bluuebunny/crossref_metadata_2025 huggingface dataset:
A SYSTEMATIC REVIEW OF SUSTAINABILITY REPORTING ASSURANCE: CURRENT PRACTICES AND ISSUES FOR FUTURE
Authors: Darshi  , Gunawardana  , Weerakoon Banda
Published: July 2023

Sustainability reporting (SR) is an important area of modern corporate reporting that is rapidly expanding. Despite the fact that the number of reports has increased, their quality has been questionable. Moreover, the credibility of sustainability information without assurance is frequently criticized. According to SR practice, external assurance provides stakeholders with transparency and credibility of sustainability information. Although sustainability reporting assurance (SRA) is still a vital activity, there is a lack of a shared understanding and approach to the practice. The objective of the study is to explore the current SRA practices and the prospects for SRA by conducting a systematic literature review (SLR). Through the SLR using the PRISMA framework, 55 published articles in the last 17 years, from 2004 to 2020, were carefully examined. The predetermined data elements such as year of publication, country of study, research method, focus of literature, and analytical approaches were analyzed using a chronological and content analysis of these articles. This methodology employs a rigorous process to identify and select the most important literary contributions in this field. The results are intended to contribute to the development and evolution of SRA in the future, as well as guide researchers in designing their future studies.
Production volume of mackarel tuna (Euthynnus affinis) as a one of fisheries commodity in Singkawang City
Authors: Pebiloka Sarah , Johansyah Alfian , Aggadhania Lutfi
Published: July 2023

The purpose of this study was to observe the production volume and production value of mackerel tuna (Euthynnus affinis) during 2018 – 2020 in Singkawang City. Mackerel tuna (Euthynnus affinis) is one of the main fisheries commodities in Singkawang City that is included in the pelagic fish species in the Scombridae family. The capture of this fish species occurs throughout the year which is marked by the volume of production that is always there every month. The production volume of mackerel tuna (Euthynnus affinis) fluctuates every year, both monthly and annually. Where, the value depends on seasonal conditions and is dominantly high during the western and transitional seasons, which is as much as 12% and 13%. Meanwhile, during the western season, mackerel tuna (Euthynnus affinis) production volume is always low with a dominance of 3%. The values range from 2,836 kg – 38,963 kg which is found in August and November. The production value of mackerel tuna (Euthynnus affinis)  also follows the pattern of production volume. The production value will be high if the production volume is high. The production value ranges from IDR 66,936,000 – IDR 839,534,000.
Profil Kejadian Ikutan Paska Imunisasi (KIPI) Pada Pemberian Vaksin Heterolog Pada Tenaga Kesehatan di Rumah Sakit 'X'
Authors: Wulandari Dewi
Published: July 2023

Mutasi virus penyebab COVID-19 yang terjadi terus menerus serta kebutuhan untuk pembentukan antibodi yang lebih tinggi dalam waktu singkat menjadi urgensi di kondisi pandemi COVID-19. Penelitian ini bertujuan untuk melihat profil KIPI pada pemberian vaksin inactivated yang dilanjutkan dengan mRNA (heterolog) pada tenaga kesehatan di RS ‘X’. Penelitian ini merupakan studi analitik observasional dengan pendekatan cross sectional. Subjek pada penelitian ini adalah 126 tenaga kesehatan di RS ‘X’ yang mendapatkan vaksin heterolog pada bulan Agustus 2021, yaitu platform inactivated (2 dosis) dan platform mRNA (1 dosis). Analisis data berupa uji proporsi untuk melihat nilai odds ratio terjadinya KIPI pada kelompok usia 23-29 tahun dan >30 tahun. Demam, nyeri kepala, dan bengkak pada area penyuntikan didapatkan sebagai KIPI terbanyak pada tenaga kesehatan di RS ‘X’. Tidak ada perbedaan risiko terjadinya KIPI pada kelompok usia 23-29 tahun dan > 30 tahun. Kelompok usia 23-29 tahun memiliki efek protektif sebesar 67% terhadap terjadinya KIPI mual dibandingkan usia > 30 tahun.
Implementation Of Micro Finance Products With Mudharabah Contract At BMT NU Sejahtera Cilimus Kuningan
Authors: Wahyuni Neneng , Fauzan Arif , Firdaus Dicky F.
Published: July 2023

ABSTRACT

Mudharabah is one of the contracts in the sharia economy that is able to accommodate financing activities for micro business actors. In fact data from the OJK, Mudharabah contracts are still classified as minority contracts in Indonesian Islamic financial institutions. This is because the process is considered more risky and difficult so it is less strategic when applied to financial institutions. Interestingly, one of the BMT operating in Kuningan, West Java, BMT NU Sejahtera carries a financing product with this profit sharing contract. Using qualitative research methods, the authors examine the implementation of Mudharabah contracts in this BMT. From the results of the study it was found that in practice of the contract, there are still things that are not in accordance with sharia principles, such as fixed monthly installment payments, collateral requirements and if the customer suffers a loss, payments are still made even though only the principal. This discrepancy with the Shari'a is understood as an attempt by the BMT to minimize risk. Hopefully in the future, all of Islamic financial institutions and the community can both understand fiqh muamalah so that the practice of contracts in Islamic economics can be carried out purely according to the Shari'a.
Developing Marketing Strategy for Used Car Business Post Pandemic
Authors: Kwan Vincent , Aprilianty Fitri
Published: July 2023

