bluuebunny/crossref_metadata_2025 huggingface dataset:
A study of serum phosphate levels and its correlation with curb-65 score in community acquired pneumonia
Authors: Gurav Nitish Ashok , Rajanna Avinash Hanbe , Hoskera Sharana Basava , KR Raveendra
Published: May 2021

Background: Community acquired pneumonia (CAP) refers to pneumonia contracted by a person with little or no contact with health care system. Phosphorus is an essential molecule in ATP, playing a central role in energy production. A normal range is 2.5 to 4.5 mg/dl. Phosphate disturbance are noted in patients with pneumonia. Hypophosphatemia, plays a role in impairing chemotaxis, phagocytosis and bactericidal activity of macrophages. Hyperphosphatemia in pneumonia result in hypocalcaemia and pulmonary calcification. Hence study of serum phosphate levels in community acquired pneumonia is of clinical significance.
Aims and Objective: The was aimed to estimate the levels of serum phosphate in patients with community acquired pneumonia and to correlate serum phosphate levels with CURB 65 severity score.
Materials and Methods: Seventy-five CAP patients admitted as inpatients are included in this study. Chest X ray is obtained in all suspected cases. Serum phosphate levels are determined through blood investigation on Day 1 and Day 3.
Results: Serum phosphate levels on Day 1 and Day 3 were significantly associated with CURB65 score. Both high and low phosphate levels were associated with high CURB 65 score. The association between phosphate levels and CURB 65 score was significant in patients who got discharged but not in patients who expired.
Conclusions: Present study of serum phosphate levels as biomarkers in CAP showed that both hypophosphatemia and hyperphosphatemia carried poor prognosis which correlated with high CURB65 score.
Clinico- bacteriological profile of Community Acquired Pneumonia (CAP) in children aged 3-59 months: A cross sectional study
Authors: Singh Manoj Kumar , Singh Sheo Pratap , Kumar Rajesh , Kumar Pankaj , Suhail Jafar , Dayal Rajeshwar , Nayak Madhu , Agarwal Arti
Published: May 2021

Background: Worldwide community-acquired pneumonia (CAP) is the major cause of high mortality among under five children in India. After introduction of Pneumococcal and H. influenzae vaccination there is paucity of data regarding etiological profile of pneumonia.
Aims and Objective: To evaluate the Clinico- epidemiological profile and etiology of community acquired pneumonia in children.
Materials and Methods: We enrolled children aged 3-59 months with CAP (based on WHO criteria of tachypnea with cough or breathing difficulty) over 18 months and recorded presenting symptoms, clinical signs and chest radiography. We performed blood and nasopharyngeal swab (NPS) bacterial culture simultaneously to detect etiological agent of community acquired pneumonia in children.
Results: Out of 150 cases of CAP, 90 % of caeses had cough and fever and nearly 80-90% cases had tachypnea and crackles on examination. Radiological findings suggestive of pneumonia was seen in 86% cases . Most common organism isolated was S aureus in both NPS culture (18.7 %) and blood culture (14.7 %). Other common organisms detected in NPS culture were S pneumoniae (6%), E Coli (4.7%), Klebsiella (4.7%), CONS (3.3%), and Pseudomonas (2.7%). In blood culture the common organism detected after S aureus was E coli (5.3%), S pneumoniae (3.3%), Klebsiella (3.3%), CONS( 3.8%), and Pseudomonas (2.5%).
Conclusions: We observed that S aureus was the predominant etiological organism isolated in both blood and nasopharyngeal swab bacterial culture in patients suffering from community-acquired pneumonia.
Bacteriological profile and antimicrobial sensitivity pattern of isolates from diabetic foot of patients attending a teaching hospital in Northern India
Authors: Aleem Seema , Multani Harman , Bashir Humaira
Published: May 2021

