bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficacy of Minimal Invasive Methods in Management of Traumatic Pancreatic Injury
Authors:   Department of General and GI Surgery, Kathmandu Medical College Teaching Hospital, Kathmandu, Nepal, Sah Bed P. , Ghimire Roshan ,   Department of General and GI Surgery, Kathmandu Medical College Teaching Hospital, Kathmandu, Nepal
Published: April 2022

Introduction Isolated pancreatic injury is relatively uncommon due to its mostly retroperitoneal location. However, if present, it is associated with other visceral injuries and causes serious complications if expected management is delayed. Cases In this report we have discussed about the different minimal invasive management approaches in two cases of pancreatic injury. The first case had American Association for the Surgery of Trauma Organ Injury Scale (AAST-OIS) grade IV pancreatic injury with late presentation who underwent ultrasound-guided percutaneous drainage of pseudocyst with video assisted lavage of cavity, followed by endoscopic retrograde cholangiopancreatography (ERCP) guided pancreatic duct stenting. Second case had AAST-OIS grade II pancreatic injury which was managed with serial percutaneous drainage. Conclusion Management of pancreatic injury is complex. Evolving trend of minimal invasive techniques of management for selected patients with higher grade pancreatic injury is associated with better outcomes.
Tailored Endoscopic Approaches for Pancreatic Traumatic Injuries
Authors:   Digestive and Interventional Endoscopy Unit, ASST GOM Niguarda, Milan, Italy, Dioscoridi Lorenzo
Published: April 2022

Pancreatic traumatic injuries should be managed by multidisciplinary approach. Standard redo surgery can be avoided or supported by innovative mininvasive approaches both endoscopically and/or radiologically. Pancreatic endotherapy has an increasing role in the management of pancreatic injuries. Understanding the pathophysiology of pancreatic leak is crucial to guide the treatment. Endoscopic treatment must be tailored on the type and site of pancreatic fistula to achieve the optimal clinical outcome: there is not a one-way standard treatment but the best treatment for different types of pancreatic injuries considering both retrograde and endoscopic ultrasound (EUS)-guided approaches.
The impact of adding nano zirconium dioxide fillers on color change, water sorption and solubility for denture liners
Authors: ERGUN Gulfem , ATAOL Ayşe Seda , ŞAHİN Zeynep , GENÇ ALTÜRK Rükan
Published: April 2022

Objective: Zirconium dioxide (ZrO2) nanofillers were added to denture liners to improve their physical properties. The main goal of this research was to evaluate the impact of adding nano zirconium oxide (ZrO2) fillers on color change, water sorption and solubility of silicone and acrylic denture liners. Materials and Method: The surface of ZrO2 nanoparticles was modified via treatment with the silane coupling agent (3-aminopropyl) triethoxysilane. Fourier transform infrared spectroscopy analysis was performed to characterize surfaces untreated or treated with ZrO2. After modification, these nanoparticles were incorporated into silicone and acrylic denture liners. Three subgroups were assigned for each test method. Kruskal-Wallis and Mann-Whitney U tests were used for the statistical analysis (p ≤ 0.05). Results: Water sorption and solubility in water values decreased with the addition of modified ZrO2 nanofiller in both test groups (respectively, acrylic-based tissue conditioner: p = 0.040 and p = 0.020; silicone-based denture liner: p < 0.001 and p = 0.017). The acrylic-based tissue conditioner test group with 1% modified ZrO2 nanofiller showed the greatest color change (ΔΕ = 37.94 ±6.62), whereas the silicone-based denture liner group with 0.5% modified ZrO2 nanofiller presented the lowest (ΔΕ = 5.02 ±2.30). Conclusion: Modified ZrO2 nanofiller–incorporated silicone-based denture liners might show better clinical success than acrylic ones according to the evaluated parameters.
Atención sin daño, acompañamiento y reparación de las violencias sexuales contra las mujeres: hacia un modelo de respuesta crítico holístico
Authors: Tardón Recio Bárbara , Mateos Casado Cristina , Pérez Viejo Jesús Manuel
Published: April 2022

El presente artículo realiza una breve aproximación histórica, conceptual y legal a la violencia sexual contra las mujeres, determinando el impacto y las secuelas en las mujeres que la sufren y los daños comunitarios y sociales. En los últimos años, gracias a la presión del movimiento feminista, el Gobierno de España ha puesto en marcha los Centros de Crisis 24 horas, amparados por la nueva Ley de Libertad Sexual y bajo el marco internacional de los derechos humanos. Desde los años 70 el movimiento antiviolación, los diferentes instrumentos internacionales de derechos humanos y las voces de las víctimas, plantean nuevos modelos de intervención integral, para garantizar el derecho a la reparación. Mediante la aplicación de una metodología feminista, se propone como resultado un modelo de respuesta crítico holístico para la atención sin daño, el acompañamiento y reparación de las violencias sexuales contra las mujeres que contempla nuevos enfoques; servicios específicos; procesos de intervención en crisis, recuperación y reparación del daño; y espacios para la atención a las mujeres y sus seres queridos. Todo con el fin de que las mujeres puedan estar expresadas y sientan seguridad, respeto institucional y buena diligencia en sus procesos, tiempos y toma de decisiones.
Han, Clara (2022): La vida en deuda. Tiempos de cuidado y violencia en el Chile neoliberal. Santiago de Chile: LOM Ediciones. (In press).
Authors: Tizzoni Salas Constanza
Published: April 2022

La antropóloga Clara Han presenta un texto fundamental para comprender los antecedentes, causas y sentidos de un Chile marcado por el "Estallido Social".
Tensiones y resistencias: la partería comunitaria tseltal y el sistema de salud mexicano
Authors: Alvarez Diana , Hernández Zinzún Gilberto
Published: April 2022

