bluuebunny/crossref_metadata_2025 huggingface dataset:
Influence of intestinal microbiota on pathogenesis of cardiovacular diseases
Authors: Stepanov Maksim S. , Karpunina Natalia S. , Khlynova Olga V. , Tuev Alexander V. , Godovalov Anatoly P.
Published: March 2023

The intestinal microbiota is a marker of the organism state, capable of direct and indirect interacting. The main mechanisms underlying interactions are immunoregulation and energy metabolism. Metabolites, formed during the life of microbiota, realize their actions through these engagements. Some metabolites arouse negative effects on endothelial vessels, causing and maintaining a systemic inflammatory response, which stands behind major cardiac risk factors. Metabolites and molecules such as lipopolysaccharide or trimethylamine N-oxide initiate endothelial dysfunction, and thus trigger the processes of atherogenesis, insulin resistance and even increase blood pressure by activating inflammasomes and pro-inflammatory cytokines. Short-chain fatty acids including the main metabolites such as acetate, propionate and butyrate are antagonists of lipopolysaccharide and trimethylamine N-oxide. These substances are a source of energy for intestinal epithelial cells. They maintain homeostasis, stimulate the production of anti-inflammatory components and activating reparative processes. Another important factor influencing levels on blood pressure and systemic inflammation is intestinal barrier dysfunction, which is determined by the regulatory protein zonulin. Besides, there are proved receptor interactions, as well as qualitative and quantitative changes in the composition of the microbiota that can influence blood pressure and atherogenesis. Each cardiovascular disease is characterized by its own microbiological pattern and the predominance of specific metabolites. The article presents a review, summarizing experimental and clinical data on the role of microbiota in the development of atherosclerosis and cardiovascular diseases.
Endoscopic Ultrasound-guided Fine Needle Aspiration for Benign Liver Diseases: Single-center Experience
Authors: TOKMAK Salih , KANTARCIOĞLU Sinem Coşkun , TORUN Serkan
Published: March 2023

Background and Aim: To report the efficacy and safety results of our initial experience with the endoscopic ultrasound-guided liver biopsy (EUS-LB).

Materials and Method: Retrospective analysis of a prospectively maintained database in a tertiary care referral center. Consecutive patients who had EUS-LB for benign parenchymal diseases, using a 19 gauge fine needle with single-pass, three actuations, and wet suction technique between June 2022 and December 2022 were included. Patient demographics, procedure-related parameters, and the quality of specimens were investigated

Results: The technical success was 100%. Of the 16 patients, four had a second procedure due to inadequate sampling. The median total sample length, the median number of pieces and the median length of the longest piece in fragmented samples, and the median number of complete portal tracts were 11mm (range, 0.2-2.5), 9.6 (range 0-20), 0.2mm (range 0.2-1.5) and 3.5 (range 0-19) respectively. None of the patients had any adverse events following the procedure.

Conclusion: EUS-LB may be an alternative to other liver biopsy procedures but further studies are needed to determine the ideal needle type and technique.
Keterampilan Memberi Penguatan dalam Pembelajaran di Kelas V SD
Authors: Hizbullah Hizbullah , Muchtar Muchtar , Mahanani Putri
Published: March 2023

Abstract: The skill of giving reinforcement is one of the basic teaching skills that is very important to be mastered by the teacher. Reinforcement is any form of response that is part of the modification of the teacher's behavior on student behavior, which aims to provide information or feedback for students on the actions of the responses given. as an encouragement or correction. Strengthening skills provided by the teacher, students will feel compelled forever to respond whenever an activity appears from the teacher, or students will try to avoid responses that are considered useless. The purpose of this study was to determine the skills of teachers in providing verbal and non-verbal reinforcement in class V SDN Kotalama 2. This study used descriptive qualitative research. Data collection techniques in the form of observation, interviews, documentation, and instruments. The research subjects were classroom teachers, religion teachers, and fifth grade students at SDN Kotalama 2. The results showed that the skills to provide reinforcement in learning in grade V at SDN Kotalama 2 had been implemented well. The skill of giving reinforcement is carried out by the teacher in every learning that takes place. However, it was also found that several barriers to the skills of providing reinforcement from both classroom and religious teachers were found to be less than optimal.

Abstrak: Keterampilan memberi penguatan merupakan salah satu keterampilan dasar mengajar yang sangat penting untuk dikuasai oleh guru, Penguatan adalah segala bentuk respon yang merupakan bagian dari modifikasi tingkah laku guru terhadap tingkah laku siswa, yang bertujuan untuk memberikan informasi atau umpan balik bagi siswa atas perbuatan responnya yang diberikan sebagai suatu dorongan atau koreksi. Keterampilan penguatan yang diberikan guru, maka siswa akan merasa terdorong selamanya untuk memberikan respon setiap kali muncul kegiatan dari guru, atau siswa akan berusaha menghindari respon yang dianggap tidak bermanfaat. Tujuan penelitian ini untuk mengetahui keterampilan guru dalam memberi penguatan verbal dan non-verbal dalam pembelajaran dikelas V SDN Kotalama 2. Penelitian ini menggunakan penelitian kualitatif deskriptif. Teknik pengumpulan data berupa observasi, wawancara, dokumentasi, dan instrument. Subjek penelitian adalah guru kelas, guru agama, dan siswa kelas V SDN Kotalama 2. Hasil menunjukan bahwa keterampilan memberi penguatan dalam pembelajaran di kelas V SDN Kotalama 2 sudah dilaksanakan dengan baik. Keterampilan memberi penguatan dilakukan oleh guru disetiap pembelajaran berlangsung. Namun, ditemukan juga beberapa hambatan terhadap keterampilan memberi penguatan baik dari guru kelas maupun guru agama yang kurang maksimal.
Menumbuhkan Kesadaran Siswa Terhadap Bahaya Merokok Melalui Konseling Kelompok Realita
Authors: Firmansyah Agus Zaqi
Published: March 2023

