bluuebunny/crossref_metadata_2025 huggingface dataset:
Optimal Drive Cycle Control for Energy Storage Systems in Parallel Hybrid Electric Vehicle
Authors: Saxena Shashank , Senger Himanshu
Published: October 2022

In HEVs, maintaining high energy density is a necessity while demanding higher peak power as well thus this results in doubling the incremental cost of the vehicle if approx. 15 % of all electric range is demanded. The SOC of the vehicle directly affects the economy and the emission rates. In this work the parallel HEV is modelled by using ADVISOR and Different SOC limits are taken for testing the performance and fuel economy for the same designed driving cycle. With the simulation results we will be able to specify best upper and lower limits of SOC such that vehicle will achieve best fuel economy and emission performance. The simulation is performed by taking repetitive velocity profiles (drive cycles) of four different curves i.e. UDDS, ECE, FTP and HWFET. The operating effectiveness of the parts must be optimised by taking the system as a whole into account. The forward-looking approach will be used to carry out the control strategy. In this technique, the operating efficiency is maximised in order to maximise fuel economy; other strategies do not have this additional component. In order to improve fuel economy, the ability controller for parallel hybrid automobiles is mentioned in this study. The older power controllers that were installed optimise operation but do not fully utilise the possibilities.
PWM Strategy with Multiple Carriers for Hybrid Multilevel Inverters Adapted from PV-Based
Authors: Verma Toran
Published: October 2022

This research makes a design recommendation for a multilayer solar inverter that uses the level shift pulse width modulation technology. Inverters that have numerous layers are able to take advantage of switching at many frequencies, with the fundamental frequency being the frequency with the lowest switching rate. In this particular instance, we make use of not one but two signals: one serves the function of a carrier signal, while the other serves the function of a reference signal. In multilayer level inverters (MLI), the triangle wave is used as a carrier signal, while the sinusoidal wave is employed as a reference signal for the method of pulse width modulation. In addition, the sinusoidal wave is used as a reference signal for the pulse height modulation technique. These two waves are combined to produce what is known as a multilayer level inverter (MLI). This study will conduct an in-depth investigation into how adjusting the level shift of the carrier signals affects hybrid PV-based MLIs and how to count harmonics in multilayer PV-based inverters. Both of these things increase voltage and significantly reduce losses. Both of these things are important for this study. Both of these subjects are going to be discussed at length in this investigation. In order to do an analysis of the voltage and current harmonics, a level shift method simulation is run on a multilayer cascaded hybrid PV-based inverter using Matlab/Simulink. This simulation is utilised to accomplish the task.
Kehidupan Anak Yang Orang Tuanya Poligami di Desa Sagu Flores Timur
Authors: Faizah Zahidah Azzah , Azhar Muh. Zaim
Published: October 2022

This study is motivated by the existence of the life of children in polygamous families. At the age of vulnerable children with surrounding conditions, the task of parents in accompanying and helping to meet the needs of children is very important. Polygamous parents certainly know the additional burdens of polygamy in Islam. The purpose of this study is to find out the life of children whose parents are polygamous by reviewing Islamic law. This type of research is a descriptive field study. In data collection, researchers use interview techniques to informants and observations, as well as data analysis with data reduction, data display, and data verification. From this study it was found that children's lives are fulfilled in terms of biophysical. However, 3 out of 4 children in other needs such as mental, social and spiritual terms are not well met. The conclusion of this study, which is reviewed from Islamic law, is only fulfilled in terms of finances. However, there will be no mental, social and spiritual needs that are a priority in Islam. So that this unbalanced thing makes children abandoned in terms of spirituality, and this is not in accordance with Islamic law.
Transformación digital en América Latina: una revisión sistemática
Authors: Trujillo Valdiviezo Guido , Rodríguez Alegre Lino , Mejía Ayala Desmond , López Padilla Rosario del Pilar
Published: October 2022

El objetivo de la investigación fue explorar la transformación digital en América Latina, vista desde las temáticas trabajadas en investigaciones recientes. La metodología consistió en la revisión sistemática que permite conocer el estado de arte de la variable abordada a partir de la interrogante ¿Cuáles son las áreas o temas de interés ligados a la transformación digital en América latina? Las bases de datos utilizadas fueron WOS y Science Direct tomando como período desde 2019 al 2022. Los resultados muestran que las investigaciones en el tema de la transformación digital en la región se orientaron de acuerdo a tres áreas: La educación, las empresas y las personas. Se concluye que la digitalización global es un fenómeno que venía en desarrollo, pero que experimentó una aceleración inesperada como resultado de la pandemia COVID-19.
Sholat Dhuha Dalam Peningkatan Akhlak di MI Al-Urwatul Wutsqo Jombang
Authors: Indana Nurul
Published: October 2022