Este artículo reflexiona sobre la brecha entre el paradigma tradicional de cuidados de la salud y el paradigma biomédico mundial respecto a la partería tradicional indígena en México. Busca identificar el contexto en el que la partería comunitaria se ejerce actualmente, así como las tensiones que emergen de su encuentro con el modelo médico hegemónico. Tiene un alcance exploratorio que examina un problema que no ha sido estudiado a profundidad: las resistencias de las parteras tseltales que mantienen vivas prácticas de cuidado a la salud reproductiva. Se trata de una investigación etnográfica de tipo cualitativa que se construye con herramientas propias de la antropología y las ciencias sociales, para analizar distintas dimensiones de un problema complejo y de gran relevancia para la salud colectiva. Encontramos que gran parte de las prácticas tradicionales de las parteras tseltales de Amatenango del Valle se han mantenido activas a pesar de los múltiples mecanismos de control y la violencia sistémica de la que son objeto, debido en gran medida a la resistencia cultural entre las comunidades indígenas de Chiapas.
Porroche-Escudero, Ana, Coll-Planas, Gerard, y Riba Sanmartí, Caterina (2017): Cicatrices (in)visibles. Perspectivas feministas sobre el cáncer de mama, Bellaterra.
Authors: Mesa Freydell Natalia
Published: April 2022

Esta recopilación de ensayos denuncia una visión exclusiva del cáncer de mama debido a la prevalencia del modelo médico biológico, y propone el enfoque de la Medicina Basada en Narrativa.
Rodríguez Cruz, Marta (2021): Los Pueblos Indígenas del Abya Yala en el Siglo XXI. Un análisis multidimensional. Ediciones Abya Yala
Authors: Viteri Tassi Akángau
Published: April 2022

Se presenta una mirada sobre el racismo estructural que viven los pueblos indígenas del Abya Yala (América del Sur), impidiendo su emancipación definitiva en todos los ámbitos de la vida social.
[RETRACTED] Iron Warrior Testo Thrust (Shocking!) Does Iron Warrior Testo Thrust Really Works? v1
Authors: Warrior Testo Thrust Iron
Published: April 2022

[RETRACTED]

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[RETRACTED] Nucentix Keto X3 Reviews - 7 Day Challenge Keto X3 Pills Diet + Improve Metabolism v1
Authors: Keto Nucentix
Published: April 2022

[RETRACTED]

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[RETRACTED] Sports Illustrated Brain Formula Customer Cost Reviews : [7 Secrets] Real Work? v1
Authors: not provided officialpearlie
Published: April 2022

[RETRACTED]

The Sports Illustrated Nutrition Brain formula is a brain supplement that has the absolute ability to give and enhance brain power. It has the scientific terms “NOOTROPIC” and “GENIUS PILL,” which it goes by.
[RETRACTED] Ketosium ACV Gummies Reviews: 100% Clinically Proven Ingredients ! v1
Authors: ACV Gummies Ketosium
Published: April 2022

[RETRACTED]

Ketosium ACV Gummies It's a natural supplement that uses the ketosis process to burn fat. It is a composition of herbal ingredients. One can get a slim, attractive, and healthy body figure. These gummies Work quickly & can assist you with getting more fit rapidly!
[RETRACTED] Limitless Glucose1(Scam Or Legit) For Healthy Blood Sugar Levels Supplement v1
Authors: not provided psenvkzvis
Published: April 2022

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Saudi Learners' Perceptions of Academic Writing Challenges and General Attitude Towards Writing in English
Authors: Khadawardi Hanadi Abdulrahman
Published: May 2022

Second language (L2) academic writing is one of the most fundamental, yet sophisticated skills for university students to master. It requires the ability to not only create ideas using sentences, but also construct meaningful, logical and comprehensible texts. Thus, understanding students’ attitudes towards L2 writing and exploring the challenges that they experience while composing texts are necessary for L2 teachers and curriculum designers. The overall goal of this study is twofold: (1) to investigate students’ perceptions of the difficulty that they experience while writing academic texts in English and (2) to explore learners’ attitudes towards writing assignments in English. The goal here is to explore these issues using data obtained from 109 Saudi university students. Data were first collected using a questionnaire and then quantitatively analysed. The results show that students tend to perceive academic writing as challenging and adopt a mildly to moderately positive attitude towards writing in English. These findings offer some implications for teachers and curriculum designers to improve the L2 academic writing skills of students.
Hayati Sağlık Verilerinin CoAP Observe Yöntemi ile İletilmesi ve Analizi
Authors: MANAP Gökçe , DEMİR Alper Kamil
Published: April 2022

