bluuebunny/crossref_metadata_2025 huggingface dataset:
Cumulative Noise Exposure and Perceived Effects
Authors: Chakraborty Arup , Lahiri Arista , Dasgupta Urmila , Saha Asim , Bhattacharya Salil K.
Published: December 2022

Background:

Adverse short-term and long-term health effects following a high level of noise have been established. The current study aims to find the relationship of these effects with an environment-specific level of noise exposure.

Materials and Methods:

A comparative cross-sectional study was conducted among 50 auto-rickshaw drivers and 51 age-matched service-sector employees. The peak average noise exposure in decibels (dB) was measured. The duration of exposure and response regarding perceptions following noise exposure was assessed through a pre-designed pre-tested semi-structured questionnaire.

Results:

The mean age of the participants was 42.24 (±13.72) years. Among the auto-rickshaw drivers, 82% perceived stress, 64% had hearing difficulty, and 74% complained of lack of sleep following exposure to a high level of noise. However, the perceptions were comparable among the comparison group and the differences were not statistically significant. The mean average peak level of noise exposure among drivers and their comparison group was 91.64 (±7.37) dB and 91.98 (± 8.06) dB, respectively, but were not different statistically. Around 52.94% of the service-sector respondents and 48% of the drivers were exposed to the lower cumulative noise levels. Those having a higher level of cumulative noise exposure, had a higher odds of feeling irritated (Odds ratio [OR]: 2.182, 95% confidence interval [CI]: 0.845–5.636), feeling stressed (OR: 5.805, 95% CI: 1.552–21.708), having palpitation (OR: 3.694, 95% CI: 1.264–10.793), and lack of sleep (OR: 3.020, 95% CI: 1.006–9.066).

Conclusion:

Stress and lack of sleep were the most important perceived effects of noise exposure. The exposures to the higher cumulative noise level in specified groups were more important in relation to quantifying perceived symptoms than the average peak noise level.
Gender and sexual orientation of undergraduate medical students in India: A cross-sectional study
Authors: Ali Tahoora , Ryali Sumalatha , Upadhyay Shiksha , Swaminathan Uma , Patki Shivani , Chaudhury Suprakash
Published: December 2022

Background:

Although the potential for alternate conceptions of gender roles and sexual orientations are diverse, it is by-and-large not well tolerated. This study explores the self-reported gender-roles and sexual orientations of Indian undergraduate medical students.

Aim:

To study self-reported gender role and sexual orientation of undergraduate medical students in India.

Method:

One hundred twenty volunteers were included in the study consisting of 60 males and 60 females. A questionnaire comprising of a sociodemographic proforma, Bem Sex-Role Inventory (BSRI), and Epstein Sexual Orientation Inventory (ESOI) were given to each participant. The scales were scored, tabulated, and statistically analyzed.

Results:

The BSRI revealed that femininity was predominant in both female and male participants, at 68.33% and 55%, respectively. The ESOI revealed that females had significantly higher opposite-sex attraction than males. Though males had higher same-sex attraction than females, the difference was not statistically significant. Females also had a significantly higher sexual orientation range and a mean sexual orientation. Sexual drive was significantly higher in males. Significantly more females supported homosexuality and bisexuality as compared to males.

Conclusion:

This study helps establish that gender roles can be non-conforming. It helps ascertain that while heterosexual orientation predominates, alternate sexual orientations also exist. It paves the way for future studies and explorations to alleviate public misconceptions.
Unexplored role of hypobaric spinal anesthesia in cardiac patients with low ejection fraction
Authors: Kadni Reena Ravindra , Pushpavathi Priya , Srinath Archana , Shivanna Apoorva Devarahosahally
Published: December 2022

Anesthetic management of cardiac patients with low ejection fraction (EF) on two-dimensional echocardiography is a challenge. Underlying cardiac condition, type and duration of surgery and overall optimization of the patient determine the plan of anesthesia in these patients. Hypobaric spinal anesthesia (SA) known for its role in anorectal procedures was found to be a suitable tool in the management of cardiac patients with low EF who underwent infraumbilical surgeries in our case series. Hypobaric SA with 0.1% bupivacaine and fentanyl as an adjuvant gave a satisfactory outcome without significant hemodynamic changes with its differential blockade nature. We found it to be a simpler, safer, economical, and efficient technique which lasted for an average duration of 2½ hours, although it is a rarely practiced technique. We conclude that the practice of hypobaric SA can be considered one of the options in the anesthetic management of infraumbilical superficial surgeries of moderate duration in cardiac patients with low EF.
Risk factors for early hyperbilirubinemia in neonates
Authors: Rehna T , Thomas Suni Ann
Published: December 2022

Background:

Neonatal hyperbilirubinemia is a commonly encountered problem in the early neonatal period. Hence, this study was undertaken in babies with significant hyperbilirubinemia to find out the factors which had caused an early rise of bilirubin (≤48 h) in some neonates compared to those who develop hyperbilirubinemia by 72 h. Factors that can predict early hyperbilirubinemia will help in early intervention.

Methodology:

This cross-sectional study was conducted in the neonatal intensive care unit of a tertiary care center from March 2021 to January 2022 among 405 healthy term neonates with significant hyperbilirubinemia. Serum bilirubin values were routinely done at 72 h, and earlier at 48 h if clinical icterus was noted by Kramer's rule and divided into two groups – one with hyperbilirubinemia at 48 h and another with hyperbilirubinemia by 72 h. Statistical analysis was done to find out the factors which could predict early hyperbilirubinemia.

