bluuebunny/crossref_metadata_2025 huggingface dataset:
Early tracheostomy in patient with severe traumatic brain injury clinical experiences in rural and remote areas
Authors: Rosyidi Rohadi M. , Priyanto Bambang , Handayani Aulannisa
Published: December 2018

Background: Brain injury accounts for most of the causes of death from trauma. Brain injury is defined as a change in brain function, or brain pathology, caused by external forces. Patients with severe brain injury usually required rapid evacuation and special care in the Intensive Care Unit (ICU) room for respiratory control, mechanical ventilation, neurosurgical evaluation, and intracranial pressure monitoring (ICP). During admission to ICU, patients using tracheostomy, because it requires analgesia, sedation, and prolonged ventilation.Methods: Descriptive retrospective study conducted in February and March 2018 at Medical Record Installation of General Hospital Province of West Nusa Tenggara. The sample size is determined by consecutive sampling method.Results: Sample size were 60 people from medical record. Male patient more common than female (90 %). Based on Age more patients are 40 years old (43.3%). More Patient with early tracheostomy was survived (68,33%), and the rest died (31,67%).Conclusions: Severe head injury patients with tracheostomy are common at <18 years and >40 years. Patients with Severe brain injury who get early tracheostomy have more good outcomes, and have relatively short duration of ICU care.
Prediction of difficult cholecystectomy, a study of 100 cases
Authors: Tudu Debananda , Mishra Bana Bihari
Published: December 2018

Background: Cholelithiasis is a common problem in day to day surgical practice, which has a prevalence of 10-15%. The prevalence is more here in this part of the country as this is a pocket of sickle cell disease region. Laparoscopic cholecystectomy is the gold standard procedure for gall stone diseases. Out of many complications one of the most important complications of laparoscopic cholecystectomy is bile duct injury particularly in difficult cases.  Difficulties arise during creation of pneumoperitonium, releasing adhesion, identifying anatomy, anatomical variations and during extraction of gall bladder.Methods: A prospective study was carried out at VSS institute of Medical Science and Research, Burla, Sambalpur, a tertiary referral centre and a teaching hospital in the western Odisha. One hundred patients with symptomatic cholelithiasis were taken up for the study after due clearance from the institutional ethical committee. They were evaluated for risk factors such as-age of the patient, sex of the patient, previous abdominal surgery, number of previous attacks, total WBC count, gall bladder wall thickness and pericholecystic collection on ultrasonography.Results: Previous abdominal surgery, duration since acute attack, number of previous attacks, ultrasonography findings of increased wall thickness, stone impaction at neck and pericholecystic collection, increased total WBC count are associated with difficult laparoscopic cholecystectomy.Conclusions: The predictors for difficult cholecystectomy will make the surgeon extra cautious during the procedure so as to minimize the complications.
The relationship between listening to religious music and reading al-Qur'an to anxiety levels of medical students
Authors: Triastuti N. Juni , Dewi Intan Kusuma
Published: December 2018

Background: The rate of anxiety in students of the Faculty of Medicine, University of Muhammadiyah Surakarta is still high at 57.1% for moderate anxiety, while those including mild anxiety levels are 36.7% and severe anxiety levels are 6.1%. Tranquility in the soul can be obtained from listening to religious music and reading the Qur'an (recitations). This study aims to determine the relationship of listening to religious music and reading the Qur'an (recitations) to the level of anxiety.Methods: This study was an analytic observational study with a cross sectional approach. Samples were taken by purposive sampling. This study uses the TMAS questionnaire to assess anxiety. The number of samples is 54. Analysis of the data used is Chi-square and Logistic Regression.Results: The results of Chi-Square test about the relationship listening to religious music to anxiety levels showed p = 0.000 and the relationship of reading Al-Qur'an (tilawah) to anxiety showed p = 0.000 which p<0.05 present a significant correlation between two variables. Logistic Regression test results of listening to religious music to anxiety levels showed p = 0.008 and OR = 7.164 and the relationship of reading Al-Qur'an (tilawah) to anxiety levels showed p = 0.002 and OR = 8.244.Conclusions: There is a significant correlation between listening to religious music and reading the Qur'an (tilawah) with the level of anxiety of students in the Faculty of Medicine, Muhammadiyah University of Surakarta. Students who listen to religious music and often read the Qur'an (recitations) will reduce the risk of anxiety. Reading the Qur'an (recitations) is more influential on reducing the level of anxiety than listening to religious music.
Age and sex variation in the distribution of visceral fat among healthy doctors
Authors: Joy Anusha Maria , Panchu Pallavi , Bahuleyan Biju , Vijayan Vineetha , Jojy John
Published: December 2018