Nesnelerin İnterneti (IoT), son zamanların en çok tercih edilen teknolojilerinden biridir. Günümüzde IoT'nin günlük hayatta kullanımı artmakta ve zamanla daha da artması beklenmektedir. IoT cihazları, herhangi bir kullanıcıya ihtiyaç duymadan birbirleriyle otomatik olarak iletişim kurabilir, diğer cihazlardan veri alabilir veya üzerlerindeki sensörler aracılığıyla veri üretebilir. IoT, akıllı şehir sistemlerinde, ev otomasyon sistemlerinde, trafikte ve diğer birçok alanda kullanılabilir. IoT sisteminin kullanıldığı alanlardan biri de sağlık sektörüdür. Sağlık teknolojisinde IoT sistemleri, hastaların sağlık verilerinin otomatik olarak alınmasında, izlenmesinde ve işlenmesinde önemli bir rol oynar. Kalabalık bir ortamda olmak istemeyen veya evde bakıma ihtiyaç duyan yaşlı hastaların uzaktan izlenip tedavi edilmeleri gerekebilir. Bu durumlara çözüm olarak bireylerin sağlık verilerini toplayıp bir sağlık kuruluşuna bu verileri hızlı ve güvenilir şekilde iletmek için bir IoT sistemi tasarlanabilir. IoT sistemleriyle çalışan ağ protokol yığınlarının performansının analiz edilmesi sistemin en iyi protokol kombinasyonunu bulmak adına oldukça faydalı olacaktır. Bu çalışmada, kişilerin nabzı, glikoz seviyesi, kalp grafiği gibi sağlık verilerini iletmek için CoAP (Constrained Application Protocol)-Observe kullanılmış ve bu yöntemin performans analizi yapılmıştır. Yapılan performans analizinde sonuçların değerlendirilmesi için gecikme, enerji verimliliği, güvenilirlik ve işlem hacmi gibi 4 farklı metrik belirlenmiştir. MAC (Media Access Control) protokollerinden CSMA (Carrier Sense Multiple Access), nullMAC ve RDC (Radio Duty Cycle) protokollerinden contikiMAC, nullRDC protokolleri kullanılarak 4 farklı senaryo ve 3 farklı PDR (Packet Delivery Ratio) değeri (100, 95, 90) kullanılarak toplam 12 farklı senaryo değerlendirmesi yapılmıştır.
L-shade Algoritmasının Otomatik Parametre Yapılandırma Yöntemi ile İyileştirilmesi
Authors: YAVUZ Gurcan
Published: April 2022

Son dönemin önemli metasezgisellerinden olan L-shade algoritması uyarlanabilir bir DE varyantıdır. Az sayıda kontrol parametresine sahiptir ve algoritmanın çalışmasını etkilemektedir. Bunların doğru şekilde belirlenmesi algoritma performansında kritik role sahiptir. Bu çalışmada, L-shade algoritmasına ait kontrol parametreleri bir otomatik parametre yapılandırma aracı olan irace kullanılarak belirlenmiştir. Yapılan işlemin etkinliği CEC 2014 ölçüt seti kullanılarak test edilmiştir. Elde edilen sonuçlar, L-shade’nin ön tanımlı parametreleri ve bir başka parametre belirleme aracı olan paramils’nin elde ettiği parametreler ile karşılaştırılmıştır. Deney sonuçları göstermiştir ki kullanılan yapılandırma aracı ile elde edilen parametre değerleri ile daha iyi sonuçlar elde edildiği görülmüştür.
Uyarlamalı Ağ Tabanlı Bulanık Mantık Çıkarım Sistemi ve Yapay Sinir Ağları ile Türkiye’deki COVID-19 Vefat Sayısının Tahmin Edilmesi
Authors: TURAN Tülay , TURAN Gökhan , KÖSE Utku
Published: April 2022

COVID-19, küresel pandemi olarak ilan edilmiş, kritik ve ölümcül bir hastalıktır. Küresel salgın tehlikesinin sürmekte olduğu bu süreçte, pandemi ile yüzleşmek için özel politikalar ve planlar yapmak oldukça önemlidir. COVID-19 doğrulanmış verilerini kullanarak, yapay zeka teknikleri ile tahminlerde bulunmak ise gelecek planlarının geliştirilmesine yardımcı olduğu için önemli bir konudur. Bu çalışmada, Türkiye Sağlık Bakanlığı COVID-19 bilgilendirme sayfasında yayınlanan veriler kullanılarak, uyarlamalı ağ tabanlı bulanık mantık çıkarım sistemi (ANFIS) ve yapay sinir ağları (YSA) ile tahmin modelleri geliştirilmiştir. Bu modeller farklı istatistiksel değerlendirme kriterleri kullanılarak karşılaştırılmıştır. Değerlendirme sonucunda ANFIS modeli 0.0247 ortalama mutlak hata (MAE) değeri, 0.0012 ortalama kare hata (MSE) değeri, 0.0351 kök ortalama kare hata (RMSE) değeri ve 0.9847 regresyon katsayısı R2 sonucu ile en iyi model sonucunu elde etmiştir. Ayrıca ANFIS ile oluşturulan modelin gelecek beş günlük vefat sayılarını %96 doğruluk oranı ile tahmin ettiği görülmüştür.
Inclusive Models of Resource and Self-Contained Classes for Children with Autism Spectrum Disorders in Nizhny Novgorod Region. Organizational Aspects
Authors: Guseva N.Y.
Published: April 2022

Nineteen resource and self-contained classes for 99 children with autism spectrum disorders have been opened in Nizhny Novgorod region over the past two years.     The article considers the models of inclusive education organization: "resource class" and "self-contained class" for these students. The factors influencing the choice between the considered models are analyzed, the data of surveys of parents of children with autism spectrum disorders, identifying their needs and requests are given. The article discusses the educational conditions of 54 students in resource and self-contained classes who have completed their first year. An analysis of the level of parents' and teachers' satisfaction with the educational process and the results achieved is given on the basis of their surveys. Based on two years of experience, a step-by-step algorithm for preparing for the opening of resource and self-contained classes was developed. The suggested algorithm can be useful for opening new classes, including in other regions.
Adoption Social Media- Movie Based Learning Project (SMMBL) To Engage Students' Online Environment
Authors: Muthmainnah  , Obaid Ahmed J. , Al.Mahdawi Raghda Salam , Khalaf Haitham Abbas
Published: April 2022