Salah satu manfaat  dari sholat dhuha yaitu perbaikan akhlak seseorang. Seorang siswa jika melakukan sholat dhuha berjamaah tiap hari di madrasahs maka akhlaknya akan baik yaitu anak akan berperilaku disiplin di sekolahnya. Melihat betapa pentingnya akhlak siswa-siswi, maka dibutuhkan seorang pendidik untuk membina dan meningkatkan akhlak siswa. Dengan penanaman akhlak siswa yang baik, siswa dapat melakukan kegiataan sholat dhuha dengan istiqomah, sehingga pelaksanaan sholat dhuha berjalan dengan lancar dan tanpa paksaan. Tujuan penelitian ini Untuk mendiskripsikan peningkatan akhlakul karimah siswa di MI Al Urwatul Wutsqo Jombang, Untuk mendeskripsikan pelaksanaan sholat dhuha siswa di MI Al Urwatul Wutsqo Jombang. Metode yang digunakan ialah metode kualitatif dengan desain deskriptif kualitatif dengan pengumpulan data melalui observasi, wawancara, dan dokumentasi. Hasil penelitian menunjukkan bahwa akhlak siswa di MI Al Urwatul Wutsqo Jombang ini dikatakan baik karena siswa selalu bersikap sopan, santun, menghormati, mendengarkan. Namun masih ada sebagian siswa yang masih kurang dikarenakan masih menjumpai siswa yang terlambat. Hal ini juga karena lamanya pandemi yang membawa efek samping pada sisitem tatap muka sekolah. Siswa yang datang terlambat diberi hukuman agar siswa tersebut tidak melakukan kesalahan lagi, hukumannya seperti berjemur dan menghafal surah-surah pendek. dengan memberi hukuman siswa lebih disiplin lagi. Dengan disiplin dalam melaksanakan sholat dhuha maka akhlak kita akan menjadi lebih baik. Sehingga guru memberi nasehat pada siswa agar mereka selalu barakhlak yang baik dengan pelaksanaan sholat dhuha tersebut melatih siswa agar berperilaku yang baik terhadap orang tua, guru dan lain-lain. Mengingatkan siswa selalu mendekatkan diri kepada Allah SWT. Dengan menggunakan metode keteladanan, pembiasaan, dan pengetahuan, yang bertujuan untuk meningkatkan keimanan siswa.
In Vitro Anticancer Activity of Kokilaksha (Hygrophila spinosa T Ander.) in Osteosarcoma Cell Lines
Authors: E.P. Anisha , Seema Pradeep , Manjunatha PM
Published: October 2022

Introduction: The drug Kokilaksha (Hygrophila spinosa T Ander.) found growing as a weed in the paddy fields is one of the commonly used drugs to treat Vatarakta (Gouty arthritis) as per classical texts of Ayurveda. A thorough literary search on the disease Vatarakta reveals that in Gambhira awastha (chronic stage) the disease involves deeper dhatus like Sandhi, Asthi, Majja; and Arbuda is mentioned as one of the upadravas (complications) of Gambhira Vatarakta according to Acharya Sushruta. Both malignant as well as benign tumours are considered under the term Arbuda. The research profile of Kokilaksha reveals its potent anti-tumour activity and efficacy in the Erythropoietic system. The current study is intended to evaluate the in vitro anticancer activity of Kashaya and hydroalcoholic extract of the drug Kokilaksha (Hygrophila spinosa T Ander.) in osteosarcoma cell lines.
Materials and Methods: The in vitro study consisting of two osteosarcoma cell lines namely MG-63 and SAOS-2 were subjected to the hydro alcoholic extract and kashaya of Kokilaksha (Hygrophila spinosa T Ander.). The anticancer activity was carried out using three assays namely MTT assay, Nitric oxide scavenging activity and LDH assay.
Results: The in vitro study showed both the hydro alcoholic extract and kashaya of Kokilaksha (Hygrophila spinosa T Ander.) exhibited anticancer activity in a time and concentration dependent manner with respect to all the three assays in both MG-63 and SAOS-2 osteosarcoma cell lines.

Key words: Kokilaksha (Hygrophila spinosa T Ander.), osteosarcoma cell lines, MTT assay, Nitric oxide scavenging activity, LDH assay, hydro alcoholic extract, Kashaya
Prevalence of Level of Stress and Quality of Life in Pre-Hypertensive Individuals
Authors: Dhaval Raval , Dave Dr Parita , Contractor Dr Edrish
Published: October 2022

Introduction: Hypertension is persistent elevation of arterial blood pressure of both systolic (over 140 mmHg) and diastolic (over 90 mmHg), believed to be an independent risk factor, and its prevalence is rapidly increasing in developing countries. Quality of life is stated as the ability of person to function normally in society, perceived by the person. Individuals who were aware of being hypertensive had poor quality of life concerning general health, physical functioning, vitality, and mental health than those who were not aware.
Aim And Objective: To determine prevalence of level of stress in pre-Hypertensive individuals. To determine prevalence of the quality of life in pre-Hypertensive individuals.
Method: 118 participants diagnosed with pre-hypertension were taken and written consent form was obtained after explanation. Individual had to fill two scales GHQ 12 (General Health Questionnaire) to assess Quality of life & Perceived Stress Scale to check the level of stress. Prevalence was found out according to the data collected.
Result: Data was analysed using SPSS v.20 with level of significance 5%.The mean age of participants was (38.92±5.01) with involvement of 53.3% females and 46.7% males. According to the data prevalence of stress is 63% which means moderate stress among prehypertensive individuals. On the basis of GHQ-12, 33% individuals were having no more than usual affection over their quality of life.
Conclusion: There is high prevalence of stress among prehypertensive individuals.