Abstract: Smoking culture among students today can not be filtered out as the purpose of toxins in cigarette filters. The presumption dashing if cigarette smoking is the main cause of their doing so. But it is obvious that there are school rules forbid it. Many students do smoke because already has a previous perception about cigarettes, either from family, advertising, as well as from her social friends. Mild sanctions for students will not be deterrent for those who smoke at school. guidance and counseling in schools is crucial in stemming the behavior of current students. Such behavior can be handled using group counseling reality, because in principle now focuses on behavior and is a form of behavior modification. With group counseling students will interact directly with members of other groups. The interaction of the group aims to increase understanding and acceptance of the values so as to reduce or even eliminate the attitudes and behavior of the smoking habit.

Abstrak: Budaya rokok dikalangan pelajar sampai saat ini tidak dapat difilter sebagaimana tujuan filter menyaring racun dalam rokok. Anggapan gagah jika menghisap rokok adalah menjadi penyebab utama mereka melakukannya. Padahal jelas aturan yang ada disekolah melarangnya. Banyak pelajar melakukan merokok dikarenakan sudah mempunyai persepsi sebelumnya tentang rokok, baik dari keluarga, iklan, maupun dari teman pergaulannya. Sanksi yang ringan bagi pelajar tidak akan menimbulkan efek jera bagi mereka yang merokok di sekolah. bimbingan dan konseling di sekolah sangatlah penting dalam membendung perilaku pelajar saat ini. Perilaku tersebut dapat ditangani menggunakan konseling kelompok realita, karena pada prinsipnya berfokus pada tingkah laku sekarang dan merupakan bentuk modifikasi perilaku. Dengan konseling kelompok siswa akan berinteraksi langsung dengan anggota kelompok lain. Interaksi kelompok tersebut bertujuan untuk meningkatkan pengertian dan penerimaan terhadap nilai sehingga mampu mengurangi bahkan menghilangkan sikap-sikap serta perilaku kebiasaan merokok tersebut.
Pelaksanaan Keterampilan Bertanya pada Pembelajaran Tematik di SD
Authors: Abibah Khofifah Nila , Cholifah Puri Selfi , Umayaroh Siti
Published: March 2023

Abstract: Questioning skills play an important role for teachers in the learning process as an assessment tool for students and as a means of interaction from teacher to student and student to teacher. This study aims to describe the implementation of basic and advanced questioning skills and describe student responses to the implementation of basic and advanced questioning skills in thematic learning at SDN Polehan 4 Malang. This study uses a mix method. The subjects of this study consisted of 5 respondents. Quantitative data was obtained from the results of observation data carried out during the thematic learning process, then qualitative data were obtained from the results of interviews and documentation. The results of the study show that basic questioning skills are used more often than advanced questioning skills. The basic questions that arise are the components of clear and concise questions, shift shifts, and question distribution. While the components of advanced questioning skills that appear are the sequence of questions and tracking questions. Students' responses to the implementation of asking skills in thematic learning are that some actively respond and some do not actively answer questions, but most students actively respond to teacher questions because teachers always give awards. When answering questions from the teacher, students tend to give short answers that require a low level of thinking.

Abstrak: Keterampilan bertanya memegang peranan penting bagi guru dalam proses pembelajaran sebagai alat penilaian kepada siswa serta sebagai alat interaksi dari guru ke siswa dan siswa ke guru. Penelitian ini bertujuan untuk mendeskripsikan mengenai pelaksanaan keterampilan bertanya dasar dan lanjut serta mendeskripsikan respon siswa terhadap pelaksanaan keterampilan bertanya dasar dan lanjut pada pembelajaran tematik di SDN Polehan 4 Malang. Penelitian ini menggunakan mix method. Subjek penelitian ini terdiri dari 5 responden. Data kuantitatif diperoleh dari hasil data observasi yang dilaksanakan selama proses pembelajaran tematik, kemudian untuk kualitatif diperoleh dari hasil wawancara dan dokumentasi. Hasil dari penelitian menunjukkan bahwa keterampilan bertanya dasar lebih sering digunakan dibandingkan keterampilan bertanya lanjut. Pertanyaan dasar yang muncul adalah komponen pertanyaan yang jelas dan singkat, pemindahan giliran, dan penyebaran pertanyaan. Sedangkan komponen keterampilan bertanya lanjut yang muncul adalah urutan pertanyaan dan pertanyaan pelacak. Respon siswa terhadap pelaksanaan keterampilan bertanya pada pembelajaran tematik yaitu ada yang aktif merespon dan ada yang tidak aktif menjawab pertanyaan, namun sebagian besar siswa aktif merespon pertanyaan yang guru karena guru selalu memberikan penghargaan. Saat menjawab pertanyaan dari guru siswa cenderung memberikan jawaban singkat yang memerlukan tingkat berpikir rendah.
Bio-Identical hormone treatment as a functional approach to treat Asherman’s Syndrome
Authors: Soudah L.
Published: March 2023