Background: Non Communicable Diseases (NCDs) are a mushrooming problem and accounts for majority of deaths. Paradoxically the population of Kerala is increasingly susceptible to NCDs despite having good access to health care. Doctors work in highly stressful conditions and often adopt sedentary lifestyles thereby forming a subset of the NCD prone population. The objective of this study was to assess the health status of the doctors which would provide an insight into their health and level of awareness regarding the role of lifestyle in prevention of NCDs.Methods: Sixty five doctors participated in this Cross-Sectional Observational study conducted at a CME in Kerala. After obtaining Institutional Ethical clearance, demographic profile was collected, and fat levels were estimated using body composition analyzer (OMRON-HBF375). The results were tabulated using Microsoft Office Excel, analyzed using SPSS version 20.Results: On classifying the study group based on BMI, only 34 were normal, 26 were Overweight, and 4 were Obese. Gender wise distribution of body fat revealed only 4 had normal body fat composition. The study also showed that as age advances the amount of total and visceral fat shows a significant upward trend in males.Conclusions: BMI alone cannot be used as a predictor of health status. Body Fat percentage analysis should be included in routine screening programs. Men have a tendency to develop visceral adiposity with age. Females depend more on fat as primary source and hence females will respond better to a properly programmed exercise regime and men to a well guided diet program with exercise.
Regulatory T cells (CD4+CD25+FOXP3+) in lupus nephritis
Authors: Mohd Kamil Mohd Khairul , Mohd Rozita , Abdul Cader Rizna , Ithnin Azlin , Mohd Shah Shamsul Azhar
Published: December 2018

Background: Systemic lupus erythromatosus (SLE) is an autoimmune disease with 20–65% of patients developing lupus nephritis (LN). Studies have reported 10% of LN patients will end up with end stage renal disease and their mortality rate is higher compared to patients without LN. Abnormality of regulatory T cells (Tregs) level is thought to be a potential factor for this LN development. The aim of study was to evaluate the percentage of Tregs in LN patients.Methods: This was a comparative cross sectional study involving LN patients and age and gender matched controls with a 2:1 ratio. The patients were grouped into active and inactive LN based on their lupus activity index; complement levels, ANA, dsDNA antibodies, ESR, SLE Disease Activity Index (SLEDAI2K) score and also urine PCI (uPCI>0.05 for active group). Disease history, demographic data, routine blood test, peripheral blood for differentials count were taken and recorded. Peripheral blood mononuclear cells were stained with CD4, CD25 and Foxp3 antibodies and percentage of Tregs was analysed using BD fluorescence-activated cell sorting (FACS) cytometer. We compared demographic and laboratory parameters between healthy controls and LN patients as well as active and inactive LN patients.Results: A total of 34 LN patients (32 females, 2 males) were recruited. Their mean age and disease duration were 37.97±11.14 years and 110.95±65.07 months respectively.  Thirteen matched controls with mean age 35.23±7.89 years were enrolled. There was no demographic difference between 2 groups of LN patients. Tregs were significantly lower in active LN compared to inactive LN and healthy control (0.44±0.37% vs. 1.89±0.46% vs. 3.12±0.56% of the CD4+, P<0.001). C3 and C4 complement fragments were significantly reduced in patients with active disease (C3; 50.92±28.43 vs. 76.31±25.63, P=0.011) and (C4; 11.17±8.41 vs. 16.70±6.50 P=0.044). Proteinuria was significantly higher while serum albumin levels were significantly lower in active patients compared to inactive patients and healthy control (urine PCI; 0.25(0.15-0.3) vs. 0.03(0.01-0.05) vs. 0.01, P<0.001) and (albumin; 29.89±6.87 vs. 36.87±3.58 vs. 40.62±1.89mmol/L, P<0.001). We found positive inversely correlation between Tregs with SLEDAI2K (r = -0.572, P=0.011) and proteinuria (r = -0.451, P=0.007).Conclusions: Tregs, C3 and C4 complements, and albumin were significantly lower while proteinuria was significantly higher in active LN. There was positive inversely correlation between the percentage of Tregs with SLEDAI2K score and proteinuria.
Management of trimalleolar fracture in Sanglah hospital: a case series
Authors: Subawa I Wayan , Ambong Hafidz Addatuang , Wibowo Trimanto , Putra I Gede Mahardika
Published: December 2018

Trimalleolar fractures are one of the most complex fracture around ankle. This study aims to assess the functional outcome and result of the surgical treatment for trimalleolar fracture. Case 1: A 49-years-old male experience closed fracture left ankle Lauge-Hansen PER type IV caused by traffic accident. Patient present with swollen and painful around ankle with an inability to bear weight on the affected extremity. Case 2: A 36-years-old female sustained closed fracture at right trimalleolar ankle, closed fracture at right talus nondisplace Hawkins I, and closed fracture at second, third, and fourth metatarsal. Case 3: A 57-years-old female came with history the left ankle twisted after got slipped and fell down at the yard. Patient was diagnosed by closed fracture left ankle Lauge Hansen SER type IV. Ankle fracture mostly happen in young men and older women during sporting activities or even bicycle or car accidents. The Lauge-Hansen system classify the fracture based on the postion and the direction of the ankle when trauma happen. The AOFAS was use for evaluation patient-relevant outcomes in patients operated on with anatomical ankle injury. In or present study of 3 patients with ankle fractures that were unstable, displaced or both treated surgically by open reduction with internal fixation in accordance with Lauge-Hansen classification. The result in our series confirm that all of 3 patients have a good result based on AOFAS scoring for evaluation the treatment and it means the management approve the good functional outcomes for the patients with ankle fractures.
Transfusion related acute lung injury: a case report
Authors: Alcazar Castro Javier , Zárate Aspiros Alejandro , Andrade Cuellar Elias N. , Álvarez Pérez Brenda M. , Valderrama Treviño Alan Isaac , Granados Romero Juan J. , Banegas Ruiz Rodrigo , Barrera Mera Baltazar
Published: December 2018