Key words: Pre-Hypertension, Perceived Stress Scale, General health Questionnaire (GHQ 12)
Combined Effect of Dynamic Wrist Hand Orthosis and Therapy on Hand Grip Strength in Subjects with Acute Hemiplegic Stroke
Authors: Sahoo Subhasmita , Behera Priyanka
Published: October 2022

Back ground: Stroke is a sudden loss of neurological function, with motor impairment, which can be regarded as a loss or limitation of function in muscle control or a limitation of hand movement through, insufficient muscle strength and inadequate muscle tone. The affected hand motion can result in a diminished ability to perform daily functional activities.
Objective: The study was evaluated the effect of dynamic wrist hand orthosis in acute hemiplegic stroke patient, which will increase the hand grip strength and over all hand function in affected hand.
Methods:30 hemiplegic stroke patients were participated in the study according to inclusion criteria. The subjects were divided into two groups; Group1 Dynamic wrist hand orthosis with therapeutic intervention and Group 2: only therapeutic intervention was given. In both group base line data and pre-test data was collected. Grip strength of affected hand was measured by hand held Camry dynamometer and hand fine motor skill test was conducted by box and block test. After 6 week the post test data was collected.
Results: There was a significant difference of grip strength and hand fine motor skill (performed by box and block test) was found in group 1 patients when compared with the only therapeutic group 2.
Conclusion: The dynamic wrist hand orthosis is an effective prescription in increasing hand grip strength and fine motor skill for that the acute hemiplegic stroke patients and they can easily perform daily activities.

Key words: Acute hemiplegic stroke, Dynamic wrist hand orthosis, Grip strength, Camry hand held dynamometer, Box and block test.
Analysis of Low Back Pain in Nurses with High Work Load: A Cross-Sectional Survey
Authors: Solanki Devi T , Jani Dr. Pooja
Published: October 2022

Introduction: Low back pain is a common, recurrent and costly health problem worldwide. Nurses, particularly, are at higher risk than other health professionals to suffer from injuries and work related musculoskeletal disorders such as low back pain (LBP). Nurses injure their backs from the physical burden associated with manual handling of patients.
Aim: The purpose of the study was to investigate the current working conditions of nurses with LBP in relation to their physical workload, and to depiction whether working prolonged shifts is associated with LBP.
Method: Total 40 nurses with low back pain with high work load were included in the study. PSEQ was used to assess pain, ODI was used to assess disability, PSFS was used to assess functional activity. Data was analysed by using Pearson test.
Result: Nurses were found to be having pain on self-efficacy for pain. On average their self-efficacy for pain was found to be moderate that is 38.78 with maximum score of 60. On average categorised themselves to have moderate disability with 27.83%. On average nurses were having moderate functioning affection with a mean total score of 6.1 when 3 major activities were considered. PSFS was found to be strongly correlated with PSEQ & moderately negative correlated with ODI and ODI was found to be moderately negatively correlated with pain and function scales.
Conclusion: The nurses with existing low back pain with high work load has considerable self-efficacy for pain and their physical function and participation were moderately affected.

Key words: Low back pain, oswestry disability index, Nurses
The Relationship Between Clinical Risk Factors and Patient’s Survival Rate in Non-Small Cell Lung Carcinoma Cases: A Cross-Sectional Study
Authors: Budi Ikhsan , Santoso Arif , Arief Erwin
Published: October 2022

Background: Non-small cell carcinoma (NSCLC) is the most common type of lung cancer. Risk factors for lung cancer include smoking, genetic factors, chronic lung disease, lung infections, radon exposure, air pollution, exposure to carcinogenic substances in the workplace and other risk factors. The significance of each of these risk factors differs by sex, race and region in a given country. Purpose: The study was conducted to assess the analysis of risk factors, treatment response and survival of NSCLC patients.
Methods: Cross sectional and survival analysis, patients undergoing diagnostic and treatment at Dr. Wahidin Sudirohusodo Makassar period January 2017-December 2019. Anamnesis of risk factors and survival by telephone and patient medical record data.
Results: There are 100 patients who fulfill the inclusion criteria; Subject characteristics were mostly male (64%), age >45 years (84%), Bugis ethnicity (50%), farmer occupation (27%), active smokers (60%), consume filter cigarettes (75%), and has severe brinkman index (BI) (51.6%). About 40% of the subjects were non-smokers, 50% of whom were passive smokers. Severe IB and high-risk occupations by type of KPKBSK were significant (p = 0.02 and p = 0.01). Age <45 years, median survival was better than age 45 years (8 months versus 4 months), p = 0.002. Subjects receiving EGFR-TKI had a better median survival of 7 months, platinum doublet 6 months, did not receive treatment for 2 months, p = <0.05.
Conclusion: Brinkman Index (BI) and high-risk occupation based on NSCLC type are significant. Age < 45 years had a good median survival. Subjects who received TKI had a better median survival.

Keywords: Non-small cell lung carcinoma, clinical risk factors, survival rate.
Effect of Oral and Local Unani Formulations in Chronic Leg Eczema: A Case Report
Authors: Khanum Saba , Naaz Iram , Nida Sumbul
Published: October 2022

Nār Fārsī muzmin (Chronic eczema) is common dermatological condition with diverse etiology and morphology. It is clinically characterised by itching, redness, edema, papulovesicles in the acute stage and dry lichenified skin in the chronic stage. Its prevalence is incessantly increasing, affecting the Quality of Life (QoL) of patients. The medical study shows that those with eczema suffer from high levels of emotional stress, and the more severe the condition is the more psychological stress there may be. A 58 years old female patient was diagnosed with chronic leg eczema and treated with Majoon Shahtara orally and Marham Kafoor topically for 2 weeks. Outcome of the study was assessed with EASI, POEM, VAS and DLQI scores before and after treatment and the difference was significant clinically and statistically.