Here we present a case of 30 year old married women suffering from asherman’s syndrome with failed IVF trials and infertility complications. A Holistic approach that includes bioidentical hormone therapy was adopted to help her in regaining fertility. A comprehensive therapeutic plan was followed to treat the patient. It included Optimizing body hormones vitamins, elimination of inflammation, improving Gut and suggesting healthy life style with continual follow up. After 13 months of continual treatment, she got pregnant and delivered a healthy baby boy .No complications during pregnancy and delivery were reported. It is concluded that women with severe Asherman syndrome who are infertile can experience promising reproductive results with quality healthcare.
Do Сovid-19 vaccines cause shoulder injuries: a survey among health care providers at Najran University hospital
Authors: Alzahrani W.M.
Published: March 2023

Background: Shoulder injury related to vaccine administration (SIRVA) is a rare but serious side effect of the COVID-19 vaccine. The incidence of SIRVA among healthcare providers is not well understood. Aim: To investigate the incidence of SIRVA among healthcare providers working at a National University Hospital in Saudi Arabia and to assess their knowledge of SIRVA. Methodology: A cross-sectional online survey was distributed to all licensed healthcare providers currently employed by the National University Hospital. The survey collected information on personal, professional, and demographic characteristics, as well as symptoms and experiences related to SIRVA. Results: Of the 81 participants, 69.1% reported experiencing pain in their shoulder after receiving the COVID-19 vaccine, with 50% rating their pain as average (4-6 on a scale of 1-10) and 41.1% rating their pain as severe (7-10). Only 4.9% of participants reported visiting an orthopedic clinic for SIRVA and 76.5% did not receive treatment for their symptoms. A majority of participants (58%) believed that SIRVA occurs when the vaccine is injected too high up on the upper arm, with 34.6% believing it occurs in the middle of the upper arm and 7.4% believing it occurs too low down on the upper arm. It was also found that only 14.3% of participants were able to correctly identify the cause of SIRVA as accidental injection into the subdeltoid bursa. Additionally, a majority of participants believed that SIRVA is a rare condition (49.4%), and only a small percentage had received training about SIRVA (5.9%). Conclusions: These findings indicate a significant incidence of SIRVA among healthcare providers working at the National University Hospital and highlight the need for increased education and awareness about SIRVA among healthcare providers, as well as proper training in injection techniques to reduce the incidence of SIRVA.
Work stress among physicians, dubai health authority, in the year 2018-2019
Authors: Ahmad H. , Mubarak F. , Almaftool W.
Published: March 2023

Background: Work stress is a significant problem that affects physicians. Multiple sources can contribute to this problem. High-stress rates among physicians can manifest in various expressions, including cognitive, behavioral, and somatic expressions. Work performance and quality of medical care administered to patients can be undermined by over-stressed physicians. The study aimed to assess the prevalence of stress among physicians working in governmental health facilities in Dubai (2018-2019) and their relationship with socio-demographic and job factors.  Methods: It is a cross-sectional study. This study population includes all physicians practicing in Dubai Health Authority hospitals and primary health care centers in the Year 2018-2019. Target Number is 1337 taken from the registry of Dubai health authority administration, but only 668 questionnaires were included with a RR of 49.9%. The data tool used in this study is a modified self-administered questionnaire from both validated health and safety executive (Barbaranelli et al., 2018) occupational stress and stress questionnaire by International Stress Management Association UK 2013. It consists of 22 items which were divided into demographic, stress indicators, factors, and other domains. They were distributed as hard copies by hand.  Findings: The study concluded that 40.2% were more likely to experience stress, while 59.8% were most prone to stress. Furthermore, the study showed a strong association with different factors such as the role of managers, shift duty, and multi-task work.  Conclusion: Work stress is a prevalent problem among physicians working at Dubai health authority. The stress is associated with factors: such as multi-task work, shift hours’ duties, time pressure, and the role of line manager. Implications for Occupational Health Nursing Practice or Implications for Occupational Health Practice: Healthier working environment will promote the well-being of its staff and ensure the proper delivery of care to the community.
Study of Staphylococcus spp. isolated from Clinical Cases and determination of its multidrugresistant to antibiotics and phytosynthesized ZnO (NPs)
Authors: Hamad M.O. , Rahi A.Y. , Guda M.A.
Published: March 2023

The current study deal with 214 clinical samples taken from in- and outpatient's of both sexes with different ages of Al-Hilla Teaching Hospital, Babylon Maternity and Pediatrics Hospital in Hilla city. All tests were conducted in the laboratories of the University of Kufa, College of Science, Department of Ecological and Pollution Sciences, in 2022. 57 bacterial isolates (26.6%) were isolated and identified according to their phenotypic characteristics and biochemical tests. The current study declared that the isolation percentage was 39 (18.2%) and 18 (8.4%) for S. aureus and S.epidermidis respectively. The antibiotics sensitivity to isolates were tested, as it included 27 antibiotics, by disk diffusion method, most of it showed high resistance. Meropenem, ceftriaxone, and amikacin were found to be the most effective antibiotics, the phytosynthesized ZnO (NPs) were also tested on the sensitivity of the isolates. The lowest inhibitory concentrations (MIC) for current isolates were high. While the ZnO (NPs) showed higher efficiency and lower concentrations. This study is important in pharmacological and epidemiological studies and could open up broader horizons to find alternatives to the antibiotics used previously.
Adverse Effects of Online Education on Student Engagement during Covid-19: Review, Synthesis and Research Agenda
Authors: Sen S. , Banerjee S.
Published: March 2023