The used car industry has a fairly good market in Indonesia. 2020 the used car market collapsed due to Covid-19 but began recovering in 2021. Unfortunately, Mobil88 Semarang did not experience this sales surge, instead seeing a 42% sales loss in 2021. The main problem is the ineffectiveness of Mobil88 Semarang's marketing strategy, which results in low brand awareness and market penetration. Therefore, this research aims to develop a creative, effective, and competitive marketing strategy for developing Mobil88 Semarang. This study included external and internal analysis, which will be summarized in the SWOT analysis. This study will employ both qualitative and quantitative research methods. The qualitative approach is utilized to collect in-depth data by interviewing the head of the Mobil88 Semarang branch, existing customers, and potential customers of Mobil88 Semarang. The data obtained from qualitative methods were analyzed using open coding. In addition, a quantitative approach using a questionnaire is applied in this study to validate several concerns. Creating a buyer persona, leveraging social media platforms, and developing cashback programs are among the recommendations for Mobil88 Semarang to solve the company's main issues.
Analysis Of The Effects Of Attitude, Subjective Norms, and Perceived Behavioral Control On Consumer Purchase Intention Of Natural Gas For Vehicle With The Moderating Role Of Price Sensitivity
Authors: Burhan Ahmad  Zakky , Sihite Janfry
Published: July 2023

This research aims to determine consumers purchase intention in using natural gas for vehicle with the moderating role of price sensitivity. This study used a quantitative approach in the form of a survey method. The population in this study consists of car users with fuel-powered vehicles located in the JABODETABEK area who have never owned a natural gas for vehicle before. The sample in this study consists of 122 car users with fuel-powered vehicles. Data processing is performed using the Partial Least Square (PLS) method. The results of this study indicate that attitude, perceived behavioural control, and price sensitivity have a significant influence on consumer purchase intention, while subjective norms do not have a significant influence. Price sensitivity also affects the relationship between subjective norms but does not affect the relationship between attitude and perceived behavioural control with consumer purchase intention. This study explores the impact of behaviour on purchase intention, emphasizing the management perspective. It reveals that positive attitudes towards environmentally friendly gas as an alternative fuel can be enhanced. The findings suggest that exogenous constructs moderately affect consumer purchase intention. Further research is needed to strengthen the influence of the dependent variable using additional variables.
Los efectos de la música en el libro VI del ‘De Musica’ de Agustín
Authors: Caruana Salvino , Campos Aurora ,   Order of Augustinian Recollects
Published: July 2023

The article deals with Augustine’s De Musica, first of all highlighting the structure of the Work, and then focusing on Book VI, stressing its main themes. A presentation is made of the main texts in Augustine’s works in which music is discussed. Subsequently, the presence of the hymn Deus creator Omnia in the work of St. Augustine is explored.
‘Miscuit cum eis’ (s. 232,3): Agustín y el arte del acompañamiento a partir de Lc 24,13-35
Authors: D’Andrea Bruno N. ,   Order of Augustinian Recollects
Published: July 2023

The article presents the main aspects of the art of accompaniment inspired by the augustinian exegesis of Lk 24:13-35, not without resorting, when necessary, to other relevant texts of the Bishop of Hippo. For this purpose, after a brief introduction which shows the actuality of the theme in the ecclesial sphere, it is briefly presented how Augustine interprets the life of the human being based on the metaphor of the journey and the pilgrimage, and how he conceives them to be a time and a path of harmonious growth. This serves as a framework to offer Augustinian orientations for the art of accompaniment based on his interpretation of Lk 24:13-35. It is shown that Augustine has been little explored as a relevant figure for the Christian tradition of accompaniment.
Agustín, multinstrumentista del Amor: un camino de purificación para toda la vida
Authors: Malgeri Graziano M. , Capolino Enrico ,   Order of Augustinian Recollects
Published: July 2023

The article deals with the theme of love in St. Augustine, highlighting how the Bishop of Hippo himself evolved in his own life from carnal and worldly loves to the love of God, as it appears fundamentally in his Confessions. In order to understand the dynamics of love, the article offers a brief summary of the Augustinian anthropological scheme. Some texts from the In epistulam Iohannis ad Parthos tractatus and the In Iohannis euangelium tractatus are also highlighted in order to corroborate the conclusions of the article.
The Use of Cognitive Behavioral Approach in the Care of Patients Diagnosed with Chronic Depression in Psychiatric Nursing: Case Report
Authors:   Kastamonu University, Tosya Meslek Yuksek Okulu, Kastamonu, Turkey.
Published: July 2023

Depression is one of the syndromes that is common among mental illnesses and creates a global burden of disease. Studies have reported that the cognitive behavioral approach has positive results in the treatment of depression. For this reason, the case was made to emphasize the effect of the cognitive and behavioral approach on the structured interview process in a patient diagnosed with chronic depression, which is one of the most common diseases that psychiatric nurses encounter in hospitals.
Developing Children’s Creativity
Authors:   Distinguished Professor Emerita, Miami University, Oxford, OH, USA., Sluss Dorothy ,   Professor Emerita, James Madison University, Harrisonburg, VA, USA.
Published: July 2023

