterioration of their mobility.Conclusions. Most patients with multiple sclerosis misjudge the quality of their lives in all its spheres. The lowering of the quality of life is mainly influenced by the health condition, disorders of many organs, advanced disability, psychological disorders, lack of sufficient support from the family, specialist and institutional support. (JNNN 2021;10(2):58–64)
Long Covid — Pathophysiology and Treatment
Authors: Szrajda Justyna
Published: November 2021

A large number of patients who have recovered from the acute phase of COVID 2019 (COVID-19), caused by the new “severe acute respiratory syndrome coronavirus 2” (SARS-CoV-2), have a host of long-term symptoms. Around 10% of suffer from long-term symptoms beyond three weeks, and a smaller proportion for months. Among them, more than half suffer from fatigue. In the above article fatigue in post-infections syndromes is described. In addition, selected hypothesis on pathophysiology of long Covid and current guidelines on approach in rehabilitation are discussed. Long Covid has a rich symptomatology with a chronic fatigue as one of many symptoms that patients might suffer from. Therefore, rehabilitation programme should be conducted in an interdisciplinary approach to aim to improve function of many body systems. Self-support should be advised, however, ideally patients should be supported throughout rehabilitation process. Further studies on natural course of long Covid and underlying pathological mechanism would be helpful in development of pharmacological and non-pharmacological long Covid treatments. If the symptomatology of long Covid patients would be as heterogenous as in Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) patients, then development of individual approach in rehabilitation might be necessary to obtain high efficacy and low adverse effects rate. (JNNN 2021;10(2):77–81)
N-Terminal Pro-B-Type Natriuretic Peptide as a Predictor of Adverse Outcomes After Off-Pump Coronary Artery Bypass Surgery: A Prospective Study
Authors: Abdel-Aleem Mohamed Fawzy , Elsedeeq Ibrahim Ahmed , Ahmed Gamal Hamid , El- Tawil Tarek , Rizk Amal , Alkady Hesham Mostafa
Published: November 2021

Background: The strength of association between preoperative natriuretic peptide levels and adverse outcomes after cardiac surgery recently has been studied in different research, but results still are diversely variable.
Methods: Sixty-five consecutive patients undergoing elective off-pump coronary artery bypass grafting prospectively were recruited. Preoperative levels of NTproBNP were measured in venous blood samples collected before induction of anesthesia.
Results: The average age was 57.62 ± 7.21. Of the patients, 86.15% were male. Euro-scoreII averaged 1.76 ± 0.34. The mean preoperative NTproBNP levels were 312.41 ± 329.93 pg/mL. Only two patients died (3%). Three patients required prolonged mechanical ventilation (4.6%). Four patients (6%) suffered from new onset postoperative AF. Five patients (7.6%) had low cardiac output, of which three needed IABP, and four patients (6%) had postoperative myocardial infarction. The mean ICU stay was 3.37 ± 0.84 days, and the mean hospital stay was 6.38 ± 1.3 days. There were no significant differences in preoperative NTproBNP levels in patients who had or didn’t have any of the postoperative complications or in-hospital mortality (P > .05).
Conclusion: Our study showed no significant correlation between preoperative NTproBNP levels and postoperative low cardiac output, atrial fibrillation, postoperative myocardial infarction, length of ICU stay, prolonged mechanical ventilation, length of hospital stay as well as in-hospital mortality following elective off-pump CABG. Therefore, more prospective specific studies are needed to delineate the role of preoperative natriuretic peptides as significant predictors of poor outcomes after CABG surgery.
The Outcomes of Patients Incidentally Confirmed with Covid-19 After Cardiac Surgery
Authors: Uysal Ayhan , Erturk Esra , Abacilar Ahmet Feyzi , Duman Umit , Dogan Omer Faruk
Published: November 2021