The study reviews the relationship between ethical consideration and student engagement with reference to online education among school, under graduate, and post graduate learners. COVID-19 outbreak has changed the way education been delivered. The exploratory research suggests a conceptual framework which can be adapted by schools and educational institutions to address to the concerns of students like stress, anxiety, and ethics. Online teaching strategies should ensure emotional, cognitive, and social engagement among student managers leading to ideal teacher-student and student-student interactive environment. The future research is expected to establish a relationship between student engagement and ethical consideration and role of mediators like stress and anxiety negatively affecting online learning. In the midst of COVID-19 pandemic, higher educational institutions should be equipped with content and resources that are leading to learning outcomes.
In silico Study to Investigate Targeting Ability of Genistein against Fatty acid binding protein 4 (FABP4) in Peripheral Artery Disease
Authors: Dongre S. , Shah N. , Sharma T.
Published: March 2023

“Peripheral artery disease” or PAD, is considered as a most prevalent condition, and it commonly coexists with vascular diseases in other body parts. The epidemiology of PAD is well known and connected to age and, particularly, the predisposing factors of smoking and diabetes mellitus. Diagnosis on early basis is important for enhancing the quality of life (QOL) in addition to the reducing risk for the development of significant subsequent vascular events such as “acute myocardial infarction (AMI)” or “stroke”. There are a variety of treatments used to manage and treat the disease. However, there are negative effects and toxicities associated with that treatment in addition to higher costs. Hence, a surge in the hunt for natural compounds of botanical origin is gaining traction. The present study aims at exploring the targeting ability of phytocompound, and genistein against FABP4 which is an emerging target for PAD in diabetes patients. The study is conducted using a computation method employing Autodock4 and other accessory tools. The results of the docking process revealed a significant binding energy of -6.14 which demonstrated a stable complex formation between protein and selected compound. Thus, showing great potential for the treatment of PAD.
Early Detection of Heart Disease Using Machine Learning Approach
Authors: Zabeeulla M. , Sharma C. , Anand A.
Published: March 2023

Heart attack is one of the leading causes of morbidity in the worldwide population. Cardiovascular disease is one of the major diseases involved in clinical data analysis or one of the most important part for forecasting. Early detection of cardiovascular diseases can help to reduce high-risk condition for heart patients to make individual decisions for their lifestyle adjustments, mitigating the challenges. Early detection of heart disease has been explored in this study using a machine-learning approach. Additionally, we used sampling strategies to deal with disparate datasets. The overall risk is estimated using a variety of machine-learning techniques. On Kaggle, the Heart Disease dataset is accessible and open for all. In present study testing set used this dataset. The ultimate objective is to determine whether the patient has a “10-year risk of developing coronary heart disease” (CHD). The dataset contained thirteen features that provided patient data, and the authors used machine learning algorithms to diagnose cardiac problems with 98.8% accuracy.
The Effects of Multi-Exergames Training on Balance and Gait in Hemiplegic Patients
Authors: Sahu B. , Varathan K.
Published: March 2023

Background: Hemiplegia shows the partial weakness of the body where balance and walking abilities are majorly affected. Exergaming can enhance balance after a stroke by utilizing game-specific exercises. Hence, the study aims to identify the effects of multi-exergames training on the parameters of balance and gait in hemiplegic subjects. Methods: The selected study subjects were forty-two as per the inclusion criteria and were allotted to a single group using convenient sampling. The Berg balance scale (BBS) was used to measure balance parameters, and the Dynamic gait index (DGI) was used for gait. The subjects were given exergaming training combined with conventional physical therapy exercises for 6 consecutive weeks 4 times a week. After a post-test evaluation, the pre-test and post-test data were examined using descriptive and interferential statistics. Findings: The study findings for the DGI pre-test were (16.83±1.102), and the Post-test was (21.05±1.248, P = 0.001). BBS pre-test was (41.02±3.605) and Post-test was (46.33±3.746, P = 0.001). A significant improvement was noted in the balance and gait parameters using paired t-tests. Novelty and Applications: There is a paucity of literature on the efficacy of multi-exergames training on balance and gait in hemiplegic patients. Hence there is a need to study the effects of multi-exergames training on balance and gait in hemiplegic patients.
Leukocytes Classification Using Convolutional Neural Network
Authors: Bushra S.N. , Sheeba A. , Subasini C.A. , Sib S.A.
Published: March 2023

