bluuebunny/crossref_metadata_2025 huggingface dataset:
Compare the level of pain using faces pain scale and colour analogue pain scale among children aged between 6 to 12 years attending in pediatric ward
Authors: Priyadarsini A. , Roshna P.S. , Jagadeeswari J. , Cecyli C. , Jency J.J.
Published: April 2023

Faces pain scale and colour analogue pain scale are two methods to assess the pain of the children. There many method to assess the pain of the children but mostly all the hospital is using faces pain scale to assess the pain of the children. Pain perception in children is a very controversial topic in children admitted in hospital. So the present study aims to compare faces pain scale and colour analog pain scale in children undergoing therapeutic procedure such as intravenous injection, intramuscular injection, postoperative children, venipuncture and other invasive procedure in Saveetha Medical College and Hospital. A Quantitative research approach with comparative research design was adopted to conduct the study among 60 children added between 6 to 12 years attending pediatric ward who were selected by non-probability convenient sampling technique. A semi-structured interview method was used to collect demographic data and pain is assessed using faces pain scale and colour analogue pain scale in Saveetha medical college and hospital. The result of the study shows that among 60 samples proves that the mean score of faces pain scale was 4.95±2.50 and the mean score of colour analogue scale was 4.77±2.83. The calculated paired ‘t’ test value of t = 0.747 was not found to be statistically significant which clearly infers that there was no significant difference in the pain score measured by faces pain scale and colour analogue scale among children 6 – 12 years attending pediatric ward.
Impact, capabilities, and credibility of video assistant referee in football/soccer
Authors: Das S. , Damle M.
Published: April 2023

The penetration of technology & media advances into football has improved referees’ choices on contestable objectives. This paper analyzes the reception of Video Assistant Referees (VAR) and Goal Line Technology (GLT), and how the understanding of the correspondence between arbitrators influences the result of the games. In this study, we take a few examples of use cases where VAR has given major yet confusing decisions that drastically affected the match’s outcome. This investigation is planned for investigating the informative frame of reference for off-field and on-field referees. Decision-making is a critical aspect of soccer. As small as a third division match to as big as a world cup final, one wrong decision on the part of the on-field referee can change the match’s outcome. Therefore, this exploration attempts to build up whether the dissemination of computerized media innovation into football administering has to ban human mistakes and goofs imagined in simple pitch and officials, subsequently setting the glue for negligible blunders in the present-day period advanced and digital officiating.
Pesticide contamination and influence of various processing factors on pesticide residues in tea – an integrative approach
Authors: Ungarala R.V. , Medithi S.
Published: April 2023

The second most commonly consumed beverage in the world is tea. Various forms of tea are destroyed and reported to show tremendous potential use in human health after consumption. Contamination of tea with pesticide residues is a constant concern from a human health point of view. This integrative review aims to evaluate pesticide residues in market tea samples and understand the behavior of pesticides while undergoing various manufacturing processes. Appropriate databases and search terms were used to conduct the literature search, and it was restricted to original research articles only. About 1406 articles were found from the primary search. However, after thorough streamlining, only 24 studies were included in the review. The monitoring studies conducted in the past decade highlighted the matter of concern. Further, the behavior of pesticide residues was explored under three main stages, including pesticides during the cropping period, manufacturing, and infusion. Various factors were identified which can degrade the residual concentrations of pesticides in tea. The articles also attenuate few suggestive measures which can pilot pesticide degradation. The attention was drawn to farmers, manufacturing unit workers, and consumers who can effectively control the pesticide residues in the final product of tea. However, the review also noted the scarcity of research conducted on this food commodity and suggested periodic monitoring.
Customer Satisfaction towards Convenient Grocery Shopping from Provisional Stores during COVID-19
Authors: Narayan R.N. , Mehendale S.
Published: April 2023

Customer satisfaction has a crucial role in forming consumers’ subsequent purchase behavior and intentions. This study aims to identify the determinants of consumer satisfaction towards convenient grocery shopping from Indian provisional stores and to examine the customer satisfaction level towards each of these convenience variables during COVID-19. A total of 378 consumers of provisional or Kirana stores spread across India were surveyed using a structured questionnaire. The data gathered was analyzed using factor analysis, multiple linear regression, descriptive statistics, and average percentage scores. The results suggest that the consumers are highly satisfied with easy and fast access to the store and an extent to the acquisition of the product and hygiene of the store but require significant improvement in the product search process and transaction period in the store. Public spending on groceries has increased since the COVID-19 pandemic, owing to the partial closing of many food-away-from-home establishments. Though grocery shopping is necessary, little is known about the complex relationship between the COVID-19 pandemic and grocery shopper behavior. We performed an online framed decision experiment to evoke expectations for ordering processes, time windows, minimum order conditions, and fees to inform heterogeneity in grocery shopper behavior under different COVID-19 pandemic scenarios.
Organ trafficking and the legal framework in India: a critical analysis of the transplantation of human organs and tissues act, 1994
Authors: Quader S. , Khan S.A.
Published: April 2023