Keywords: Eczema; Majoon Shahtara; Marham Kafoor; Nār Fārsī; EASI; POEM; VAS; DLQI.
Knowledge, Attitude and Practice of People Working in Construction Sites Towards Noise Induced Hearing Loss
Authors: Srivastava Aanchal , N Balambigai
Published: October 2022

Construction activities generate high levels of noise due to the equipment and machinery used and thus construction workers are exposed to exceedingly high levels of noise. The study aimed to assess the Knowledge, Attitude and Practice (KAP) among the people working in the construction industry towards Noise Induced Hearing Loss. The survey was conducted in 8 different construction sites in Delhi among 46 laborers and 52 civil engineers. The questionnaire consisted of a total of 42 questions comprising of 3 sections, with 12 questions examining Knowledge, 20 questions assessing Attitude and 10 questions examining practice. The results revealed that the knowledge was limited among people working in the construction field, and the engineers with higher education levels had better Knowledge, Attitude and practice towards noise induced hearing loss, when compared to laborers.

Keywords: Knowledge, Attitude and Practice (KAP), Noise Induced Hearing Loss (NIHL), Construction workers, Laborers, Engineers.
The Development of Interactive Media Learning Innovation Based on Local Wisdom in Improving Financial Literature
Authors: Jayanti Siti Nur , . Forijati , . Sugiono
Published: October 2022

Economics is a subject that aimed of understanding students about economic problems and events in their environment. So, it can be used as a guide in making rational economic decisions in various choices. In the mission of achieving these goals, economics teachers need to innovate learning that can teach students. Through the development of interactive media based on local wisdom, students are required to actively participate and be able to apply their real roles in daily life in accordance with the national identity, as well as improve students' financial literacy. The problem in this study is how interactive media learning innovations can improve financial literacy and the quality of accounting learning. This study uses the 4 D method, namely define, design, develop, and disseminate. The results showed: (1) the validity test showed a score of 95.3%. This means that interactive media learning innovations based on local wisdom are very feasible to use without revision. (2) The scoreof financial literacy was 83.2% or was in the high category. This means that respondents have high financial knowledge.

Keywords: Economics, Local Wisdom, Learning Innovation
The Effect of Leadership, Organizational Culture and Competency on Employee Performance in Radio Sikamoni Group
Authors: Meliala Nikolas , Edward Yusuf Ronny , Sutanto Alex Tribuana
Published: October 2022

The purpose of this study was to determine the influence of leadership, organizational culture and competence on employee performance at Radio Sikamoni Group, either partially or simultaneously. The population in this study were all employees who worked at Radio Sikamoni Group, many samples in this study were 67 respondents. Data were collected using a questionnaire. The data is tested using validity and reliability tests, and the data must meet the elements of the classical assumption test. Furthermore, the data analysis test was carried out using multiple regression analysis, t test, F test, and coefficient of determination. The results of this study indicate that there is a positive and significant influence of leadership on employee performance. There is a positive and significant influence of organizational culture on employee performance. There is a positive and significant effect of competence on employee performance. There is a positive and significant influence of leadership, organizational culture, competence on employee performance at Radio Sikamoni Group. The magnitude of the ability to influence leadership, organizational culture, competence to explain employee performance is 70.3% while the remaining 29.7% is explained by other variables that are not included in this research model.

Keywords: Leadership, Organizational Culture, Competence, Employee performance
ESTIMATION OF DISSOLVED ORGANIC CARBON IN RIVER FLOWS AND IDENTIFICATION OF THE RELATIONSHIPS BETWEEN PEAT HUMIC FRACTIONS AND PHYSICOCHEMICAL QUALITIES
Authors: Mutonkole P. S. , Tangou T. T. , Kanda V. N.
Published: October 2022

Peatlands are wetlands that contain higher amounts of carbon, some of which is often released with water in dissolved form, especially when land use change occurs. However, peatland carbon is mostly stabilized in humic fractions where it forms complexes with metallic elements. This study sought to measure the levels of dissolved organic carbon (DOC) in rivers and analyze the link between physicochemical parameters and humic fractions along the Buhandanda and Lushala peat profiles. Inductively-Coupled Plasma Optical Emission Spectrometry, chemical fractionation followed by sulfochromic oxidation, and dosing by indirect chemical oxidation were used to determine major geochemical elements (MGE), humic fractions (HS), and DOC, respectively. Average MGE concentrations were 4.1±1.4, 3.6±0.5, 2.8±0.6, 1.8±0.7, 1.1±0.4, 0.3±0.1, 0.1±0.0, 0.5±0.3, 0.1±0.0, 0.03±0.0, 0.03±0.0 and 1.9±0.9, 3.6±0.8, 2.5±0.6, 2.0±0.5, 1.1±0.4, 0.3±0.0, 0.09±0.01, 0.18±0.1, 0.06±0.04, 0,02±0.0 for Ca, Fe, Si, Al, S, Ti, K, Mg, Mn, Na for Lushala and Buhandanda, respectively. Fulvic acid (FA) fractions were constantly higher than humic acid (HA) from 0 to 80 cm and lower beyond on Buhandanda peaty profile. FA was also higher than HA for Lushala peat except for depths 20, 90, 140, and 200 cm. Humin (HU) was the highest fraction on the two peatlands. Humification index (HI) and degree of transformation (DT) of HS had values of the same order of magnitude (from 0.32 to 2.43). No association was found between physicochemical properties and HS, except for FA and Fe, Ca, S, Mg, Mn, Se on Lushala peat. DOC showed a downward trend from entry to exit of peatlands. The two sites were not statistically different. Mountainous peat can contain high levels of MGE and loses a tiny fraction of its carbon with runoff waters.
Специальная сессия Индийского национального конгресса в Дели 1923 г. и роль Абул Калам Азада в сохранении единства партии
Authors: Гепалов Александр Сергеевич
Published: October 2022