Background: The aim of this study was to investigate the clinical outcomes of cardiac surgery in patients who were incidentally diagnosed with Covid-19 in the postoperative period.
Patients and methods: We performed 826 open cardiac surgeries in five tertiary centers. Most of the surgeries were elective coronary artery bypass grafting (CABG) (93.8%). A preoperative RT-PCR test and transcutaneous oxygen saturation were routinely investigated prior to surgery. We also investigated whether the patients already received Covid-19 treatment or had any contact with a Covid-19 patient in the last two weeks. We analyzed high sensitive C-reactive protein (hs-CRP), d-dimer, and fibrinogen, which plays a main role in the activation of procoagulant state after surgeries.
Results: Acute lung injury related to Covid-19 activation was observed in 48 out of 826 patients (5.8%). The median age of 48 patients was 63.9±12.4 years. Euro-Score and body mass index (BMI) were 6.1±1.1 and 29.2±4.1kg/m², respectively. RT-PCR test results were positive in 29 patients (60.4%). We performed thoracic computed tomography (CT) in all patients with or without positive RT-PCR test results. Thoracic CT images showed that there was a different degree of ARDS (mild, moderate, and serious). The median time of extracorporeal circulation (ECC) was 93.2±14.6 min. in on-pump surgery (IQR, 68-155 min.). Common symptoms included dyspnea (N = 22; 45.8%) and fever (N = 12; 25%). Eleven patients needed readmission to ICU. Compared with non-admitted to ICU patients, ICU patients were higher comorbidities and severe laboratory abnormalities (eg, high blood d-dimer and fibrinogen). We also detected significantly low oxygen saturation, hypercapnia, and severe acidosis in readmitted patients. Radiologic investigations showed that there were severe ARDS with bilateral pneumonic infiltration resistant to medical treatment in 6 out of 11 patients who died (54.5%).
Conclusion: Diffuse pneumonic infiltration related to Covid-19 may develop in asymptomatic cardiac surgery patients with negative RT-PCR test results. Immunologic disorders resulting from ECC, physiologic distress, and anesthesia may activate Covid-19 during the incubation period. We need randomized clinical trials to explain Covid-19 activation in the latent period of the virus, and clinical outcomes in cardiac surgery.
Investigating effects of deficit irrigation levels and fertilizer rates on water use efficiency and productivity based on field observations and modeling approaches
Authors: Shoukat Muhammad Rizwan , Shafeeque Muhammad , Sarwar Abid , Mehmood Kashif , Masud Cheema Muhammad Jehanzeb
Published: November 2021

Investigating the effects of optimized fertilizer and irrigation levels on water use efficiency and productivity of wheat crop at small farms is of great importance for precise and sustainable agriculture in Pakistan's irrigated areas. However, traditional farmer practices for wheat production are inefficient and unsustainable. This study aimed to investigate the effects of deficit irrigation and nitrophos fertilizer levels on bread wheat grain yield, yield parameters, nutrient use and water use efficiencies in bed planting wheat compared to traditional farmers' practices in the flat sowing method. The two-year field experiment followed a randomized complete block design of three replications, taking three irrigation treatments according to the requirement of crop estimated by CROPWAT model (100% of ETC), deficit irrigation (80% of ETC), and deficit irrigation 60% of ETC and three nitrophos fertilizer treatments (farmer practice 120 kg N ha-1, optimized 96 kg N ha-1, and 84 kg N ha-1) at different growth stages. Crop ETC was calculated using the FAO CROPWAT 8.0 model from the last ten years (2003-2013) average climate data of the experimental station. The traditional farmer practice treatment was included as a control treatment with a flat sowing method compared with other sown-by-bed planter treatments. All treatments were provided with an equivalent amount of fertilizer at the basal dose. Before the first and second irrigation, top-dressing fertilizer was used in traditional farmers' treatment at the third leaf and tillering stages. It was applied in optimized treatments before the first, second, and third irrigation at the third leaf, tillering and shooting stages, respectively, under the bed planting method. The deficit level of irrigation (80% of ETc) and optimized fertilizer (96 kg N ha-1) showed the optimum grain yield, nutrient use, and water use efficiencies, with 20% reduced irrigation water and fertilizer levels than traditional farming practice. The results suggest that bread wheat should be irrigated with 80% of ETC and applied 96 kg N ha-1 nitrophos fertilizer at the third leaf, tillering, and shooting stages to achieve higher grain yield and water and nutrient use efficiencies under bed planting.
Discourse Network Analysis of Nuclear Narratives
Authors:   University of Oklahoma, Gupta Kuhika , Ripberger Joseph , Fox Andrew , Jenkins-Smith Hank , Silva Carol ,   University of Oklahoma
Published: November 2021