Results:

Of the 405 neonates with significant hyperbilirubinemia, 270 (66.6%) had early hyperbilirubinemia and 135 (33.3%) had hyperbilirubinemia by 72 h. There were no statistically significant differences between the two groups with respect to sex, birth weight, mode of delivery, and baby blood group. Forty-two (49.4%) neonates with umbilical cord bilirubin (UCB) <2 mg/dl, 113 (65.6%) with UCB 2–2.5 mg/dl, 75 (72.1%) with UCB 2.5–3 mg/dl, 34 (89.5%) with UCB 3–3.5 mg/dl, and 6 (100%) with UCB >3.5 mg/dl developed early hyperbilirubinemia. Sixty-four (79%) neonates with bilirubin–albumin ratio (BAR) ≥0.79 developed early hyperbilirubinemia compared to 206 (63.6%) neonates with BAR <0.79 who had early hyperbilirubinemia.

Conclusions:

The UCB and bilirubin–albumin ratio correlated well with the development of early hyperbilirubinemia. Hence, it was concluded that those babies with a high UCB >2.1 mg/dl and/or high BAR ≥0.79 should be screened early for the development of hyperbilirubinemia.
Childhood gastroesophageal reflux disease with laryngopharyngeal reflux and association of psychosocial risk factors
Authors: Jose Priya , Ganesh S. Solai , Deve Lakshana , Kurien Mary
Published: December 2022

Gastroesophageal reflux disease (GERD) and laryngopharyngeal reflux (LPR) are inflammatory sequelae following the backflow of stomach contents to the esophagus or larynx/pharynx, respectively, the latter most often occurring in GERD. Unlike adults, the clinical parameters of “reflux symptom index” and “reflux finding score” are not routinely done in children suspected of LPR associated with GERD. Proton-pump inhibitor (PPI) trial with a 50% reduction of symptom severity following 2–4 weeks of empirical PPI, which is then continued for 12 weeks, is considered a valuable diagnostic and therapeutic tool for GERD in children. We present our successful management of an 8-year-old child, who had primarily respiratory symptoms with no associated respiratory, cardiac, or neurological etiology. Clinical evidence of underlying LPR secondary to GERD was confirmed by otolaryngologists with Reflux Finding Score. Significant psychosocial risk factors observed during her evaluation were addressed by psychologists. PPI therapy and behavioral therapy were initiated and the child improved drastically. The association of significant psychological issues in family and the social context appears to be significant in childhood GERD. A multidisciplinary comprehensive clinical approach is the cornerstone for its successful medical management.
A rare case of the complex phenotype of hereditary spastic paraparesis due to a mutation in a novel gene variant
Authors: Antonieo Raja B. Jude , Abirami Sakthi , Jose Priya , Kumar Kommu Peter Prasanth
Published: December 2022

Hereditary spastic paraplegia (HSP), is a heterogeneous group of corticospinal tract disorders leading to progressive lower limb weakness and spasticity. Recessive mutations in DDHD2 characteristically involve early onset delay in motor and cognitive milestones coupled with spasticity. The complex nature of HSP is always confounding for appropriate management. An 11-year-old boy was brought by his parents for developmental delay noticed from 7 months of age and was diagnosed to have possible spastic cerebral palsy initially. Due to increasing spasticity, he underwent tendon release surgery for achilles and iliopsoas at 4 years of age. Now, he presented to us with increasing stiffness in his lower limbs even after regular physical therapy and myoclonic jerks. He had severe spasticity in the lower limbs with a power of 4/5. His activities of daily living were restricted due to severe spasticity. The lower limb deep tendon reflexes are exaggerated with positive Babinski sign and Scissoring of gait. He also had a mild intellectual disability. He was started on symptomatic management with muscle relaxants. Clinical exome sequencing showed a novel homozygous nonsense variation in exon 6 of DDHD2 gene. Prenatal genetic counseling was given for the next pregnancy and hence chorionic villus sampling for the variant testing of the developing fetus was done. The reports revealed a heterozygous state and asymptomatic carrier, unlikely to be affected by DDHD2-associated phenotype (spastic paraplegia genes 54). HSP should be considered when there is global developmental delay and increasing spasticity in lower limbs despite rehabilitation therapies.
Classification of low- and high-grade gliomas using radiomic analysis of multiple sequences of MRI brain
Authors: Zachariah Rhea Merin , Priya P S , Pendem Saikiran
Published: December 2022

Background:

Gliomas are frequent tumors of brain parenchyma, which have histology similar to that of glial cells. Accurate glioma grading is required for determining clinical management. The background of this study is to investigate the accuracy of magnetic resonance imaging (MRI)-based radiomic features extracted from multiple MRI sequences in differentiating low and high-grade gliomas.

Materials and Methods:

This is a retrospective study. It includes two groups. Group A includes patients with confirmed histopathological diagnosis of low (23) and high-grade (58) gliomas from 2012 to 2020 were included. The MRI images were acquired using a Signa HDxt 1.5 Tesla MRI (GE Healthcare, Milwaukee, USA). Group B includes an external test set consisting of low- (20) and high-grade gliomas (20) obtained from The Cancer Genome Atlas (TCGA). The radiomic features were extracted from axial T2, apparent diffusion coefficient map, axial T2 fluid-attenuated inversion recovery, and axial T1 post-contrast sequences for both the groups. The Mann - Whitney U test was performed to assess the significant radiomic features useful for distinguishing the glioma grades for Group A. To determine the accuracy of radiomic features for differentiating gliomas, AUC was calculated from receiver operating characteristic curve analysis for both groups.