История Индии 1-й пол. XX в. – это пример героической борьбы за независимость против британского владычества, пример поиска и нахождения компромисса между различными политическими течениями в целях сохранения единого антиколониального фронта. Примером такого компромисса явилась специальная Делийская сессия Индийского национального конгресса, прошедшая в сентябре 1923 г. Её главным достижением являлось то, что удалось избежать раскола и найти компромиссное решение, позволившее продолжать борьбу за обретение независимости, используя новые методы. История борьбы за независимость Индии 20-х гг. XX в. в отечественной историографии изучена достаточно хорошо. Это время проведения компании несотрудничества, разделения Конгресса на «сторонников перемен» и «противников перемен», образование Партии сварадж и изменения тактики политической борьбы. Однако в отечественной науке отсутствуют работы, которые подробно описывают события Делийской сессии 1923 г. Практически нет трудов, освещающих деятельность одного из виднейших участников национально-освободительной борьбы в Индии 1-й пол. XX в. – мауланы Абул Калам Азада. Именно он был избран председателем Конгресса в это время и сыграл весомую роль в нахождении компромиссного решения между сторонниками участия в законодательных собраниях и их противниками.
Специфика Ближнего Востока как подсистемы международных отношений в конце холодной войны
Authors: Гофман Артём Владимирович
Published: October 2022

В статье исследуется специфика ближневосточного региона как подсистемы международных отношений. Отмечается, что Ближний Восток длительное время рассматривался в качестве периферии противостояния между СССР и США. При помощи историко-сравнительного подхода показано, что многочисленные конфликты внутри региона были вызваны его самобытностью, уникальностью исторического процесса. Советский Союз и Соединённые Штаты не являлись первопричиной данных конфликтов, но пытались использовать их в своих интересах. Окончание холодной войны привело лишь к закреплению США как единственного гегемона, но не внесло решающих изменений в структуру ближневосточного региона.
An Efficient Viterbi Algorithm for Communication System
Authors: Ganesh Padgal Gouri , Oza Shruti
Published: October 2022

The Viterbi decoding algorithm is widely used in areas like Decoding convolutional codes in satellite communication, digital TV, wireless local area networks, mobile relay. Also, the method is used in the development of Automatic Speech Recognition (ASR) and storage systems that work automatically. For Viterbi decoder-based architectures with low latency and complexity, which proposes error detection techniques that are effective. This paper explores the Viterbi algorithm which has two types of approaches for two types of subparts. Important aspects of any communication system are area/power consumption and throughput /efficiency. Minimization of these aspects is the need for an efficient system. This paper explores unwanted logical block reduction by modifying the present logical block. This paper explores signature-based approaches which result in acceptable efficiency. Also, another approach is used to achieve error detection in permanent and transient faults. This error detection is achieved by recomputing with encoded operands. Encoding means the use of shifting operation or the use of rotation operation. This approach makes the system slightly efficient. The proposed approaches can be based on reliability and the efficiency objective.
Cloud computing Technology in Academic Libraries: A paradigm shift
Authors: Kumar Rajput Brijendra , Malviya R.N.
Published: October 2022

Cloud computing has presented to us another point of view to take a gander at the current asset – sharing issue, cloud computing can be applied to advanced library assets to further develop data sharing abilities, further develop asset use. This paper portrays how cloud computing assists with accomplishing more effective utilization of IT equipment and programming ventures and give a way to speed up the appropriation of advancement. The study gives an overview of cloud computing and how it might be combined with library administrations in the online environment.
Raw oyster consumption causing vibrio vulnificus bacteremia in ESRD patient
Authors:   BronxCare Hospital Center, Department of Internal Medicine, Bronx, NY, USA., Chinta Siddharth , Kulkarni Mugdha ,   BronxCare Hospital Center, Department of Internal Medicine, Bronx, NY, USA., Patel Dhruv ,   BronxCare Hospital Center, Department of Internal Medicine, Bronx, NY, USA., Chandok Taruna ,   BronxCare Hospital Center, Department of Internal Medicine, Bronx, NY, USA., Nasr Rabih ,   BronxCare Hospital Center, Division of Nephrology, Bronx, NY, USA.
Published: October 2022

Vibrio is gram negative bacteria found in warm salty water [1]. Vibrio vulnificus is one of the most common species causing vibriosis in the United States [2]. It is associated with primary sepsis, skin infections as well as gastrointestinal tract infection. Here we present a case of Vibrio vulnificus bacteremia in a hemodialysis dependent ESRD patient [3], with h/o treated colon carcinoma, and liver cirrhosis presenting as bilateral leg edema rapidly escalating to septic shock.
Octreotide scintigraphy mimicking whole body bone scan
Authors:   Ionizing and Non‑Ionizing Radiation Protection Research Center (INIRPRC), Shiraz University of Medical Sciences, Shiraz, Iran., Alavi Mehrosadat , Rezvani Alireza ,   Hematology Research Center Shiraz University of Medical Science, Shiraz, Iran., Abravan Bahareh ,   Department of Nuclear Medicine, Medicine School, Shiraz University of Medical Sciences, Shiraz, Iran., Azami Hamideh ,   Department of Nuclear Medicine, Medicine School, Shiraz University of Medical Sciences, Shiraz, Iran., Zahraei Seyed Ali Hossein ,   Medical Doctor, Shiraz University of Medical Sciences, Shiraz, Iran.
Published: October 2022