This study combines insight from discourse network analysis (DNA) and the Narrative Policy Framework (NPF) to develop a new approach to studying narrative discourse within and across policy coalitions. The approach facilitates examination of narrative cohesion, which may impact the stability of coalitions and the impact of narrative discourse on policy change. We demonstrate the value of the approach by using it to study meta narratives on Twitter within and across groups of policy actors who support and oppose the expansion of nuclear energy in the United States. The approach reveals a variety of patterns that are unlikely to be seen using more common approaches to narrative policy analysis. Most notably, there were signs of narrative cohesion within both groups, but there were also slight fissures that may indicate strategic efforts to communicate with different constituents or fault lines that threaten group stability. These findings set the stage for future work on the relationship between narrative cohesion and policy outcomes.
Stepping Forward: Towards a More Systematic NPF with Automation
Authors:   University of Colorado Denver, School of Public Affairs, Wolton Laura P. , Crow Deserai A ,   University of Colorado Denver, School of Public Affairs, Heikkila Tanya ,   University of Colorado Denver, School of Public Affairs
Published: November 2021

Advancements in automated text analysis have substantially increased our capacity to study large volumes of documents systematically in policy process research. The Narrative Policy Framework (NPF)—which promotes empirical analysis of narratives—has the potential to usher policy narrative research along the same path. Using the NPF and existing semi-automated analysis tools, we investigate the relationship between narrative components—namely, characters and proposed solutions—and the more “skeletal” frames that tie policy narrative elements to one another. To illustrate how these tools can advance policy narrative research, we auto-code 5,708 state and local news articles focusing on hydraulic fracturing of oil and gas. The findings suggest that the use and role of characters and policy solutions are portrayed in significantly different ways depending on the frame used. By using an autocoding approach, these findings increase our methodological and theoretical understanding of the relationship between narrative elements and frames in policy narratives. In discussing these findings, we also consider their implications for how issue frames matter theoretically in the NPF.
Agreement and Trust: in Narratives or Narrators?
Authors:   Idaho State University, Lybecker Donna L. , McBeth Mark K. ,   Idaho State University, Sargen Jessica M. ,   Idaho State University
Published: November 2021

Narratives concerning the working class and their relationship to climate change are important. In particular, how the narrative constructs the relationship and, within this, who communicates a narrative (the narrator) is key. That said, this is a less studied element; the Narrative Policy Framework (NPF) has limited research on narrators. Subsequently, this work examines individuals’ support of narratives and narrators using an Amazon Mechanical Turk (MTurk) survey of 435 participants. After pretesting for climate change views, the subjects chose which narrator they expected to agree with: Mechanic Pat or Organic Farmer Chris. Through randomization, subjects joined either a congruent treatment group (Mechanic Pat tells the anti-climate change narrative and Organic Farmer Chris tells the pro-climate change narrative) or an incongruent treatment group (Mechanic Pat tells the pro-climate change narrative and Organic Farmer Pat tells the anti-climate change narrative). Results indicate that before reading the narratives, climate change “devotees” (those who agree that climate change is occurring and is human-caused) thought they would agree with Organic Farmer Chris over Mechanic Pat. Whereas there was division in the climate change “skeptics” (those who disagree that climate change is real and human-caused) on the question of what narrator they thought they would agree with. Devotees significantly supported the pro-climate change working-class narrative when told by Organic Farmer Chris as compared to when Mechanic Pat told the same narrative. Further showing the power of a narrator, devotees supported the anti-working class climate change narrative more when told by Organic Farmer Chris rather than when Mechanic Pat told the same narrative. Our findings demonstrate that narrators matter and suggest that the NPF needs to consider narrators as a narrative element worthy of further study.
Sanctuary Cities, Focusing Events, and the Solidarity Shift: A Standard Measurement of the Prevalence of Victims for the Narrative Policy Framework
Authors:   University of Massachusetts Lowell, Smith-Walter Aaron , Fritz Emily ,   University of Massachusetts Lowell, O’Doherty Shannon ,   University of Massachusetts Lowell
Published: November 2021