Organ trafficking, due to its subtle nature, is a less-addressed form of trafficking, among others. It has been decades that the first-ever successful organ transplantation took place. Since then, medical science has advanced in leaps and bounds to gift us another chance of life, even in cases of acute organ failures. However, this has created a huge demand for transplantable organs building an unbridgeable gap between its demand and supply, which on the other hand, has generated booming markets for the illegal sale of organs leading to organized crime of organ trafficking, especially in the developing nations. The Transplantation of Human Organs Act (THOA), 1994, was enacted to provide regulatory frameworks and prevent the commercialization of human organs in India. Although THOA, with its latest amendments and rules, is somewhat successful in curbing the menace, recent studies show that it has failed to achieve its goals largely. The authors in this paper argue that the existing laws in India dealing with organ trades and trafficking are inadequate, in comprehensive, and lags far behind compared to the advancements in medical technologies and report the findings of a systematic analysis of THOA, highlight inadequacies, and recommends relevant reforms.
Challenges and solution of digitalization in retail sector of India during covid-19
Authors: Jain A. , Pande M.
Published: April 2023

Digitalization has helped in the transformation of several industries in the last 20 years. Merging various computer functionalities, such as internet facilities usage, super-fast processing ability, improved ability to acquire, and utilizing digital form data is a major success factor in this context. In this paper, we would mainly like to focus on the retail sector and how digital platforms transform the logic of retail exchanges and assess the challenges where digitalization can overcome in retail industries. In this day and age of the internet and electronic gadgets, almost everything is going virtual. A large portion of the population is finally transitioning from traditional to modern technology for any transaction type, whether banking, business, selling, and purchasing or any other activity. The digital revolution has significantly altered the efficiency and speed of economic operations, particularly during the recession and after the pandemic, which caused the global economy to slow. As a result of this situation, and to avoid a breakdown shortly, the global economy has been revolutionized by the internet and digital devices.
Effect of covid 19 on it business and stock market
Authors: Barman A. , Kulkarni A.
Published: April 2023

During a pandemic, the most affected aspects are the business economy and other sectors and areas globally. This research analyses the IT sector’s condition during COVID-19 by taking a sample of four companies, analyzing the stock market and financial records of the previous few months, and predicting future stock market value to see the stock market graph. Random function and MS excel used for prediction of future stock market and records of the previous financial year to conclude status of the company with graphs. After analyzing a four-sample company, a conclusion for the sector is provided. Research analysis found most companies are stable even though they are going through certain losses because of their existing assets, fluctuating financial records, and stock market graphs. Sample companies can easily recover losses and still showing a bullish graph successfully. Even though suffering a percentage of error with the actual stock market price, it successfully portrayed the IT industry scenario in this uncertain situation. However, the magnitude of the impact has never been precisely calculated. This thesis suggests a COVID-19 impact calculation model. Assets gains in the COVID-19 timeframe are weighted means of prior COVID-19 standard yields and COVID-19-induced returns in the proposed model. The COVID-19-generated gains are negatively auto-correlated and extremely unpredictable, and they substitute the prior COVID-19 standard gains. During the COVID-19 era, the COVID-19-generated gains are unique natural gains.
Understanding Investors Behaviour Based On Changing Market Scenario Due to COVID-19
Authors: Yadav G. , Dhaigude R.
Published: April 2023

COVID-19 has created a misbalance in the global economy by affecting multiple sectors. It has also affected the mindset and, consequently, the behavior of economic agents, one of whom is the investors. This study aims to learn about investors’ investment behavior in COVID-19 by looking at their preferred sources of information, which influence investment decisions, and their preferred investment avenues. A deep learning model is also proposed for accurately predicting stock market movement. For this study, data was collected from 50 investors. Factors such as the respondents’ age, salary, educational background, investment experience, and income were considered when selecting the sample. According to the findings, most investors trust modern investment vehicles such as stocks and mutual funds. For most investors, liquidity and fund safety have emerged as the most important factors influencing their investment goals. A deep learning model proposed is a combination of CNN network plus bidirectional LSTM network.
Impact of COVID-19 and Online Streaming Services on the Movie Theater
Authors: Akram M. , Bhoyar P.K.
Published: April 2023

Movie Theaters in India face a big crisis amid COVID-19, which leads to the shutdown of Theaters for more than five months. In the meantime, Online Streaming Services are expanding their business and revenue like never before. This scenario raises the very prominent questions (1) whether the movie theater business will survive this hard time and get back to normal growth and business once COVID-19 cases will reduce. The situation gets back to ‘old normal’. (2) Will Online Streaming services and Movie Theater business co-exist in the future, as Satellite TV and Movie Theater exist for many decades. Based on data from an empirical survey conducted among regular moviegoers, this paper questions the claims of the industry that the Movie Theater business is in danger due to the emergence of online streaming services. It has been observed that the increase in traffic on these online streaming services is mainly because of the lockdown situation, and once theater reopens and the COVID-19 health crisis went, people will get back to Theaters in a large number. Data from the reopening of Theaters in other countries are also showing the same result.
Effects of Country of Origin on Imported Cosmetics and Skincare Products in India
Authors: Shokeen T. , Bhoyar P.K.
Published: April 2023