In A 70-year-old man presented with unknown primary origin Neuroendocrine tumor (NET) and known liver metastasis. Tc-99m-octreoride scintigraphy showed widespread bone metastases, mimicking whole body bone scan. Keywords: Neuroendocrine tumor; Octreotide scintigraphy; Diffuse bone metastases.
A delayed presentation of bilateral anterior fracture dislocation of the shoulder from a domestic electric supply
Authors:   Department of Trauma and Orthopaedics, Hull Royal Infirmary, HU3 2JZ, Hull, United Kingdom., Patel Ravi , Lu Victor ,   Department of Trauma and Orthopaedics, Addenbrooke’s Hospital, CB2 0QQ, United Kingdom.
Published: October 2022

Bilateral anterior fracture dislocation of the shoulder secondary to a high voltage electric shock is extremely rare, with only a few case reports available. To our knowledge, a prolonged delayed presentation (>4 weeks) of an anterior fracture dislocation of the shoulder has not yet been reported in the English literature. We report an unusual case of a bilateral anterior fracture-dislocation of the shoulder, following an electric shock from a high voltage domestic electric supply. The patient was treated operatively with an open-reduction of both dislocated shoulder joints, followed by splinting immobilisation of the joint in full internal rotation for 3 weeks and attendance to physiotherapy for 6 months. At the last follow-up after more than 10 years after the injury, the patient was pain free with no impingement of activities of daily living and had returned to his former job.
Double edge sword
Authors:   Specialty Medical Officer, ESIS Hospital, Satpur, Nashik, India., Vaidya Sameer , Gothi Dipti ,   Professor & Head, Department of Pulmonary Medicine, ESI-PGIMSR, Basai Darapur, New Delhi, India., Patro Mahismita ,   Assistant Professor, Department of Pulmonary Medicine, ESI-PGIMSR, Basai Darapur, New Delhi, India.
Published: October 2022

Anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitides (AAVs) are characterized blood vessel inflammation and necrosis which may lead to diffuse alveolar hemorrhage (DAH) resulting in life threatening respiratory failure. We present a case of microscopic polyangiitis presented in respiratory failure secondary to DAH that developed a rare treatment related complication. A 50 year old lady presented in respiratory failure with hemoptysis & falling hemoglobin. Chest X-ray showed bilateral inhomogeneous opacities and urine showed granular casts and red blood cells. Red colored bronchoalveolar lavage was obtained and serology came positive for pANCA. She was treated with corticosteroid and rituximab. The patient improved initially, but later developed rituximab induced late onset neutropenia. She unfortunately developed pulmonary mucormycosis and could not be revived. Thus, rituximab behaved as a “double edge sword”, helping the patient initially but later making her susceptible for opportunistic infection.
Assessment of corneal topographic patterns and densitometric parameters in patients with severe delayed-onset mustard gas keratopathy and patients suffered from corneal scarring
Authors:   Vision Health Research Centre, Semnan University of Medical Sciences, Semnan, Iran., Bagheri Shiva , Jadidi Khosrow ,   Vision Health Research Centre, Semnan University of Medical Sciences, Semnan, Iran.
Published: October 2022

Purpose: This study was performed to evaluate the densitometric values and the type of corneal topographic pattern extracted from Pentacam HR (OCULUS, Wetzlar, Germany) in two groups of severe delayed-onset mustard gas keratopathy (DMGK) and old herpes simplex corneal scarring. Materials and methods: Twenty eyes of each group were enrolled to the study and were examined using the Pentacam HR. Total corneal densitometry was measured over a 12 mm diameter area, divided by annular concentric regions and depths. Also, the corneal topographic pattern from the axial curvature map of the anterior corneal surface was determined in all patients. Results: The most common observed patterns in severe DMGK and old corneal scarring were superior steepening and irregular pattern, respectively. Densitometry measurement in 10 to 12 mm in diameter in DMGK was significantly higher than old corneal scarring. There were not any significant differences in other densitometry values between the groups. Conclusion: It seems that clinical evaluation of corneal structure using Pentacam can improve our knowledge about this rare mustard gas keratopathy. Keywords: Delayed-onset mustard gas keratopathy; Corneal scarring; Pentacam HR; Densitometry; Corneal pattern.
Gastric pneumatosis: An unexpected complication in multiple myeloma patient
Authors:   University of Arkansas for Medical Sciences, Little Rock AR, USA., Hussain Munawwar
Published: October 2022

Gastric pneumatosis is an unusual and rare condition with unclear management recommendations. We report a case of gastric pneumatosis in an adult patient with multiple myeloma on chemotherapy with concomitant fungemia. Patient presented with right lower abdominal pain and subsequently developed spinal cord compression and got treated with high dose dexamethasone and chemotherapy. Patient developed upper GI symptoms and diagnostic imaging was ordered. A CT scan of the abdomen and pelvis was done which showed intramural gas in the gastric and esophageal wall along with positive blood cultures for candida krusei. Our patient was managed conservatively with antifungal, antibacterial therapy along with decompression via nasogastric tube but failed to improve. General surgery team recommended operative management, but the patient and family opted for comfort measures.
Cerebrovascular malformations in adults: What mode of revelation? About 53 cases
Authors:   Central Service of Radiology, Ibn Rochd University Hospital Center of Casablanca, Morocco. Hassan II University of Casablanca, Morocco., V Ndayishimiye
Published: October 2022