Numerous state and local jurisdictions across the United States have adopted policies limiting their cooperation with federal deportation efforts carried out by Immigration and Customs Enforcement (ICE). Sometimes referred to as “sanctuary cities,” these jurisdictions interpret federalism in a way that resists active participation in federal immigration enforcement. Employing the Narrative Policy Framework (NPF), we analyze 164 public consumption documents to examine policy narratives disseminated by interest groups engaged in the policy debate surrounding sanctuary cities between 2010 and 2017. Using data derived from a content analysis of these documents, we develop a new measure, the solidarity shift, to capture the prevalence of victims in policy narratives; we find there are significant differences in the narrative strategies employed by advocates and opponents of sanctuary jurisdictions, with opponents’ narratives demonstrating more active responses to external events and a higher proportion of victims, relative to other characters. We also find that the killing of Kathryn Steinle in San Francisco can be seen as a focusing event because of the narrative actions of anti-sanctuary city advocates and their reliance on the solidarity shift, which resulted in significant changes to anti-sanctuary city narrative strategies.
Exploring e-tutors teaching of the design process as content knowledge in an Open and Distance e-Learning environment
Authors: SEDİO Mpipo Zipporah
Published: November 2021

Purpose: It is argued that Open and Distance eLearning (ODeL) institutions are expected to provide student support by focusing on critical aspects of content knowledge. Technology is a critical factor in student support through e-tutoring. The main question is ‘How are the varied procedural steps of the design process taught in the targeted ODeL institution”? It is assumed that ODeL institutions have competent e-tutors when supporting students through the teaching of content knowledge of the design process. Sample: The focus was on the postgraduate students who registered for two modules for a programme (n=250) in 2020. Method: The South African Ministry of Education for Curriculum and Assessment Policy Statement (CAPS) was used to investigate, design, make, evaluate, and communicate. A quantitative approach with an online survey was used in exploring the perceptions of students about e-tutors’ content knowledge. Data analysis: It was done numerically and thematically. Results: The procedural steps vary depending on the different ministries of education worldwide. E-tutors seem to lack content knowledge to teach at a distance learning mode. The teaching of the design process to student teachers requires insights into the procedural steps of the design process curriculum. Suggestions: E-tutors should be provided with training in the design steps.
[RETRACTED] Guardian Botanicals Blood Balance Australia - DoesGuardian Botanicals Blood Balance Australia Really Work Or Cam? v1
Authors: Blood Philip
Published: November 2021

[RETRACTED]

https://olymptradestrategy.com/guardian-blood-balance-australia/
[RETRACTED] Golly CBD Gummies Reviews: (Scam or Alert) Is it Worth For You? Shocking Results and Complaints v1
Authors: not provided gollycbdgummiesbuy
Published: November 2021

[RETRACTED]

https://supplementstree.com/golly-cbd-gummies-reviews/
Physicochemical properties of various alginate-based raft-forming antacid products: a comparative study
Authors: Savla Hemali M. , Naik Isha V. , Gargote Chandrashekhar , Shashidhar Nischal , Nair Sneha , Menon Mala D.
Published: November 2021