The county of origin research has studied the influence of a product’s origination on a buyer’s impression. According to the literature, the country-of-origin effect would lead Indian consumers to choose domestic cosmetics and skincare goods over imported cosmetics and skincare products. Age and gender are taken into account to see how they affect the COO and other factors in the research. The study’s goal was to get 266 active surveys. SPSS 21.0 was used to analyze the data. To assess consideration, factor analysis was carried out using a t-test and a one-way ANOVA. The findings revealed a flimsy beneficial influence on Indian individuals’ views and thinking of foreign products. The study’s conceptual and pragmatic inference is proven by making suggestions for additional investigation. Cosmetics are becoming increasingly important for women and men worldwide as the need for beauty and personal care grows in modern life. This study provided an overview of the influence of extrinsic signals linked to cosmetic goods such as brand, price, and country-of-origin (COO) on female customers and the cosmetic business in Vietnam, based on papers with relevant theories and literature. The information might be used to develop a model or framework for future consumer behaviour research.
Impact of COVID-19 on Sports Industry
Authors: Mishra R. , Pillai S.
Published: April 2023

Objectives: To find the impact of COVID-19 on the sports industry and how the industry will adapt to the changes. Methodology: Secondary data was collected from several websites related to various sports’ revenues, broadcasting, and sponsorships. Primary data was collected in the form of public opinion to analyze the change in the coming years. A qualitative method was used for the analysis. Findings: After analyzing the data following results are indicated concerning the changes in the sports industry: a) Sports industry is set to take a massive loss in terms of revenue, b) The public would not attend any sports event until early next year or until a vaccine is developed, whichever is the earliest. Limitations: The limitations of the research could be the revenue data which is likely to change with the resumption of sporting activities. Public opinion might vary as the situation improves, and the idea will differ from one country to another. Application: The study will be helpful for all sports enthusiasts as they would get to know the overall industry scenario and for students who would want to explore the sports industry from the outside.
Impact Of You Tube On Millennials Buying Decision
Authors: Abhishek M. , Pradhan V.
Published: April 2023

Objective: Customer thinks many times before the purchase of service or product. Many people prefer different sources to identify its legality, such as YouTube, friends, and relatives influencing their purchase decision. Therefore, the main aim of the research reflects on the factors influencing millennial buying decisions while referring to YouTube. Method: Through the structured questionnaire using the Likert scale, the data has been collected through an online survey where research found 132 respondents as sample size. The one-sample test has been computed to prove the significance of four factors. Findings: The study found there are four factors (Presentation of Product, Feedback of Customers, Trust on Familiar Channels, and Satisfaction Level) that have a significant impact of YouTube on millennials’ buying behavior. Practical Implication: An implementation of such factors could work for them if applied effectively and attractively. Consumers only want accurate and trustworthy detail so that they can think about purchasing. Originality/Value: By applying theories and evaluating the buying behavior of millennials, researchers have studied the impact of YouTube on the purchase intention of millennials, but significant factors have not come out. The current research considers such factors what millennials see on YouTube and impacts on their purchase decision
Analysis and Comparison of Prediction of Heart Disease Using Novel K Nearest Neighbor and Decision Tree Algorithm
Authors: Pavithraa G. , Sivaprasad S.
Published: April 2023

Aim: Prediction of coronary illness utilizing novel Novel k nearest neighbor (KNN) and contrasting its accuracy with decision tree algorithm. Materials and Methods: Two gatherings are proposed for foreseeing the accuracy (%) of coronary illness. To be specific, novel Novel k nearest neighbor and decision tree algorithm. Here we take 20 examples each for assessment and look at. The sample size was calculated using G power with pretest power at 80% and the alpha of 0.05 value. Result: The decision tree gives better accuracy (84.95%) contrasted with the Novel k nearest neighbor accuracy (76.29 %). Along these lines the factual meaning of the decision tree is superior to the novel k nearest neighbor algorithm with significance value of 0.115. Conclusion: From the outcome, it may very well be inferred that the decision tree helps in anticipating the coronary illness with more precision contrasted with the novel k nearest neighbor algorithm.
Analysis and Comparison of Kidney Stone Detection using Minimum Distance to Mean Classifier and Bayesian Classifier with Improved Classification Accuracy
Authors: Kishore U. , Ramadevi R.
Published: April 2023

Aim: The goal of this research is to use minimum distance to mean classifier and bayesian classifiers to predict and detect kidney stones. Materials and Methods: This investigation made use of a collection of data from Kaggle website. Samples were collected (N=10) for normal kidney images and (N=10) for kidney with stone images. Total sample size was calculated using clinical.com. As a result the total number of samples 20 was considered for analysis. Using Matlab software and a standard data set collected from Kaggle website, the classification accuracy was obtained. Pretest G power taken as 85 in sample size calculation can be done through clinical.com. Results: The accuracy (%) of both classification techniques are compared using SPSS software by independent sample t-tests. There is a statistical significant difference between minimum distance to mean classifier and Bayesian classifier.Comparison results show that innovative minimum distance to mean classifier give better classification with an accuracy of (78.85%) than bayesian classifiers (71.1314%).There is a statistical significant difference between minimum distance to mean classifier and bayesian classifiers. The Minimum Distance to Mean classifier with p=0.708, p>0.05 insignificant and showed better results in comparison to Bayesian classifiers. Conclusion: The Minimum Distance to Mean Classifier appears to give better accuracy than the Bayesian Classifiers.
Bounce of caregivers expressed emotions on schizophrenia
Authors: Ajithakumari G. , HEMAVATHY V.
Published: April 2023