Background: Diabetic foot ulcer is a major cause for diabetes related morbidity and hospitalization. Up to one-third of people with diabetes develop diabetic foot ulceration (DFU) during their lifetime and over 50% of these ulcerations become infected. Diabetic foot infections (DFIs) are associated with major morbidity, increasing mortality, high costs, increased risk of lower extremity amputation (LEA), and reduced quality of life.
Aims and Objective: The current study was conducted to determine the microbiological profile and antibiotic susceptibility pattern of organisms in diabetic foot ulcers patients at a tertiary care center in Srinagar province.
Material and Methods: This was a Cross-sectional, observational study conducted in diabetic patients with diabetic foot infection, randomly selected from outpatient departments (OPDs) and wards of Surgery and Medicine department, with Wagner grade 1-5 ulcers and irrespective of anti-diabetic treatment and diabetic foot injury treatment. Samples were processed and bacterial isolates were identified by standard microbiological procedures.
Results: After following inclusion and exclusion criteria, 120 patients were considered for this study. In present study most common age group was 51-60 years age group (44%) followed by 41-50 years (32%). 66% of participants were males. 55% patients had diabetes for more than 10 years. 43% patients had ulcer size less than 5 cm2. The most common category as per Wagner’s classification was Grade 1, which comprised of 48% of study participants, followed by Grade 0 (28%) and Grade 2 (18%). Grade 3 and above comprised 7% of cases. Of the 120 study participants, 103 (86%) showed growth on culture. Among these 62 (60%) showed mono-microbial growth with 41 cases showing mixed growth. The most commonly isolated bacteria were Methicillin Resistant Staphylococcus aureus (MRSA) (23%), Coagulase Negative Staphylococci (CoNS) (18%), pseudomonas aeruginosa (18%), Methicillin Sensitive-Staphylococci Aureus (9%), Klebsiella Pneumoniae (9%), and Escherichia Coli (8%). Linezolid, vancomycin, clindamycin, gentamicin were most effective antimicrobial agents against gram positive bacteria. Iimipenem, piperacillin tazobactam, cefoperazone sulbactam & gentamicin were most effective antimicrobial agents against gram negative bacteria.
Conclusion: Early microbiological evaluation for bacteriological profile, the nature of the infection either monomicrobial or polymicrobial and antibiotic sensitivity testing can improve treatmentoutcome, reduces complications, morbidity as well as multidrug resistance.
Chance that matter or matter of chance: changing prevalence of fundic gland polyps and proton pump inhibitors
Authors: Wani Zeeshan Ahmad , Mir Muzzafer Mohamad , Khan Afaq Ahmad , Baba Iqbal , Mir Showket , Rather Majid , Lone Shaheen , Raina Akhter
Published: May 2021

Background: Proton pump inhibitors (PPI) are considered one of reasons for changing prevalence of gastric fundic gland polyps (FGP), not only in western world but trend is being seen in Asian countries as well.
Aims and Objective: This study was designed to evaluate prevalence of FGP and to look into endoscopic and histological profile of these polyps in PPI users and non-PPI users. We also assessed background gastric mucosal histology in FGP patients.
Materials and Methods: This is a retrospective observational study of 1800 cases. Medical records of patients who underwent esophagogastroduodenoscopy (EGD) in three gastroenterology centres between 2011 and 2019 were analysed at Noora super speciality Hospital, Kashmir; Northern India. Biopsy specimens of patients with FGP were reviewed by expert pathologists. PPI use was quantified as significant when Pantoprazole 40 mg per day or equivalent doses of other PPI was used four times or more per week for more than one year. Statistical Analysis was conducted using SPSS version 22.
Results: FGP were most common, observed in 900 (50%) of all gastric polyp cases. PPI use one year and more was noted only in 360 (40%). FGP were mostly located in fundus 630 (70%), multiple in 840 (93.33%), with average size between 6 to 10 mm. On histology parietal cell hyperplasia, parietal cell protrusion and foveolar hyperplasia were seen in 666 (74%), 716(79.55%) and 254 (28.22%) cases respectively. Background gastric histology was normal in 543 (60.33%).
Conclusions: FGP were most common gastric polyps in Northern India. We observed similar endoscopic and histological characters in FGP irrespective of whether cases were using PPI or not. Majority of cases had normal background gastric mucosal histology.
Management of COVID-19 Related Myocarditis: A Systematic Review
Authors: Koç Şahbender , Şener Yusuf , Doğan Emre , Kırdağ Emine , Altuntaş Emine , Bedir Ömer , Edem Efe
Published: May 2021