Background: Alginate-based, raft-forming antacid products with reflux suppressant activity are complex formulations expected to achieve effective raft formation and cause elimination or displacement of the acid pocket, which is typically manifested in gastroesophageal reflux disease (GERD).Methods: In the present study, six alginate-based raft-forming products commercially available in the Indian market were compared in terms of their acid neutralization properties, strength, resilience and structural and thermal properties of their rafts. Percent alginate content was also determined.Results: Rafts of products containing calcium-based antacids formed voluminous, porous and floating rafts within seconds of addition to the simulated gastric fluid (SGF) compared with the products that contained aluminium and magnesium-based antacids. Marked differences were not evident in the ANC (acid neutralization capacity) values of the various products. No correlation was observed between ANC and raft-forming capacity or duration of neutralization. Raft structures affected their neutralization profiles. Rafts of porous and absorbent nature could retain their ANC probably due to release of trapped antacids. Further, raft strengths of only two products were above the British Pharmacopoeia specification of not less than 7.5 g. Sodium alginate content was within specifications (85-115%) for three of the six products.Conclusions: Raft-forming formulations with higher alginate content and calcium-based antacids have better physicochemical properties such as ANC, neutralization profiles, raft strength and raft resilience than those with lower alginate content or those containing aluminium or magnesium-based antacids.
Pre-operative predictors of difficult laparoscopic cholecystectomy and its correlation with post-cholecystectomy syndrome and its impact on quality of life in North Indian population
Authors: Agrawal Priyanka , Alam Mahboob , Pratap Dhirendra , Singh Krishna K. , Gupta Lokesh , Tripathi Utkarsh
Published: November 2021

Background: Laparoscopic cholecystectomy (LC) is the most preferable surgical procedure worldwide. LC is not completely risk-free and 2 to 15% of attempted LC procedures have to be converted to open cholecystectomy. The aim of the study was to assess the predictors of difficult LC procedures and for knowing the impact of difficult LC procedures on post-cholecystectomy syndrome and quality of life of patients.Methods: A prospective observational study was conducted on patients who underwent LC. Clinical, demographic, radiological and biochemical parameters along with detailed history of patients were documented. Laparoscopic cholecystectomy was then done on patients using standard technique. Level of difficulty in LC procedure was assessed and graded. Occurrence of post-cholecystectomy syndrome was investigated and quality of patient’s life was assessed using SF-36 inventory.Results: The difficulty rate in LC procedure was observed to be 17.4%. The clinical predictors of difficult LC procedures were old age and prior history of abdominal surgery. Contracted gall bladder, peripancreatic fluid and thick gallbladder wall were radiological predictors and presence of adhesions, longer duration of surgery and conversion to open procedures were intraoperative predictors of difficult LC procedures. Early PCS was affected by difficult LC procedures; though with passage of time it reduced. Post-operative quality of life was affected more by PCS incidence than the difficult LC procedure.Conclusions: The findings of the study would help in anticipating predictors of difficult LC procedures and in understanding the phenomenology and determinants of PCS along with its relationship with operative difficulty and quality of life of patients.
Risk factors and mortality profile of post neonatal deaths; 1 month to 1 year, in a rural medical college hospital, South India
Authors: Balamurugan Kuppan , Ponprabha Rajangam , Sivashankari Veeramani
Published: November 2021

Background: Infant mortality is the most important indicator which reflect country growth standards and development. This study was aimed to assess the risk factors and clinical profile of post neonatal deaths, admitted in PICU, government Villupuram medical college.Methods: A retrospective analysis was done on post neonatal mortality data by pediatric department of government Villupuram medical college, Mundiyambakkam from January 2019 to December 2020, referral and LAMA patients were excluded from study. Data was analyzed using SPSS 18.0Results: Overall post neonatal mortality was 7.3%. Mortality amongst boys were 28 (41.1%) and girls were 40 (58.8%). Mortality of female babies were higher than male babies.Among the 68 post neonatal deaths, maximum number of mortalities was seen in 1-3 months (61.9%), maximum within 24 hours of hospital stay (54.4%), 37 cases (54.4%) were referred from GHPHC and private practitioners of the nearby districts, 28 babies (41.1%) had previous admissions, 22 babies had SNCU admissions and 6 babies had pediatric admissions. Three most common causes of mortality were bronchopneumonia, sepsis and acute CNS infections. Congenital malformations and heart disease along with failure to thrive are other causes of morbidity.Conclusions: Analysis reflects the disease occurrence, treatment modalities and quality of treatment available. Treatment at primary level can prevent postnatal deaths from infections. The preventive and primary health care system should be strengthened. All special newborn care units (SNCU) discharged babies should have both community and district early intervention centre (DEIC) follow up, immunization practices, explaining danger signs to the parents, improving the quality of life has got great impact on the post neonatal outcome.
Endoscopic dacryocystorhinostomy for nasolacrimal duct obstruction: an assessment of post-operative outcomes at a tertiary health care centre
Authors: Dantuluri R. K. L. N. Raju
Published: November 2021