Cerebrovascular malformations include a broad spectrum of intracranial blood vessel disorders, involving the arterial wall, capillary bed, venous and lymphatic systems. Their main associated risks are intracerebral hemorrhage, seizures and focal neurological deficits. We carried out a retroprospective study over a period of 45 months (3 years and 9 months), ranging from April 01, 2018 to December 31, 2021; from the files of patients referred for magnetic resonance imaging (MRI) or CT scan cerebral exploration in the context of neurological symptomatology or as part of an assessment carried out for other medical or surgical purposes, with as judgment criterion the demonstration of a cerebrovascular malformation. We collected fifty-three (53) patients, with an average age of 47 years old and as extremes ages 18 years old and 70 years old. We noted a female predominance with a sex ratio of 1.7 in favor of female sex. The most of patients were explored with MRI in 85% of cases. Our patient history was dominated by arterial hypertension in 20% of cases and hemorragic stroke in 12% of cases. The symptomatology presented by the patients was mainly represented by headache and epileptic seizures in 20% of cases each, dizziness in 15% of cases. The cerebrovascular malformations were dominated by cavernomas in 54% of cases (complicated of bleeding in 27% of cases). Other cerebrovascular malformations were : aneurysm: 19%, arteriovenous malformations: 15% and developmental venous abnormalities in 12% of cases. MRI and CT scans are very important radiological modalities for diagnosing malformative cerebral vascular abnormalities. Their discovery is more often made during a radiological assessment motivated by another cause.
A leaking food pipe: Bronchoesophageal fistula secondary to lung cancer
Authors:   Department of Internal Medicine, Reading Hospital, Tower Health System, West Reading, Pennsylvania, USA., Oke Ibiyemi
Published: October 2022

A 58-year-old female with advanced lung cancer, hypertension, hyperlipidemia, pulmonary artery thrombosis, bilateral subclavian artery stenosis, and vocal cord dysfunction presented to the ER with cough, shortness of breath, dysphagia, and weight loss. HR 114 bpm, RR 24/min, SpO2 95% on 4L, Temperature 36.2o C. She was lethargic, chronically ill-looking, and had bronchial breath sounds and crackles in the right upper lobe. Chest x-ray revealed enlarging previously known right upper lobe mass and loculated right pleural effusion. Contrast CT of the chest showed unchanged necrotic right apical mass, increased consolidation inferior to a mass in the right middle lobe, and metastatic infiltration of the right lateral 6th rib. She also had purulent secretions in all airways on bronchoscopy. Shortly after bronchoscopy, she had an episode of aspiration and required Intensive Care Unit (ICU) admission.
Shone’s complex: An extremely rare congenital cardiac anomaly in a preterm newborn
Authors:   Division of Neonatal Perinatal Medicine, Women’s Wellness and Research Center, Qatar., Khazzam Fadi Al
Published: October 2022

Shone’s Anomaly (SA) is a rare congenital cardiac malformation that consists of four obstructive lesions of the left heart and the aortic arch. We report on a preterm infant with Respiratory Distress syndrome diagnosed with SA after cardiac auscultation revealed a loud second heart sound. A 2D echocardiogram study revealed a large ventricular septal defect and a variant of SA consisting of sub-valvular aortic stenosis, hypoplastic aortic arch, coarctation of the aorta, and dysplastic mitral valve along. The infant underwent a successful Hybrid procedure at two months of age consisting of pulmonary artery banding, stenting of the patent ductus arteriosus, and placement of an atrial stent. Although SA can present in infancy, we have not found a separate report of a preterm infant with SA in the literature. This case presentation raises awareness about this anomaly, sheds light on the importance of careful cardiac examination in newborns, and emphasizes the importance of an echocardiographic exam in evaluating preterm infants with an unusual course of RDS.
A rare triad of fractures in the upper limb. Simultaneous fractures of the distal radius
Authors:   Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar, Elgassim Mohamed
Published: October 2022

We’re reporting a 35-year-old gentleman that presented with a rare combination of ipsilateral fracture of both proximal and distal ends of the radius associated with ulna styloid fracture due to a fall with outstretched hands. Thorough clinical examination of two adjacent joints (elbow and wrist) is critical in identifying such an unusual or rare combination of injuries. Appropriate management for such cases depends on the characteristics of the injury, such as fracture patterns, job, hand dominance, and age of the patient. The treatment should aim to preserve the radial head to avoid the possibility of proximal radial migration, particularly in young patients. Such a combination of injury implies complex injury and needs special consideration in deciding management plan. In this case, the proximal end of the radius and the ulna styloid fractures were treated conservatively. In contrast, the distal end of the radius was treated with open reduction internal fixation
Challenges in the diagnosis and management of Cushing’s disease: A case series
Authors:   National Institute of Child Health (NICH), Hospital in Karachi, Pakistan., Rai Versha Rani
Published: October 2022

Cushing disease is considered as a rare condition characterized by the increases secretion of the Adrenocorticotropic Hormone (ACTH) due to a pituitary adenoma that ultimately causes endogenous hypercortisolism state by stimulating the adrenal glands. Cushing disease is associated with many complications like short stature, weight gain, osteoporosis, cardiovascular and respiratory disorder which leads to high rates of morbidity and mortality. It is important to diagnose and manage Cushing disease as early as possible in order to implement a treatment plan, to lead a successful prognosis and to decrease the complications. We here present the case series of 4 clients that illustrates some of the challenges in diagnosing and managing patient with Cushing disease.
Takotsubo can also occur during minimally invasive treatment of paraganglioma liver metastasis!
Authors:   Department of Anesthesia and Critical Care, Medical University of Tours, 10 Boulevard Tonnellé, 37032, Tours, France
Published: October 2022