Schizophrenia is a severe type of mental illness that is both persistent and burdensome. Because they are under a lot of stress coping with caring for schizophrenia patients, family members of these patients often have a negative attitude and a wide spectrum of expressed emotion towards them. The quality of interaction patterns and the type of family ties among family caregivers and individuals with schizophrenia and other psychiatric conditions are classified as an unfavorable family environment. [1] Large volumes of emotion directed directly at a person or within a family environment are referred to as “high expressed emotion.”One or more parents’ critical or emotionally over-involved attitudes and behaviors toward their schizophrenia offspring are referred to as expressed emotion. [2]. Any aberrant processes inside a family, such as conflict, communication problems, cold parenting, criticism, control, and excessive amounts of expressed emotions, are referred to as family dysfunction.. These could be risk factors for schizophrenia onset and maintenance. Schizophrenics who returned home to such a family were more prone to relapse than those who returned home to a family that expressed little or no emotion. While not on medication, returning to a high expressed emotion family resulted in a large rate of recurrence. [20] Family members of schizophrenia patients require psychosocial nursing care to assist them cope with their stress. [21]
Analysis and Comparison of Image Enhancement Technique for Improving PSNR of Lung Images by Unsharp Mask Filtering Technique over Histogram Equalization Technique
Authors: Sabarish R.T. , Ramadevi R.
Published: April 2023

Aim: The goal of study in this image enhancement technique is to enhance both contrast and sharpness of an image simultaneously to improve PSNR. Materials and Methods: Both unsharp mask filter and novel histogram equalization techniques were implemented on lung images which were collected from kaggle software. Samples were considered as (N=30) for unsharp mask filtering and (N=30) for novel histogram equalization technique with total sample size calculated using clinical. com. As a result the total number of samples was calculated as 60. Matlab coding was written for extracting PSNR values of each image. Comparison and analysis has been made through SPSS software. Results: In the final output of image enhancement, novel histogram equalization technique shows better performance in improving PSNR of lung images than unsharp mask filtering technique. Comparison of PSNR values are done by independent sample test using IBM-SPSS software. There is a statistical difference between histogram technique and unsharp mask filtering. The novel histogram equalization technique showed higher results of PSNR (67.2860dB) with (p=0.04) in comparison with unsharp mask filtering (37.9313dB). Conclusion: Within this research study histogram equalization image enhancement technique has greater PSNR value of lung images than unsharp mask filtering technique.
Analysis and Comparison for Innovative Prediction Technique of COVID-19 using Support Vector Machine over Neural Network algorithm with Improved Accuracy
Authors: Charan G.V.S. , Kumar N.S.
Published: April 2023

Aim: The primary purpose of this study is to improve the accuracy of COVID-19 prediction and evaluation. Materials and Methods: This project is based on data extracted from Kaggle’s website, which is separated into two categories. According to the total sample size estimated by clinical.com, each group comprises 20 samples (N=20) for both the Support Vector Machine (SVM) and Neural Network methods, by keeping 0.05 alpha error-threshold, 95% confidence interval, enrolment ratio at 0:1, and G power at 80%. In MatLab 2021a, this entails training the data and verifying 20 validations ranging from 5 to 24. Results: The SPSS Software and Independent sample T-test are used to contrast the accuracy, sensitivity, and precision rates. The Neural Network has 94.55 percent accuracy (P<0.001), 93.11 percent sensitivity (P<0.001), and 95.31 percent precision (P<0.001), compared to 91.25 percent accuracy (P<0.001), 93.93 percent sensitivity (P<0.001), and 86.11 percent precision (P<0.001) for the SVM. Conclusion: The Neural Network algorithm outperforms the SVM approach in terms of results.
Analysis And Comparison Of Ventricular Cardiac Arrhythmia Classification Using Calcium Channel Parameters With KNN And ANN Classifier
Authors: Mahanya G.B. , Nithyaselvakumari S.
Published: April 2023