Maintaining a healthy life is very important in today’s world. Our body has ability to fight against contagious diseases with the aid of white blood corpuscles (WBC) which generates natural immune system. Preserving a good WBC count is crucial as it leads to various hematological problems, one among them is Leukemia, a condition which results in blood cancer, huge accumulation of WBC cells in bone marrow, an abnormal growth of WBC cells, hinders natural immune system fighting against infectious diseases. White blood cells can be categorised into Eosinophils, Lymphocytes, Monocytes, Neutrophils and Basophils. In this study, a pre-trained Convolutional neural network architecture called Le Net is used to automatically classify WBC cells. It efficiently classifies WBC cells from the given input sample blood cell images compared to other pre trained models such as Alex-Net and custom-built CNN called white capsule net. The hyper parameters Le Net are fine tuned to yield higher accuracy of 96%.
IoT based Chronic Obstructive Pulmonary Lung Disease Patient Management System using Air Quality
Authors: Balasubadra K. , Umamageswaran J. , Saravanan K.
Published: March 2023

Smoking is primarily responsible for the development of chronically obstructing pulmonary disease (COPD), a breathing condition that is treatable and preventable. One of the environmental challenges that cannot be ignored is air pollution. Extended exposed to contamination slows or harms the treatment of the lungs in COPD patients. Air quality, temperature, humidity, and dusty density tracking are given top priority during the product's development. Because Bronchitis is a disease that may be treated, air quality is essential.The major objective of this research is to develop a method for monitoring air quality that will alert patients to it and promote awareness. This product will assess how COPD patients are affected by exposure to poor air quality. A model mobile device that continually monitors ventilation rate, breathing rate, physically activity, nap quality, the possibility of respiratory problems, and the degree of distress and tiredness was developed in order to fulfil this unmet need. The information stored by this gadget would be accessible from portable devices all around the world via a safe central server.
Awareness, Perceived Benefits and Barriers of Usage of Open Access Scholarly Publishing among Faculty
Authors: Benjamin L.S. , Sivaram P. , Shanmugam S.R.
Published: March 2023

Introduction: Information and communication technologies has brought innovation to scholarly publishing. Now, open access is a subject of much concern among academics and are important sources for scientific research and development. Despite the benefits of open access, faculty are still unaware of the usage of open access. Methods and materials: A descriptive correlational study among 100 nursing facultywas conducted using a rating scale on awareness of open access in scholarly publishing and perceived benefits and constraint factors to effective use of open access through the self-administration method. Data was analyzed using SPSS-24. Results: Therewasa significant difference in the mean awareness scores on open access scholarly publications between undergraduate(29+5.93) andpostgraduatefaculty(37+6.26)at (p
A Study to Assess the Knowledge Regarding Self-Breast Examination on Prevention of Breast Cancer Among Women Attending OPD in Sree Balaji Medical and College And Hospital
Authors: Priyadarshini P. , Sarathi S. , Hemavathy V.
Published: March 2023

Self-examination of the breasts is less expensive than mammography. Breast cancer can be discovered sooner, and women's survival rates can be raised. Rural residents have limited access to medical treatment and have a poorer educational position. As a result, it is critical that they be educated about breast cancer prevention and early diagnosis by systematic breast self-examination. Breast cancer risk begins to climb in a woman's early thirties and reaches an all-time high by the time she reaches her sixth decade. Because women between the ages of 30 and 60 are at high risk, an educational programme for them would be quite useful. Because the perceived threat of breast cancer should inspire children to practise breast self-examination on a regular basis, improved knowledge about breast cancer and competence to do breast self-examination at this age would be useful. According to a study, the five-year survival rate of breast cancer patients is 75 percent, and it is suggested that 50 percent of all breast cancer patients worldwide could have their lives extended by increasing public awareness through early detection and effective treatment at the community level.
Nursing Management of Insomnia
Authors: SARADHADEVI S. , HEMAVATHY V.
Published: March 2023

All mammals and birds, as well as a variety of reptiles, amphibians, and fish, sleep as a natural resting condition. Humans, other mammals, and a wide range of other creatures[1] studied, including fish, birds, ants, and fruit flies, all require regular sleep to thrive.Arousal from sleep serves as a defence mechanism as well as a requirement for health and life.The anterior hypothalamus' suprachiasmatic nucleus regulates the sleep-wake cycle, as well as other circadian rhythms like body temperature[2]. This area, which is Receives information regarding darkness and light from the retina and is positioned above the optic chiasm. Melatonin production is regulated by the suprachiasmatic nucleus, which is regarded to be a powerful sleep inducer. A functioning reticular activating system is necessary for arousal from sleep, wakefulness, and the ability to respond to stimuli (RAS). From the brain stem to the thalamus and cortex, the RAS is a signalling route. Because of feedback loops, the RAS' diffuse network of neurons is in a critical position to monitor ascending and descending impulses.
Assess the Modified Early Warning Score (MEWS) in Predicting Critical Care Unit Admission Among Patient in Emergency Department at Saveetha Medical College and Hospital, Thandalam
Authors: Govindaraj U. , Karpagam K. , KalaBarathi S.
Published: March 2023

Background: In the hospital, sickness severity and worsening were predicted using the Modified Early Warning Score (MEWS). The MEWS makes it possible to detect patient deterioration early, take prompt treatment, and consistently gauge the seriousness of a disease. Objectives: To assess the Modified Early Warning Score (MEWS) in predicting critical care unit admission among emergency department patients. Methodology: Research approach: quantitative approach, descriptive research design was used for 60 samples by convenience sampling techniques. Modified Early Warning Score (MEWS) tool was used to predict critical care admission in emergency department. Result: out of 60 samples, 30(50%) had medium score which infers that key threshold urgent response in critical care unit admission, 16(26.7%) had low score which interprets ward based admission and 14(23.3%) had high score which interprets urgent (or) emergency response admission. Regarding critical care admission in emergency department patients the demographic variables age, education and clinical variable in mechanical ventilator support had shown statistically significant association with Modified Early Warning Score in predicting critical care unit admission among patients in emergency department at p
The influence of prenatal screening on the contemporary operative outcomes and functional alleviation after vascular ring surgery in children
Authors: Verma P. , Jhanwar A. , Singh R.R.
Published: March 2023

