bluuebunny/crossref_metadata_2025 huggingface dataset:
The Effect of Using Web 2.0 Tools in the Primary School 4th-Grade Science Course on Various Variables
Authors: UYSAL Mustafa Ziya , ÇAYCI Barış
Published: August 2021

In this study, we aimed to determine the effects of Web 2.0 animation tools for science education on 4th-graders’ academic achievements and basic skills, as well as their attitudes and motivations towards science courses. The study was designed with pretest-posttest control group quasi-experimental pattern. The sample consisted of 4th-grade students studying at one of the primary schools in Selçuklu, Konya, Turkey. In the comparison of the pretest mean scores of the students in the data collection tools applied to the experimental and control groups as a pretest, it was determined that the groups were equivalent to each other in terms of their baseline characteristics. The topics in the experimental and control groups were taught in accordance with the methods-techniques prepared and recommended according to the 4th grade curriculum. Unlike the students in the control group who did not receive any additional intervention, the students in the experimental group watched animations prepared by the researcher. In the posttest mean scores of the students in the experimental and control groups, there was a significant difference in favor of the experimental group (t(55)achievement=-2.23, p<0.05). Accordingly, the teaching process applied in the experimental group was more effective on academic achievement than the teaching process in the control group. In the comparison of the results of the test of basic process skills (t(55)Skill=–.730, p>0.05) applied as a posttest to the experimental and control groups at the end of the teaching processes and the posttest mean scores obtained by the students in terms of their attitude (t(55)attitude=–.730, p>0.05) and motivations (t(55)motivation=.149, p>0.05) towards science, no significant difference was found between the groups. In this respect, the teaching processes applied to the experimental and control groups did not create any difference in the students’ basic skills, attitudes or motivations towards science
Engaging with Hard‐To‐Reach Clients: Towards the Last Resort Response by Welfare Workers
Authors: Saario Sirpa , Hall Christopher , Lydahl Doris
Published: August 2021

Client non‐cooperation is a widely recognised problem in welfare services. Being ‘hard‐to‐reach’ is considered a risk especially for the most vulnerable clients, for example in terms of increased homelessness. Such clients pose challenges to social inclusion, and services make some allowances to achieve engagement. However, even a minimum level of cooperation is required from hard‐to‐reach clients. In the context of home visiting, we study welfare workers’ efforts to engage with clients who continuously avoid contact. We examine three services in Finland, England, and Sweden that provide floating support to clients in their own accommodation. Utilising Robert Emerson’s idea of ‘the last resort,’ we analyse how workers justify their decisions to continue or terminate the support with the hard‐to‐reach. The data consist of team meeting recordings and home visit observations. We aim to demonstrate that justifications deployed to make the decision to end the home visiting service or tighten control, draw on ‘last resort responses.’ We identify three types of justifications: retrospective summaries on past failures to reach the client, intensifying remedial actions to engage clients, and characterisations of clients as uncooperative. While such justifications can be seen to draw on shared ethics, they have different ethical implications.
Outer Space Law: A Human Future
Authors: Serpa Nilo , Cathcart Richard Brook
Published: August 2021

Present paper discusses critical aspects of the colonization of outer space in view of the broad and robust law required in accordance with democratic ideals. The article also addresses ethical issues touching planetary environmental preservation — especially in the event of alien life — as well as relevant topics relating to future terraforming projects.

Key-words: outer space law, ethics, terraforming, alien life.

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O presente trabalho discute aspectos críticos referentes à colonização do espaço exterior em vista da ampla e robusta legislação requerida em conformidade com os ideais democráticos. O artigo também aborda questões éticas tocantes à preservação ambiental planetária — especialmente na eventualidade de existência de vida alienígena — bem como tópicos relevantes relativos a futuros projetos de terraformação.

Palavras-chave: lei do espaço exterior, ética, terraformação, vida alienígena.
Surgical treatment of stress urinary incontinence and activation of reflex mechanism of the pelvic floor
Authors: Danilov V. V. , Volnikh I. Yu. , Danilov V. V. , Danilov V. V.
Published: August 2021

The study included a group of 133 women (average age 55 years) suffering from urinary incontinence and operated on by the synthetic sling method. A number of studies were performed before and after surgery, including non-invasive uroflow monitoring. The processing and analysis of the data obtained, including the results of urodynamic monitoring, made it possible to provide a mechanism of urinary retention, which is based on the activation of the 4th mating reflex of a forced change in the receptive field by an installed synthetic tape. Based on the reflex nature of the described mechanism, one should use any operation from the class of synthetic sling of limiting effectiveness, use an instrument for implantation, and the material itself is not of key importance for eliminating incontinence.
The Kumaraswamy Pareto IV Distribution
Authors: Tahir Muhammad Hussain , Cordeiro Gauss M. , Mansoor Muhammad , Zubair Muhammad , Alzaatreh Ayman
Published: August 2021