Developing ICT as English Language Teaching (ELT) materials in Indonesia is still being studied in higher education contexts. Nowadays, amid covid 19 there are many tools, apps and technologies are being integration in virtual classroom.  ICT can be used as media for teaching and learning process it should be related today’s fact by integrating ICT easy enough to share it and easy to access by the students’ technologies devices (Muthmainnah, et.all, 2021 and Apriani et.al, 2021 The purposes of this study is to investigate the impact of development instructional design incorporating social media- movie based learning project (SMMBLP) in Computer Science Faculty in learning English to engagement student’s online environment. The method of this study is quantitative research and used pre-experimental design to investigates the impact of SMMBLP on students’ English skill and student’s motivation in ELT. The participants in this study were the first semester students of Computer Science Faculty academic year 2020-2021 at Universitas Al Asyariah Mandar consisted 40 students. The data were collected by test; pre-test, post-test and questionnaire.  The result of the study implied the impact on integration social media- movie based learning project (SMMBLP) that very effective to enhancing students’ English skill and motivation. The study suggests SMMBL can be integration in online or Hybrid/ Blended environment for the next education teaching model in ELT for EFL students.
Role of Psychological Capital as a Mediator between Authentic Leadership and Learning Organization in Bangkok Metropolitan Schools: A Causal Relationship Model
Authors: Akkakanjanasupar Pakorn , Panchit Longpradit Arisara Leksansern,
Published: April 2022

The purpose of the research was to develop the empirical causal relationship model of learning organization, with psychological capital as a mediator, impacted by authentic leadership in Bangkok Metropolitan school, Thailand. The literature review was extensively conducted to identify the research hypothesized model, and the causal relationship modelling was implemented by 1,080 teachers. Descriptive and inferential statistics and structural equation modelling were conducted to empirically investigate causal relationships. The findings revealed that the causal relationship model fit the data well, as indicated by fit indices; Chi-square indicated at 26.464 (df=34; p=0.818), with non-statistical significance. Model consistency was identified by Goodness of Fit Index (GFI) at 0.997, Adjusted Goodness of Fit Index (AGFI) at 0.988, Root Mean Square Residual (RMR) at 0.00519, and Root Mean Square Error of Approximation (RMSEA) at 0.000. The findings consistently and significantly revealed direct and indirect effects of authentic leadership on learning organization as mediated by psychological capital, which identified an indirect effect (0.56**) and a total effect (0.65**). The direct effects of authentic leadership were the highest impact on psychological capital (0.81**), though with a non-significant direct impact on learning organization (0.08). The results significantly indicated a direct effect of psychological capital on learning organization (0.69**), verified psychological capital as an effective mediator enhancing learning organization. By square multiple correlations of the latent variables, psychological capital was explained and predicated by authentic leadership for 66%, and learning organization was explained and predicated by authentic leadership and psychological capital for 58%.
Factor Analysis Affecting the Implementation of the Generative Learning Model with a Cognitive Conflict Strategy in the Computational Physics Course during the COVID-19 Pandemic Era
Authors: Akmam A , Hidayat R , Mufit F , Jalinus N , Amran A
Published: April 2022

This study aimed to analyze the factor model affecting the implementation of the Generative Learning Model with a Cognitive Conflict Strategy in the Computational Physics Course during the COVID-19 pandemic era. This study used quantitative descriptive data. The research respondents were 105 Physics study program students who took the Computational Physics course for the 2020/2021 academic year. A questionnaire with the Likert Scale used for the survey has been tested for validity by experts and limited tryout. The questionnaire used has high validity and reliability. Data were used for modeling structural equations through Exploration Factor Analysis (EFA). EFA results were used to determine the level of Confirmatory Factor Analysis (CFA) to obtain a complete Structural Equation Modeling. The results show that dynamic interactions and interdependent correlations are formed between variables that affect the implementation of Computational Physics learning. After analyzing the 20 (twenty) variables, it was formed 5 (five) factors affecting the implementation of the Generative Learning Model with a Cognitive Conflict Strategy in the Computational Physics Course. The five influencing factors are 1) the learning syntax and teaching materials used (x1); 2) the activity of expressing ideas (disclosure) and model practice (x2); 3) learning styles and creative thinking (x3); 4) Attitudes and final target score of learning (x4); 5) attitude towards learning materials and learning methods (x5). The five factors produce a model F = 0.366 x1 + 0.161 x2 + 0. 959 x3  + 0.682 x4 + 0. 549 x5.
Aftershocks Preferentially Occur in Previously Active Areas
Authors: Page Morgan T. , van der Elst Nicholas J.
Published: April 2022

The clearest statistical signal in aftershock locations is that most aftershocks occur close to their mainshocks. More precisely, aftershocks are triggered at distances following a power-law decay in distance (Felzer and Brodsky, 2006). This distance decay kernel is used in epidemic-type aftershock sequence (ETAS) modeling and is typically assumed to be isotropic, even though individual sequences show more clustered aftershock occurrence. The assumption of spatially isotropic triggering kernels can impact the estimation of ETAS parameters themselves, such as biasing the magnitude-productivity term, alpha, and assigning too much weight to secondary rather than primary (direct) triggering. Here we show that aftershock locations in southern California, at all mainshock–aftershock distances, preferentially occur in the areas of previous seismicity. For a given sequence, the scaling between aftershock rates and the previous seismicity rate is approximately linear. However, the total number of aftershocks observed for a given sequence is independent of background rate. We explain both of these observations within the framework of rate-and-state friction (Dieterich, 1994).
Utility of clinical methods and ultrasonography compared to actual birth weight in estimating the fetal birth weight
Authors: Y Swapna , Arjumand Aamina
Published: April 2022

It is important to find out the most effective method for monitoring the growth of the fetus. The method should also identify the women with problematic pregnancy prone to IUGR so that early action can be taken to prevent adverse consequences.