The difference between people who are motivated to finish what they start even though it may take them hundreds of effortful actions and people who see only one solution to a problem or way to do something or who give up when their first attempt fails is the difference between creative and noncreative people. We all know these people who are creative and who live among us and we turn to them for solutions when we have a problem.
Synchronus Oral Squamous Cell Carcinoma in A Female: A Rare Case Report
Authors:   Dept of Surgical Oncology, Currae Cancer & Multispeciality Hospital, Mumbai, India, kadam Tejaswini ,   Dept of Ophthalmology, Shree Ramakrishna Netralaya Super Speciality Eye Hospital, Mumbai, India
Published: July 2023

Worldwide, the number of new cases of lip and oral cavity cancer in both sexes, all age groups in 2020 are around 377713 and the number of deaths in both sexes, all age groups are around 177757. In India, lip and oral cavity cancer ranks at 2nd position with incidence around 10.3%, mortality 8.8% and 5- year prevalence around21.77%. Multiple theories have been put forth describing the multifocal origin of squamous cell carcinoma (SCC) of the oral and aerodigestive tract. “Field Cancerization “is the first theory described in oral squamous cell carcinoma (SCC) which explains the multifocal or synchronous origin of the SCC. Synchronous carcinomas are defined as second neoplasms at the same time or within 6 months period of primary lesions. After that, they are described as metachronous neoplasms. The criteria to describe synchronous tumours were elaborated by Warren and Gates and Moertel et al. “Field Cancerization “theory was explained by widespread epithelial exposure to carcinogens; however, the alternative theory of common clonal origin is now supported by the recent molecular studies. Second Primary Tumours (Synchronous or Metachronous) are usually more aggressive, more resistant, metastasizes early and they require a more aggressive treatment strategy. Hence, their early detection is the crucial step in planning the best possible management. We are reporting an unusual case of synchronous oral squamous cell carcinoma in 58-year-old female who underwent surgery followed by adjuvant treatment after diagnosis.
Penerapan Strategi Inquiry dalam Pembelajaran Pendidikan Agama Islam
Authors: Arlina Arlina , Ramadhan M. Rayhan , Pohan Nelliana , Mandasari Dayanti , Nurhasanah Nurhasanah
Published: July 2023

This study examines the application of the inquiry strategy in learning Islamic religious education. This type of qualitative research, the method of literature seen by the authors from various journals, theses and books. The results of the conclusions obtained regarding learning the application of inquiry strategies in learning Islamic religious education are very significant. because it can make students active in finding and understanding the material being studied through preparatory steps, stimulus, problem identification, collecting data, data processing, proof, drawing conclusions so that students can truly understand the material.
Eksistensi Masyarakat Islam dan Kristen terhadap Kegiatan Keagamaan dalam Perspektif Islam dan Kristen di Desa Jawi Jawi
Authors: Erika Putri , Harahap Indra , Nasution Muhammad Ali Azmi
Published: July 2023

This research examines the Islamic and Christian Society's Animo towards Religious Activities in Jawi Jawi Village, Sei Kepayang Barat District, the Community in Jawi Jawi Village towards understanding religious teachings can be assessed as a stimulus that has an impact on a person's religious behavior. Religious behavior as an activity based on believed religious values, is influenced by the intensity of individual activity, the level of understanding of religious teachings, and the intensity in carrying out activities related to religious teachings. This research uses the type of research conducted by researchers is qualitative research with a theological approach. This research was conducted in Sei Jawi Jawi Village, Sei Kepayang District, Asahan District, North Sumatra Province. In this case researchers classify sources into two categories, namely primary sources and secondary sources and researchers collect data by means of observation, interviews and documentation. The results of this study are that religious activities are all forms of activities related to religious values, which are used as routines in daily life and used as guidelines in establishing relationships with Allah SWT and relationships with other human beings. The views of the Muslim and Christian communities on religious activities in Jawi Jawi Village are activities that are based on Islamic or Christian religious teachings which are a form of Islamic development and one of its goals is to help build morals, especially as a form of moral development in the Jawi Jawi Village community. With the activeness of a person in participating in religious activities, it is hoped that the quality of a person's faith will be better than before where this will appear in his moral behavior in everyday life. This means that Islamic and Christian religious activities contribute to the process of developing the morals of the people of Jawi Jawi Village.
“The Europe” Weekly on the Danish-Prussian War
Authors: Movsisyan Feliks
Published: July 2023

Key words: Schleswig, Holstein, Denmark, Prussia, war, German Union, armistice, Frankfurt Parliament, “The Europe”