We introduce a new model named the Kumaraswamy Pareto IV distribution which extends the Pareto and Pareto IV distributions. The density function is very flexible and can be left-skewed, right-skewed and symmetrical shapes. It hasincreasing, decreasing, upside-down bathtub, bathtub, J and reversed-J shaped hazard rate shapes. Various structural properties are derived including explicit expressions for the quantile function, ordinary and incomplete moments,Bonferroni and Lorenz curves, mean deviations, mean residual life, mean waiting time, probability weighted moments and generating function. We provide the density function of the order statistics and their moments. The Renyi and q entropies are also obtained. The model parameters are estimated by the method of maximum likelihood and the observed information matrix is determined. The usefulness of the new model is illustrated by means of three real-life data sets. In fact, our proposed model provides a better fit to these data than the gamma-Pareto IV, gamma-Pareto, beta-Pareto,exponentiated Pareto and Pareto IV models.
Specifics of Research Papers Expertize Regarding Detection of Academic Dishonesty
Authors: Romakh Oksana
Published: August 2021

The article deals with the difficult issue of plagiarism, self-plagiarism, falsification and other violations of academic integrity in the research papers, which an expert must identify. The objective of the study is to establish the specifics of scientific texts expertize for detecting academic dishonesty. To achieve this goal, we implemented an comprehensive approach, within which qualitative and quantitative methods were applied. The qualitative methods were used to study state regulatory documents, as well as internal regulations and regulations of the best universities of Ukraine in 2020 (according to the rating of the Center for International Projects “Evroostvita”); the reports of universities’ rectors. In the process of analysing, we used free coding of text segments, which can be identified as a guide/advice/specific to check the works for plagiarism. We used the quantitative methods to confirm the hypothesis about exclusive focus of universities on the percentage of originality (coincidences) of texts, as well as to establish a correlation of mentions of “percentage” and “plagiarism” as analysis units. The main result of the study is a number of tips and specifics that are worth exploring by the specialists involved in scientific texts checking in order to detect academic dishonesty.
Mass Emotions in Social Communication as a Resource for Strengthening Mass Media Impact
Authors: Demutska Alevtyna
Published: August 2021

Current research on the issues of social communications pay little attention to the problem of mass emotions, despite the effect of “implicit presence” of this phenomenon in social communications. Characterizing the crowd and mass audience, the author’s previous researches show the important role of mass emotions as a tool that unites people in social communications, induces a centrifugal force that reformats “collective soul” of the audience to the state of “public opinion” through communication apperception. The objective of the study is to determine the tools of the process of the audience’ emotional massification and the mechanisms of explicit or implicit provocation of mass emotional outbursts through mass media impact. The methods of observation, description, comparison, generalization were used to achieve the goal. The method of observation was used to select material for the analysis of social phenomena, where it was potentially possible to state the media impact on the audience. The method of description was used to characterize the trends and features of increasing impacts on the audience at the peak of political discourses. The main results and conclusions of the study is the existence of cause and effect relationship of mass emotions in social communications, their interaction with mass information, mass interpretation, which confirm the threefold nature of modern social communication.
Artificial intelligence technologies in predicting preeclampsia
Authors: Ivshin A. A. , Bagaudin T. Z. , Gusev A. V.
Published: August 2021

The strategy for preserving reproductive potential in the Russian Federation is focused on the personalized women’s health care and based on preclinical identification of gynecological diseases and major obstetric syndromes at the stage of predicting adverse outcomes and subsequent preventive measures able to reduce maternal and perinatal morbidity and mortality, decrease women and neonatal disability as well as profoundly reduce extremely high costs on care of premature infants. The search for effectivepredictive methods of preeclampsia (PE) at the stage of preconception and in the first trimester of pregnancy is driven by the desire to identify women at greater risk of developing hypertensive disorders in order to take the necessary effective measures forpreventing placental pathology as early as possible, thereby preventing or reducing incidence rate of PE. At the same time, identifying a group of high-risk women would allow to rationally plan prenatal care, timely recognize emergence of multiple organdysfunction and immediately begin pathogenetic and symptomatic therapy. Taking into account the national and global experience of using predictive analytics software proving their success in reproductive medicine, it is reasonable to assume that converting prognosis into digital format by using artificial intelligence (AI) algorithms will open new opportunities for increasing accuracy of individual risk calculation for PE by meeting current paradigm of personalized preventive medicine. Our scientific review on domestic and international publications aims to inform a wide range of obstetricians-gynecologists about advances in AI technologies as well as prospects for machine learning to predict PE.
Computer simulation in the development of vaccines against covid-19 based on the hla-system antigens
Authors: Vologzhanin Dmitry A. , Golota Aleksandr S. , Kamilova Tatyana A. , Shneider Olga V. , Sсherbak Sergey G.
Published: August 2021

The genetic variability of population may explain different individual immune responses to the SARS-CoV-2 virus. The use of genome- and peptidome-based technologies makes it possible to develop vaccines by optimizing the target antigens. The computer modeling methodology provides the scientific community with a more complete list of immunogenic peptides, including a number of new and cross-reactive candidates. Studies conducted independently of each other with different approaches provide a high degree of confidence in the reproducibility of results. Most of the effort in developing vaccines and drugs against SARS-CoV-2 is directed towards the thorn glycoprotein (protein S), a major inducer of neutralizing antibodies. Several vaccines have been shown to be effective in the preclinical studies and have been tested in the clinical trials to combat the COVID-19 infection. This review presents the profile of in silico predicted immunogenic peptides of the SARS-CoV-2 virus for the subsequent functional validation and vaccine development, and highlights the current advances in the development of subunit vaccines to combat COVID-19, taking into account the experience that has been previously achieved with SARS-CoV and MERS-CoV. The immunoinformatics techniques reduce the time and cost of developing vaccines that together can stop this new viral infection.
The ML scale in northern Baja California, México
Authors: Vidal Antonio , Munguía Luis
Published: August 2021