Background: Endoscopic dacryocystorhinostomy (Endo DCR) is a well-established surgical treatment for nasolacrimal duct obstruction (NLDO) cases. Advances in surgical technique and a better understanding of the anatomy have resulted in improvement of the success rate. The objective of this study is to assess the factors responsible for the recurrence of nasolacrimal system obstruction by evaluating the post-operative outcomes of Endo DCR at a tertiary health care centre.Methods: A retrospective study was conducted in the department of ENT, GVP IHC and MT, Visakhapatnam – Andhra Pradesh on 52 patients who underwent Endo DCR procedure from September 2018 to September 2021. The data regarding lacrimal drainage system, operative details, surgical outcomes and complications were analysed.Results: Fifty-two patients (18 male and 34 female) underwent 63 Endo DCR surgeries for NLDO. Success was achieved in 50 cases (79.4%), and failure in 13 (20.6%). Of the 13 failed cases, anatomical obstruction at the fistula site was found in 6 (46.2% of failed cases), whereas functional failure with no evidence of obstruction was found in 7 (53.8%).Conclusions: The success rate appears to be influenced by preoperative parameters like clinical as well as radiological examination of eye and nose; ruling out intraoperative conditions like sinusitis, deviated nasal septum, polyps. These are essential for better coordinating therapeutic expectations and better patient selection. Endo DCR proved to be a safe invasive procedure as it has direct approach to the sac and produced excellent results without any external scar.
Pre-operative assessment of difficult laparoscopic cholecystectomy: a scoring method
Authors: Malligurki Vamsi K. , A. Bhaskaran
Published: November 2021

Background: Laparoscopic cholecystectomy (LC) has become the gold standard procedure for management of symptomatic gallstone disease. At times, it is difficult and takes longer time or has to be converted to an open procedure. The study was undertaken to determine the factors which predict difficult LC. The aim of the study was to evaluate a pre-operative scoring method to predict difficult LC.Methods: This was a prospective study conducted in the department of general surgery, MVJ Medical College, Bangalore from December 2020 to August 2021. There were 100 cases operated by experienced surgeons. Scoring method which included parameters from history, clinical and sonological findings with maximum score up to 15. Score up to 5 predicted easy, 6-10 difficult and 11-15 is very difficult.Results: Pre-operative scoring system correlated with 85.7% for easy, 83.3% in difficult cases and 100% in very difficult cases. The factors like previous history of hospitalization (p=0.004), clinically palpable gallbladder (GB) (p=0.009), impacted GB stone (p=0.001), pericholecystic collection (p=0.04), and abdominal scar due to previous abdominal surgery (p=0.009) were found statistically significant in predicting difficult LC.Conclusions: Pre-operative prediction of risk factors to assess the operative difficulty is an important point for planning the surgery and the high-risk patients may be informed accordingly.
Non-traumatic bilateral comminated acetabular fracture
Authors: Alsaeed Abdullah A. , Alsaeed Abdullah Y.
Published: November 2021

High-energy trauma has been confirmed as a cause of bilateral acetabular fracture. However, there are few reports on nontraumatic bilateral acetabular fracture. We report a case of bilateral acetabular fracture that occurred acutely with no preceding trauma in a 50-year-old man with osteoporosis. The case shows the significance of regular annual calcium and vitamin D screening of patients at a high risk of pathological fracture.
Assessment and classification of chronic pruritis and its relation to systemic diseases
Authors: Alyamani Nawal Rajeh , Almutairi Noura Talal , Alkhamis Riam Saleh , Brnawa Rehab Bakr , Badeghaish Samah Omar , Alhazmi Renad Ghazi , Hilmi Rana Mohammed , Alfakeeh Abeer Hassan , Abushanab Orjuwan Maher , Abdullah Ruya Adel , Alhakeem Wadiah Mahdi , Safar Mohammed Ahmed
Published: November 2021