Pheochromocytomas and paragangliomas are catecholamines’ producing tumors with metastatic potential. In expert centers, new techniques have been developed, especially for the management of metastases in interventional radiology. However, during any therapeutic procedure, there is a risk of release of catecholamines. Intraoperative complications are poorly documented during interventional radiology. This case reports a cardiac decompensation during the management of liver metastasis of a paraganglioma by chemoembolization and cryotherapy. The main message of this case study is that cardiovascular events can occur also during interventional radiology management. These procedures require education and close collaboration between the radiologist and the anaesthetiologist.
An unusual cause of abdominal bloating
Authors:   Department of Gastroenterology and Hepatology, Apollo Hospital, Navi Mumbai, India., Satyendra Badhe
Published: October 2022

Bloating is a common symptom reported in Gastroenterology clinics. A 37-year old man presented with history of abdominal bloating and increased frequency of stools for two months which was not relieved with pro-kinetic drugs or proton pump inhibitors. His physical examination was unremarkable. Lab tests and abdominal USG were normal. Since his symptoms persisted, he was subjected to an upper GI endoscopy revealing numerous white spots over the duodenal mucosa (Figure 1A), which were biopsied. Pink pear shaped trophozoites of Giardia lamblia (arrow) were seen attached to the surface epithelium and in the luminal aspect. Moderate eosinophil rich infiltrate was present in the lamina propria along with mild villous atrophy (Figure 1B, Hematoxylin and Eosin staining X 400). The patient was effectively treated with a course of tinidazole.
A rare case report: Giant cell tumor of the presacral space and it’s management
Authors:   Department of Obstetrics and Gynecology, Weill Bugando School of Medicine, Catholic University of Healthy and Allied Sciences, P.O. Box 1464, Mwanza, Tanzania., Ndaboine Edgar
Published: October 2022

Giant Cell Tumor (GCT) is a rare primary skeletal lesion accounting for approximately 5% of all primary bone tumors in adults. GCT has been described histologically as a benign neoplastic lesion. It clinically presents as painless, firm, well defined mass without any fixity to underling structures. Although it is benign in nature but rarely GCT may exhibit a much more aggressive phenotype, and the role of chemotherapy in metastatic GCT or residual tumor is not well defined in the literatures.
Melatonin treatment of delirious state: A case study
Authors:   Department of Gerontology, Kepler Universitätsklinikum, Neuromed Campus, Linz, Austria., Leblhuber Friedrich , Steiner Kostja ,   Department of Gerontology, Kepler Universitätsklinikum, Neuromed Campus, Linz, Austria., Sonnberger Michael ,   Department of Radiology, Kepler Universitätsklinikum, Neuromed Campus, Linz, Austria., Fuchs Dietmar ,   Division of Biological Chemistry, Biocenter, University of Innsbruck, Austria.
Published: October 2022

Melatonin secretion decreases with age and in neurodegenerative diseases like Alzheimer’s Disease (AD). Sundown syndrome (“sundowning”), characterized by agitation, wandering, anxiety, aggression and confusion in the evening and at night is prevalent among demented patients [1,2]. Delirious state is a very common complication in severe dementia, dysregulation of the sleep-wake cycle is one characteristic finding during delirium. Melatonin is able to correct this circadian rhythm disorder [1,3]. Dysfunction of noradrenergic regulation and low tryptophan levels were found to be associated with delirium in the elderly, supporting the hypothesis of a possible role of tryptophan or tryptophan-like compounds such as melatonin in the pathogenesis of delirium [1,4].
On the synthesis and sintering behavior of a novel Mg-Ca alloy, Part I: Mechanical alloying
Authors: Golmohammadi Parisa , Saljooghi Fatemeh , Bahmani Ahmad , Parvin Nader , Nayebi Behzad
Published: October 2022

A novel Mg-0.7Ca alloy was prepared by the mechanical alloying (MA) process. Different variables were examined in order to obtain the optimum sample with the best milling behavior and potential sinterability. The structural studies were carried out using X-ray Diffractometer (XRD) and scanning electron microscopy (SEM). Crystallite size and lattice strain of the milled samples were examined by Scherrer and Williamson-Hall methods in order to finalize the investigation.

The optimum milling time was found to be 60 minutes. In addition, a starch-containing sample with a fraction of 2.5 weight percent seemed to have the best microstructural properties, based on SEM observations and crystallite size assessments. Due discussions about the effective phenomena during the mechanical alloying were also included.
Optimum temperature, time and atmosphere of precursor pyrolysis for synthesis of B4C ceramics
Authors: Feiz Seyed Faridaddin , Nikzad Leila , Majidian Hudsa , Salahi Esmaeil
Published: October 2022

In this paper, the variables of the pyrolysis operation such as temperature, time, and atmosphere were studied and optimized. At first, the effect of increasing pyrolysis time at lower temperatures was investigated to understand the mutual influence of pyrolysis time and temperature in enhancing the efficiency of B4C synthesis. Then, three pyrolysis atmospheres were selected to find the optimal conditions: burial method in box furnace (air), pyrolysis in tubular furnace (argon), and pyrolysis in box furnace (air). The pyrolyzed powders were finally located inside the tubular furnace at 1500 °C for 4 h under argon atmosphere to synthesize B4C ceramics. X-ray diffractometry (XRD) was employed to determine the optimal processing conditions. The temperature of 600 °C and the holding time of 2 h were selected as the optimal pyrolysis conditions. Meanwhile, the burial method was chosen as the best atmosphere despite having a higher percentage of impurity because of the much lower cost compared to the argon atmosphere.