We found that the attenuation functions proposed for southern California by Richter (1958) and Hutton and Boore (1987) are not entirely suitable for local magnitude calculation for earthquakes in northern Baja California. In this study, we used zero-to-peak amplitudes from synthetic Wood-Anderson seismograms to determine appropriate − log A0 attenuation functions and station magnitude corrections through a multiple linear regression analysis. Our data were grouped so that each energy path was entirely contained in either the granitic Peninsular Ranges of Baja California (PRBC) or the sedimentary environment of the Mexicali-Imperial Valley (MIV). The best solutions of the regression analysis are -log A0 = (1.0134 ± 0.0288) log (r/100) + (0.0025 ± 0.0005) (r − 100) + 3.0 for MIV and −log A0 = (1.1319 ± 0.0197) log (r/100) + (0.0017 ± 0.0002) (r − 100) + 3.0 for PRBC, where r is hypocentral distance. A comparison of these functions with those for southern California revealed the following: (a) a remarkable agreement between Richter's function and the function for MIV at distances between 40 and 450 km, (b) Hutton and Boore's function and the function for PRBC are quite similar in the whole distance range considered (10 to 450 km), and (c) for both areas, at distances shorter than 50 km, the −log A0 Richter function was as much as 0.5 units lower than the others. Thus, as for other regions, the use of Richter's function results in understimation of local magnitudes at near-source distances. Additionally, the attenuation function for PRBC was 0.30 units lower than Richter's at 400 km, which means that at such longer distances the Richter function overestimates the magnitude of PRBC earthquakes. Finally, station magnitude corrections from −0.42 to 0.26 units were obtained, suggesting significant effects due to station site properties.
Recent earthquake sequences at Coso: Evidence for conjugate faulting and stress loading near a geothermal field
Authors: Bhattacharyya Joydeep , Gross Susanna , Lees Jonathan , Hastings Mike
Published: August 2021

Two recent earthquake sequences near the Coso geothermal field show clear evidence of faulting along conjugate planes. We present results from analyzing an earthquake sequence occurring in 1998 and compare it with a similar sequence that occurred in 1996. The two sequences followed mainshocks that occurred on 27 November 1996 and 6 March 1998. Both mainshocks ruptured approximately colocated regions of the same fault system. Following a comparison with the background seismicity of the Coso region, we have detected evidence of stress loading within the geothermal field that appears to be in response to the 1998 earthquakes. The ML = 5.2 mainshock in the 1998 sequence occurred at 5:47 a.m. UTC and was located approximately 45 km north of the town of Ridgecrest in the Coso range. The mainshock of the 1996 sequence had an ML magnitude of 5.3. There have been no observable surface ruptures associated with either of these sequences. Though the mainshocks for both sequences were located about 900 m apart and have nearly the same local magnitudes, the sequences differ in both their temporal and spatial characteristics. An analysis of the fault-plane solutions of the mainshocks and the aftershock locations suggests that the two sequences ruptured fault planes that are perpendicular to one another. We observe a much faster temporal decay of the 1998 sequence compared to the one in 1996; moreover, while the 1996 sequence was not followed by any sizeable (i.e., ML > 4.0) aftershocks, the 1998 sequence had four such events. From an estimate of the tectonic stressing rate on the fault that produced the 1998 sequence, we infer a repeat cycle of 135 years for an earthquake of comparable magnitude at Coso.
Produksi Susu dan Komposisi Susu Sapi Friesian Holstein yang Mendapat Suplemen Tepung Temulawak (Curcuma xanthorriza Roxb)
Authors: Harjanti Dian Wahyu , Mustaqim Arif , Hartanto Rudy
Published: August 2021