Although pruritis might not be a serious condition with significant healthcare impacts, it is usually associated with an unpleasant sensation that leads to scratching the skin. It has been demonstrated that the severity of the condition is significantly variable and ranges between disabling and mild conditions. Chronic pruritis has been defined as the presence of daily itching for >6 months. In the present literature review, we have discussed the different approaches that have been previously indicated to assess and evaluate chronic pruritis, and the classification of the condition its relation to the different systemic diseases. The classification of chronic pruritis can be done using a clinical or an etiological diagnosis. The clinical diagnosis is usually based a primary skin condition, while the etiological diagnosis is based on the presence of different diseases that may be systematic, neurological, or psychiatric disorders. Accordingly, conducting a thorough examination is essential to establish a proper diagnosis before adequately managing the affected patients. Furthermore, the treatment of the underlying etiology should also be adequately considered for adequate management and enhanced prognosis.
Evaluation of role of remdesivir in covid-19 patients outcome: A retrospective analysis
Authors: Tummala Vengamamba , Kalyani Chilamakuri , Vadlapudi Saikrupa , Jangiti Nagalaxmi , Sai Beri Abhilash , Balasubramanyam Kotha
Published: November 2021

Coronavirus disease 2019 (COVID-19) is a contagious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Remdesivir, a broad spectrum antiviral agent, is currently the only drug that is approved by the Food and Drug Administration for the treatment of COVID-19.  It is recommended for use in hospitalized patients who require supplemental oxygen. There are insufficient data either for or against to recommend for routine use of Remdesivir in high risk patients who doesn’t require supplemental oxygen.

To evaluate the efficacy of Remdesivir in covid positive patients.

A retrospective analysis of 300 patients was done, out of which 150 patients belong to Group 1 and 150 patients belong to Group 2. Group 1-Elderly patients with comorbidities who doesn’t require supplemental oxygen Group 2- Patients requiring oxygen supplementation (SpO2 88% to 94% on room air).

Group 1 patients were discharged earlier than Group 2 patients.

Elective use of Remdesivir has a definitive role in prevention of progression of disease especially in high risk susceptible individuals.
Trends in oxygen therapy in patients with moderate to severe COVID-19 admitted to the ICU
Authors: Raghunath S S  , Devanand Bheema , Nizamuddeen B Mohammed , Bhaskar S Bala , Kothari Pradnya , Chand N Kiran
Published: November 2021

The most concerning complication of severe acute respiratory syndrome corona virus 2 (SARSCoV-2) pneumonia is acute hypoxemic failure. Though various antivirals, steroids, immunomodulators have been tried, oxygen therapy remains the mainstay of treatment.

After obtaining institutional ethical clearance, a prospective observational study was conducted on 102 COVID-19 positive patients aged 20 years and above, admitted in the ICU with moderate to severe disease. COVID-19 infection was confirmed by polymerase chain reaction or rapid antigen test. Data of two demographically comparable groups i.e., patients on HFNO and NIV was analysed outcome was defined as discharge from ICU, shift to other non-invasive modes of oxygen therapy, endotracheal intubation or death, and comfort level for each mode. The data was analysed using SPSS-16.0, Chi-square test and “t” value test were applied.

Comparison ofthe mean number of invasive ventilator free days of HFNO and NIV was insignificant(p>0.05). Among the patients on HFNO (high flow nasal oxygen) 49.09% were stepped down to NRB (non-rebreathing mask) whereas 7.27% went for intubation which is significant compared to NIV mask (non-invasive ventilation), where 13.64% were stepped down to HFNO and 34.09% were intubated (p=0.000).

Oxygen therapy with HFNO is associated with better outcome and less mortality when compared with NIV.
Successful anesthetic management in a case of grade V splenic injury in covid 19 positive patient: A case report
Authors: Kumari Anupama , Husain Farah , Sethi Anjili , Saxena Kirti Nath
Published: November 2021

Splenic injuries are amongst the most frequent trauma-related injuries which requires emergency surgeries demanding meticulous surgical and anesthetic management. The aim while managing splenic trauma patients, is to restore homeostasis and normal pathophysiology in the body by achieving hemostasis with an emergency splenectomy.