German Union unfolded in the duchies of Schleswig-Holstein, which turned into the Danish-Prussian war. It found its response in the Armenian press of the time, as well as in “The Europe” political weekly of the Mkhitaryan Congregation in Vienna. The Mkhitaryan Congregates considered the comprehensive representation of the political events the main task of their newspaper; so that readers would be able to evaluate the facts objectively. Simultaneously, the staff of the weekly sought to cover the course of the Danish-Prussian war with “gravity, calmness, choice and distinct style”.
The Mkhitaryans considered the King’s desire to constitutionally unify the duchies with Denmark as the main reason for the German Schleswig-Holstein duchies to rise and take up arms. They also knew that Schleswig-Holstein was struggling to join the German Union. The reporters of “The Europe” noticed that the Danish-Prussian war had gone beyond the scope of the conflict between the two states and had acquired Pan-European significance. According to the Mkhitaryans, the Danish-Prussian war violated the decision of the Vienna Assembly of 1815 to maintain political balance in Europe. That’s why the leading European countries were trying to stop the war as quickly as possible and sign a truce. The weekly also stated the fact that the European states, seeking a truce, pursued their own interests. “The Europe” presented the terms of the armistice, discussed its reaction in the Frankfurt Parliament and the ratification of the armistice. The weekly called the participants of the September events “rioters”.
The Mkhitaryans noted that the population of the duchies didn’t want to obey Denmark, against which they resumed the war after the expiration of armistice. The Mkhitaryans didn’t try to praise any of the parties in the conflict. They didn’t approve their struggle either. Understanding the goal of the struggling sides, the Mkhitaryans commented on their struggle from the positions of impartiality and neutrality.
The Role of the Tax System in the Country’s Economy
Authors: Zakaryan Meri , Zakaryan Zhasmen
Published: July 2023

Key words: principle, function, tax legislation, efficient, competitive, tax revenues, collection

The role of taxes, the tax system and tax policy in the economic development of the country cannot be overestimated. They affect economic growth, development sustainability, structural shifts in the economy, and ultimately, the quality of life and the level of population’s well-being. Important tasks of any state are: establishing an optimal structure of taxation, achieving high efficiency of all tax functions. One of the guarantees for ensuring the economic development of the country is its economic security, which is due to the activities of the public administration system. From this point of view, it is important to constantly improve the tax system, which is an important tool for influencing the economy. One of the main factors hindering the development of the country’s economy is the imperfection of the tax system and the instability of tax legislation. Thus, the effective functioning of the economic system of the state depends on how correctly and elastically the tax system is formed. To characterize the tax system and evaluate its role in stimulating the economy, it essentially needs to be competitive and neutral. It is a competitive and neutral tax system that can create favorable conditions for the development of the economy as a whole, increase production efficiency, and contribute to an increase in the quality of living standards.
At the same time, the presence of a competitive and neutral tax system is a necessary but not sufficient condition for realizing the full potential of collecting tax revenues to the budgets of various levels, which is facilitated by the presence of an effective tax administration.
Socio-Psychological Features of the Value System of Volunteers Participating in the War and Strategies for Coping and Self-Control of Behavior
Authors: Avagimyan Hayk , Stepanyan Lilit
Published: July 2023

Key words: combat stress, coping strategy, combat situation, values, war, life purpose, problem solving

Currently, the problem of mental health of participants in local wars (combatants) is one of the socially significant issues for health care. Its scientific and practical relevance lies in the need to improve the system of psychological assistance to participants in local wars for their adaptation in the post-war period. When examining the psychological effects of war, if we set aside political considerations, it is evident from research data that the impact on the human psyche during hostilities and, particularly, during the time of post-war adaptation, is similar in various situations. This is demonstrated by the same age groups of the fighters, the swift and striking transition from the battlefield to civilian life, and most importantly, the attitude of people toward combatants. The article describes the socio-psychological features of the value system and coping strategies of combatants. Formed and more clearly manifested during the war, their psychology changes after its end, leaving its characteristic mark on the life of society as a whole. The feelings and behavior of a person in a moment of danger demonstrate their specificity in comparison with the emotions and actions of everyday life situations, revealing the characteristics of one’s personality from a completely unexpected side. The specificity of the combat situation significantly determines the formation and consolidation of certain values, suggesting that combat veterans differ from people who did not participate in hostilities by a particular system of values that discover the general direction of behavior in a wide range of situations, including stressful ones. It was revealed that combatants are characterized by problem-oriented coping, active behavioral strategy in which they try to use all possible personal resources to effectively solve problems. The latter indicates a closer connection with future life goals that enrich life with meaning, guidance, and chronological perspective.
The Role of Mobile Games in the Process of Physical Education of Young School Children
Authors: Aghanyan Gevorg
Published: July 2023

Key words: physical education, physical development, upbringing, motor activity, ability, health

In recent years, there has been an aggravation of health problems among the growing generation, including children of primary school age. Diseases of the locomotor system (scoliosis, etc.) occupy the first place in terms of the prevalence of diseases among children studying in primary school. The number of children with low height, underweight, physical development level and biological age discrepancy has increased. The number of functional deviations occurring with age is increasing.
The above-mentioned data prove that the development of motor abilities among children is currently at a relatively low level, which, in fact, cannot meet the modern requirements for solving educational, health-improving and upbringing problems presented to physical education at school. Therefore, the education problem of children’s motor skills in public schools through outdoor games is very relevant and requires the search for effective ways to further improve it.
Primary school age is the most favorable time to include outdoor games as a means and method in the educational process. In this regard, the analysis of scientific and methodological literature and pedagogical observations show that the most important effect and result of the game is the joy and emotional uplift of children that create a purposeful educational environment for the effective assimilation of motor actions.
Thus, the study and analysis of literary sources on the problem showed that the role of outdoor games in the system of physical and sports education is great. Outdoor games not only strengthen health and develop the body, but are also a means of cultural, moral education and integration of a person into society.
Classification, Structure, Biomedical Properties
Authors: Tatulyan Haykuhi , Ghazaryan Armine
Published: July 2023