On January 7 in China, one patient was identified with a new corona virus in throat culture, and World Health Organization called it severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Herein, we aimed to summarize overall data for COVID-19 disease related myocarditis and its treatment. In the initial stages, patients developed symptoms of severe acute respiratory infection and afterwards other serious symptoms such as septic shock, metabolic acidosis, coagulation disorders, multiple organ failure problems developed.Complications were mostly associated with pneumonia (91.1%) and acute respiratory distress syndrome. Before the Coronavirus Disease 2019 (COVID-19) infection, the presence of cardiovascular diseases has been found to increase the severity and side effects of primary respiratory syndrome. Since management of COVID-19 related myocarditis is crucial, 114 publications indexed in Pubmed between Dec 10, 2019 and October 16, 2020 were scanned extensively in this review in order to summarize the treatment options of COVID-19 related myocarditis. Analysis of 44.672 COVID-19 cases showed an increased risk of mortality in elderly people (14.8% for patients over 80 years old) and patients with cardiovascular disease (10.5%). Patients with diabetes (7.3%) and hypertension (6%) also demonstrated an increased risk of mortality. The rate of underlying chronic respiratory disease was 6.3%. Arrhythmia was found in 16.7% and acute heart injury existed in 7.2% of 138 hospitalized COVID-19 patients. ACE inhibitors or ARBs should be administered in patients with wall motion abnormality or heart failure with reduced EF. Diuretics should be considered in patients with volume overload and torsemide should be preferred as first option. Non-steroidal antiinflammatory drugs and cardiac glycosides should be avoided. Physical activity should be restricted until the disease resolved. IVIG and interferon therapy are feasible treatment options with reasonable side effect profile.
Occupational health and safety of the frontline healthcare workers in Nepal in COVID-19 pandemic
Authors: Joshi Sunil Kumar
Published: May 2021

Occupational health and safety (OHS) is essential for every professional especially healthcare workers who work day and night serving patients. According to the WHO, health workers should not face any kind of workplace violence during their professional activities. Attention should also be paid to the mental and psychological health of healthcare workers and their protection should be of paramount importance. OHS related policies, rules and regulations have been formulated in Nepal. According to the law, the responsibility of the OHS of the employees has to be taken by the concerned organization.
In Nepal, during the COVID-19 pandemic, health workers have to take the risk of infecting themselves while providing care for the patients. This has led to the infection of thousands of health workers and we have also lost quite a few healthcare workers in the line of duty in Nepal. On one hand, there is a psychological fear of acquiring COVID-19 infection in healthcare workers despite adopting health and safety measures, while on the other hand, in case of infection they will have to pay for the treatment from their own pockets. Sometimes ICU and ventilator services are not available not only in their working hospital but also in government referral health institutions which have given rise to incidences that healthcare workers themselves have to be admitted to other hospitals for the treatment. In such a situation, not just mental but also a financial burden has been added to the healthcare workers.
Voltage stability analysis of wind power plant integration into transmission network of Nepal
Authors: Dharel Sagar , Maharjan Rabindra
Published: May 2021

Government of Nepal has realized that wind energy could become a major source of alternative energy to solve energy crisis in the country as well as serve the purpose of energy mix. Various studies have identified several locations with potential for wind power generation in Nepal. The integration of wind power plant to the national grid, however, raises concerns regarding the power system stability. The voltage stability of the grid is a key issue, the effect on which increases with the increase in wind power penetration in the grid. This study performs voltage stability analysis due to high penetration of wind power in Integrated Nepalese Power System (INPS). Both steady state and dynamic stability study is performed using the power system simulation software DigSILENT/PowerFactory for different types of wind turbine generators.
Effects of source digital elevation models in assessment of gross runoff-river hydropower potential: A case study of West Rapti Basin, Nepal
Authors: Bista Sunil , Singh Umesh , Kayastha Nagendra , Ghimire Bhola NS , Talchabhadel Rocky
Published: May 2021

Advancements in Geographical Information System (GIS), Remote Sensing (RS) technology, hydrologic modeling and availability of wider coverage hydrometeorological data have facilitated the use of GIS and hydrological modelling tools in studies related to hydropower potential. Digital Elevation Model (DEM) is the primary data required for these tools. They have become more accessible and many are freely available. These DEMs have different resolution and their errors vary due to their primary data acquisition techniques and processing methods. However, their effects on the hydropower potential assessment are less investigated. This study evaluates the effects of 6 freely available DEMs: ALOS 12.5 m, SRTM 90 m, SRTM 30 m, ASTER G-DEM version-3 30 m, AW3D 30 m and Cartosat-1 version-3 30 m on the Gross Run-off-River Hydropower Potential (GRHP) assessment, using GIS and hydrological modelling tools. West Rapti River (WRR) basin in Nepal was chosen for the case study.