To date, there have been few reports describing the anaesthetic management of COVID-19 patients presenting for emergency surgery. In this article, we outline the anaesthetic management for a case with hemoperitoneum, posted for emergency exploratory laparotomy and splenectomy in our operating theatre who was incidentally diagnosed to be COVID positive in the emergency unit by a rapid antigen test.
Assessment of post-operative analgesia in modified radical mastectomy patients using surgical wound irrigation with 0.25% bupivacaine
Authors: Varma Brejesh Ravi , Shafi C Muhammed , Shenoy Mangesh , Kutty Salman Mohammed
Published: November 2021

Modified Radical Mastectomy is the widely followed treatment for operable breast cancers. Among the methods used to alleviate pain, irrigation of wound with 0.25% Bupivacaine is one of the under-utilized methods with good efficiency compared to other drugs.

To evaluate the role of local irrigation of 0.25% bupivacaine in alleviating the post-operative pain.

This observational study was conducted among 60 female patients who underwent Modified Radical Mastectomy in a tertiary care teaching hospital between January 2017 and July 2018. Thirty (30) patients were randomly allotted to control group, where the routine post-operative pain management was followed. Another 30 were randomly allotted to study group where, before closure of the wound, a 20G scalp vein set was used along the length of the incision with multiple punctures in it for continuous irrigation with 0.25% Bupivacaine. Post operatively Visual analogue scale was used to measure the pain sensation at every six hours for 24 hours. The adverse effects like pain, hematoma, wound dehiscence, infection was noted on all the post-operative days.

Both the groups were similar with respect to basic parameters measured. There was a significant reduction in need for rescue analgesia in the study group. There was a significant difference in mean VAS score between both groups from 6 hour of surgery. Post-operative nausea and vomiting was significantly less in the study group.

Irrigation of wound with 0.25% Bupivacaine is found to reduce the pain sensation with minimal side effects without systemic compromise.
A prospective randomised study of adjuvants for supraclavicular brachial plexus block: Clonidine vs Dexamethasone
Authors: Aggarwal Akanksha , Gandhi Nimit
Published: November 2021

Supraclavicular brachial plexus block is among foremost technique of regional anaesthesia administered during upper-limb surgery. Different adjuvants have been used with varied results for prolonging the sensory and motor blockade. Dexamethasone and Clonidine have been established as suitable adjuvants for blocks. Adding adjuvants to local anaesthetic drugs in nerve blocks has many benefits. We studied performance of dexamethasone or clonidine as additives to local anaesthetic in subclavian perivascular block as a part of upper limb surgery. Aim was to ascertain which of them is a better adjuvant.

Study population was randomized to 2 groups of 50 patients each. Group 1 was given 5 ml of 2% lignocaine and 15 ml 0.5% bupivacaine with 8mg dexamethasone. Group 2 received 5ml 2% lignocaine and 15 ml 0.5% bupivacaine with 0.150 mg clonidine. Time to establishment of sensory & motor block, duration of analgesia and any adverse effects were observed. Statistical analysis was done with SPSS 13.0. Quantitative variables were assessed using student t test. Qualitative variables were analysed using Chi square test. P value < 0.05 was defined as significant.

 Onset of sensory blockade was at 7.23+4.24 in group 1 and 8.36+2.68 minutes in Group 2. Average time to motor block was at 8.48+3.22 minutes in Group 1 and 9.58+3.71 minutes in Group 2. Analgesia’s duration in Group 1 and Group 2 was 998.2+338.5 and 879.3+284.5 minutes respectively. No major adverse events were seen in either group.

 Performance of dexamethasone was similar to clonidine as adjunct to local anaesthetic in subclavian perivascular approach of brachial plexus block. However, it has faster sensory and motor blockade’s onset. Analgesia’s duration observed was found to be longer, though the difference was statistically insignificant.