Transfusion Related Acute Lung Injury (TRALI) is one of the most serious complications of blood transfusion. All blood components have been implicated and most often those that contain plasma. The diagnosis is based fundamentally on the integration of clinical, radiological and gasometry elements, once the rest of the possible causes of acute lung injury have been ruled out. The differential diagnosis of a patient who develops a sudden pattern of respiratory failure after a transfusion of blood products must include hemodynamic overload, anaphylactic reaction, bacterial contamination of transfused blood products, haemolytic transfusion reaction and TRALI. Author presented the clinical case of a 33-year-old female patient with grade III hypovolemic shock due to a ruptured ectopic pregnancy, reanimated with crystalloid solutions, globular packages and fresh frozen plasma. The patient developed TRALI for what was managed with ventilatory and hemodynamic support in ICU.
Porokeratosis ptychotropica: a rare case report with unusual presentation
Authors: K. Sangheetha , A. Raja Shareef , N. Azeem Jaffer
Published: December 2018

Porokeratosis is a rare disorder of epidermal keratinization characterized clinically by annular plaque with thread like hyperkeratotic border with a central groove that expand centrifugally and this border corresponds to coronoid lamellae histologically which are the columns of parakeratosis that overlie an epidermal invagination with loss of granular layer and dyskeratosis of upper spinous keratinocytes. The disorder was erroneously named porokeratosis because the coronoid lamella was initially described as being present over a sweat pore, which is a fixed structure that cannot expand peripherally. Five primary clinical variants have been described: classic porokeratosis of mibelli, disseminated superficial actinic porokeratosis, linear porokeratosis, punctate porokeratosis and porokeratosis palmaris et plantaris disseminate. Porokeratosis ptychotropica one of the rare variants of porokeratosis described by lucker et al which has been added recently in the classification. It is characterized clinically by symmetrical verrucous papules and plaques resembling psoriasis plaque in the gluteal cleft, buttocks and rarely extends to genitalia and histologically by multiple coronoid lamella. We report a case of 43year old female, presented with 10years duration of pruritic raised skin lesion over the left gluteal region. Dermatological examination revealed single well defined erythematous scaly plaque with central atrophy, hyperpigmentation and peripheral thread like elevated border. Histopathological examination revealed multiple coronoid lamella which is the hallmark for porokeratosis ptychotropica, confirmed the diagnosis. The patient was treated with 5-fluorouracil cream. we report this case due to its rarity and the unusual presentation of single plaque of porokeratosis ptychotropica.
Proteases and tissue repair: peri operative role of chymotrypsin: trypsin in surgical patients
Authors: Kondreddy Suhas , Palli Shirin
Published: December 2018

Background: Proteolytic enzymes have been used to facilitate tissue repair ever since ancient times. Trypsin: Chymotrypsin, proteolytic enzyme oral preparation which has been in clinical use ever since 1960s, provides a better resolution of inflammatory symptoms and promotes speedier recovery of acute tissue injury by minimising the fibrinolytic shut down. This paper revisits the role and clinical utility of chymotrypsin: trypsin oral combination in tissue repair, in surgical patients. The aim of the present study was to determine the efficacy of chymotrypsin n trypsin in reducing post-operative oedema and haematoma formation and its role in surgical prophylaxis and scar formation.Methods: A prospective study was done on 50 electively posted surgical patients during a period of 6months comparing placebo with chymotrypsin and trypsin oral combination.Results: Statistically significant reduction in post-operative oedema, seroma and haematoma formation and reduction in pain and incidence of suture site infection, better cosmetic appearance of the scar and decline in need for secondary suturing was noted.Conclusions: From the current study, it is thus concluded that trypsin: chymotrypsin prophylaxis pre-operatively and post-operative treatment in surgical patients hastens the healing process and significantly reduces the recovery time.
Patient education in management of diabetes with medical comorbidities: an interventional study in South-eastern India
Authors: Devarapalli Pradeep , Mehdiratta Nikita , Mamillapalli Supriya , Akella Sruthi
Published: December 2018

Background: These days the effective management of diabetes has boundless challenges. Patient involvement is paramount for the successful care of diabetes. The aim of the study was to control medication adherence by providing patient education to the diabetic patients and also evaluating their drug-use, comorbidities, lifestyles and knowledge about diabetes and its management.

Methods: Total 240 diabetic patients of above 18 years of age with comorbidities were included in the study, in which 128 of study group and 112 of control group. Patient's comorbidities, drug-use and also knowledge level about diabetes was also assessed using a questionnaire.  

Results: Among the enrolled patients type-1 diabetes patients were 12 (5%) and 228 (95%) were type-2. Most of the patients about 25% were from age group of 40-50 years. The major number of patients has comorbidities of Systemic and coronary artery disease. Later the post counselling of test group, the mean score was 9.860±0.21 which is significant compared to pre-counselling 7.769±0.201 (p<0.001).