Objective: The impact of prenatal screening on contemporary operative outcomes and functional alleviation during pediatric Vascular Ring Surgery (VRS) is analysed in this research. Methods:All patients who had surgical treatment of an isolated VR at the Texas Children’s Hospitalbetween 1996 and 2018were included in the study. Patients who simultaneously underwent intracardiac repair were disqualified. Other congenital cardiac conditions, clinical symptomatology, contemporary surgical intervention, perioperative outcome, reoperation rates, functional alleviation, and complications were all examined in the data analysis.To examine the data for this investigation, we employed SPSS 13.0.Results: 148 participants were chosen for analysis. Of the 148, 72(48.6%)have a Double Aortic Arch (DAA), 69(47.2%) have a ligamentum and a normal left subclavian artery or Right Aortic Arch (RAA) with a left-sided ductus, 5 (2.7%)have an RAA, Left Descending Aorta (LDA) and 2(1.3%) had RAA, Left Ligamentum Arteriosum (LLA), mirror-image branching. Right aortic arch vascular ring(RAAVR) aregeneral than Double Aortic Arch Vascular Ring (DAAVR): 31 patients had the earlier, with a frequency of 5.7 per 10,000 live births, whereas 6 patients had the latter, with an incidence of 1.1 per 10,000 live births (p = 0.0001).Conclusion: VRs are a prevalent form of congenital cardiovascular abnormality, especially when they affect the right aortic arch. Additionally, prenatal screening reveals a significant percentage of VRs.
Bliss effect of taxpayers in adopting blockchain technology
Authors: Setiawan Priscilla Amanda , Mangoting Yenni , Nuralim Elizabeth
Published: March 2023

Research aims: This study aimed to investigate the intention to adopt blockchain technology (BT) from the taxpayer’s perspective.Design/Methodology/Approach: The data were collected from an online survey with 135 effective respondents and analyzed using Partial Least Square (PLS) for model and hypothesis testing.Research findings: It was found that perceived enjoyment could mediate the effect of autonomy on intentions to use blockchain technology in tax administration. However, it has been proven that autonomy had a greater direct effect than the indirect effect of perceived enjoyment as a mediation.Theoretical contribution/Originality: This research discusses how people react to using blockchain technology in the tax administration system. The use of blockchain technology will later have an impact on the transparency and effectiveness of taxation. Practically, from within the taxpayer arises a desire to carry out his obligations using blockchain technology. Blockchain technology is essential to facilitate and increase transparency in the effectiveness of tax administration systems.Practitioner/Policy implication: The findings of this study offer a practical guide for tax authorities as regulators in designing the BT implementation in the tax administration system that will increase transparency and efficiency.Research limitation/Implication: This study has several limitations. First, the model and hypothesis in this study have never been researched as one model. Second, some respondents only have a hazy understanding of how the blockchain works. Hence, future research may be able to broaden the research by investigating the outcomes of blockchain technology adoption.
Hyperphosphatemia-a predictor of poor prognosis among patients with sepsis or septic shock
Authors: A. Rakshith , C. Yogitha , S. Basanth Kumar
Published: March 2023

Background: Sepsis is a life-threatening organ dysfunction resulting from dysregulated host responses to infection. Serum phosphorus level was closely related to the occurrence and prognosis of kidney disease and cardiovascular disease. It is of vital importance to re-evaluate the association between serum Phosphorus level and mortality in patients with sepsis and different septic subgroups. This study aims to examine the association of serum phosphorous levels with clinical outcomes among patients with sepsis.
Methods: This study included 100 cases and was conducted at KIMS hospital Bangalore. Patients were included in the study as per inclusion criteria. SOFA scoring and APACHE-II scoring was done on first day of admission and serum phosphorus levels were sent. Patients were categorised according to phosphorous levels normal range (2.5-4.5mg/dl).  Patients were followed up till primary and secondary outcome.
Results: Of the 100 patients in this study 53 patients had normophosphatemia, 17 patients had hypophosphatemia, 30 patients had hyperphosphatemia. Comparison of mean APACHE-II scores, mean length of ICU stay (in days), mean length of hospital stay (in days), serum creatinine levels, between 3 groups was statistically significant. 
Conclusions: Hyperphosphatemia on first ICU admission day indicates poor clinical outcome among patients with sepsis or septic shock. Therefore, when patients are on ICU admission and under treatment, clinicians should pay more attention to the change of serum phosphate.
Diagnostic utility of bone marrow aspiration in bicytopenia
Authors: Sandhu Silvi , Vaid Arundhati , Khajuria Ruchi , Kaur Ameet , Sharma Ayushi
Published: March 2023