Results:

Our study noticed in Group A, fourteen MRI-based radiomic features from four MRI sequences showed a significant difference (p < 0.001) in differentiating gliomas. In Group A, we noticed T1 post-contrast radiomic features such as first-order variance (FOV) (sensitivity - 94.56%, specificity – 97.51%, AUC – 0.969) and GLRLM long-run gray-level emphasis (sensitivity – 97.54%), specificity – 96.53%, AUC – 0.972) had the highest discriminative power for distinguishing the histological subtypes of gliomas. Our study noticed no statistical significant difference between ROC curves of significant radiomic features for both groups. In Group B, the T1 post-contrast radiomic features such as FOV (AUC–0.933) and GLRLM long-run gray-level emphasis (AUC–0.981) had also shown high discriminative power for distinguishing the gliomas.

Conclusion:

Our study concludes that MRI-based radiomic features extracted from multiple MRI sequences provide a non-invasive diagnosis of low- and high-grade gliomas and can be implemented in clinical settings for diagnosing the glioma grades.
Priority setting in cardiovascular research in Iran using standard indigenous methods
Authors: Sarrafzadegan Nizal , Bagherikholenjani Fahimeh , Noohi Fereidoun , Alikhasi Hassan , Mohammadifard Noushin , Ghaffari Samad , Hassan Adel Seyed Mohammad , Assareh Ahmad Reza , Zibaee Nezhad Mohammad Javad , Tabandeh Mahmood , Farshidi Hossein , Khosravi Alireza , Nematipour Ebrahim , Kermani-Alghoraishi Mohammad , Hassannejad Razieh , Sadeghi Masoumeh , Najafian Jamshid , Shafie Davood , Shabestari Mahmood Mohammadzadeh , Mansouri Asieh , Roohafza Hamidreza , Shahidi Shahla , Yarmohammadian Mohammad Hossein , Moeeni Maryam
Published: December 2022

Background:

Determining cardiovascular disease (CVD) research priorities is essential given the high burden of these diseases, limited financial resources, and competing priorities. This study aimed to determine the research priorities in CVD field in Iran using standard indigenous methods.

Materials and Methods:

An extensive search was done in relevant international and national studies. Then, an indigenous standard multistage approach based on multicriteria decision analysis steps was adapted to local situation and implemented. This process included forming a working group of experts in priority setting methodology, identifying the context and prioritization framework, discussing the methodology with the National Network of CVD Research (NCVDR) members who ultimately determined the priority research topics, weighted topics criteria, ranked topics, and reviewed all determined research priorities for final report.

Results:

Thirteen cardiovascular research priorities were determined by the NCVDR members. The first five priorities based on their scores include studies in hypertension, prevention and control of ischemic heart disease (IHD) and its risk factors, burden of IHD, Registration of CVDs, and COVID-19 and CVDs.

Conclusion:

Cardiovascular research priorities were determined using a standard indigenous approach by national experts who are the NCVDR members. These priorities can be used by researchers and health decision makers.
Serum selenium status in Graves’ disease and Hashimoto's thyroiditis in an iodine-sufficient area
Authors: Heidari Zahra , Sheikhi Vahid
Published: December 2022

Background:

Selenium (Se) can be found in the molecular structure of selenoproteins; including thioredoxin reductase and glutathione peroxidase and also in Type I and II deiodinases. Previous studies have shown that Se deficiency has been linked to autoimmune thyroid disease (AITD). In the present study, we investigated the serum Se levels of patients with Graves’ disease (GD), Hashimoto's thyroiditis (HT), and euthyroid individuals as a control group.

Materials and Methods:

The present study was performed on patients with newly diagnosed AITD (GD and HT). The control group was matched with the case group in terms of parameters such as age and sex. Free thyroxine, free triiodothyronine, thyroid-stimulating hormone, antithyroid peroxidase, antithyroglobulin, and serum Se levels were measured in all participants. These parameters were compared between groups.

Results:

Data from 132 patients with HT, 120 patients with GD, and 120 healthy euthyroid patients as a control group were analyzed. The Se level in patients with HT (104.36 μg/l) and GD (97.68 μg/l) was significantly lower than in the control group (122.63 μg/l) (P < 0.001). The incidence of Se deficiency in patients with HT, GD, and in the control group was 15.2%, 2.5%, and 2.5%, respectively (P < 0.001). In patients with GD, 34 patients (28.33%) had Graves’ orbitopathy. Se levels in patients with orbitopathy were significantly lower than in patients without orbitopathy.

Conclusion:

The serum Se level was significantly lower in newly diagnosed patients with GD and HT than in the control group. Overall, Se deficiency can be considered a risk factor for AITDs.
Safety Assessment of Hydro-Ethanolic Extract of Falcaria vulgaris in Wistar Rats
Authors: Haghighi Meinoush Siavash , Arya Marjan Moeini , Mojarrab Mahdi , Rahimi Zohreh , Hajialyni Marzieh , Hosseinzadeh Leila , Amin Niloufar , Jalilian Fereshteh
Published: December 2022

Background:

Falcaria vulgaris is a medicinal plant with culinary uses and widespread therapeutic applications. Despite already proven as a very promising dietary supplement, its safety and possible effects on the human body are yet to define. This study was designed to investigate the acute and subchronic toxic effects of hydroethanolic F. vulgaris in male and female Wistar rats.

Experimental:

To evaluate the safety of a hydroethanolic extract of F. vulgaris, acute and subchronic toxicity in Wistar rats treated with extract was investigated. For investigation of acute toxicity of F. vulgaris, both genders of rats were treated for 45 days with a single dose of the extract (4000 mg/kg) via gavage. Also for sub-chronic testing, the extract was administrated orally at the doses of 150, 300, and 450 mg/kg for 45 days. At the end of the study, the animals were sacrificed and the hematological, biochemical, and histopathological parameters were assayed.