Key words: surfactants, hydrophilic group, hydrophobic chain, dimeric (two-centered) surfactants, intrinsic toxicity, spacer

Surfactants make it possible for soap to mix with water by lowering the water surface tension. Beyond soaps and detergents, surfactants are used in lubricants, inks, anti-fogging liquids, herbicides, adhesives, emulsifiers and fabric softeners.
Surfactants added to cleaning agents, allow the detergent to mix into water, helping cleaning agents remove dirt from the cleaned surface. Without surfactants, soaps wouldn’t mix with the water, making the cleaning process much more difficult.
Surfactants are also used as an ingredient in lubricants, such as shaving cream, which make it easier to remove stubble and help limit irritation.
Surfactants added to car engine lubricants help keep particles from sticking to engine parts, allowing the parts to move easily and keep a car in proper running order.
The uses of Surfactants are far broader than those that have been described above; therefore, having such a large-scale application in the industry and everyday life, in this work we will present the main types of Surfactants, their applications, development prospects and their impact on the human body and the environment.
As a result, it is important to note that amino acid-based 2-centered Surfactants are of the most interest and have great development potential among the newest Surfactants. The use of dicenter Surfactants synthesized from amino acids is increasing in the production of cosmetics, pharmaceuticals, and biomedical products, mainly because they are less toxic, environmentally friendly, and actively biodegradable. In general, amino acid-based dicenter Surfactants are promising compounds for biomedical applications and many exhibit a broad spectrum of antimicrobial activity while being non-cytotoxic.
Backup & Data Recovery in Cloud Computing: A Systematic Mapping Study
Authors: PLAKA Roland
Published: July 2023

Context: Digital data is being stored in large quantities in Cloud, requiring data backup and recovery services. Due to many factors such as disasters and other disruptive events, the risk of data loss is huge. Therefore, backup and data recovery are essential and effective in improvement of system availability and maintaining Business Continuity. Nevertheless, the process to achieve the goal of business uninterrupted faces many challenges regarding data security, integrity and failure prediction. Objective: This paper has the following goals: analyzing system- atically the current published research and presenting the most common factors leading to the need of Disaster Recovery and backup plan; investigating and identifying the adopted solutions and techniques to prevent data loss; and lastly, investigating the influence Data Recovery and Backup has in terms of business continuity and identifying the privacy and security issues regarding the disaster recovery process. Method: A systematic mapping study was conducted, in which 45 papers, dated from 2010 to 2020 were evaluated. Results: A set of 45 papers is selected from an initial search of 250 papers, including 10 papers from snowball sampling, following the references from some papers of interest. These results are categorized based on the relevant research questions, such as causes of disasters, data loss, business continuity, and security and privacy issues. Conclusion: An overview of the topic is presented by investigating and identifying the following features: challenges, issues, solutions, techniques, factors, and effects regarding the backup and recovery process.
Ad-hoc wireless sensor communications for health monitoring systems
Authors: DURRESI Mimoza
Published: July 2023

The Covid 19 challenge, the increased aging population, and the modern way of living are increasing the need for health monitoring communications services. Healthcare monitoring is a very important research field of study. This is related in finding new, more efficient ways in health data communications with three main quality of service requirements: low delay, high security, high quality data transmission. Considering these requirements and recent developments in domestical health monitoring services, it is important not only the equipment used for health monitoring sensing but also the communication protocol used to access the data center. In this paper we develop a new communication protocol for ad-hoc wireless network created by the sensors used for personal health monitoring systems installed in patient wrists. This is a hierarchical protocol where the sensors communicate through a virtual infrastructure that helps to collect the data from the personal health monitoring equipments in an efficient way even in the areas with no wireless infrastructure. The communication scheme ensures a hierarchy of nodes that gets translated to hierarchy of costs as only a few nodes need to have a larger processing power resulting in a lower battery consumption for most of the patients. The neighbourhood area is divided into virtual cells where each cell is represented from one node center that holds the communication for all the surrounded nodes and forwards its information towards the next cell center found in the direction of the sink. As a result the information collected even in the fields without any wireless infrastructure might be carried towards the cells that are in a communication distance with the sink. The updated information data is forwarded toward the data centers to be analysed by the specialists. Taking in consideration that even in the urban areas the elderly population doesn’t have internet services, this ad-hoc communication protocol represents a good solution for health monitoring equipments. Moreover, the same communication protocol can be used for signaling life signs in war areas.
Lavado endoscópico con colocación de catéter trans acueducto de Silvio en paciente lactante con ventriculitis de difícil manejo
Authors: Alejos CB Maldonado , L Grisotto , Colombo G , Gómez Ávalos JM , Bustamante JL , D´Agustini MO
Published: July 2023