Background: Haematological diseases are frequently seen now a days in different age groups. Patients can present with a variety of presentations in form of cytopenia of a single lineage or in a dual combination or with pancytopenia. Our study focusses on the utility of bone marrow aspiration for diagnosis of bicytopenias by assessment of pattern of bicytopenias in peripheral smear examination.
Methods: This was a retrospective study that was conducted over a period of one year in a tertiary care institute of Northern India. Cases of bicytopenia were subjected to bone marrow aspiration and parameters such as cellularity, myeloid to erythroid ratio and cytomorphological details of the cells were documented.
Results: Study consisted of male predominance with maximum patients in the age group of 21-30 years. Most common bicytopenia was found to be anaemia with thrombocytopenia and normoblastic erythroid hyperplasia was the most common aetiology.The results of this study were similar to those in the earlier literature with the inference that bone marrow aspiration performed for all cases significantly helped in arriving at the diagnosis.
Conclusions: Bicytopenia is a good haematological indicator for many non-malignant and malignant diseases. Knowledge of its aetiologies can help in the diagnosis and efficient management of patients. Bone marrow study forms a cost-effective tool in interpretation of bicytopenia.
Necrotising soft tissue infection secondary to an incarcerated De Garengeot hernia
Authors: McElhatton Claire P. , Lewin Joel , Muduioa Geoff
Published: March 2023

De Garengeot hernias are rare and can be difficult to diagnose pre-operatively. This case presented as a right groin abscess with necrotising soft tissue infection extending into the right thigh. At operation, a perforated appendix was found within the femoral canal with a distal loop of small bowel fistulating into the abscess cavity. On review of the literature, this is the first case to be reported describing this finding.
Study of refrigerated storage of blood at 4°C on automated hematological parameters & morphological changes in peripheral blood smear: A prospective study
Authors: Kadam Poornima , Patil Nikhita , Mane Vaibhav P
Published: March 2023

: Complete hemogram & peripheral blood smear are primary tests done in day to day practice for correct diagnosis & further treatment of patients. EDTA blood samples are used for this regular screening tests which shows less stability in case of delaying sampling. Hence, the final results of these tests can be affected by different storage conditions & duration. This present study provides data analyzed from EDTA blood samples stored upto 24 hour at both room temperature & 4°C refrigeration.

This study includes total 150 blood samples from indoor & outdoor patient without any specific criteria which were collected randomly. These blood samples were analyzed using haematological analyzer for complete blood count & their peripheral smear after storage in both room temperature & 4°C refrigeration for 24 hrs.

There was significant increase in MCV & decrease in MCHC, reduced WBC count & platelet count with storage at room temperature which was prohibited by refrigeration. However, both room temperature & refrigerated storage does not affect RBC count & hemoglobin.

Blood samples stored at room temperature for 24 hrs results in changes in haematological parameters & morphology of cells. Hence, refrigerated storage at 4°C is recommended for accurate results in case evaluation of delayed samples.
Sarcomas in fluid cytology: Experience from a tertiary care centre in India
Authors: Samanta Satarupa , Kapoor Shilpa , Kaur Kanwalpreet , Maru Paheli , Trivedi Priti
Published: March 2023

Cytological evaluation of fluids for sarcomatous exfoliation is extremely rare. However, recently studies have come up describing characteristics of sarcomatous malignancies exfoliating into fluids but study from an Indian experience is still lacking.

Description of clinico-pathological landscape in known cases of sarcomas, involving body fluid with emphasis on cytomorphologic details.

Study includes cases reported as positive for involvement by sarcoma on fluid cytology including pleural, ascitic and cerebrospinal fluid (CSF) specimens between Jan 2016 to June 2022. Cases were retrieved and reviewed for cytomorphologic features which were subsequently correlated with its parent histology and IHC. IHC was applied on cell blocks for two cases where involvement was doubtful.

In total, 21 fluid samples/cases including 4 CSF, 6 ascitic and 11 pleural fluid specimens were incorporated. Case spectrum comprised of 6 cases of Ewing Sarcoma (ES), 3 cases of rhabdomyosarcoma (RMS), 3 cases of osteosarcoma (OS), 2 cases of malignant peripheral nerve sheath tumor (MPNST), 2 cases of synovial sarcoma (SS), a case each of chondrosarcoma (CS), leiomyosarcoma (LMS) angiosarcoma (AS) and two cases of other malignancies with exfoliation of their sarcomatous component. Two cases presented as isolated latent metastasis so an IHC panel was applied to exclude involvement by secondary malignancy and prove involvement by primary diagnosed sarcoma.

Majority of exfoliated sarcomas presented with epithelioidto pleomorphic morphology where at times it becomes obligatory to rule out occurrence of a secondary malignancy. It’s the first study from an Indian institute’s perspective that reflects upon such diversity of sarcomas with variability in morphology on exfoliation which can be overwhelming for a cytopathologist at times. IHC panel might be used when clinical background is unknown or when involvement is uncertain. More studies are needed that can help come up with recommendations that address such problems.
Role of hematological and inflammatory marker in granulomatous compared to non-granulomatous lymphadenitis
Authors: Ahmad Faiyaz , Samin Faiza , Mittal Ankita , Awasthi Seema , Nasir Ariba
Published: March 2023

Lymphadenopathy can result due to an increase in lymphocytes in the lymph node due to various infections like tuberculosis and lymphoproliferative conditions. Granulomatous lymphadenitis causes an increase in inflammatory biomarkers which can be assessed by simple hemogram using TLC and DLC and ratios derived from it like NLR (Neutrophil Lymphocyte Ratio) and PLR (Platelet Lymphocyte Ratio).