Conclusions: The present study revealed that the patients were unaware of the basic concept related to diabetes mellitus. For better control of hyperglycaemia, there is a need for advancement of policies regard of disease education.
Cu-sil denture: an innovative approach to preserve the few remaining natural teeth: a case report
Authors: Goel Divya , Talukder Dhaniram , Datta Pankaj , Paul Geeta , Singh Saurabh
Published: December 2018

According to De Van, the preservation of what remains is of utmost importance rather than the meticulous replacement of what has been lost. Need based use of unconventional approach is a growing demand in prosthodontics in India. The increasing demands of the patients have led to innovative techniques for fabricating complete dentures. Conventional techniques may provide satisfactory results in most patients but may not be suitable in all cases. Cu-sil denture is one of the transitional dentures which is easy to fabricate, saves time as well as reduces the cost of treatment. These dentures provide a psychological boost to the patients and serve as a viable alternative. They not only promote the alveolar ridge integrity but also help in retaining the proprioceptive ability of the periodontium. This paper presents a case of fabrication of Cu-sil denture in a patient with two teeth remaining in the maxillary arch.
Assessment of efficacy of CT scan and diagnostic nasal endoscopy in chronic atrophic rhinitis cases
Authors: Parameshwar Keshanagari , Goud Katakam Pampapathi
Published: December 2018

Background: Chronic rhinosinusitis (CRS) is a heterogeneous disorder leads to inflammation of nose and paranasal air sinuses. CRS affects quality of life of affected people, its diagnosis and management of is still a major challenge for the ENT specialists. CT scan and diagnostic nasal endoscopy of nose and paranasal sinuses plays an important role in the management of CRS.

Methods: A total 42 cases with clinically diagnosed chronic rhinosinusitis between age group 2nd -6th decade were considered. All the participants underwent a systemic diagnostic nasal endoscopy and CT scan of nose and paranasal air sinuses before surgery.  

Results: Nasal blockage/obstruction (95.2%), headache/facial pain (90.4%), nasal discharge (85.7%), sneezing (76.1%) are commonest symptoms. Diagnostic nasal endoscopy noted to be a sensitive investigation tool for the sphenoethmoid recess, hiatus semilunaris and frontal recess. The sensitivity of above parameters is 100%, 94.8% and 95.1% respectively whereas, specificity is 83.2%, 79.5% and 94.8%.

Conclusions: Diagnostic nasal endoscopy findings and CT scan findings correlated very well with the operative findings. In few cases DNE could not visualize all the parameters due to anatomical deviations. But CT scan is a specific diagnostic tool which depicted all the parameters except maxillary sinus and its bony shell in very few cases.
Laryngeal lipoma: a rare cause of hoarseness
Authors: Sukumaran Yuvenesvary , Azrin Noor , Ping Loong Siow , Jane Elsie , Madatang Angeline
Published: December 2018

The incidence of lipoma in the laryngeal region is rare. Here we report a case of left false cord lipoma in a 78 years old man who presented with hoarseness for 2 years. Clinically, a bulge with a smooth surface was seen at the left false cord. Intraoperatively, the specimen taken from the left false cord appeared yellowish and was floating on normal saline solution giving a suspect to lipoma. Histologically, the tumors composed of mature adipose tissue. Postoperatively, the patient recovered well with no signs of recurrence.
Diffuse large B-cell non-hodgkin lymphoma of the ear with intracranial invasion
Authors: Guakil-Haber Alberto , González-Arciniega Erasmo , García-Enríquez Benjamin , Olvera-Suarez María Y. , Segovia-Forero Enrique , Munguía-Vázquez Raymundo
Published: December 2018

We report a 62-year-old woman with primary diffuse large B-cell lymphoma (DLBCL) of the ear. The patient presented with facial palsy, left ear hearing loss and a mass in the left external auditory canal. CT and MRI showed an occupied external auditory canal, middle ear and temporal bone with extensive intracranial invasion, R-CHOP therapy was started, but she died after one course. Primary lymphoma of the ear is extremely rare and to the best of our knowledge this is the first case reported in a Mexican medical center, and also the first overall with such an extensive invasion.
An unusual differential of neck swelling: left apical hernia
Authors: Pandit Ankush
Published: December 2018

Pulmonary herniation is a protrusion of the lung beyond the usual boundaries of the thoracic cavity, which is caused by increased intrathoracic pressures coupled with thoracic wall defects. Most lung hernias are asymptomatic, but when symptomatic they present as a bulging, crepitant mass protruding through the chest wall. A computed tomographic scan is usually diagnostic, and a small subset of patients requires surgery to correct the defect. In my report there is a 49 year old male patient with cystic swelling in the left side of the neck which increases on coughing, along with a small nodular midline swelling which moves on deglutation. Probable diagnosis of thyroid swelling with laryngocele as a differential was made. FNAC of nodular swelling was suggestive of nodular colloid goitre. CECT neck implied solitary thyroid nodule. The patient was taken for surgery to remove the thyroid nodule but surprisingly left apical lung hernia was diagnosed along with the thyroid nodule. Apical lung hernias are more common in males than in females (2:1) and more common on the right side than on left (6:1). However this patient had herniation on the left side which is quite rare. Usually asymptomatic, surgical treatment is rarely warranted unless it undergoes incarceration. Apical lung hernia though a rare entity should be considered in the differential diagnosis of a neck swelling.

 
A rare case of primary hydatid cyst of neck
Authors: Hirani Narendra , Khilnani Ajeet Kumar , Lanjewar Dhaneshwar , Patel Navin , Solanki Vipul , Bhadesia Bhoomi
Published: December 2018

Primary hydatid cyst swelling of neck is an uncommon occurrence even in regions where hydatidosis is common. We report a case of a 13 year old male patient who presented with a swelling in right side of neck since 4 years, which turned out to be a hydatid cyst. FNAC is a useful pre-operative investigation for diagnosis of hydatid cyst. Complete surgical excision followed by medical treatment (benzimidazole derivatives) is considered to be the treatment of choice. Hydatid cyst should always be considered in the differential diagnosis of neck swellings.
Evaluation of management of malunited supracondylar fracture of humerus by lateral closing wedge osteotomy
Authors: Deokar Sharma Bharati Pankaj , Sharma Pankaj Nandkishor
Published: December 2018

Background: Various osteotomies have been in use for correction of varus deformity at elbow secondary to malunited supracondylar humerus fracture in children. The objectives of the study were to determine the efficacy & outcome of lateral closing wedge osteotomy in children as a treatment of malunited supracondylar fracture of humerus with cubitus varus and to evaluate various technical problems, morbidity, complications of Lateral closing wedge osteotomy and to suggest ways to overcome them.