Results:

After a single oral administration of F. vulgaris (4000 mg/kg), no mortality was observed in both control and groups in either sex. Also, histopathological inspection of vital organs and tissues revealed no obvious alteration in these organs. The obtained results showed a significant reduction in the weight of heart and liver in male rats that received the highest dose of the extract. The level of red blood cell distribution width (dose of 450 mg/kg) from the hematological parameters and the level of serum creatinine (dose of 150 and 450 mg/kg) from the biochemical parameters increased significantly in male rats. On the contrary, during treatment the concentration of all examined minerals remained unchanged. Histopathological inspection indicated that liver, kidney, and testis were found to be affected by subchronic exposure to F. vulgaris extract.

Conclusion:

The results of the acute study revealed that F. vulgaris may be nontoxic even at doses less than 4000 mg/kg body weight. However, the result of subchronic study confirmed the liver dysfunctions in Wistar rats and also suggested the significant effect of F. vulgaris on testicular tissue, which may cause serious male infertility. The ability to impair male fertility by such a medicinal plant has not been reported yet. It can be concluded that the no observed adverse effect level (NOAEL) of F. vulgaris are 150 and 450 mg/kg for male and female rats, respectively.
3D Printing in Capsule
Authors: Mohd Aasim , Chaurasiya Chanchal
Published: December 2022

The 3D printing technique is a 3D fabricating technique, which involves numerous working operations and manufacturing techniques. Nowadays, the technique is mostly used in the healthcare and pharmaceutical industries. This is not very new while the seed of this technique originated in the 1980s. The article contains background, historical development, types, global market, and examples of 3D-printed marketed preparations. This paper gives a focus in particular on 3D printing in capsules. In 3D printing, capsules will be a defining moment in capsule development and capsule applications for customized and personalized medications.
Amalgam of Ternary Solid Dispersion and P-gp Efflux Inhibition in Development of Colon-targeted Tablets of Rifaximin
Authors: Lalan Manisha S. , Shah Pranav J. , Kadam Ruchita , Patel Himan P.
Published: December 2022

Background:

Rifaximin, a BCS class IV drug, possesses low bioavailability due to low solubility and low permeability attributable to P-gp efflux. The studies attempted to develop pH-sensitive rifaximin tablets based on ternary solid dispersion (TSD) for spatial and temporal drug release in colon.

Materials and Methods:

Rifaximin TSD was prepared using Neusilin US2 as a mesoporous carrier and Poloxamer 188 as a hydrophilic carrier and P-gp inhibitor by solvent evaporation technique employing acetone at 1:5 ratio. The TSD was assessed for P-gp inhibition using the gut sac method and Caco-2 permeability studies. The TSD was compressed into tablets and coated with pH-sensitive polymers. Coating optimization was carried out using a 32 factorial design, wherein % coating and ratio of Eudragit S100:Eudragit L100 were the independent variables and % drug release at 2 h and % drug release at 8 h were the dependent variables.

Results:

Differential scanning calorimetry, X-ray diffraction, and scanning electron microscopy studies of rifaximin TSD suggested amorphization of the drug. Gut sac studies indicated higher mucosal to serosal permeability of rifaximin from TSD. Caco-2 permeability studies demonstrated a 4.83-fold higher permeability of rifaximin from TSD (polaxamer 25% w/w and Neusilin 55% w/w of TSD) and a significant change in efflux ratio. In-vitro release studies of the coated tablets displayed controlled and site-specific release at pH of the colon.

Conclusion:

Effective, stable, pH-dependent rifaximin colon-targeted tablets with enhanced dissolution, permeability, and reduced P-gp efflux were developed. The achieved merits could translate into augmented bioavailability and dose reduction. Further in-vivo studies on this novel formulation, which is cost-effective and industrially scalable, can improve the pharmacoeconomics of inflammatory bowel disease management.
Research progress of artificial intelligence-based imaging diagnosis of infectious diseases
Authors: Guo Lin , Xia Li , Lure Fleming , Li Hongjun
Published: December 2022

With the rapid development and progress of theory and technology, artificial intelligence (AI) has overcome many early technical limitations. Remarkable advances have recently been made in the application of AI to various areas of health care, and improvements in the performance of computer-aided diagnostics, such as accuracy, specificity, and processing speed, have been achieved, especially in the classification and identification of lesions. We review the various applications and worldwide progress of AI-based imaging diagnosis of infectious diseases.
Computed tomography findings and clinical evidence of improvement in coronavirus disease 2019 infection after convalescent plasma therapy in a critically ill patient
Authors: Tan Bangguo , Ou Jing , Li Rui , Lu Fulin , Zhang Xiaoming , Chen Tianwu , Li Hongjun
Published: December 2022

The spread of severe acute respiratory syndrome coronavirus 2 worldwide has created a major threat to human life and safety. Antiviral drugs and antibiotics have poor therapeutic effects, and there is no specific treatment for this virus. Chest computed tomography (CT) plays an important role in the diagnosis and management of coronavirus disease 2019 (COVID-19). We report a patient who was critically ill with COVID-19 and recovered after receiving transfusions of convalescent plasma. To evaluate the efficacy of convalescent plasma in the treatment of COVID-19, we compared chest CT findings, clinical manifestations, and laboratory findings before and after treatment with convalescent plasma. After the transfusion of convalescent plasma, clinical manifestations and indicators of inflammation improved, accompanied by an increase in the partial pressure of oxygen and oxygen saturation. Chest CT showed some resolution of the lung lesions, and multiple viral nucleic acid tests were negative. Therefore, the patient's condition was improved after the transfusion of convalescent plasma, suggesting that it may be an effective treatment for patients who are critically ill with COVID-19.
Preprocedural ultrasonography as an adjunct to landmark technique for identification of epidural space in parturients for labor analgesia
Authors: Jayanth Midathala N. , Arumulla Shiny P. , Kesana Pravallika , Kandukuru Krishna C. , Basireddy Hariprasad R. , Peddi Shreevani
Published: December 2022

Background:

Pregnancy-induced softening of tissues and ligaments may increase the false-positive rates when identifying the epidural space in parturients by the landmark technique. To mitigate these problems, Ultrasonography (USG), which has now become the eye of anesthesiologists, can be used as a reliable tool to facilitate more accurate epidural needle placement in parturients. This study was conducted to know the efficacy of USG when compared to the traditional landmark method.