To establish the role of hematological and inflammatory biomarkers in granulomatous and non-granulomatous lymphadenitis.

The study was performed in a tertiary care center from august 2020 to September 2022. The study included 150 patients with neck mass taking inclusion and exclusion criteria into account. Cytologically proven cases were categorised into granulomatous and non-granulomatous cases depending on cytological evaluation. Different laboratory parameters like TLC, DLC, ESR, CRP, NLR, and PLR were used to compare granulomatous lymphadenitis to non-granulomatous.

In the studied population there were 92(61.3%) females and 58(38.7%) males but when compared to the non-granulomatous lymphadenitis group, females predominated by 70.7% hematological markers like NLR, PLR, and CRP in the granulomatous lymphadenitis group was significantly higher. The mean Neutrophil was considerably higher among granulomatous lymphadenitis but in non-granulomatous lymphadenitis, the group showed considerably greater mean lymphocytes.

Tuberculosis is the most frequent clinical condition connected to cervical lymphadenopathy in our area. More often than not, women are involved. Hematological and biochemical parameters like NLR, PLR, and CRP can give us some indication before FNAC for the presence of granulomatous and non-granulomatous lymphadenitis. It will help the treating doctor think methodically about early case identification and avoid diagnostic delays in situations like tuberculosis, especially at the primary care level.
Overdiagnosis of lobular carcinoma of breast- A review of histomorphological features and immunohistochemistry: A case series
Authors: Rajkumari Priyadarshini , Pallipady Aravind
Published: March 2023

: Invasive lobular carcinoma (ILC) accounts for 5%–15% of all invasive breast cancers (BCs) and is the second most common type of BC behind invasive ductal carcinoma (IDC) of no special type. ILC of the breast is characterized morphologically by small, noncohesive cells that infiltrate the stroma in a single-file pattern(Indian file pattern). ILC tumours display features associated with a good prognosis, being low grade, oestrogen receptor positive and is mainly associated with the complete loss of E-cadherin (E-cad) expression.

To review the cases of invasive lobular carcinoma and to immunohistochemically categorize IDC and ILC.

This is a retrospective study including all the modified radical mastectomy cases of invasive lobular carcinoma of breast reported in the department of Pathology of a tertiary care centre from January 2021 to January 2022. Histopathological and immunohistochemical analysis of those cases were reviewed.

We encountered 10 cases of invasive lobular carcinoma of breast from January 2021 to January 2022. The average age of the patients was 55.9 years old (35–72). The classic presentation was a breast lump found in 100% of the cases. On physical examination, breast carcinoma was suspected in all the patients. The average size of the tumours was 4.5 cm (1.4– 9cm). Out of those 10 cases, 4 cases were right sided lesion and modified radical mastectomy was performed in all the 10 cases. All the 10 cases were diagnosed as invasive lobular carcinoma on histopathology and review of those cases showed 7 out of 10 cases to be IDC. Those cases showed pitfalls in histomorphological analysis which were later confirmed by immunohistochemistry. The findings are presented in the study.

Our study found that there was a histomorphological pitfall in the diagnosis of IDC. In ambiguous cases with histologically equivocal features, a strong, complete, membranous E-cadherin expression may help in resolving the problem and in aiding in the subclassification of invasive breast carcinoma.
An unusual case of mediastinal mass with pleural and pericardial effusion
Authors: Dsouza Shirley Maria , Rao Purnima S
Published: March 2023

Myeloid sarcoma is a tumor mass consisting of myeloid blasts, with or without maturation, occurring in an anatomical site other than bone marrow. More than 2000 case reports so far, only few comprehensive studies have been done, which reflects the rarity and difficulties in treatment of this neoplasm.

: A 17-year-old female presented with complaints of neck swelling since 2 months, breathlessness since 5 days. PET CT- Bilateral pleural and pericardial effusion Large mediastinal mass, multiple enlarged lymph nodes and appendicular skeleton showing increased FDG uptake. CT-Guided biopsy of the mediastinal mass: Uniform blue cells in sheets.

: CD45-Weak positive CD20, CD3, TdT-Negative CD99-Diffuse strong positive Parallelly, blood and bone marrow examination was done. Peripheral smear-80% blasts. Bone marrow-Monomorphous population of myeloblasts.

: About 21% of Myeloid Sarcomas (MS) are reported to occur in the mediastinum. Clinical presentation is dependent on tumour location, with symptoms due to tumour mass effect or local organ dysfunction. Recent studies show a misdiagnosis of 25-47%, with Hodgkin's lymphoma, lymphoblastic lymphoma, DLBCL, Ewing's sarcoma, thymoma, round blue cell tumours, or poorly differentiated carcinomas, mostly due to inadequate immunophenotyping. It was not corrected until a diagnosis of acute leukaemia was later established by bone marrow biopsy or peripheral blood examination.

: Recognition of MS with/without AML is essential for prognosis. Correlating radiological, hematological, bone marrow and flowcytometry features with histomorphology and immunohistochemistry of the tumor is essential. A rare possibility of MS should be kept in mind for mediastinal masses for timely diagnosis and treatment.