Aim: Aim of this research is to analyze and compare ventricular cardiac arrhythmia classification using calcium channel parameters with Artificial Neural Network (ANN) and K- Nearest Neighbour (KNN) classifier. Materials and Methods: For the classification of arrhythmias, A.V.Panifilov (AVP) is used. THVCM contains well defined Calcium channel dynamics and its properties. Sample size was calculated by keeping threshold 0.05, G Power 80%, confidence interval 95% and enrolment ratio as 1. Number of samples considered is 20 for each analysis and will be imported to the classifier such as K-Nearest Neighbour (KNN) and Artificial Neural Network (ANN) classifiers to find better accuracy. Finally, the results (accuracy) will be validated by using Statistical Package for the Social Science (SPSS) software. Results: The results obtained from Normal, Tachycardia and Bradycardia data are imported to the ANN and KNN classifier. In which KNN shows accuracy value (12.3950%), standard deviation (0.96490) and Standard error mean (0.21576). And ANN shows accuracy value (35.3400%), standard deviation (3.22285) and Standard error mean (0.72065). Conclusion: From the results, it is concluded that ANN produces better results when compared with KNN classification in terms of accuracy.
Analysis And Comparison Of Ventricular Cardiac Arrhythmia Classification Using Sodium Potassium Pump Channel Parameters With ANN And KNN Classifier
Authors: Mahanya G.B. , Nithyaselvakumari S.
Published: April 2023

Aim: The intent of this research is to analyze and compare ventricular cardiac arrhythmia classification using sodium potassium pump (Na+/K+) channel parameters with Artificial Neural Network (ANN) and K-Nearest Neighbor (KNN) classifiers. Materials and Methods: P.J.Noble and A.V.Panfilov model (PJAV) is used for human ventricular study based on the action potential distance. PJAV uses alternative methods of computer simulations which include major ions, pumps and exchangers. Sample was calculated by keeping threshold 0.05, G Power 80%, confidence interval 95% and enrolment ratio as 1. Number of samples considered is 20. According to these data the accuracy is obtained from the classifiers by training novel ANN and KNN classifiers by alternating the Cross fold validation to obtain 20 different samples. These samples are imported to Statistical Package for the Social Science (SPSS) software for graphical representation and overall accuracy. Result: The concluded results shows that ANN has accuracy of 12.25% with standard deviation (4.0911) and Standard error mean (0.9148). Similarly KNN produces an accuracy value of 4.54 % with standard deviation (2.5732) and Standard error mean (0.5754). Conclusion: As of the results, it clearly shows that ANN has better accuracy for classification than KNN.
Analysis and Comparison for Prediction of Diabetic among Pregnant Women using Innovative K-Nearest Neighbor Algorithm over Logistic Regression with Improved Accuracy
Authors: Kumar P.V.S. , Kumar N.S.
Published: April 2023

Aim: In comparison to the K-Nearest Neighbor (KNN) algorithm, Logistic Regression (LR) was used in machine learning algorithms for the prediction of diabetes among pregnant women to get better accuracy, PEARCEsensitivity, and precision. Materials and methods: To verify the usefulness of the technique, researchers collected data sets from free available data sets such as the Pima Indian dataset from the UCI website to examine diabetes among pregnant women. There are two groups in this study: K-Nearest Neighbor (N=20) and Logistic Regression (N=20), each having a sample size of 40. A pre-test power of 80%, a threshold of 0.05, and a confidence interval of 95% are used in the sample size calculation. Results: The accuracy, sensitivity, and precision of algorithms are used to evaluate their performance. K-Nearest Neighbor (KNN) accuracy rate is 72.44 percent, but Linear Regression (LR) accuracy is 76.67%. The sensitivity rate for K-Nearest Neighbor is 74.42 percent, while the sensitivity rate for Linear Regression (LR) is 76.16 percent. The precision rate for K-Nearest Neighbor (KNN) is 73.75percent, whereas the precision rate for Linear Regression (LR) is 81.87 percent. The accuracy rate is significantly different P=0.366 (P>0.05). Conclusion: When compared to the Innovative K-Nearest Neighbor algorithm, the Logistic Regression algorithm predicts better classification in discovering the accuracy, sensitivity, and precision for accessing the rate for prediction of diabetes among pregnant women.
Analysis and Comparison of Image Enhancement Techniques for Improving PSNR of Liver Image by Median Filtering over Wiener Filtering
Authors: Prasad K.D. , Ramadevi R.
Published: April 2023

Aim: The purpose of this study is to use median filters and wiener filters to minimize noise in liver images in order to improve them. In addition, the output of both filters was analyzed based on their Peak Signal to Noise Ratio (PSNR). Materials and Methods: The research includes two groups; each group has a sample size of 20. Grayscale medical images collected from the kaggle website were used in this research. Samples were considered as (N=20) for guided filter and (N=20) for fast bilateral filter with total sample size 40 calculated using clinicalc.com. Image enhancement is used to enhance the niceness of a picture for the visible notion of human beings. The kaggle website was used to collect data for this study. According to clinical.com, samples were considered as size 20 for PSNR ratio of image G power of 80%, and total sample size determined. Using matlab programming and a standard data set, the Linear filtering, Median filtering were computed. Results: According to Matlab simulation results, unique median filters have a PSNR of 48.1240, while wiener filters have a PSNR of 67.8360. Comparison of PSNR values are done by independent sample test using IBM-SPSS software. There is a statistical insignificant difference between both techniques. The significant value of PSNR (Peak Signal to Noise Ratio) (0.409) and p>0.05 was found in the statistical analysis. Conclusion: On ultrasound liver pictures, the innovative median filter gives greater PSNR than the wiener filter for medical image enhancing purposes, according to this study.
Comparative study between ultrasound guided modified pectoral nerve block versus erector spinae block in breast surgeries-prospective randomised comparative study
Authors: Shanmugam Priadharshini , Dunna Hemalatha , Paleti Sophia , A. Venkateswara Rao
Published: April 2023