ABSTRAK. Penelitian ini bertujuan untuk mengkaji produksi susu dan komposisi susu sapi Friesian Holstein (FH) yang mendapat suplemen tepung temulawak (Curcuma Xanthorriza Roxb). Materi penelitian menggunakan sapi FH berjumlah 12 ekor. Penelitian menggunakan Rancangan Acak Kelompok dengan 2 perlakuan dan 6 kelompok. Perlakuannya adalah T0 = pakan basal (kontrol), T1 = pakan basal + suplemen temulawak (1% kebutuhan BK). Parameter yang diamati yaitu konsumsi bahan kering, produksi susu dan komposisi susu. Data yang diperoleh di analisis menggunakan sidik ragam, untuk data komposisi susu dilakukan uji lanjut dengan Paired T test. Hasil penelitian menunjukkan bahwa pemberian suplemen temulawak tidak berpengaruh nyata terhadap konsumsi BK, produksi susu dan komposisi susu (laktosa, lemak dan protein). Konsumsi BK T0 sebesar 18,06 kgBK, T1 sebesar 18,15 kgBK, rataan produksi susu T0 sebesar 6,49 liter/hari, T1 sebesar 6,30 liter/hari dan komposisi susu T0 dan T1 secara berturut pada laktosa sebesar 4,58 dan 4,56, kandungan lemak secara berurutan 3,65 dan 3,78 serta kandungan protein secara berurutan sebesar 3,16 dan 3,16. Disimpulkan bahwa pemberian suplemen temulawak 1% kebutuhan BK belum mampu meningkatkan konsumsi bahan kering, produksi dan komposisi susu sapi perah laktasi. (Milk production and milk composition of friesian holstein cows fed with temulawak (Curcuma xanthorriza Roxb) supplement) ABSTRACT. This study aims to examine the milk production and milk composition of friesian holstein cows that fed with temulawak (Curcuma xanthorriza Roxb) supplement. The material of research using 12 FH cows. The study used a randomized block design with 2 treatments and 6 groups. The treatments were T0 = basal feed (control), T1 = basal feed + Curcuma supplement (1% dry matter (DM)). The parameters observed were DM consumption, milk production and milk composition. Data obtained were analyzed using ANOVA, for milk composition data were analyzed using Paired T test. The results showed that the administration of temulawak supplement was not proven significantly towards the dry matter intake, milk production and milk composition (lactose, fat and protein). Dry matter intake T0 group was 18,06 kg, dry matter intake T1 group was 18,15 kg, the average milk production T0 group was 6,49 liters / day, milk production T1 group was 6,30 liters / day. Lactose concentration of group T0 and T1 was 4, 58% and 4,56%, fat concentration of group T0 and T1 was 3,65% and 3,78% and protein concentration of group T0 and T1 was 3,16% and 3,16%. In conclusion, supplements of curcumma 1% DM were not alter dry matter intake, milk production and milk composition.
Kecernaan Bahan Kering, Bahan Organik, Lemak Kasar dan Nilai Total Digestible Nutrient Hijauan Pakan Kambing
Authors: Rahmawati Puspadina Dwi , Pangestu Eko , Nuswatara Limbang Kustiawan , Christiyanto Marry
Published: August 2021

ABSTRAK. Penelitian ini bertujuan untuk mengkaji nilai kecernaan bahan kering (KcBK), kecernaan bahan organik (KcBO), kecernaan lemak kasar (KcLK) dan total digestible nutrient (TDN) dari hijauan pakan kambing. Percobaan menggunakan rancangan acak kelompok (RAK) terdiri dari 7 jenis hijauan pakan sebagai perlakuan dengan 3 kelompok cairan rumen kambing Jawarandu yang diambil pada waktu dan kambing yang berbeda. Perlakuan meliputi : R1 : daun indigofera; R2 : daun insulin; R3 : daun jambu Biji; R4 : daun melinjo; R5 : daun rambutan; R6 : daun singkong; R7 : daun waru. Hasil penelitian menunjukkan bahwa perbedaan jenis hijauan pakan memberikan pengaruh nyata (P0,05) terhadap kecernaan bahan kering (KcBK), kecernaan bahan organik (KcBK), kecernaan lemak kasar (KcLK) dan total digestible nutrient (TDN). Simpulan penelitian diperoleh bahwa kecernaan bahan kering (KcBK), kecernaan bahan organik (KcBO), kecernaan lemak kasar (KcLK) dan total digestible nutrients (TDN) dipengaruhi oleh kandungan protein, lemak, karbohidrat hijauan pakan pada ternak kambing. (Digestibility of dry matters, organic matters, crude lipid and total digestible nutrients of forage for goats) ABSTRACT. The objectives of this research to evaluate digestibility of dry matter (DMD), organic matter (OMD), crude fat (CFD) and total digestible nutrients (TDN) of various forages for goat. The experimental design used randomized block design (RBD) which consists of 7 types of forages as treatment with 3 different groups of rumen fluid of Jawarandu goats taken at different times and goats. The treatments were R1: indigofera leaves; R2: insulin leaves; R3: guava leaves; R4: melinjo leaves; R5: rambutan leaves; R6: cassava leaves; R7: waru leaves. The results indicated that the different types of forages have significant effects (P 0.05) on digestibility of dry matter (DMD), organic matter (OMD), crude fat \ (CFD) and total digestible nutrient (TDN). The research concluded that dry matter digestibility (DMD), organic matter digestibility (ODM), crude fat digestibility (CFD) and total digestible nutrients (TDN) were affected by protein, fat, and carbohydrate contains of various forages for goat.
a Cardiac cephalalgia attacks provoked by Prinzmetal angina - a case report
Authors: Cvetkovic Vlasta , Jensen Rigmor
Published: August 2021

A 51-year-old man with no past medical history of headache or risk factors for vascular diseases was diagnosed with supraventricular tachycardia (SVT) in 2005. In 2014 SVT attacks were longer and always followed by severe headache attacks. Accompanying symptoms were dizziness, non-rotational vertigo, confusion, episodes of double vision and tinnitus; these symptoms would last one day, followed by severe tiredness for 2 days. Neurologic and cardiologic evaluation as well as extensive diagnostic test between the attacks was normal. Catheter coronarography showed no stenoses but did show spasms in distal left anterior descending artery. A remarkable effect on SVT and headaches was shown after the introducement of diltiazem. The diagnosis cardiac cephalalgia (CC) was established. As our case report is unique, we hope that our observations will help cardiologists and neurologists to better understand and treat patients with CC. CC should be distinguished from migraine, to avoid prescribing triptans and vasoconstrictors.
The effect of spinach-derived thylakoids on anthropometric parameters and metabolic profile in antipsychotic treatment: A case report
Authors: Lycken Kajsa , Albertsson Charlotte
Published: August 2021