Introducción: La ventriculitis representa una emergencia infectológica, generalmente asociada a un procedimiento neuroquirúrgico. La incidencia es desconocida debido a la variación de los criterios diagnóstico.Descripción del caso: Presentamos una paciente de sexo femenino de 6 meses de edad con antecedente de hidrocefalia post hemorrágica, con diagnóstico de ventriculitis por Enterobacter complex asociada a sistema de derivación ventrículo peritoneal (DVP) de difícil manejo. La misma realizó tratamiento combinado de antibiótico con Meropenem y Colistin endovenoso e intraventricular asociado a tratamiento endoscópico que consistió en lavados, aspiración del contenido purulento intraventricular, tercer ventriculostomía endoscópica (TVE), coagulación bilateral del plexo coroideo y acueductoplastia con colocación de catéter de derivación ventricular externa (DVE) entre el tercer y el cuarto ventrículo con el objetivo de mantener la permeabilidad de la misma y de esta manera asegurar la llegada de antibiótico intraventricular al cuarto ventrículo.Discusión: La ventriculitis se asocia a múltiples complicaciones y una elevada tasa de morbi-mortalidad. El tratamiento de las ventriculitis de difícil manejo, es aún controvertido, actualmente existe bibliografía que reporta buenos resultados del tratamiento con lavado endoscópicos asociado al tratamiento combinado endovenoso e intraventricular para lograr mayores concentraciones de antibiótico intraventricular.Conclusión: Consideramos que el tratamiento combinado es una herramienta frente a las ventriculitis por patógenos resistentes a los tratamientos convencionales. En los casos con obstrucción del acueducto de Silvio recomendamos realizar acueductoplastia y colocación de catéter multifenestrado; para mantener la permeabilidad y la llegada de antibiótico al cuarto ventrículo.
Complicaciones inusuales de las derivaciones ventrículoperitoneales. A propósito de 2 casos pediátricos
Authors: Grijalba Miguel , Jaimovich Sebastián , Ruiz Johnson Agustín , Mantese Beatriz
Published: July 2023

Introducción: Durante el seguimiento de los pacientes con derivación ventrículoperitoneal (DVP) para el tratamiento de la hidrocefalia se pueden presentar complicaciones habituales relacionadas a la derivación, tales como infecciones u obstrucción/ruptura del sistema derivativo. Sin embargo, raramente se pueden observar complicaciones más raras y graves que pueden afectan a órganos como el corazón y el pulmón.Pacientes y métodos: Presentamos 2 pacientes con raras complicaciones relacionadas a la DVP. El primero, un paciente de 10 años, que después de 7 años de la implantación de una DVP presentó episodios de neumonía recurrente secundaria a la migración intrapulmonar del catéter distal. El segundo caso, un paciente de 3 años, que 5 meses posteriores a la colocación de una DVP presentó síntomas de hipertensión endocraneana secundarios a migración intracardíaca del catéter distal.Conclusión: La migración intrapulmonar e intracardíaca del catéter distal son complicaciones extremadamente raras, pero que pueden producir morbilidad importante. Los pacientes con derivación ventrículoperitoneal deben ser controlados de forma rutinaria de por vida, con la finalidad de evitar comorbilidades asociadas a sus complicaciones.
Fusión lumbar intersomática por vía oblicua (OLIF) L2-L5: descripción de la técnica y revisión de una serie de casos.
Authors: Gagliardi Martin
Published: July 2023

Introducción

La técnica de fusión lumbar intersomática oblicua (OLIF) es una alternativa para la fusión lumbar intersomática que utiliza el corredor anatómico que se encuentra entre el psoas y la aorta abdominal permitiendo la exposición discal sin la necesidad de movilizar los grandes vasos ni disecar la musculatura paraespinal. Esta característica lo diferencia significativamente de otras técnicas anterolaterales de fusión intersomática lumbar. El objetivo del siguiente trabajo consiste en describir paso a paso la técnica de OLIF y evaluar los resultados y complicaciones a corto plazo en una serie de casos.

Material y métodos

Se revisaron las historias clínicas de 18 pacientes tratados con técnica OLIF entre 2018 y 2019. Se descartaron aquellos casos con información incompleta y seguimiento de menos de 6 meses. Además de la estructura demográfica se evaluaron variables relacionadas con la patología previa, la cirugía realizada y los resultados operatorios. La descripción de la técnica quirúrgica se realizó teniendo en cuenta la experiencia del equipo quirúrgico y de diferentes artículos dedicados al tópico

Resultados

El resultado clínico fue favorable en todos los casos, presentando complicaciones menores en 3 pacientes. Se realizó una exhaustiva descripción de la técnica quirúrgica.

Conclusión

En nuestra serie de casos, la utilización del OLIF se mostró eficiente y segura. La realización de una correcta técnica quirúrgica es fundamental para disminuir las complicaciones relacionadas a este abordaje. Se necesitan ensayos clínicos randomizados a larga escala para determinar la utilidad clínica de este procedimiento.
Abordaje lumbar intermuscualr de Wilse en patología no discal
Authors: Mezzadri Juan José , Rivadeneira Conrado , Campero Alvaro , Basso Armando
Published: July 2023

Se analizan los resultados obtenidos en tres casos de patología no discal, que comprometían las áreas foraminal y extraforaminal, con el abordaje lumbar intermuscular de Wiltse. El caso 1 (sexo femenino/ 59 años) con antecedentes de linfoma primario de piel, padecía un dolor radicular en L5 causado por un tejido hiperintenso en las IRM ubicado en L5-S1. La biopsiafue inespecífica. El caso 2 (sexofemenino/ 33 años) padecía un dolor radicular L5 causado por una megapófisis transversa en L5 que fue resecada. El caso 3 (sexo femenino/ 23 años) con antecedentes de haber sido operada en la infancia de un tumor congénito, mostraba en las IRM un tejido hiperintenso extenso que invadía el canal a través de varios forámenes entre D12 y L4. La biopsia dio ganglioneuroma. El dolor radicular desapareció en todos los casos. El alta a las 72 horas fue sin complicaciones. Este es un abordaje de bajo riesgo, directo, que se facilita con el empleo de técnicas microquirúrgicas.
Nuestra experiencia en aneurismas disecantes en pediatria y revision de la literatura
Authors: Besada Diego A. , Giacobbe Héctor , Jaimovich Sebastián , Jaimovich Roberto
Published: July 2023