Background: Breast cancer is the most common cancer in women, comprising approximately 25% of all cases. Failure to provide effective pain control is associated with poor quality of recovery & chronic postsurgical pain after breast surgery. According to a recently published PROSPECT guideline, pectoral nerve (PECS) blocks seem to be an effective alternative to PVB for postsurgical pain management in breast surgery. In order to relieve post-operative pain in patients undergoing MRM, in this study we compared the efficacy of modified pectoral nerve block versus erector spinae plane block for breast cancer surgeries.
Methods: A comparative study was conducted among 80 female patients of age 25-65 years scheduled for modified radical mastectomy surgery with ASA class I and II after obtaining approval from ethical committee. Written informed consent was obtained and research process were explained to the patients. They were randomly allocated into two groups of 40 each. Group 1: was assigned to receive 0.2% Ropivacaine 25ml for Erector spinae block and Group 2: Was assigned to receive 0.2% ropivacaine 25 ml for modified pectoral nerve block, p value <0.05 was considered statistically significant.
Results: In patients receiving modified pectoral nerve block (PEC 2) there was considerably lesser opioid consumption, Ionger duration of analgesia and lesser postoperative pain score as compared to patients receiving erector spinae block (ESP) for modified radical mastectomy surgeries.
Conclusions: Modified Pectoral nerve block is a potential analgesic technique in breast surgeries since it has less perioperative opioid consumption, proIonged duration of anaIgesia, Iesser postoperative pain score when compared to Erector Spinae block.
Use of off-label drugs in the neonatal intensive care unit in India
Authors: Amit Jain  , Shashikant Dhir  , Satinder Kaur Sandhu
Published: April 2023

Background: Off-label use of drugs is widespread in pediatrics and almost all neonates hospitalized in NICU are affected by the use of off-label drugs regardless of gestational age and birth weight. This is because of the lack of regulation for medications in the neonatal population and the delays in updating drug instructions. This is mainly due to the ethical difficulty in the research and difficulties in conducting clinical trials in this vulnerable population. Hence, the study was planned to assess the extent of the use of off-label drugs in the NICU.
Methods: An observational study was carried out in the NICU of a tertiary care center from May 2021 to Oct 2022 and case records of neonates admitted to the NICU were evaluated.
Results: Among 1745 drug prescriptions in 360 neonates, 1208 (69.22%) were off-label. Anti-infectives were the most commonly used off-label class of drug, Piperacillin+tazobactam was the most commonly used off-label drug and most common reason for off-label prescriptions was indication and administration. It was found that 79.44% of neonates received at least one off-label drug.
Conclusions: Off-label use of drugs, specifically anti-infective drugs, is common in NICUs of India as in other countries. So, more research should be done to generate evidence-based guidelines for the rational use of drugs in neonates.
A case report on Beckwith-Wiedemann syndrome with macroglossia
Authors: Jefferey Joel  , Priya A.  , K. Arun Chander
Published: April 2023

Beckwith-Wiedemann syndrome (BWS) is a genetic disorder characterized by the overgrowth of various body parts and an increased risk of certain types of cancer. One of the physical features of BWS is macroglossia or an enlarged tongue. In some cases, macroglossia can cause difficulty with speaking, eating, and breathing. A case report on BWS with macroglossia and reduction glossectomy would describe the patient's symptoms and medical history, as well as the diagnosis, treatment, and outcome of the condition. The patient, a 6 -year-old female, presented with symptoms of macroglossia, which was confirmed by physical examination. The patient also had a history of BWS, which had been diagnosed at birth. The patient's macroglossia was causing difficulty with speaking and eating regurgitation of food through the nose and was also putting her at risk for sleep apnoea. After a thorough evaluation, the decision was made to perform a reduction glossectomy, which is a surgical procedure that involves removing a portion of the tongue in order to reduce its size. The surgery was performed under general anaesthesia and was successful in reducing the size of the patient's tongue and improving his ability to speak and eat. The patient recovered well from the surgery and was discharged from the hospital after 3 days of admission. At the 3 months follow-up appointment, the patient had no difficulty with speech, or eating and did not have sleep apnoea. This case report highlights the importance of early diagnosis and treatment of BWS, as well as the potential benefits of reduction glossectomy in managing the symptoms of macroglossia in this condition.
Risk factors for asphyxia neonatorum in full-term newborns at the University Hospital of Mahajanga Madagascar
Authors: Razanamanana Safidisoa N. , Henintsoa N. Raveloharimino  , Setra H. Rambeloson  , Norotiana H. Rabesandratana  , Diavolana K. Andrianarimanana
Published: April 2023