Methods:

After the approval from the institutional ethics committee and CTRI registration, 62 parturients of ASA-2 requesting labor analgesia were randomized into 2 groups of 31 each: Group-L (conventional landmark technique) and Group-U (preprocedural USG done before epidural). In group-U, Tuohy's needle was introduced through the USG predetermined insertion point and epidural space was located using the LOR technique.

Results:

USG increased the success rate of epidural at first attempt from 51.6% in group “L” to 87% in group “U.” Fewer needle attempts (P-value - 0.001) were required in group “U” as compared to group “L.” No accidental dural puncture in group-U, compared to 2 in group-L. Mean Depth of epidural space (cm) ultrasound depth (UD) = 3.89 ± 0.45 cm and needle depth (ND) = 4.05 ± 0.37 cm. Side effects profile in the ultrasound group was better.

Conclusion:

Preprocedural ultrasonography is a simple safe, accurate tool with less number of attempts to determine the needle insertion site, decrease the incidence of accidental dural punctures, and assess epidural space depth in parturients.
Point-of-care transthoracic echocardiography
Authors: Almeida Carlos , Cunha Pedro , Vieira Lígia , Antunes Pedro , Francisco Emilia
Published: December 2022

The pulmonary thromboembolism may be a life-threatening condition. A hip fracture surgery patient aged >90 years old had a sudden post-operative episode of shock, de-saturation, and reverted cardiac arrest. A point-of-care transthoracic echocardiography (TTE) undertaken by an anesthesiologist revealed inferior vena cava dilation/flattening, right cardiac chamber dilation, and McConnell signs (right ventricular apex hyperkinesia and lateral wall hypokinesia); the ventricular septal wall was shifting to the left side, and the left ventricular chamber collapsed at the end-systole, indicating a high ejection fraction in the context of obstructive shock. As such, it revealed signs of pulmonary thromboembolism. Despite the absolute contraindication for thrombolysis and therapeutic hypocoagulation, the treatment was started immediately along with vasopressor support, which was life-saving in this patient. A summary TTE played a pivotal role in our patient's case, helping with the differential diagnosis of the cause of shock.
Anesthesia management of pediatric subglottic stenosis
Authors: Viana Patrícia B. , Sousa Francisco A. , Pinto Ana I. N. , Leal Teresa B.
Published: December 2022

Subglottic stenosis balloon dilation in selected patients may be an option for the treatment of acquired subglottic stenosis, reducing the need for open surgical approaches or tracheostomy. This treatment is a major challenge to otolaryngologists and anesthesiologists, with an interactive collaboration being critical throughout the procedure. When performed, it is fundamental that otolaryngologists and anesthesiologists communicate properly during the procedure to achieve acceptable results. The complex management of the airway and inherent delicacy and risks of the intervention may be challenging. A proper preparation of the procedure and familiarization with the step-by-step technique could optimize the results and prepare the team to deal with intervening complications. We report a case of management and treatment of an 8-month-old baby with subglottic stenosis proposed for endoscopic balloon dilation treatment from Porto, North of Portugal.
Severe bradycardia and hypotension induced by autonomic neuropathy in a diabetic patient during general anesthesia – A case report
Authors: Lee Nawon , Kim Kanghui , Kim Hyuckgoo
Published: December 2022

Cardiovascular autonomic neuropathy (CAN) is characterized by dysregulation of sympathetic and parasympathetic nervous systems that causes cardiovascular and respiratory disorders. The number of diabetic patients undergoing surgery is increasing in line with the prevalence of DM. Anesthesiologists should pay attention to diabetic patients with CAN because it is related to serious cardiovascular morbidity and mortality. We report an 80-year-old male who underwent cervical laminoplasty. He had severe bradycardia and hypotension from induction to the suspension of surgery. His blood pressure dropped to 70/40 mmHg and his heart rate to 20 bpm. Ephedrine, phenylephedrine, and atropine administration had minimal effect, but after epinephrine administrations, his heart rate and blood pressure increased to 70 bpm and 170/90 mmHg. The operation was discontinued because of the patient's unstable, fluctuating vital signs. The results of autonomic nervous system function examination indicated postganglionic cholinergic sympathetic dysfunction, sympathetic adrenergic dysfunction, and parasympathetic cholinergic dysfunction.
Anesthetic challenges in the management of Larsen syndrome
Authors: Das Subhasree , Panda Aparajita , Jena Sritam S. , Jain Mantu
Published: December 2022

Larsen syndrome is a rare inherited disease associated with dislocations of multiple joints, typical syndromic facies, and multiple spine abnormalities. They often required multiple corrective orthopedic surgeries to regain their functional ability, thus needing repeated anesthesia. Apart from skeletal deformities, they have predicted difficult airway and need extreme care during intubation and positing of the patient. Abnormal posturing due to spinal deformity and poor pulmonary reserve due to kyphoscoliosis creates an extremely challenging situation for the anesthetist to manage the case during the perioperative period. Here we are describing the perioperative anesthetic management of a patient with Larsen syndrome.
The role of point of care thromboelastography (TEG) and thromboelastometry (ROTEM) in management of Primary postpartum haemorrhage
Authors: Khanna Puneet , Sinha Chandni , Singh Akhil K. , Kumar Ajeet , Sarkar Soumya
Published: December 2022

Background:

The utility of instantaneous evaluation of coagulation during primary postpartum haemorrhage (PPH) is paramount in the context of empirical blood product transfusion-related risk of dilutional and consumptive coagulopathy and circulatory overload.