INTRODUCCIÓN: Los aneurismas en niños son raros, siendo su incidencia menor al 5% de todos los aneurismas. Describimos tres casos de aneurismas disecantes en pacientes pediátricos. Los tres casos tuvieron resolución endovascular y se realizó una revisión de la literatura sobre dicho tema.

CASO CLÍNICO: Paciente masculino de trece años de edad presenta cuadro de 24 horas de evolución caracterizado por cefalea y vómitos en varias oportunidades, agregando convulsiones tónico-clónicas con ictus prolongado, se realizó tomografía cerebral (TAC)  que  evidenció hemorragia subaracnoidea (HSA) y una masa ocupante, probablemente un aneurisma de la arteria cerebral posterior derecha.  La angiografía cerebral digital evidenció un aneurisma disecante de 2 centímetros del sistema vertebro basilar a nivel de la unión de los segmentos P2/P3 de la arteria cerebral posterior derecha.  Se optó por la resolución endovascular y oclusión de la arteria portadora con coils y material embolizante.

Paciente femenina de 5 años, sin antecedentes, la cual sufre traumatismo encéfalo craneano sin pérdida del estado de conciencia en domicilio. Al ingreso TAC de cerebro sin sangrado, observándose en la misma, una imagen espontáneamente hiperdensa, redondeada en el valle silviano izquierdo, se realizó angiografía digital, la cual observa un aneurisma de aspecto disecante distal a la bifurcación silviana izquierda de aproximadamente 10 mm. Se optó por  conducta expectante durante 10 meses esperando trombosis espontánea, pero al presentar un episodio de HSA se decidió oclusión del vaso portador del aneurisma. (IMAGEN)

Paciente femenina de 15 años de edad que consulta por cefaleas de 6 meses de evolución con examen neurológico normal, se le realizaron (TAC) y resonancia de cerebro que evidenciaron aneurisma disecante de la arteria cerebral posterior derecha, se realizó angiografía que confirmó el diagnóstico y se optó por resolución endovascular con oclusión del vaso portador. La paciente lo toleró perfectamente con restitución ad integrum post procedimiento.

DISCUSIÒN: Se presenta como discusión la terapéutica a dichos aneurismas disecantes dado que puede ser conservadora optando por la trombosis espontánea, endovascular con oclusión del vaso portador y quirúrgica convencional

CONCLUSIONES: La baja incidencia poblacional de los aneurismas en pediatría, sobre todo los aneurismas disecantes hace difícil la toma de decisiones a la hora de optar por la resolución de la patología, siendo la oclusión del vaso una opción segura, recomendada por toda la revisión bibliográfica hecha, de baja tasa de complicaciones, nuestro servicio se inclinó por dicha resolución.
Uso de stents de bajo perfil (mini stent) en el tratamiento de aneurismas distales de cuello amplio
Authors: Purves Cynthia Paula , Casagrande Walter
Published: July 2023

Antecedentes y objetivo:

 El tratamiento endovascular de los aneurismas distales de cuello amplio representa un desafío. La colocación de stents a nivel del cuello del aneurisma asistiendo la colocación de coils evita desplazamientos, permite mantener la permeabilidad del vaso portador y de los ramos distales. Los stents pequeños de bajo perfil, también llamados ministents, son una alternativa útil en aneurismas distales situados en arterias portadoras de pequeño diámetro (1.5 a 3.10 mm), ya que pueden navegar por microcatéteres con un diámetro interno de 0.0165 pulgadas.

 El objetivo del presente análisis es evaluar la seguridad y eficacia del uso de distintos mini stents (Leo Baby, LVIS jr, Acclino Flex, Accero, Neuroform Atlas) en el tratamiento de aneurismas cerebrales distales de cuello amplio.  Presentamos una serie de 60 aneurismas tratados con los dispositivos mencionados.

Materiales y métodos: Análisis retrospectivo de pacientes intervenidos en 7 instituciones en el periodo comprendido entre el 01 de enero 2013 al 31 de marzo de 2021 con al menos 6 meses de seguimiento clínico y angiográfico. Se evaluaron historias clínicas, Tomografías (TC), resonancias (RMN) cerebrales, estudios angiográficos y terapéuticos de los pacientes tratados con stents de bajo perfil, compatibles con microcatéteres 0.0165 ̈de diámetro interno (Leo Baby, Lvis Jr, Acclino, Accero, Atlas) en aneurismas distales a la bifurcación carotídea y a la arteria basilar. Revisión de la bibliografía en PUBMED de los artículos publicados en el mismo periodo relacionados introduciendo los términos: Leo Baby, Lvis Jr, Acclino, Accero, Neuroform Atlas, low profile stents, AND broad-neck aneurysms.