To study the utility of clinical methods and ultrasonography compared to actual birth weight in estimating the fetal birth weight

A Hospital based Comparative Longitudinal Study was carried out among 200 antenatal women. Symphysio-Fundal Height (SFH) measurements and fetal weight was estimated by simplified Johnson’s formula: McDonald’s measurement for estimation of SFH wasdone i.e., distance from height of fundus to the upper edge of pubic symphysis.SFH at different weeks of gestation from 24 weeks until delivery was noted with a non-stretch centimeter tape. Fetal weight was estimated by Hadlock’s formula using USG.

Sensitivity of 74.55% and specificity of 95.17% was observed for Johnson’s method while sensitivity of 90.91% and specificity of 98.62% by USG method. Mean difference between birth weights estimated by USG compared to actual birth weight was lesser (59.73 gm) compared to 418.96 gm by Johnson’s method. Mean error by USG was less (127.86 gm) compared to Johnson’s method (437.23 gm). Johnson’s method was found to be have less percentage error overall, across the birth weight categories. Overestimation of actual birth weight by USG method was seen in 131 cases compared to 192 cases by Johnson’s method.

Of the two methods studied for estimation of fetal weight, ultrasonographic method, i.e., Hadlock’s formula has better predictable results in fetal weight estimation, compared to clinical method, i.e., Johnson’s formula
Role of colour doppler indices in diagnosing intrauterine growth restriction in high risk pregnancies in second and third trimester
Authors: Sujana Kanamatha Reddy
Published: April 2022

Intrauterine growth restriction (IUGR) is associated with impaired neurological development of child, increased morbidity and increased risk of death during perinatal period. Doppler ultrasound during pregnancy is a useful tool for early detection of IUGR and this helps in early management to prevent further complications associated with IUGR.

To study efficacy of color doppler in diagnosing Intrauterine growth restriction in high risk pregnancies in second and third trimester.

Diagnostic efficacy study was conducted among 100 subjects with high risk pregnancy presenting in second and third trimester. IUGR was suspected when there was a growth lag of >4 weeks between gestational age and fundal height. Further two-dimensional ultrasound was performed. Bi-parietal diameter, Head circumference, Abdominal circumference, Femur length were noted, estimated fetal weight was calculated. IUGR fetuses were identified if abdominal circumference is<5 percentile and estimated fetal weight was<10 percentile for that gestational age. Vessels studied were Uterine artery, Umbilical artery, Middle cerebral artery, Ductus venosus. The doppler indices studied were RI, PI, S/D, Cerebro-Placental ratio (CPR).

Majority were of 22-25 years (52.5%); 53.75% were primigravida; 41.25% presented at 33-37 weeks; 46.25% had gestational hypertension. The overall sensitivity of doppler indices as seen in the present study was good (89.9%) but specificity was only 9.1%. Among the other indices, CPR had the best diagnostic utility with sensitivity=64%; specificity=100% and PPV=100% followed by umbilical artery doppler with sensitivity=55.1%; specificity=81.8% and PPV=96.1%.

The overall color doppler indices are highly sensitive in detection of IUGR and lacks the specificity. CPR and Umbilical artery doppler can be used with more reliability.
Neonatal outcome in hypertensive disorders of pregnancy in tertiary care centre
Authors: Ganguly Sristi , Mohanty Supriya , Pradhan Madhusmita , Champatiray Jyoti Ranjan
Published: April 2022

Hypertensive disorders of pregnancy, contribute to significant neonatal mortality and morbidity, with complications ranging from prematurity, low birth weight and respiratory morbidities.

This study is a observational study done in tertiary care hospital in Cuttack, Odisha during the period December 2018 to November 2020. Mothers, aged 18 to 36 years, beyond 20 weeks of pregnancy with hypertensive disorders complicating pregnancy admitted, with booked pregnancy and regular antenatal check-up were included in the study. Those with underlying chronic diseases like chronic diabetes mellitus, chronic renal failure, chronic hypertension, heart disease, twin or multiple pregnancy and polyhydramnios were excluded. The neonates born followed and outcomes noted. Data analysed using SPSS 26 and results expressed in percentage and comparison across the groups done using Chi Square test / Fisher's Exact Test as appropriate.

: Among 150 mothers, majority were suffering from severe preeclampsia (36%) followed by gestational hypertension (27.3%), with most (66.7%) being a term pregnancy. 20.9% were stillbirths and 34% needed NICU admission for various complications. The most common neonatal complication noted was intrauterine growth retardation. A significant association noted between the severity of hypertension and maturity (p<0.001), birth weight (p=0.001), delivery outcome (p=0.001) and neonatal complications (p=0.009).

The delivery outcome, gestational age and birth weight, along with neonatal complications had a significant association with increasing severity of the hypertension. Thus, there is urgent necessity for strict protocols to screen, early detection and efficient management of these disorders in pregnant women, in order to ensure a safe outcome for both mother and newborn.
Comparison of surgical biliary bypass and biliary metallic stents for palliation of incurable malignant distal bile duct obstruction: A prospective observational study
Authors: Kulkarni Mukund P , Naik Nagaraj
Published: April 2022

: Management of obstructive jaundice from periampullary and pancreatic head malignancies is mostly palliative. With advancements in endoscopic and stent technology and instrumentation, endoscopic interventions are gaining popularity and acceptance over surgical relief of jaundice.