Methods: This prospective study was conducted among 50 cases of malunited supracondylar fracture of humerus who visited in OPD during 1st September 2008 to 31st August 2010. After pre-operative assessment, lateral closing wedge osteotomy was done and fixed with two 3.5 mm screws, figure of eight tension band stainless steel wire and a supplemental lateral k-wire. Post operatively x-ray of patient was taken and carrying angle and range of movement were calculated. Patients were re-assessed at complete union.

Results: Maximum patients were from the age group of 8 to 10 years- 22 cases, mean age 13.08 years, 80% male. Left (non-dominant) side was involved in 30 (60%) cases. Around 18% cases developed complications. 25 (50%) patients had no loss of range of movement and 2 (4%) had 16 to 20 degrees loss of range of movement. Almost 36 (72%) cases had excellent outcome, 11 (22%) cases had good outcome, 3 (6%) cases had poor outcome due to loss of fixation, 47 (94%) patients/parents were satisfied with the final outcome.

Conclusions: Lateral closing wedge osteotomy with a lateral K-wire is a sound, cost-effective, technically less demanding modality of treatment for varus deformity due to malunited supracondylar fracture of humerus in children with minimum complications.
Management of communited patellar fracture with combined Tension Band Wiring Technique and Encirclage
Authors: Desai Tarun V. , Moradiya Niravkumar P.
Published: December 2018

Background: The objective of the study was to evaluate functional results of combined encirclage wiring and tension band fixation in comminuted patellar fractures.

Methods: This is a prospective study of 15 patients treated with this method. All fractures described herein were classified as 45-C3 (based on Orthopaedic Trauma Association classification) and were fixed with encirclage wire and tension band wire proximally looped through the quadriceps tendon and distally through the patellar ligament in a figure-of-eight configuration. Knee function was evaluated using the Rasmussen scores at final follow-up.

Results: 13 patients gained up to 90 degrees of active flexion at the end of the first week. 4 patients had 10–15 degrees of extensor lag at the end of the first week which improved after vigorous physiotherapy and none of them had any residual extensor lag at the subsequent follow-up. Two patients developed superficial infection. All fractures united at the end of 12 weeks. One patient underwent a second surgery; due to implant related complications. Malunion or non-union was not noted in any of the cases. The average Rasmussen scores was 27.9 out of 30 (range, 27–29).

Conclusions: The tension band technique combined with cable encirclage for treatment of communited fractures of patella is a simple and technically less demanding operative technique producing a rigid fixation, stable osteosynthesis and minimal injury to the tendon. It can be done with easily available implants. 
Estimation of prevalence of multidrug resistance in spinal tuberculosis, antibiotic susceptibility patterns and clinical outcomes
Authors: Ghoti Santosh , Sah Saurabh , Mitra Sajal , Bochare Amol
Published: December 2018

Background: There are no adequate data in literature referring to the early diagnosis and treatment (especially surgical) of MDR tuberculosis of spine and evaluation of its clinical outcome. We aimed to address this lacunae, by using gene expert test (CBNAAT) and drug sensitivity/susceptibility tests (DST) and by studying subsequent actual clinical outcomes.

Methods: Forty patients with clinico-radiological scenario of spinal tuberculosis were evaluated using biochemical, radiological and histo-pathological studies. Anti-tuberculosis treatment was empirically started based on initial clinico-radiological suspicion of spinal tuberculosis. All tissue specimen and intra-operative samples were subjected to CBNAAT, MGIT culture and histopathological examination. Culture of those samples which showed rifampicin resistance on CBNAAT were followed up for DST (Drug Susceptibility Test) and the treatment modified accordingly, if required. All cases were followed up at 3, 6, 9 and 12 months interval.

Results: Out of 40 patients, mycobacterium tuberculosis was detected in 23 patients by CBNAAT. Out of these 23 cases, 20 showed mycobacterium tuberculosis sensitivity to rifampicin and 3 were resistant. Out of these 3 cases, one had culture positive. Sensitivity and negative predictive value of gene expert test in comparison with the culture were 100%. Specificity and positive predictive value were calculated at 58.6% and 47.8% respectively. Accuracy of gene expert in our study was found to be 70%.