Background: The aim of this survey was to study the risk factors associated with asphyxia neonatorum in full-term newborns in the neonatal unit in Child and Mother Complex at Androva Mahajanga Hospital.
Methods: This was a retrospective case-control study conducted from August 2016 through September 2018.
Results: The prevalence of neonatal asphyxia was 5.9%. Determinant factors for birth asphyxia were maternal education level below the tenth grade [OR=1.8 (1.2-2.6), p=0.003] especially if the mother was illiterate [OR=2.3 (1.5-3.6), p<0.001]; less than four prenatal care check-ups [OR=2.9 (1.7-4.9), p<0.001]; presence of maternal disease during pregnancy [OR=2.4 (1.6-3.6), p<0.001], arterial hypertension [OR=3.4 (1.6-7.2), p<0.001]; duration of labour ≥24h [OR=2.1 (1.2-3.6); p=0.007] ; rupture of membranes ≥12h [OR=2.9 (1.6-5.3), p<0.001]; labour outside teaching hospital [OR=21,1 (8,9-49,5), p<0,001]; home birth [OR=26.7 (3.6-199), p<0.001].
Conclusions: Good monitoring of pregnancy, training of providers in neonatal resuscitation, and an increase in technical platforms could reduce the incidence of perinatal asphyxia.
Nutritional assessment of pre-school children in Anganwadi centres and to understand its association with various socio-demographic factors
Authors: Najiya  , Roshni Gangan
Published: April 2023

Background: Malnutrition is clearly linked to inappropriate feeding practices rather than food availability or household food security. A proper diet is essential from early stages of life for growth and development.
Methods: It was a cross-sectional study.
Results: Eighty-six percentage of children had normal weight for age, while 8.6% had low weight for age. 5% of children were stunted. Female children, those living in joint family, those having more number of siblings, low educational qualification of parents and late weaning were associated with under nutrition and stunting.
Conclusions: Results of the present study showed that the nutritional status of children in the studied population were better compared to other available studies and the national standards.
Prognostic significance of serum pro-calcitonin level in paediatric intensive care unit patients
Authors: Penugonda Sudheer Kumar  , Ajay Kumar  , Monica N. Belagodu  , Gera Rani
Published: April 2023

Background: Serum procalcitonin (PCT) is already known predictive marker in serious bacterial infection and it is emphasized that these biomarkers can be used as a marker of increased mortality in critically ill patients. The aim of the study was to evaluate the serial PCT level and find out whether these biomarkers can be used to predict mortality.  
Methods: This was a prospective observational study. Primary objective was to study the serum PCT as a prognostic marker in critically ill children (2 months to 12 years) admitted in PICU while secondary objective was to find out the association of level of serum procalcitonin with different organ system disease involvement and to compare the results of the serum procalcitonin with the PRISM-3 score in diagnosing the severity of illness in the patient. Patient outcome was assessed at hospital discharge, and the patients were divided into non-survivors and survivors. A p value of <0.05 will be considered statistically significant.
Results: A total of 185 patients were enrolled, the median age was 5 years (2 months to 12 years) with 56.76% being males. Majority (34.59%) of patients the primary diagnosis was of respiratory system. The median of serum PCT on day 1, day 3 and day 7 with outcome (p<0.05) in dead was significantly higher as compared to alive. The median PRISM score in dead was 21(13-33) which was significantly higher as compared to alive 11 (8-12.7). Serum PCT and PRISM score had significant discriminatory power to predict mortality.  
Conclusions: In the present study serum PCT found to be a good prognostic marker for all cause mortality in critically ill patients admitted in PICU.
Congenital bilateral scrotal agenesis with bilateral cryptorchidism: a case report
Authors: Ram Jeewan Singh  , Bijay Kumar Suman  , Keerthana Bachala  , Amit Kumar Sinha  , Bindey Kumar
Published: April 2023

Congenital bilateral scrotal agenesis is very rare anomaly and characterized by the absence of scrotal rugae. It may be associated with other extra-genital anomalies as a part of a syndrome. Etiology is unknown but may be due to primary failure of labioscrotal folds development or secondary to localized 5-alpha-reductase type 2 deficiency. Various surgical techniques used for neoscrotum construction with different types of complications. In index case, we performed bilateral orchidopexy without creating neoscrotum.
Self-knotting of infant feeding tube in urethra in male child an unfortunate complication-case report
Authors: Bijay Kumar Suman  , Ram Jeewan Singh  , Keerthana Bachala  , Amit Kumar Sinha
Published: April 2023

Urethral catheterisation is a common routine procedure. Knotting of infant feeding tube in genitourinary tract is a rare complication. Various methods have been used in the removal of a knotted catheter. The methods include gentle but sustained traction under general anaesthesia, open cystostomy and endoscopic retrieval.
A giant congenital ranula: ignorance leading to feeding difficulties
Authors: Bachala Keerthana , Bijay Kumar Suman  , Ram Jeewan Singh  , Shreyas Dudhani  , Amit Kumar Sinha
Published: April 2023