Methods:

A profound screening of electronic databases till August 15, 2022 was carried out after being enlisted in PROSPERO (CRD42021275514). Randomized control studies, comparative cohort studies, and cross-sectional studies comparing point-of-care viscoelastic test guided blood product transfusion with empirical transfusion in patients with PPH were included.

Results:

We retrieved five studies, with a total of 1914 parturient with PPH. Patients receiving transfusion based upon point of care viscoelastic tests had lesser risk of having emergency hysterectomy (Odds ratio (OR) = 0.55, 95% CI 0.32–0.95, I2 = 7%), transfusion-associated circulatory overload (TACO) (OR = 0.03, 95% CI 0.00–0.50), reduced transfusion of fresh frozen plasma (OR = 0.07, 95% CI 0.04–0.14, I2 = 89%), platelets (OR = 0.51, 95% CI 0.28–0.91, I2 = 89%), packed red blood cell transfusion (OR = 0.70, 95% CI 0.55–0.88, I2 = 89%), and had better cost-effective treatment [Mean difference (MD) = −357.5, 95% CI − 567.75 to −147.25, I2 = 93%] than patient received empirical transfusion. However, there was no significant difference in the requirement of ICU admissions (OR = 0.77, 95% CI = 0.46–1.29, I2 = 82%). No mortality was detected across the studies.

Conclusions:

Point of care viscoelastic assessment guided transfusion in PPH confederates with reduced morbidity. Nevertheless, more studies on the triggering values for transfusion, long-term survival, and cost-benefit in patients with PPH are warranted to establish its utility.
Perfusion index during endotracheal intubation and extubation
Authors: Shah Prerana N. , Kezo Azho
Published: December 2022

Introduction:

Perfusion index (PI) can be detected using a pulse oximeter. Its value decreases in response to noxious stimuli. Here, we investigated its efficacy in detecting hemodynamic responses during endotracheal intubation and extubation.

Methods:

An approval from the institutional ethics committee was obtained along with a written informed consent from the patients involved in this study. A sample size of 30 was calculated. Reading of PI, heart rate, and blood pressures (systolic, diastolic, and mean arterial) were recorded at pre-intubation, post-intubation, during neuromuscular block reversal, pre-extubation and at extubation. Clinically significant heart rate, blood pressure (systolic, diastolic, and mean) and PI was defined as increase by >10 bpm, rise by ≥15 bpm and a decrease by ≥10%, respectively, from pre-intubation value.

Results:

Clinically significant change in PI was seen at all intervals with maximum decrease in PI occurring during neuromuscular block reversal (42.6% at the start and 56.7% at the end of neuromuscular block reversal). A negative correlation was noted between PI and the other non-invasive hemodynamic parameters.

Conclusion:

PI decreases on noxious stimuli and correlates negatively with the other non-invasive hemodynamic parameters. Hemodynamic response at neuromuscular block reversal is maximum.
Combined neuraxial-general anesthesia in opsoclonus–myoclonus syndrome
Authors: Abreu João B. , Cordeiro Catarina R. , Amorim Ana I. , Catanho Tiago G. , Gama Karina D.
Published: December 2022

Opsoclonus-myoclonus syndrome (OMS) is a very rare neurological disorder thought to be the result of autoimmune responses in the nervous system. The relationship between this disorder and anesthesia procedures has not been studied in detail. To our knowledge, there are only 4 case reports, none of them with epidural-general combined anesthesia.

We present a 9-year-old female with OMS due to low-grade neuroblastoma, for 7 years, who underwent tumor remotion due to the large size. Intravenous induction was done with alfentanil, lidocaine, propofol and rocuronium and ropivacaine was administered via lumbar epidural catheter. Adding to the sparse anesthetic management information in OMS, we now show one more possible approach, that can be valuable in high-risk cases, where general anesthesia can be involved with higher risk for the patient.
Can low dose of intratracheal dexmedetomidine be used to attenuate peri-extubation cough? - A prospective, double-blinded, randomized clinical trial
Authors: Nahar Afreen R. , Gopinath V , Ruth Merlin Shalini
Published: December 2022

Background:

Peri-extubation cough is an undesirable event during extubation, prevention of which has been studied with multiple drugs, amongst which intravenous dexmedetomidine has emerged as one of the favourable drugs. Intratracheal route is attractive because of its ease of administration, provided it avoids the hypotension and bradycardia that occurs during intravenous bolus administration. There is a paucity of data exploring the utility, doses, and adverse effect of intratracheal dexmedetomidine.

Methods:

After obtaining ethical committee approval, 60 eligible, consenting adult patients undergoing surgery under general anesthesia in a tertiary teaching hospital were recruited and randomised into three groups—DEX0.3, DEX0.5, and NS. The plan of general anesthesia was standardized. Half an hour prior to extubation, study drug was instilled intratracheally—dexmedetomidine 0.3 mic/kg, 0.5 mic/kg, and NS in groups DEX0.3, DEX0.5, and NS, respectively. 4-point cough score was used to assess extubation response. Hemodynamic response and time to Ramsay sedation score 3 was also recorded.