Conclusions: Early detection of MDR spinal tuberculosis using highly sensitive CBNAAT test would be helpful to avoid consequences of inappropriate chemotherapy and would result in favourable outcomes.
Surgical Management with Particular Reference to Failure Rate in a Case Series of 1498 Consecutive Cases of Chalazion Incision and Curettage by a Single Practitioner
Authors: Cook Nicholas James
Published: December 2018

A series of 1498 consecutive vertical incisions of chalazia was studied by the author to examine the spectrum of epidemiological presentation of chalazia for a population, the failure rate for incision and curettage and how each failure was managed. The number of incisions made in each chalazion was also examined as the author had developed an impression over the years that a better success rate was achieved with more than one incision. Using 3 vertical incisions, the 7.6% failure rate is considerably lower than previous studies in the literature in which only one incision was undertaken. This case series also supports a practical pragmatic approach as to how to manage failure of incision and curettage and questions the need for routine diagnostic biopsy to exclude ocular sebaceous cell carcinoma after first failure in incision and curettage.
Inverted Internal Limiting Membrane Flap Technique for Extra Large Macular Holes
Authors: Okonkwo Ogugua Ndubuisi , Hassan Adekunle Olubola , Oderinlo Olufemi
Published: December 2018

Aim: To investigate the outcome of the inverted Internal Limiting Membrane (ILM) flap technique for extra large idiopathic macular holes (MHs).Methods: A retrospective non-comparative surgical case series of seven eyes of 7 patients with MHs (base diameter of at least 1000 ?m) was conducted. All the MHs were treated using pars plana vitrectomy and brilliant blue G (BBG)-assisted inverted ILM flap technique. Spectral Domain- Optical Coherence Tomography (SD-OCT) images were used to assess the anatomical outcomes of surgery including the macular microstructure, while Best Corrected Snellen Visual Acuity (BCSVA) was used to evaluate the functional outcomes.Results: The average MH size was 1241microns and average symptom duration was nineteen months. All eyes achieved successful anatomical closure and there was no occurrence of a flat open type closure. SD-OCT microstructural study revealed a reconstruction of the Ellispod Zone (EZ) and External Limiting Membrane (ELM), in only 3 eyes. There was an improvement in visual acuity in 5 eyes, while 2 eyes maintained the same as pre operative vision. The largest increase in post operative visual acuity gain was a 4-line improvement in Best Corrected Snellen Visual Acuity (BCSVA) noted in one of the 3 eyes with reconstructed EZ and ELM. The 3 months symptom duration in this patient was the shortest in this series.Conclusion: Inverted ILM flap technique is a safe and effective approach for the management of extra large chronic idiopathic MHs with demonstrably good anatomical and limited functional results in a majority of cases. Postoperative reconstruction of the microstructure is however seen only in a minority of eyes. Despite an absence of the outer retina (EZ and ELM), some eyes still experience an improvement in vision. The symptom duration may play a vital role in functional outcome in this subset of extra large chronic MHs.
Loperamide-Induced Pancreatitis: Report of Three Cases
Authors: Fantin Alberto , Peserico Giulia , Barbuscio Ilenia
Published: December 2018

Background: Only 0.1-2% of acute pancreatitis seems to be drug-induced, being this etiology probably underestimated and often classified as idiopathic. Loperamide is an opiate with peripheral action, used in the treatment of diarrhea. Since 2012 it belongs to the FDA list of drugs potentially able to cause acute pancreatitis, because of its capacity of modulating the secretion from the exocrine pancreas and of causing sphincter of Oddi dysfunction.Case presentation: We report the cases of three women, admitted to our hospital for acute pancreatitis. In their medical history two of them referred remote cholecystectomy. They all reported recent loperamide intake, given to acute diarrhea, denying alcohol consumption, smoking or family history for pancreatic disease. During the hospitalization laboratory tests showed increase of pancreatic enzyme and liver function alteration, with a rapid clinical improvement after loperamide suspension. Pancreatic Magnetic Resonance Imaging (MRI), including MR cholangiopancreatography, was performed in all the cases, showing a well-defined pancreatic gland without any sign of acute inflammation and excluding common bile duct lithiasis. Given the absence of common risk factors and the temporal correlation between drug intake and occurrence of symptoms, we considered loperamide responsible of these three cases of acute pancreatitis.Conclusion: In patients with acute pancreatitis, referring recent loperamide intake, in the absence of any other causes, iatrogenic damage must be considered as a possible etiologic factor.
Diagnostic and Management Difficulties in the Adenocarcinoma Third Part of Duodenum: A Case Discussion
Authors: Singh Sunita , D Mohanty , NK Srivastava , H Sharma , V Singh
Published: December 2018

Duodenal Adenocarcinomas (DA) represent approximately 0.3% of all malignant gastrointestinal tumors. DA is the most common site for adenocarcinoma in gastrointestinal track. The most common site of DA within duodenum is the 2nd part of duodenum. A high degree of suspicion is required for the diagnosis of third/fourth part DA. Push enteroscopy is the definitive diagnostic tool for third/fourth part DA. We discussed a case of adenocarcinomas third part of the duodenum with brief discussion on controversies in optimal surgical management.
Massive Pulmonary Bleed from Undiagnosed Hepatitis C Infection
Authors: Kink Rudy John , Hanna W. Ricks
Published: December 2018

A 14 year-old previously healthy female patient presented with back pain, halitosis, and hemoccult positive stool.She was ultimately diagnosed with Takayasu’s Vasculitis and thrombo-angiitis vasculitis as well as a post-mortemdiagnosis of Hepatitis C. The two vasculitides created a pulmonary arterial-esophageal fistula with a necrotic areaand a ruptured pulmonary artery, which led to the patient’s death. Further discussion with the familyindicated thatthey were unaware of the patient’s Hepatitis C status and they denied any risk factors the patient may have had thatlead to Hepatitis C infection. Obtaining a history in pediatric patients is often limited by what the family knows anddiscloses, but when a patient presents with elevated inflammatory markers, halitosis, and hemoccult-positive stool,an esophageal fistula should be considered in one’s differential diagnosis.
Isolated Congenital Alacrima in a Child with Autism Spectrum Disorder
Authors: Shee Anutosh
Published: December 2018