Soil and Water Tool (SWAT) hydrological model, coupled with GIS was used to discretize the WRR basin into several sub-basins/streams. Flow at the inlet and outlet of streams were estimated from the SWAT model whereas the topographic head was extracted from the DEMs. The GRHP of the streams were computed using the estimated stream flow and the topographic head for flows at 40% to 60% Probability of Exceedance (PoE). The total potential of the basin was computed by summing up the potential of all streams. The GRHP of WRR basin for flows at 40% PoE was estimated as 512 MW for ALOS 12.5 m resolution DEM, referred as a base case in this study. The GRHP estimated from the remaining DEMs showed the variation of less than 6% compared to the base case. The topographic head was found to be sensitive with respect to the DEM resolution and the highest variations were observed in the main river channels.
Window to wall ratio and orientation effects on thermal performance of residential building: A case of Butwal Sub-Metropolis
Authors: Uprety Sanjaya , Kafley Shiva , Shrestha Barsha
Published: May 2021

The orientation and glazed surface area used for windows in a building have significant effects on its indoor thermal comfort and overall energy consumption. The increasing use of glazed windows and lack of consideration of orientation in building design have become a major problem in warm and humid regions as windows cover sensitive skin areas for the exchange of energy leading to increased solar gain inside the building. This paper describes the effect of the varied ‘area ratio of glazed window to the wall for different building orientations’ on the thermal performance of the residential building in a warm humid climatic region of Nepal. A typical residential building located in Kalikanagr of Butwal, the fast-urbanizing sub-metropolis of Western Nepal, was selected for the study from 18 houses surveyed using the purposive sampling method. Nine varying values of Window to Wall Ratio (WWR) of glazed façade ranging from 0.1 to 0.9 with a constant increment of 0.1 in north and south façades, and the change in the building orientations were considered for the detailed study. Altogether eighty different test scenarios including base case scenarios were created and annual thermal energy consumption was computed for each test scenario using the Autodesk Ecotect Analysis, 2011. Findings from the study showed that the south orientation is the most appropriate compared to the north-east for all WWR to reduce the building energy consumption and an increase in WWR also results in increased energy consumption. The study concludes the careful considerations of WWR and the south orientation during the designing of building will contribute to efficient energy consumption in residential buildings.
Design and simulation of components of vacuum forming machine using household vacuum cleaner
Authors: Adhikari Navaraj , Timilsina Nirajan Sharma , Gautam Sanskar , Kaphle Snehraj , Shrestha Pratisthit Lal
Published: May 2021

Plastic products ranging from toothbrushes to smartphones are an inseparable commodity in daily human life and their impact cannot be underestimated. This paper aims to design and simulate the vacuum forming process using readily available materials in context of Nepal. Vacuum forming process is a thermoforming process where the heated plastic sheet derives the shape of the mold through the application of vacuum and is used to make packaging products and other household products. Simulations were done to find out the optimum distance between the plastic sheet and the heater, arrangement of the wire in the heater, load bearing capacity of the design and the flow of vacuum in the arrangement. Nichrome wire coiled as heater coil is used as the heating material and laid in a spiral path with the plastic sheet 35mm below provided the best heating results and 1800W vacuum cleaner provided the necessary pressure of 85-90kPa and velocities of 100- 115m/s while the steel posts provided adequate strength.
Development of rainfall – runoff model for extreme storm events in the Bagmati River Basin, Nepal
Authors: Devkota Nirajan , Shrestha Narendra Man
Published: May 2021