To study efficacy of surgical biliary bypass over biliary metallic stents for palliation of incurable malignant distal bile duct obstruction

Prospective observational study was carried out among 77 patients withincurable malignant distal bile duct obstruction. 45 of them chose to undergo surgical bypass while 32 agreed to undergo metallic stenting. Parameters like improvement in jaundice, procedure related morbidities, need for re-hospitalization, need for re-intervention, quality of life and survival were compared in two groups. Chi square test and t test were applied to compare two groups.

: There was prompt and good relief of jaundice in both groups. There was one procedure related mortality in each group. The morbidities were comparable. The stented patients were hospitalized for a cumulative mean period of 34.1 days compared to 14.2 days in the surgical bypass group (p= 0.0001). The global quality of life, pain, nausea, vomiting and appetite were significantly better in the surgical bypass group. There was significantly improved overall survival in the surgical bypass group (163.5 days vs. 150 days, p= 0.0001).

urgical bypass offers safe and superior palliation to obstructive jaundice from inoperable periampullary and pancreatic head cancer.
Left ventricular dysfunction in patients with HIV/AIDSon HAART in correlation with CD4 count
Authors: Behera Bibhu Prasad , Thomas Teena , Sen Ranjan Kumar , Sarangi Jagannath
Published: April 2022

According to World Health Organization (WHO) global HIV report 2019, people living with HIV is about 38 million. Especially after the advent of antiretroviral therapy (ART), in PLHIV, cardiovascular complications signify an increasingly important health concern. This vastly active HAART regimen has provided more efficient prophylactic treatment. With the increased duration of survival, this has progressed to an increased episodes of cardiovascular complications associated with PLHA.

The following review overviews the left ventricular dysfunction in patients with HIV infection on HAART focusing on early diagnosis, therapy and prognosis.

It is a Cross sectional study conducted on HIV infected patients attending ART clinic and admitted in medicine wards of MKCG medical college & Hospital from MARCH 2017 to OCTOBER 2018 were included in the study.

Maximum patients were in the age group 25 – 49 years (68.44%) in our study. Mean age of the study group 41.32 + 11.24 years. Gender distribution shows that 82.46% of the patients were males and 14.04% were females. 4 (7%) patients have cardiac disorder. All the patients having cardiac disorders are male. Only 2 patients (3.5%) had left ventricular dysfunction with reduced ejection fraction.

Males are involved more than females. Most patients are in the middle age group between 25 – 49 years. Heterosexual mode was the most common mode of transmission. Most of the study population belonged to rural area 61.4%. Three patients (5.3%) were on anti tubercular drugs. The systolic LV dysfunction was found in 50% of PLHA patients with cardiac disorders. CD4 count was positively correlated with fractional shortening. Presence of cardiac dysfunction was significantly associated with the adherence to ART treatment.
A prospective study on variations in haematological parameters in pulmonary tuberculosis
Authors: Kalidoss Abinayaa , Narmadha C.
Published: April 2022

: In India tuberculosis is a communicable infectious bacterial disease caused by Mycobacterium tuberculosis causing major public health problem. The present study is a prospective study of various haematalogical parameters in sputum positive pulmonary tuberculosis.

: The study included thirty patients of fresh pulmonary tuberculosis with sputum positive for acid fast bacilli (AFB). It was conducted for a period of three months in the institution of Coimbatore medical college hospital. The various hematological parameters were analyzed by means of automated cell counter and peripheral smear examination. The smears were stained with Ziehl Neelsen stain used to identify acid-fast organisms mainly mycobacteria.

: The study included 30 cases of newly detected pulmonary Tuberculosis patients who were positive for acid fast bacilli out of which 6 were females and 24 were males. Maximum number of cases were found in between 40-60 years of age. The commonest hematological findings were anemia 100% then raised ESR 93.33%, followed by, thrombocytosis 16.66%., neutrophilia 56.66%, leukocytosis 56.66% and lymphocytosis 6.66%. The commonest peripheral smear picture was microcytic hypochromic anemia 63.33% followed by normocytic normochromic anemia 30% then macrocytic anemia 6.6%.

Various changes in haematological parameters has been observed in patients with patients who are sputum positive for pulmonary tuberculosis. The present study is being done to evaluate the hematological profile in tuberculosis and analyse the variations in hematological manifestations. These parameters acts as a valuable tool to reduce the morbidity and mortality thus aids in improving then prognosis in patients with pulmonary tuberculosis.
Does early separation of the neonate impact the knowledge, attitudes and feeding practices of their mothers? - A cross sectional study in a rural teaching hospital in Telangana
Authors: Preethi Subramanian , Sandhya Dasari , Raj Chitgupikar Sudharshan , Anusha Saini
Published: April 2022

: Promotion of knowledge on breast feeding improves the attitude and breast feeding practices of mothers. Studies regarding knowledge, attitude and practices of breastfeeding among Indian mothers are limited, with no studies among mothers of neonates admitted to NICU. Hence this study was planned.

1): To assess the difference in knowledge, attitude and practices regarding breast feeding between mothers whose neonates were admitted in NICU ≤24 hours of birth, and whose neonates were admitted ≥96 hours of birth. 2): To assess gap in knowledge to feeding practices among both groups.

: A Cross Sectional KAP (Knowledge, Attitude and Practice) study.

: 440 postnatal mothers of neonates admitted to NICU between 1June 2019 to 31 December 2020 were included. Based on age at admission of their neonates to NICU, mothers were divided into 2 groups. 1group comprised of 205 mothers of neonates admitted to NICU ≤24 hours of life and 2group comprised of 235 mothers of neonates admitted ≥96 hours of life. Data was collected from mothers on KAP of breast feeding by interview, on a pretested questionnaire by the primary researcher.