Isolated congenital absence of lacrimal glands is a very rare condition in children, only few cases were reported so far. Its symptoms can be quite variable depending on the other associated factors like absence of accessary lacrimal glands and/or salivary glands. Children with isolated absence of lacrimal gland can have normal tear film but lack tear production upon emotional stimuli. Although, alacrima can be a part of other rare syndromes, isolated absence has never been reported in the literature in association with autism spectrum disorder. In this article we present a case of alacrima with autism spectrum disorder, never reported in the literature to our knowledge. With increasing recognition of autism spectrum disorder, it is important to report common and rare association of other clinical co-morbidities as this may influence the initial presentation posing diagnostic challenges to the diagnosticians. In this case the lack of tears with the emotional stimuli was considered exclusively caused by the lack of social-emotional reciprocity, which is one of the core symptoms of autism spectrum disorder.
Validation and reliability study of a ventilator usability assessment tool
Authors: Paykari A. , Mazloumi A. , Halvani G. H. , Ghaneh S. , Mashayekhi Musa
Published: December 2018

Background: Usability is an index to assess a product from the viewpoint of users satisfaction, efficiency and productivity improvement. The main attributes of usability that are derived from the human factors are  and used  in usability design of the interfaces Include: compatibility, consistency, flexibility, minimal action, perceptual limitation, usefulness, learnability, ease of use, minimal memory load, user guidance, satisfaction and errors. The main aim of this study was to assess the usability of interface design tool for a ventilator utilized in the hospitals of Arak city, Iran; and study its validation and reliability.
Methods and Materials
After constructing the initial questionnaire from the standard sources, specific techniques to determine the validity,  and Cronbach's alpha coefficient were used for the validity and reliability study. The study procedure was: determining the scope and dimensions of the questions, drafting questionnaire, assigning members of the expert panel, study, questionnaire data acquisition  and analysis methods, determining acceptance criteria of the questions and the content validity and reliability index.
Results
Final tool was a 42-items questionnaire. The content validity index (CVI) of questionnaire was 0.86. The results showed that the total Cronbach's alpha coefficient was 0.89 as an acceptable value for the reliability of questionnaire.
Conclusion
After the final questionnaire design and the appropriate validity and reliability of it, adopting this tool to assess the usability of breathing apparatus (ventilator) is recommended. With usability assessment of such vital instruments, quality improvement, higher efficiency and productivity as well as errors reduction and good design user interface will be achieved.
Keywords: usability, ventilator, evaluation questionnaire, content validity, reliability
Comparing Cognitive Performance in Patients with Obstructive Sleep Apnea and healthy Subjects
Authors: Maghsoudipour Maryam , Memari Shoaleh , Haghighi Khosro Sadeghniiat , Rezasoltani Pourya
Published: December 2018

Introduction::  
Daily performance deficits are inevitable results of a large group of sleep disorders. Cognition and cognitive performance might be defected as a direct consequence of sleep disorder assessed by subjective or objective measures. So, this survey was performed in order to compare cognitive performance of obstructive sleep apnea patients and healthy subjects in Baharloo hospital of Tehran. 
 Method:  In this case control study, the samples were chosen by  convenience sampling, from Baharloo hospital patients and were assigned to case group (apnea patients) and control group (healthy subjects), based on AHI score. Also, we used a demographic questionnaire, ESS, Berlin, and STOP BANG. Appropriate tool was used to assess cognitive performance in two groups. In order to analyze data we used SPSS (version 19).  Independent T test, Chi square, Fisher test, Kruskal-wallis Test, and Pearson correlation test were used. Results:   Results demonstrated a significant difference of sleepiness and cognitive performance between healthy subjects and OSA (Obstructive Sleep Apnea) patients. 
Conclusion:
 
Screening and diagnosis of OSA patients, and considering the deficient cognitive performance is crucial. Also, education about the importance of OSA Syndrome and the treatment is necessary.
 
 
Keywords: 
Obstructive sleep apnea, Cognitive performance, Excessive daytime sleepiness
Application of QFD method in toothbrush design for the cervical spinal cord injury handicapped (Tetraplegia)
Authors: Naeini Hassan Sadeghi , Mitra Rafiee (MA) Seyyedeh
Published: December 2018

Background: The spinal cord trauma is a lost physical performance that causes physical limitations in addition to mental, social and economic disadvantages. The mouth and tooth health is known as one of the related issues to the physical quality of life. Providing the conditions of the more independence for these people in brushing teeth can improve the level of mouth and tooth hygiene. The aim of this study is offering proper patterns in designing toothbrush by emphasizing on the tetraplegia handicapped.
Methods: The results indicate, by considering the motoric limitations of spinal cord injury handicapped (C5-C7) and re-revaluating the dimensions of their palms, it should use stammer instead of grip. Also, by considering the movement rang among handicaps, the rotation of the brush set in 2 directions, brush fixation in 4 degrees and the angle between the brush and handle has been considered.
Results: The results show that the light and sanitary materials should be used in producing. The handle of toothbrush should have a little friction with the user’s hand. The pressure points should be identified and investigated, but a little pressure on hand is necessary due to grip of toothbrush.
Conclusion: It seems that in designing a product, the weight, the facility and the used material must be considered. A little pressure on hand is necessary due to grip of toothbrush.
Key words: tetraplegia, manual tools, QFD
Utilization of Phytoremediation By-Product
Authors: Sharma Jot ,   Department of Biotechnology, Vijayaraje Institute of Science and Management, NH-75, Turari, Jhansi Road, Gwalior (M.P.) 474001, India.
Published: December 2018