Background: Antipsychotics is the first line, evidence-based treatment of schizophrenia and other primary psychotic disorders. Metabolic adverse effects are common, including body weight gain, hypertension and metabolic syndrome. There is still no safe treatment for these adverse effects, except from lifestyle changes. Studies of thylakoids have shown body weight loss and improved metabolic parameters in overweight women. Case report: A 53-year old female with a history of unspecified nonorganic psychosis, treated with Quetiapin and Topimax (Topiramat), was given a supplement of 5g thylakoids daily for 12 weeks. She reported a rapid decrease of sweet craving and loss of body weight was observed. Conclusion: We report a successful treatment with thylakoid supplements of the metabolic side effects of antipsychotics in a female adult with a history of body weight problems and sweet craving. Further investigation and larger studies are needed. A safe treatment of metabolic side effects could increase quality of life for patients in need of antipsychotic treatment.
Ehlers-Danlos Syndrome (EDS) : A Common and often Disregarded Cause of Serious Gastrointestinal Complications in Children and Adults
Authors: Hamonet Claude , Delarue Mickael , Lefevre Jeremie , Rottembourg Jacques , Zeitoun Jean-David
Published: August 2021

Ehlers-Danlos is a hereditary disease of the whole connective tissue initially described by dermatologists (Tscherchnogobov Moscow 1892, Ehlers, Copenhagen, 1900, Danlos, Paris, 1908). They emphasized the joint hyperlaxity and stretchiness of the skin which has long summed up the clinical expression of this entity. In recent decades, many other manifestations have been described and gradually identified, mainly by rheumatologists (Grahame, London, 1960). Several of them concern the digestive tract, mainly gastric reflux and constipation. They can be the cause of serious accidents: bronchial flooding by gastric reflux or aspiration, intestinal obstruction, hernial constriction, eventration, intestinal rupture, peritonitis of vesicular or appendicular origin, hemorrhages. It is important that gastroenterologists know how to link these manifestations to their etiology in order to adapt treatments, prevent iatrogenic accidents and direct the patients towards the treatment of other manifestations of Ehlers-Danlos disease. Nine clinical signs, including digestive manifestations, allow diagnosis by their significant grouping. The proof of hereditary origin is based on the identification of other identical cases in the family,, even if they are paucisymptomatic. A person affected by the disease systematically transmits the disease to all his children. We have verified this in all our patients.
A case report on serous cyst fibroadenoma of ovary
Authors: Jain Saloni , Tyagi Mamta , Gupta Smriti , Verma Yamini , Shukla Swati , Chaudhary Drishti
Published: August 2021

A 16-year-old unmarried female patient presented to the Subharti hospital with a lump in her abdomen that had been there for one year. For the previous two months, there had been abdominal pain. Constipation, intermittent fever, and vomiting were all present. A mass of around 25×25 cm (approximately) was found on per-abdominal examination, which was firm in consistency, non-tender, afebrile to touch with smooth borders, and restricted mobility. On the basis of the above mentioned examination and investigation, a diagnosis of ovarian cyst with typhoid immunoglobulin G (IgG) and immunoglobulin M (IgM) positive, dengue IgG with hepatitis B surface antigen (HbsAg) positive was made.
The population control bill, 2021: exploring newer perspectives
Authors: Nagabhushana Prerana , Sarkar Avir
Published: August 2021

As we observe the World Population Day on 11th July, the current population stands at roughly 7.9 billion in 2021, with India bagging the second place at 1.39 billion. The net growth rate stands at 1.1% or 83 million per year and the projected world population by 2050 is estimated to be 9.7 billion. These figures are alarming to us-the millennials, who grew up writing ominous essays on ‘population explosion’ at school. Governments across the world, historically Romania to more recently China, have adopted population policies to control the rate of population growth to cater to their advantage-either economically or politically. Some of them directly against reproductive rights- to decide freely and responsibly the number, spacing and timing of their children and to be able to do so without discrimination, coercion and violence.
Thoracic empyema: clinical course and management in Trivandrum Medical College
Authors: P. S. Sony , C. V. Vinu , J. Suresh Kumar , Lal Kishore
Published: August 2021