: The group 2 mothers whose neonates were admitted at ≥96 hours of life demonstrated better KAP which was statistically significant. There was no significant difference noted in implementation of knowledge to practices among all 440 mothers. Out of 440 mothers, only 17% had knowledge to initiate breast feeds within 1hour after birth & 15% fed the babies within 1hour after birth. 88% of mothers had knowledge that colostrum should be fed & 82 % practiced it; 80% knew that pre-lacteals should be avoided & 87% practiced it; 68% were aware of burping the baby; 91% practiced burping before putting the baby down.

Early separation of neonates from mothers impacts the knowledge, attitude and practices towards breastfeeding. Poor attendance at the antenatal counselling clinic is also a contributing factor.
Immunohistochemical expression of K-ras protein and p53 in chronic pancreatitis and precursor lesions of pancreatic carcinoma- 5 year study in a tertiary care centre
Authors: S Preethamol , P S Prasanth
Published: April 2022

K-ras mutation is an early event and p53 mutation is a late event in the tumorigenesis pathway of carcinoma associated with Chronic Pancreatitis.

To identify the immunohistochemical expression of K-ras protein and p53 in surgical specimens of pancreas with chronic pancreatitis.

: A 5 year study of chronic pancreatitis with associated pancreatic lesions received in the Histopathology Department, Government Medical College, Trivandrum. All cases of chronic pancreatitis, (n=60) were histopathologically examined along with the adjacent pancreatic tissue which showed precursor lesions. Immunohistochemical expression of K-ras protein and p53 in all cases were studied.

In a total 60 cases of chronic pancreatitis, adjacent pancreatic tissue showed ductal adenocarcinoma in 20 cases (30%). Pancreatic Intraepithelial neoplasm (PanIN) was present in 6 cases accounting for 10%. 1 case was IPMN and one case was associated with serous cystadenoma.

7% of chronic pancreatitis showed K-ras mutations. Immunostaining for mutated p53 protein always was negative. p53 was positive in Pan IN 1A , Pan IN 1B, IPMN and carcinoma cells in 0 of 4(0%), 0 of 2(0%), 0 of 1(0%), and 18 of 20(90%), respectively, and K-ras was positive in 3 of 4 (75%), 2 of 2(100%), 1of 1(100%) and 12 of 20(60%), cases respectively.

Chronic pancreatitis and precursor lesions may progress to the development of pancreatic cancer. Further molecular studies for evaluation of oncogenes may be done in future for targeted therapy in pancreatic cancer.
Cytomorphological spectrum of cervicovaginal infections and their prevalence with clinical correlation on pap smears: A three-year retrospective study
Authors: Kumar Uma , Singhal Udita , Jain Pooja , Trivedi Shalini
Published: April 2022

Cervical-vaginal infections are one of the most common infections seen in women of the reproductive age group. The important infectious agents in Gardnerella vaginalis, Candida, and Trichomonas vaginalis. Pap smear cytology is used as an important screening test for various epithelial cell abnormalities and cervical cancer. It is also useful in the diagnosis of various pathogenic microorganisms causing cervicovaginal infections.

To determine the prevalence of cervicovaginal infections on Pap smears, and study their cytomorphology and clinical correlation.

: This is a three-year retrospective study from June 2018 to May 2021 performed on conventional Pap smears in the Pathology laboratory of a Government hospital in North India. The prevalence of various cervicovaginal infections was determined and their cytomorphological spectrum was studied. The Bethesda System of classification was followed for reporting Pap smears. All the females attending Gynaecology OPD of the hospital with various complaints were included. Females with a history of cervical cancer and unsatisfactory samples were excluded from the study.

Out of the total number1344 pap smears examined during the three years, 1291 (96.058%) were reported as NILM, remaining 53(3.044%) were diagnosed as epithelial cell abnormalities and cervical cancer. Among the 1291 cases of NILM, 421(32.61%) smears were positive for specific pathogenic microorganisms. Out of, 421 smears, examined,254(60.33%) were BV followed by136 (32.30%) of candida infection. Trichomonas contributed to 22(5.22%) cases, whereas in one case (0.23%) each of Actinomyces and HSV was seen. Mixed infection by Trichomonas and leptothrix was seen in 4(0.950%) cases and Candida and leptothrix contributed to 3(0.712%) cases.

Cervico-vaginal infections are an important cause of morbidity in the reproductive age group. Cervical cytology is an invaluable method to diagnose these infections. About 90% of infections are caused by Bacterial Vaginosis and Candida. All women of the reproductive age group should undergo a Pap smear examination for timely diagnosis and proper management of cervicovaginal infections.
A cross-sectional study to validate neck circumference, waist circumference, wrist circumference and mid upper arm circumference as a screening tool for overweight in adolescents at school of Ahmedabad city
Authors: Prajapati Vaishali J , Halpara Shraddha V , Kakkad Khyati M , Parmar Hardik R
Published: April 2022

Obesity is a major health problem in children & adults. Due to physiological changes during growing up in children and adolescents, it is difficult to develop one simple index for measurement of overweight & obesity. So, this study was carried out to identify simple methods like neck, waist, wrist, and mid upper arm circumference used as screening tools for overweight & obesity.

: To correlate neck, waist, wrist & mid upper arm circumference with BMI for prediction of overweight.

This was a cross-sectional study done on healthy urban school going children in the age group of 9 -17 years old. After measuring height and weight, BMI (body mass index) was calculated and nutritional status was classified. BMI was compared to neck, waist, wrist & mid upper arm circumferences to find out correlation. Cut off values of all four parameters to predict overweight & obesity were obtained by analysing the ROC (receiver operating characteristics) curve.