Results:

Majority of patients in DEX0.3 (60%) and DEX0.5 (85%) group had no cough (cough score 0), while majority of the patients in the NS group (70%) had either mild or moderate cough (cough score 1, 2). Kruskal Wallis test followed by post-hoc pairwise comparison showed statistically significant difference in 4-point cough score between GroupDEX0.3 and GroupNS (P < 0.001) and between GroupDEX0.5 and GroupNS (P = 0.038). DEX0.5 group, compared to DEX0.3 group, had significantly higher time from reversal to extubation (P < 0.001) and time to achieve Ramsay sedation score of 3 (P < 0.001).

Conclusion:

We conclude that both 0.3 mic/kg and 0.5 mic/kg of dexmedetomidine when given intratracheally are effective in preventing peri-extubation cough. Further, 0.3 mic/kg dexmedetomidine showed a better recovery profile compared to 0.5 mic/kg dexmedetomidine when administered intratracheally.
Buprenorphine for acute post-surgical pain
Authors: Albaqami Mohammed S. , Alqarni Adel A. , Alabeesy Musab S. , Alotaibi Ayidh N. , Alharbi Hazzaa A. , Alshammari Mishari M. , Aldhfery Ahmed H.
Published: December 2022

Our study was designed to evaluate the efficacy of buprenorphine for the management of acute post-surgical pain reported in published studies in the years 2015–2022. Comprehensive research was performed by using online resources like PUBMED and the Wiley Library database to gather the relevant literature. Two authors were assigned to independently collect the information. Cochran's Q-test and I square statistic were used to determine the heterogeneity across the studies. Publication bias was estimated by using the Egger regression analysis and found to be significantly present once the P value <0.05. In this review, 15 studies were included. The pooled ratio of pain reduction after 12 hours of surgery was reported as 11.2% with 97% heterogeneity. Day one shows 5.9 reductions in pain with 98% heterogeneity. The 3% more pain was reduced on day 2. The day 3 pooled pain reduction score was observed as 1.9%. The overall pool prevalence of pain reduction was noted as 6.2% at different time duration with significant heterogeneity of 100%. Buprenorphine transdermal and sublingual both have significant pain relief scores. The analgesic drug consumption was reduced at the end of the follow-up duration.
Moser–Tardos resampling algorithm, entropy compression method and the subset gas
Authors: Fialho Paula , de Lima Bernardo , Procacci Aldo
Published: December 2022

We establish a connection between the entropy compression method and the Moser–Tardos algorithmic version of the Lovász local lemma through the cluster expansion of the subset gas. We also show that the Moser–Tardos resampling algorithm and the entropy compression bactracking algorithm produce identical bounds.
Further investigations into the graph theory of $\phi^4$-periods and the $c_2$ invariant
Authors: Hu Simone , Schnetz Oliver , Shaw Jim , Yeats Karen
Published: December 2022

A Feynman period is a particular residue of a scalar Feynman integral which is both physically and number theoretically interesting. Two ways in which the graph theory of the underlying Feynman graph can illuminate the Feynman period are via graph operations which are period invariant and other graph quantities which predict aspects of the Feynman period, one notable example is known as the

c_2

invariant. We give results and computations in both these directions, proving a new period identity and computing its consequences up to

11

loops in

\phi^4

-theory, proving a

c_2

invariant identity, and giving the results of a computational investigation of

c_2

invariants at

11

loops.
Subconvexity for $L$-functions on $\operatorname{GL}_3$ over number fields
Authors: Qi Zhi
Published: December 2022

In this paper, over an arbitrary number field, we prove subconvexity bounds for selfdual

\operatorname{GL}_3

L

-functions in the

t

-aspect and for self-dual

\operatorname{GL}_3 \times \operatorname{GL}_2

L

-functions in the

\operatorname{GL}_2

Archimedean aspect.
Exponential rarefaction of maximal real algebraic hypersurfaces
Authors: Ancona Michele
Published: December 2022

Given an ample real Hermitian holomorphic line bundle

L

over a real algebraic variety

X

, the space of real holomorphic sections of

L^{\otimes d}

inherits a natural Gaussian probability measure. We prove that the probability that the zero locus of a real holomorphic section

s

of

L^{\otimes d}

defines a maximal hypersurface tends to

0

exponentially fast as

d

goes to infinity. This extends to any dimension a result of Gayet and Welschinger (2011) valid for maximal real algebraic curves inside a real algebraic surface.

The starting point is a low degree approximation property which relates the topology of the real vanishing locus of a real holomorphic section of

L^{\otimes d}

with the topology of the real vanishing locus a real holomorphic section of

L^{\otimes d'}

for a sufficiently smaller

d'<d

. Such a statement is inspired by the recent work of Diatta and Lerario (2022).
Cooperation of idiotypic and anti-idiotypic antibodies at the steroid-depended chemical carcinogenesis
Authors: Polenok Elena G. , Gordeeva Lyudmila A. , Mun Stella M. , Kostyanko Mikhail V. , Antonov Alexander V. , Verzhbitskaja Natalia E. , Bairamov Pavel V. , Kolpinskiy Gleb I. , Vafin Ilgiz A. , Glushkov Andrey N.
Published: December 2022