Background: The incidence of empyema thoracis among adults is increasing steadily. It may be primary empyema (pleural infection developing without pneumonia) or secondary empyema. The common cause of secondary empyema being- community acquired pneumonia or hospital acquired pneumonia, empyema due to iatrogenic causes, secondary to trauma etc. With advancement in science and technology, early recognition of empyema in patients with symptoms is now possible. But the treatment guidelines are not unified so that each physician may treat this condition in a different way without referring to higher concerned specialties making it complicated. The objective of this study was to determine the clinical profile of thoracic empyema in Trivandrum Medical College a tertiary care centre in South Kerala.Methods: A total of 56 patients with empyema admitted to Government Medical College, Trivandrum, Kerala in 2018-2019 were reviewed retrospectively. The demographic details, clinical presentation, etiology, microbiological findings, and management were recorded in a planned proforma, and analysis was done.Results: The mean age was 49.1 years with peak incidence seen in 40-60 years of age. The male to female ratio was 4.6:1.0 and right pleura was more involved than left pleura. Risk factors were diabetes mellitus, chronic obstructive pulmonary disease, pulmonary tuberculosis, and smoking. Etiology of thoracic empyema was infective in 78.6% cases and traumatic in 21.4% cases. Only two cultures showed gram positive aerobe, rest of the culture was sterile. Only a few cases resolved with medical management. Decortication was needed for 52 patients (82.1%).Conclusions: A unified protocol need to be formulated and followed up in all centres for the management of empyema before its evolution and thus reducing the incidence of empyema and its associated complications.
Coronary artery disease in post-COVID patients: a prospective study
Authors: Chhabra Abhinav , Shisode Vinod , Rajput Richa
Published: August 2021

Background: Corona virus disease 2019 or COVID-19 is defined as infectious illness caused by severe acute respiratory syndrome corona virus 2 (SARS-CoV-2). The cardiovascular manifestations of COVID-19 has been a topic of immense interest amongst epidemiologists, physicians and cardiologists alike. Cytokine storm seen in patients with COVID-19 is known to cause damage to multiple organs including cardiac myocytes. Coronary arteries are also affected by direct damage as well as cytokine mediated injury to coronary endothelial cells.Methods: This was a prospective study conducted in the department of cardiology of a tertiary care hospital. 40 patients recovered from COVID-19 and having symptoms related to coronary artery disease were included in this study on the basis of a predefined inclusion and exclusion criteria. The presenting complaints such as chest pain, breathlessness and fatigue were asked for and were documented. An informed written consent was obtained from all the participants. A standard Judkins technique was used to do coronary angiography. Severity of stenosis was assessed in all the cases. The statistical analysis was done using SSPS 21.0 software. P value less than 0.05 was taken as statistically significant.Results: Out of 40 post COVID-19 patients presenting with symptoms attributable to coronary artery disease there were 34 (85%) males and 6 (15%) females with a M:F ratio of 1:0.17. The mean age of male and female patients was found to be 51.33±6.47 years and 44.50±6.82 respectively. 12 (30%) patients had history of hypertension, 8 (20%) had history of diabetes mellitus. 3 (7.5%) patients had history of asthma. Chest pain (95%), breathlessness (67.5%), reduced exertional capacity (55%) and diaphoresis (40%) were common presenting complaints. Slow flow due to endothelial dysfunction was the most common single finding and was seen in 8 (20%) patients. In 7 (17.5%) 51-60% stenosis with thrombosis was found whereas in 6 (15%) patients 81-90% stenosis with thrombosis was seen. In 3 (15%) patients 70-80% stenosis with thrombosis was found and in remaining 3 (7.5%) total occlusion was seen.Conclusions: A high index of suspicion and timely intervention is necessary to diagnose and manage coronary artery disease in post covid patients.
Stiff Person syndrome: a case report
Authors: Lakkad Ashraf A. , Hussien Hesham , Sami Mahmoud , Salah Mohamed , Khalil Salah E. , Ahmed Osama , Hassan Walid
Published: August 2021

Stiff person syndrome (SPS) is rather unique among neurologic diagnoses. At relaxation, motor- unit activation, continuous agonist and antagonist muscular contractions, as well as contractions triggered by tactile triggers, quiescent stretch, and involuntary movement of affected or unaffected musculature, startled sounds and emotional stimuli are the clinical signs of SPS. Sleep, general anesthesia, myoneural, and peripheral nerve blockage all help to reduce rigidity and spasms. The syndrome may be a sporadic autoimmune syndrome (associated with anti–glutamic acid decarboxylase (GAD) antibodies and often accompanied by other autoimmune diseases such as type 1 diabetes) or paraneoplastic (associated with anti–amphiphysin antibodies). People with SPS respond to high doses of diazepam and several anti-convulsants, gabapentin and tiagabine. Immunomodulatory drugs including steroids, plasmapheresis, and intravenous immunoglobulin appear to help significantly. The symptoms of our patient progressed slowly over time. Neuroimaging and electrophysiological studies ruled out other possible causes of comparable symptoms such as neuromyotonia. Raised anti-GAD autoantibodies titer in serum found by immunocytochemistry assays, our patient's history, clinical examination findings, and reaction to benzodiazepines all pointed to SPS.
Ferritin in COVID-19 infection and its diagnostic significance
Authors: Harimohan Hridya , Kandiyil Manojan Kannan , Sivaraman Sreekanth Kavitha
Published: August 2021