: Total 907 students of age group 9 to 17 years old were screened. Correlation of Neck circumference (NC), Waist circumference (WC), Wrist Circumference (WrC) and Mid Upper Arm Circumference (MUAC) with BMI by Pearson’s correlation coefficient were correlated positively. The bland Altman plots showed higher concentration of points at the 95% limit of agreement (±1.96 SD) and that the mean difference in Z-score of two tests was equal or close to zero. AUROC for NC was 0.81, for WC 0.9, for WrC 0.811 and for MUAC 0.893.

Neck circumference, Waist circumference, Wrist circumference and Mid upper arm circumference can be used as a screening test for predicting overweight or obesity in adolescents.
Study of soft tissue cover in compound lower limb trauma
Authors: Kishore Puli Ashwin , Chandralekha M.
Published: April 2022

: Early vascularized soft tissue closure has long been recognized to be essential in achieving eventual infection free union. The question of whether muscle or fasciocutaneous tissue is superior in terms of promoting fracture healing remains unresolved.

: To study options of different flaps in compound lower limb trauma and to know the pattern of providing flap cover in our setup.

This was prospective observational study conducted in all the cases admitted under orthopaedics department who are hemodynamically stabilised, later referred to our department of plastic surgery for the flap cover. Isolated compound lower limb injuries with or without fractures were included in study.

: Among 45 cases one patient (2.2%) had defect in the thigh, two patients had defect around knee (6.6%), nine cases had defect in upper third leg (20%), thirteen patients had defect in middle third leg (28.8%), seventeen patients have defect in lower third leg (37.7%) and three patients had in the foot (6.6%). Cross leg flap were used in 11 cases (24.4%) Gastrocnemius myo-cutaneous flap were used in 9 cases (20%). Fascio-cutaneous flaps superiorly based were used in three cases (6.6%) and Inferiorly based Fasciocutaneous flaps were used in 6 cases (13.3%), Reverse sural artery flap were used in six cases (13.3%) and Lateral premalleolar flap were used in 8 cases (17.7) and Advancement flap done in one case over defect of the thigh (2.2%). In a case with defect over thigh (2.2%). Complications like total flap loss was noted in one case (2.2%) marginal necrosis noted in five cases (11.1%) and pin track infection in three cases (6.6%).

In Grade IIIB fractures external fixator was the choice of skeletal stabilisation. Delayed flap cover gave good results but it increases duration of hospital stay.
To study the ventilator associated pneumonia in the ICU patients in a tertiary care hospital: Incidence, risk factors and etiological agents
Authors: Khan M Imran , Harish V. K Sabarigirivasan , B Loknath
Published: April 2022

Ventilator Associated Pneumonia (VAP) is the second most common nosocomial infection in the United States, with high mortality and morbidity. Duration of hospital stay increased in average of 7 to 9 days with increase in treatment cost of $40,000 per patient. However, clinical evidence on the incidence of this infection is poor, especially from ICUs in India.

: To study the incidence, risk factors and etiological agents in ICU patients developing VAP in a tertiary care hospital in India.

In this study, patients who were kept on ventilator for more than 48 hours in ICU were enrolled. To clinically diagnose VAP, the modified clinical pulmonary infection score (CPIS) and clinical criteria were used as a screening tool. A full clinical history of the patients was documented, as well as the date of admission to the ICU, the date of initiation of mechanical ventilation, and the method of access to the patients' airway. A standard PROFORMA was used and the collected data was observed and analysed further.

: In the present study out of 45 patients enrolled for the study, only 6 patients (13.3%) showed VAP. The presence of early VAP was observed in 3 patients whereas late VAP was also observed in 3 patients. The male and female patients exhibited similar incidences of VAP. The patients with an age group more than 70 years showed a maximum (37.5%) prevalence of VAP. Clinical features like fever and increased amount of secretions were found to be associated with the occurrence of VAP. Smoking and diseases like hypertension, kidney disease, malignancy and chronic lung disease were non-significantly associated with VAP. Whereas disease states like coma and enteral nutrition were found to be significantly associated with VAP. Acinetobacter and Klebsiella were the most common organisms isolated in our institution.

: VAP remains a significant concern to patients admitted to an ICU for mechanical ventilation, highlighting the critical need for preventive measures.
To study the radiation induced oral mucositis in head and neck cancer - A prospective study
Authors: S Vijayakumar
Published: April 2022

Patients suffering from Head and Neck Cancers (HNC), when treated with radiotherapy (RT), often experience Oral mucositis (OMS) side effects. OMS can complicate the treatment and worsen the management of HNC. The Radio-oncologist should find a way to minimize the incidence of OMS during the treatment of HNC.

To study the Radiation-induced OMS in HNC patients and its associated factors.

This prospective study was performed from October 2018 to September 2019. Total 80 patients of with HNC, who were treated with RT, were enrolled for the study with informed consent. In the study, 40 patients received RT and 40 received concurrent chemo-Radiotherapy (CCRT).

Amongst 80 patients included in the study, 72.5% were found to be male. Poor oral hygiene was observed in 77.5% of patients in the study. The tongue cancer (35%) and Cancer of Stage IVa (47.5%) were more prevalent in the patients under study. OMS was observed maximum (60%) in 1 to 4 weeks of treatment.

Inflammation response of epithelial mucosa to chemo- radiotherapy cytotoxic effects leads to mucositis, a painful side effect. This study gives proper understanding of Radiation-induced OMS and identifies the predisposing factors for OMS.