Resultados:  Se analizaron 59 pacientes con 60 aneurismas a los que se le efectuaron 62 procedimientos terapéuticos. El promedio de edad de los pacientes fue de 53.66 años. La incidencia fue mayor en el sexo femenino. 1/3 de los pacientes se presentaron con sangrado. La localización más frecuente de los aneurismas fue en la bifurcación silviana derecha. Se implantaron 64 stents. 2 stents no pudieron implantarse. En 52 casos se colocaron coils. Se registraron 5 trombosis intra procedimiento (4/5 asintomáticas), 1 hemorragia, 2 aperturas incorrectas y 3 posicionamiento inadecuado del stent. Los grados de oclusión fueron de Raymond Roy modificado (RR) de 1: 37%,2: 20%, 3ª: 17% y 3b: 26%.  Requirieron nuevo tratamiento 6/61 aneurismas. No se registró morbilidad ni mortalidad en el corto plazo. 

Conclusiones:

 El presente análisis evidenció que en el tratamiento de aneurismas distales de cuello amplio el uso de stents de bajo perfil asociados a coils logran tasas adecuadas de oclusión con baja morbimortalidad en el corto plazo.
Drenaje ventricular al exterior de tunelización larga: un método costo-efectivo para reducir las complicaciones
Authors: Amparo Sáenz  , Romina Argañaraz  , Beatriz Mantese
Published: July 2023

Introducción: La colocación de drenajes ventriculares al exterior (DVE) es uno de los procedimientos más frecuentes de la neurocirugía, tanto en pediatría como en adultos, sin embargo, no se encuentra exento de complicaciones. La tasa de infección asociada al drenaje puede serdel 25%. En nuestro Hospital encontramos una incidencia del 22% anual.Al ser sistemas que no cuentan con una regulación de la salida del líquido, el paciente debe permanecer en decúbito dorsal estricto todo el tratamiento.Nuestro objetivo es diseñar un nuevo sistema de drenaje ventricular al exterior de tunelización larga (DVET) que lidie con estos problemas al mismo tiempo que reduzca los costos hospitalarios.Material y métodos: Se realizó un ensayo clínico prospectivo en el que se colocaron 25 DVETL entre el 1/9/2018 al 1/5/2019 que se compararon con el sistema tradicional de DVE.Resultados: La presencia de fístula se asoció más frecuentemente a los DVE en comparación con los DVETL, esta diferencia fue estadísticamente significativa (30% vs 8% p=0,029). La presencia de infección asociada al drenaje fue significativamente mayor en los DVE en comparación con los DVETL, esta diferencia fue estadísticamente significativa (22% vs 0% p=0,009). Los pacientes con DVE tradicional utilizaron el doble de recursos y generaron el doble de costos que los pacientes con DVETL.Conclusión: Se realizó una presentación detallada del nuevo sistema de DVETL que presenta una disminución en la incidencia de fístula de LCR e infección asociada al drenaje. A su vez aparenta ser costo-efectiva en comparación con el sistema tradicional de DVE.
Programa de Simulación Neuroquirúrgica
Authors: Massa Daniela , Rasmussen Jorge , Kornfeld Sebastián , Plou Pedro , Padilla Fernando , Villaescusa Miguel
Published: July 2023

Objetivo: Describir un programa de entrenamiento básico para implementar en la residencia de Neurocirugía con una metodología estructurada, diferentes niveles de complejidad y elementos de fácil adquisición.Introducción: La simulación se define como el uso de modelos para imitar experiencias de la vida real. Debido a la complejidad del aprendizaje en Neurocirugía, el programa de la Residencia debería incluir entrenamiento básico mediante simulación que permita al residente entrenarse en habilidades básicas fuera del quirófano, o bien, desarrollar y complejizar las ya aprendidas.Materiales y Métodos: Se realizó un programa de entrenamiento básico a desarrollar en el Centro de Simulación Quirúrgica del Hospital italiano, dividido en tres niveles de complejidad quirúrgica. Se idearon distintos ejercicios con materiales accesibles, de bajo costo y replicables. El programa se diseñó para ser llevarse a cabo con una frecuencia de una vez por semana durante cinco horas.Discusión: Los modelos propuestos presentan fácil acceso y alta disponibilidad; y permitieron el desarrollo de habilidades microquirúrgicas desde etapas muy tempranas de la residencia, abarcando la utilización del instrumental microquirúrgico y la magnificación microscópica, y simulando distintas técnicas quirúrgicas en materiales biológicos y sintéticos realistas; enmarcado por un programa basado en objetivos sin límites de repeticiones. La evaluación con un neurocirujano Senior permitió brindar un espacio relajado de enseñanza y debate, sin ser influenciado por las presiones propias de la cirugía. El aprendizaje de técnicas quirúrgicas se basa en la repetición de maniobras específicas, por lo que el desarrollo de habilidades quirúrgicas en ámbitos académicos no asistenciales es fundamental en cualquier aprendizaje quirúrgico.Conclusión: La simulación en el entrenamiento neuroquirúrgico sigue siendo un campo de estudio que requiere mayor investigación y validación en su implementación. En nuestra experiencia resulta una herramienta sumamente favorable para su posterior aplicación en procedimientos quirúrgicos reales, que podría mejorar y homogeneizar la enseñanza en programas de formación quirúrgica.