COVID-19 caused by (severe acute respiratory syndrome corona virus-2) SARS-CoV-2 is the major health issue facing the entire world at present. There are several pathological mechanism associated with the infection which aggravates to significant morbidity and mortality among the population. Of the several complications, hypercoagulation due to fibrin clot formation is one of the complications often seen in patients suffering from COVID-19 infection. The link of iron with hypercoagulation and related events are always a matter of discussion in the scientific world. Yet another cause of disseminated intravascular coagulation seen in these patients is cytokine storm, which occurs due to release of pro inflammatory signaling molecules as a result of increased inflammation due to depletion of iron stores. The viral attack can destroy the hemoglobin; release the iron content by separating it from the heme. This free iron in the blood will be able to produce free radicals which can convert fibrinogen into fibrin clots. More over iron could elicit oxidative stress which can subsequently lead to increased erythrocyte viscosity and thrombosis. Further ferritin, the iron storing protein will actively get released and can lose its inner iron content leading to increased free iron in circulation. It was evident that iron overload was one of the critical factor which determines the immunological processes leading to a type of cell death referred as ferroptosis. This review discussed with the mechanism involved in the release of iron and cytokine storm along with the diagnostic significance of ferritin in COVID-19 infection.
Systemic enzyme therapy in chronic venous disease: a review
Authors: Bakhshi Girish D. , Rangwala Zarin S. , Chauhan Akansha R.
Published: August 2021

Chronic venous disease (CVD), a sequel of venous insufficiency, has great medical and socioeconomic impact. Varicose veins and venous ulcer are amongst its commonest manifestations. In CVD, incompetent valves, weakened vascular walls, venous hypertension and increased permeability of venous walls lead to the release of proinflammatory mediators like tumor necrosis factor (TNF)-α, interleukin (IL)-1β, reactive oxygen species (R.O.S.), and reactive nitrogen species (R.N.S.) in the venous milieu. Pharmacotherapy with nonsteroidal anti-inflammatory drugs (NSAIDs) is often used to relieve pain caused by venous disease. However, there is a need for therapies that target the microcirculatory disorders and act on chronic inflammatory processes. Systemic enzyme therapy (SET), with orally administered combination of proteolytic enzymes- trypsin, bromelain, and flavonoid rutoside, has been used since decades for their anti-inflammatory, analgesic, anti-edematous, antithrombotic and antioxidant properties. This review discusses the various relevant pharmacodynamic properties demonstrated by the ingredients, followed by clinical studies of SET, which have demonstrated benefit in both subjective and objective parameters. These studies indicate that SET has good efficacy, tolerability and holds great promise to improve the quality of life of a patient with CVD.
Radiological and functional outcome of unstable intertrochanteric fractures treated with proximal femoral locking plate
Authors: Singh Chanchal Kumar , Deshpande Juhi
Published: August 2021

Background: Intertrochanteric fracture is a common orthopaedic injury sustained in elderly population because of osteoporosis and trivial fall. Life threatening systemic complications occur mainly due to immobility.

Methods: We included 62 patients (40 males and 22 females) of unstable intertrochanteric fracture (AO 31 A2 and A3) attending Department of Orthopaedics. They were all subjected to surgical treatment with proximal femoral locking plate. Patients were followed up at 3rd, 6th and 12th month for outcomes variables i.e.; functional (Harris hip score, Palmer and Parker mobility score) and radiological outcomes (neck shaft angle, loss of reduction, union and implant related complications). Statistical analysis was done using Friedman’s test after calculating the data in terms of mean and median using SPSS 20 software.

Results: Mean age of our patients was 64 years, 40 were males and 22 females. 50 patients sustained fracture due to trivial fall and 12 due to RTA. 35 out of 62 patients had medical co-morbidites. 26 patients needed open reduction of fracture and 36 were close reduced. 22 of patients had severe comminution (AO A 3 III type). Average blood loss was 254 ml. Mean degree of loss of reduction was 5 degrees in 6th month and 4 degrees in 12th month. Union was achieved in 48 out of 50 patients at 12th month.  Most of the patients achieved fair to good functional outcome scores at 12th month of follow up. We noticed difficulties in fracture reduction as well as complications related to implant.

Conclusions: PFLP is an effective implant in comminuted intertrochanteric fractures with broken lateral wall. Complications can be minimised by following principles of locking plate meticulously.
Evaluation of functional and clinical outcome of open reduction and internal fixation of Barton’s fracture of the wrist in a central hospital of Kashmir
Authors: Bhat Jawed A. , Khurseed Faesal , Javaid Abdul H.
Published: August 2021

Background: Fractures of the distal end of radius continue to pose a management challenge. Defective alignment of extra articular as well as intra articular fractures result in a variety of complications like post traumatic arthritis, decreased in grip strength and endurance as well as limited range of motion and instability of carpus. The main aim of this study is to assess the functional results of open reduction and internal fixation in the treatment of volar Barton’s fracture.

Methods: From December 2006 to December 2019, forty cases of volar Barton’s fracture were operated in Skims Medical College Hospital, Srinagar, Kashmir, however only 32 cases were included in the study group and 8 cases were lost to follow up. In the majority of our cases the injury was sustained as a result of road traffic accident followed by fall. Majority (24) of the cases were operated within one week of trauma, followed by six in two weeks and two in 3 weeks of time since injury.

Results: Functional evaluation was done after a mean follow-up of 28.7 months. Fracture union was achieved within 8 to 12 weeks and excellent results were obtained in 18 cases and 10 cases were categorized as good followed by fair result in 4 cases. Median nerve compression was not observed in any case.