The term “Ranula” originates from the Latin Word Rana which means “underbelly of a frog.” Ranula are epithelial retention cyst or mucus extravasation pseudo cyst arising from the sublingual glands. They are rare in children. A one-year-old female was brought to paediatric surgery emergency OPD by her mother with complaints of swelling arising from oral cavity since birth, gradually increased in size to attain current size. Mother also gives History of difficulty in feeding. Clinical examination revealed a large protruded tongue, with a cystic swelling in the floor of the mouth measuring around 6×4 cm, with elevation of the tongue. Child was further evaluated; ultrasound was suggestive of ranula. Marsupialisation of the cyst was done. Intraoperatively, cyst fluid was aspirated for analysis and cyst wall was opened and excised, lateral margins of cyst were sutured to base of mouth. Cyst fluid analysis revealed elevated amylase and normal LDH levels. The post-operative period was uneventful. The histopathology report showed a pattern consistent with ranula. Child was followed up for a period of 1 year and there was no evidence of recurrence. We report a case of giant congenital ranula. The rarity of this condition in children and its atypical size make this case report unique. We treated the child with marsupialization and there was no recurrence noted. Hereby I would like to state that congenital symptomatic ranulas though rare can be managed with marsupialisation.
Exercise-induced urticaria with muscle injury: a case report
Authors: S. Mithra , Narasingan Monisha
Published: April 2023

Exercise has become an integral part of life in this modern era due to sedentary lifestyle. Although, urticaria patients are being evaluated for all the common triggering factors like food, environmental allergens and infections, an entity called exercise induced urticaria often get missed. Exertional and asymptomatic rhabdomyolysis must be kept in mind during evaluation. A 27 year male patient was diagnosed with severe exercise induced urticaria with muscle injury. Patient developed urticaria within 30 minutes of strenuous exercise. Clinical history was insignificant for any allergen exposure except for clear history of urticaria once weekly after strenuous exercise. Patient also reported need for oral analgesics on the day of strenuous exercise indicating muscle injury. Asymptomatic phase correlated with abstinence of exercise. His lesions gradually got relieved with anti-histamines. Routine blood investigations were normal except elevation of aspartate aminotransferase (AST-354U/L), Lactate dehydrogenase (LDH-619U/L) and normal alanine aminotransferase (ALT-51U/L), altered AST/ALT ratio more than 6. Creatinine kinase (CK) can increase ten folds in healthy individuals following strenuous exercise. Hence, CK was not done for this patient. Aminotransferases may remain elevated even after normalisation of CK up to 2-3 weeks.  LDH was done as an additional investigation. Simple routine investigation for altered AST and confirmation with LDH or CK for its source from muscle injury can be done. Severe exercise induced urticaria with muscle injury can be managed with moderation of exercise intensity along with short course of antihistamines owing to the benefit of exercise. This patient was followed up for 2 years and there was no episode of urticaria after stepping down the exercise intensity. Detailed history of exercise duration and intensity is required along with basic investigations for evaluating exercise induced urticaria. A sub-entity called severe exercise induced urticaria with muscle injury must be kept in mind due to the risk of asymptomatic or exertional rhabdomyolysis.
Erythema elevatum diutinum: a rare case of atypical presentation involving palms
Authors: Bhandare Ruchi M.
Published: April 2023

Erythema elevatum diutinum (EED) is a rare chronic dermatosis which mostly affects adult individuals. The classical skin lesions are asymptomatic, plum colored, erythematous nodules and plaques of variable sizes distributed symmetrically over extensor aspect of extremities. We reported a case of EED in a 50-year-old female presenting with lesions involving palms owing to its rare presentation.
Cost analysis of childhood glaucoma surgeries using the US Medicaire allowable costs
Authors:   Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida 33136, USA; Department of Ophthalmology, Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA, Elhusseiny Abdelrahman M. , Yannuzzi Nicolas A. ,   Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida 33136, USA, Chang Ta C. ,   Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida 33136, USA, Lee Richard K. ,   Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida 33136, USA, Smiddy William E. ,   Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida 33136, USA
Published: April 2023

AIM: To analyze and calculate the relative cost of various childhood glaucoma surgical interventions per mm Hg intraocular pressure (IOP) reduction ($/mm Hg).
METHODS: Representative index studies were reviewed to quantitate the reduction of mean IOP and glaucoma medications for each surgical intervention in childhood glaucoma. A US perspective was adopted, using Medicare allowable costs to calculate cost/mm Hg IOP reduction ($/mm Hg) at 1y postoperatively.
RESULTS: At 1y postoperatively, the cost/mm Hg IOP reduction was $226/mm Hg for microcatheter-assisted circumferential trabeculotomy, $284/mm Hg for cyclophotocoagulation, $288/mm Hg for conventional ab-externo trabeculotomy, $338/mm Hg for Ahmed glaucoma valve, $350/mm Hg for Baerveldt glaucoma implant, $351/mm Hg for goniotomy, and $400/mm Hg for trabeculectomy.
CONCLUSION: Microcatheter-assisted circumferential trabeculotomy is the most cost-efficient surgical method to lower IOP in childhood glaucoma, while trabeculectomy is the least cost-efficient surgical method.