This article displays the status of phytoremediation innovations with specific accentuation on phytoextraction of soil, overwhelming metal sullying. The different procedures to improve phytoextraction and the use of the results have been expounded. Since part of biomass is delivered during this process, it needs appropriate transfer and administration. It likewise gives an understanding into the work done by creators, which centers around high biomass extractor plants. High biomass weeds were chosen to limit the entry of contaminants into the evolved way of life by choosing non-consumable, ailment safe and tolerant plants, which can be a sustainable power source, hence making phytoextraction more suitable for present usage.
Örgütsel Bağlamda Uyum Metodolojisi
Authors: Çiçek İşik , Evcimen İdil V. , Biçer İsmail Hakkı
Published: December 2018

Günümüzün artan rekabet koşullarında
insan’ın önemi daha da belirgin hale gelmekte, örgüt, iş ve çalışma grupları
ile uyumlu işgöreni seçme ve elde tutma çok daha önem kazanmaktadır. Artan
sorunlara  çözüm bulma arayışı
profesyonelleri  olduğu kadar
akademisyenleri de araştırma yapmaya sevk etmekte, özellikle teknolojinin iş ve
örgütlere olan etkileri dikkate alındığında, yalın örgüt modellerinin geliştiği
ve proje türü örgüt yapılarının yaygınlaştığı görülmektedir. Bu bağlamda,  insan odaklı sorunlara çözüm bulmada önemli
bir boyut, örgüt/iş/grup ile uyumlu “insan” ın seçilmesi ve örgütte tutulması
olabilecektir.  Bireylerin çalıştıkları iş ve
organizasyonlara gösterdikleri uyum ya da uyumsuzluklar bir süredir Örgütsel
Davranış ve İnsan Kaynakları Yönetimi literatürünün ara kesitinde incelenen
konulardan biri olma özelliğini taşımaktadır. Literatürde çeşitli boyutlarda
kavramlaştırılmış olan kişi- çevre uyumu, söz konusu alt boyutlara yönelik geliştirilen
operasyonel tanımlara göre farklı türlerde belirlenmekte, böylece uyum
türlerine yönelik bir uyum metodolojisi gelişmektedir. Bu araştırmada,
literatürde tanımlanan uyum türleri için geliştirilmiş operasyonel tanımlara
bağlı olarak uyum değerini belirleyen skorlama yöntemlerinden söz edilerek  uyum metodolojisi açıklanmıştır.
An Evaluation of the External Trade Policy of the European Union in terms of a Unified Structure: Case of Doha Round
Authors: Özer Torgalöz Alev
Published: December 2018

In the first part of this study, the external trade policy of EU will be
explored by elaborating the policy tools and decision making procedures in
order to reach an argument about whether EU is a unified actor on these bases.
For this reason, in order to go into details, a comparison of European external
trade in goods and services will be specifically focused on in the second part
for the sake of any conclusion related to its collectivity on these trade
activities. In the third part, Doha International Trade Round will be
introduced as an example case to be studied in the final part, where the
reflections of a possible unified structure within the EU will be examined.
Kredi Temerrüt Swapları İle Vade Farklarından Kaynaklanan Risk Primleri Arasındaki İlişki: Türkiye Üzerine Bir Uygulama
Authors: Akkuş Hilmi Tunahan , Sakarya Şakir
Published: December 2018

Bu çalışmada Türkiye’de borçlanma
araçlarının risk göstergesi olarak Kredi Temerrüt Takası (Credit Default Swap -
CDS) ile vade farklarından kaynaklanan risk primleri arasındaki ilişki analiz
edilmiştir. Bu çerçevede tahmin edilen risk primleriyle CDS’ler arasında nedensellik
ilişkisi ortaya konmaya çalışılmıştır. Analizde borçlanma araçlarının risk
göstergesi olarak 5 yıl vadeli CDS prim değişimleri bağımlı değişken olarak
kullanılırken, bağımsız değişkenler olarak da Campbell ve Shiller (1987) yaklaşımından
yararlanılarak türetilen iki aylık ve üç aylık bono faiz oranları arasındaki
risk primi kullanılmıştır.  Bunun nedeni
ise iki ve üç aylık vadeli bono getirilerinin likiditeyle ilişkili en yakın gösterge
olmasıdır. Böylece likidite riski ile uluslararası piyasalardaki finansal risk
göstergesi olan CDS’ler arasındaki ilişki araştırılmıştır. Analizde Mayıs 2001
– Mart 2017 dönemine ait aylık veriler ve analiz yöntemi olarak da Hill (2007)
tarafından geliştirilen “kayan pencere nedensellik yaklaşımı” kullanılmıştır. Çalışmanın
sonucunda, 2010 ve 2016 yıllarının yaklaşık olarak tamamında CDS’ler ile risk
primleri arasında ilişki bulunurken diğer dönemlerde neredeyse hiç ilişkiye
rastlanmamıştır. Bunun durum CDS’lerin her zaman risk primlerini göstermediği şeklinde
yorumlanmıştır.