Immunological research of steroid-depended chemical carcinogenesis in humans is based on positive experience in the clinical usage of selective estrogen receptor modulators and experimental design of immunological methods for human protection from environmental carcinogens. Our study aimed for research of idiotypic antibodies against benzo[a]pyrene, estradiol and progesterone (IgA1-Bp, IgA1-E2 and IgA1-Pg), in connection with anti-idiotypic antibodies specific to estradiol and progesterone (IgG2-E2 and IgG2-Pg) in serum samples of postmenopausal healthy women (HW) and ER+/PR+ stage I breast cancer patients (BCP). Idiotypic antibodies were studied in 402 HW and 475 BCP using ELISA technique, with BP, E2 and Pg conjugated with bovine serum albumin as adsorbed antigens. The anti-idiotypic antibodies were studied using ELISA method and monoclonal antibodies against E2 and Pg as adsorbed antigens. High individual ratios of IgA1-Bp/ IgA1-Pg 1 and IgA1-E2/IgA1-Pg 1 were revealed in 42.1% and 48.5% HW, and in 71.1% and 78.1% of BCP cases (p 0.0001, OR = 5.9 and OR = 3.8, respectively). High IgG2-E2 4 levels were found in 23.4% HW and in 41.2% of BCP group (p = 0.0001, OR = 2.3). Combination of IgA1-Bp/IgA1-Pg 1 with IgG2-E2 4 and IgG2-Pg 2 was more common in HW, than in BCP (29.3% vs 5.8%, p 0.0001, OR = 0.1). Combinations of IgA1-Bp/IgA1-Pg 1with IgG2-E2 4 or with IgG2-Pg 2 were more frequent in BCP, than in HW (12.0% and 31.8% vs 4.9% and 15.2%, accordingly, p = 0.01, OR = 2.7 and p = 0.001, OR = 2.6), as well as combination of IgA1-Bp/IgA1-Pg 1 with IgG2-E2 4 and IgG2-Pg 2 (23.4% vs 9.8%, p = 0.0003, OR = 2.8). Similar specific features were found in HW and BCP when studying IgA1-E2/IgA1-Pg ratio with IgG2-E2 and IgG2-Pg. Nevertheless, high IgA1-Bp/IgA1-Pg 1 or IgA1-E2/IgA1-Pg 1 combined with low IgG2-E2 4 + IgG2-Pg 2 were revealed in HW (27.7% and 28.8%) more frequently, than in BCP (19.7%, p = 0.06 and 17.9%, p = 0.008). Excess of IgA1-Bp and IgA1-E2 levels over IgA1-Pg in combination with high IgG2-E2 and IgG2-Pg levels in HW is associated with ER+/PR+ BC stage I condition and may serve as an marker for preventive BC therapy by the targeted ER modulators.
Pesquisa de campo com mídias digitais
Authors: Padilha Felipe , Facioli Lara
Published: December 2022

Considerando o impacto da pandemia da síndrome respiratória aguda grave por coronavírus (SARS-CoV-2) sobre a pesquisa de campo, neste breve ensaio, buscaremos apresentar e discutir algumas questões e impasses que envolvem a transposição de desenhos de investigação para campos digitalmente mediados. Buscaremos refletir sobre como as Ciências Sociais, em especial a Sociologia, podem mobilizar o digital como recurso, como campo ou como ferramenta para a coleta de dados, oferecendo respostas criativas a determinadas situações críticas que afetam o trabalho de campo. Ao final, destacamos algumas questões éticas que se apresentam diante das especificidades de campos mediados pela tecnologia.
Ruralidades, ambiente e sociedade
Authors: Constante Martins Rodrigo , Pires Cardoso Jéssica , Sabadin Ana Carina
Published: December 2022

Este ensaio objetiva apontar possibilidades de problematização das desigualdades sociais no Brasil a partir de uma sociologia direcionada para o tema dos conflitos agrários e ambientais no século XXI. Para tanto, revisita os temas e trajetos teórico-analíticos empreendidos pelo Grupo de Pesquisa CNPq Ruralidades, Ambiente e Sociedade - RURAS, com vista ao desenvolvimento de um programa de pesquisas que atravessa as condições de produção de desigualdades socioambientais.
Design and Simulation of Safe Truck-Cargo Matching System for Rollover Prevention
Authors: Oh Seongjin , Jeong Jongpil
Published: December 2022

Commercial vehicles have a higher center of gravity than passenger vehicles, so the rollover rate is higher. In particular, overloading has the effect of further raising the center of gravity, causing rollover even at small lateral acceleration. In this study, we propose a system that identifies and recommends trucks that can safely drive on curved roads by finding factors that cause vehicle rollover through cargo information and driving conditions. It is expected that drivers will be able to transport more safely by preventing overloading, and users will be able to reduce transportation costs by reducing the occurrence of errors in vehicle selection.
PENINGKATAN HASIL BELAJAR IPA MATERI PERKEMBANGBIAKKAN VEGETATIF TUMBUHAN DENGAN QUANTUM TANDUR DI SDN 3 KRACAK KABUPATEN BANYUMAS
Authors: Nurseptyani Riski
Published: December 2022

Penelitian ini bertujuan untuk meningkatkan hasil belajar IPA khususnya pada materi perkembangbiakkan vegetatif pada tumbuhan. Penelitian dilaksanakan di kelas VI B SDN 3 Kracak dengan jumlah subyek penelitian sebanyak 24 siswa. Metode yang digunakan dalam penelitian ini adalah Penelitian Tindakan Kelas (PTK) yang dilaksanakan dalam 2 siklus. Hasil penelitian menunjukan adanya peningkatan hasil belajar siswa, dilihat dari hasil belajar pra siklus, siklus I, dan siklus II. Rata-rata hasil belajar siswa pada prasiklus adalah 35,50. Setelah dilakukan pembelajaran dengan metode Quantum TANDUR, pada siklus I terjadi peningkatan sebanyak 25,38 dengan nilai rata-rata 60,88. Selanjutnya setelah dilaksanakan kegiatan pembelajaran pada siklus II terjadi peningkatan sebanyak 16,91 dengan nilai rata-rata menjadi 77,71. Dengan demikian kriteria keberhasilan pada penelitian ini telah tercapai, karena 83,3% siswa telah mendapatkan nilai diatas Kriteria Ketuntasan Minimal (KKM).