Conclusions: Good to excellent result can be achieved after open reduction and internal fixation which restores joint congruity.
Outcome of posterior lumbar interbody fusion in low-grade spondylolisthesis
Authors: Nimmagadda Vamshikrishna Chand , Seenappa Hiranya Kumar , Mittemari Karthik Narayanamurthy , Paidipati Rajashree
Published: August 2021

Background: Spondylolisthesis is the slippage of all or part of one vertebra in relationship to a caudal vertebra, most commonly occurring in the lumbar spine. Fusion is the recommended treatment of choice. Posterior stabilization with posterior lumbar interbody fusion (PLIF) is an established procedure with good outcomes. To study functional and radiological outcomes of PLIF in grade 1 and 2 lumbar spondylolisthesis.

Methods: This is a prospective study in 30 patients who underwent PLIF and followed up for one year. Functional outcomes were measured in terms of visual analogue scale and the Modified Oswestry Disability Index, and the fusion was assessed on plain radiographs.

 Results: There was a significant improvement in VAS of low back pain (90.71%, p<0.001) and VAS of radiating (82.52%; p<0.001). The ODI scores were significantly improved (63.65%, p<0.001) at 1 year follow up. The fusion rate was 70%, and 56.66% patients reported excellent outcomes.

Conclusions: Based on functional outcomes and the fusion rates of PLIF, we conclude that PLIF is a recommended and excellent surgical option in the management of low grade lumbar spondylolisthesis.

 
Functional outcome of displaced mid shaft clavicular fractures treated by plate fixation: a prospective observational study
Authors: Ebrahim Junaid , Variyathodi Abdul Asraf , Thody Uppil Thody Mohamed Shakeeb Kannan , Chandrasekharan Nithin
Published: August 2021

Background: Clavicle fractures are one of the commonest injuries to the shoulder girdle. Traditionally these fractures are treated conservatively. This study was to assess the functional outcome of displaced mid shaft clavicular fractures treated with plate fixation.

Methods: This was a single center prospective observational study conducted at department of orthopaedics M.E.S medical college Perinthalmanna between the period January 2018 to December 2018 in patients with displaced mid shaft clavicle fractures treated by plate fixation. Out of 51 patients 35 patients were males and 16 were females with mean age of 37.7 years (range 19-59). All patients included in this study were included under Allman group 1. All Patients were treated with plate fixation. Post op follow done at 1 1/2 ,3 and 6 months. During follow up clinical and radiological union were checked. Final functional outcome was assessed at 6 months follow up by Constant-Murley Score.

Results: Out of 51 patients with displaced mid shaft clavicle fractures treated with plate fixation 43 patients (84.3%) showed excellent functional outcome 8 patients (15.7%) showed good functional outcome. None of the patients showed moderate or poor outcome. The radiological union was attained at 9.35 weeks. No complications in 83.4% of patients.

Conclusions: Mid shaft clavicle fractures are more common in young males sustaining high energy trauma, and those fractures treated with plate fixation has a better functional outcome in terms of pain relief, activities of daily living and range of motion.
Delayed fracture union in a case of vitamin D dependent rickets associated with pulmonary tuberculosis - a case report
Authors: Mahajan Neetin P. , G.S. Prasanna Kumar , Patil Tushar C. , Jain Kevin A.
Published: August 2021

Rickets is a defect of bone mineralization caused by vitamin D deficiency, seen most significantly at growth plates that result in radiological bony abnormalities like metaphyseal flaring and cupping, physeal widening with focal and generalised osteomalacia. Here we present a rare case of 7 years old male, a case of vitamin D3 deficiency rickets in a known case of multi drug resistant pulmonary tuberculosis.  The patient had suffered left proximal fibular fracture following trivial fall 1.5 month back and had delayed bony union leading to difficulty in walking and pain. The patient was treated with oral vitamin D supplementation. In vitamin D deficiency rickets, there is decreased bone mineralization leading to weak bones and delayed fracture healing in children. Low serum vitamin D levels also caused decreased immunity with increased susceptibility to respiratory infections like pulmonary tuberculosis. Appropriate treatment with injectable or oral vitamin D3 with adequate exposure of sunlight and proper nutrition is the best modality of treatment.

 
A retrospective study on management of bell\'s palsy in a tertiary care hospital
Authors: Purushothaman P.K , Harshidan Dhanyan , Elangovan Priyangha
Published: August 2021

Bell's palsy is the most common facial nerve disorder. The clinical symptoms of Bell's palsy include facial muscle paralysis, difficulty in eating, drinking and talking. Bell's palsy management is still controversial. Many patients recover spontaneously; some require medicines like corticosteroids, antiviral drugs and other managements.

To study the effectiveness of Bell's palsy management that has been followed in our institution.

This analysis had carried out from June 2016 to June 2019at SRM Medical College Hospital and Research Institute, Chennai. Total of 30 patients with Bell's palsy who had admitted in the Department of Otorhinolaryngology had enrolled in this study. All the patients underwent thorough clinical examination and laboratory investigation, and the results were statistically analyzed and discussed.

Out of 30 patients, 16(53%) patients were males, and 14(47%) patients were females. 53.3% of patients had onset of symptoms after 48 hours. There was a statistical significant improvement in House-Brackman scale on 6 months follow-up.

The therapeutic measures for Bell's palsy if initiated within 72 hours of onset aids in bringing better outcome and improves the quality of life in patients.