This study is based on the Bagmati river basin that flows along with the capital city, Kathmandu which is a small and topographically steep basin. Major flood occurring in 1993 and 2002 as stated in the report of DWIDP shows that the basin is subjected to water-induced disaster in monsoon season affecting people and property. This study focuses on the development of a rainfall-runoff model for Bagmati basin in HEC-HMS using the Synthetic Unit Hydrograph (SUH) with Khokana as the outlet. The coefficients for SUH like Lag time coefficient (Ct), peak discharge coefficient (Cp), unit hydrograph widths at 50% and 75% of peak and base time were determined calibrating the Synder’s equation where Ct varies from 0.244 to 1.016 and Cp varies from 0.439 to 0.410. The rainfall-runoff model in HEC-HMS has been calibrated from daily data of 1992-2013 and validated from hourly data for July 2011, August 2012, and July 2013. Furthermore, the model has been tested to compare the discharge for various return periods with the observed ones which are in close agreement. The determination of Peak Maximum Flood (PMF) using the calculated Peak Maximum Precipitation (PMP) is also another application of the model which can be used to design various hydraulic structures. Thus the values of coefficients, Ct and Cp can be used to construct unit hydrograph for the basin. Moreover, the satisfactory performance of the model during calibration and validation proves the applicability of the model in flood forecasting and early warning.
Multilayer shallow-water model with stratification and shear
Authors: Beron-Vera F. J.
Published: May 2021

The purpose of this paper is to present a shallow-water-type model with multiple inhomogeneous layers featuring variable linear velocity vertical shear and startificaion in horizontal space and time. This is achieved by writing the layer velocity and buoyancy fields as linear functions of depth, with coefficients that depend arbitrarily on horizontal position and time. The model is a generalization of Ripa's (1995) single-layer model to an arbitrary number of layers. Unlike models with homogeneous layers the present model is able to represent thermodynamics processes driven by heat and freshwater fluxes through the surface or mixing processes resulting from fluid exchanges across contiguous layers. By contrast with inhomogeneous-layer models with depth-independent velocity and buoyancy, the model derived here can sustain explicitly at low frequency a current in thermal wind balance (between the vertical vertical shear and the horizontal density gradient) within each layer. In the absence of external forcing and dissipation, energy, volume, mass, and buoyancy variance constrain the dynamics; conservation of total zonal momentum requires in addition the usual zonal symmetry of the topography and horizontal domain.  The inviscid, unforced model admits a formulation suggestive of a generalized Hamiltonian structure, which enables the classical connection between symmetries and conservation laws via Noether's theorem.  A steady solution to a system involving one Ripa-like layer and otherwise homogeneous layers can be proved formally (or Arnold) stable using the above invariants. A model configuration with only one layer has been shown previously to provide: a very good representation of the exact vertical normal modes up to the first internal mode; an exact representation of long-perturbation (free boundary) baroclinic instability; and a very reasonable representation of short-perturbation (classical Eady) baroclinic instability. Here it is shown that substantially more accurate overall results with respect to single-layer calculations can be achieved by considering a stack of only a few layers. A similar behavior is found in ageostrophic (classical Stone) baroclinic instability by describing accurately the dependence of the solutions on the Richardson number with only two layers.
Temperature proﬁles due to continuous hot water injection into homogeneous ﬂuid-saturated porous media through a line source
Authors: Medina A. , Higuera F. J. , Pliego M. , Gómez G.
Published: May 2021

We report a theoretical study to determine the temperature proﬁles due to the continuous andconstant injection of hot water through a line source, into a homogeneous ﬂuid-saturated porous medium which has had initially a constant temperature T∞. In our treatment we have taken in to account the simultaneous injection of constant ﬂuxes of volume ﬂuid, q, and of heat, φ. By using a far-ﬁeld description, we found similarity solutions for the dimensionless temperature depending on the Peclet number, P e, as the single parameter of the problem.
Optical Soliton perturbation with fractional temporal evolution by extended modified auxiliary equation mapping
Authors: Seadawy Aly
Published: May 2021

In this article we  discussed the analytical analysis of perturbed nonlinear fractional Schr$\ddot{o}$dinger equation with the help of our new introduced technique extended modified auxiliary equation mapping method(EMAEMM). By using this newly proposed technique we have found some new  and more general variety of exact traveling wave solutions which are collecting some kind of semi half bright, semi half dark, doubly periodic,  dark, combined, periodic, bright, half dark and half bright via three parametric values which is the primary key point of difference of our technique. These results are highly applicable to develop new theories of plasma physics, quantum mechanics, biomedical problems, soliton dynamics, nuclear physics, optical physics, fluid dynamics, electromagnetism, industrial studies, mathematical physics, and in many other natural and physical sciences. For detailed physical dynamical representation of our results we have shown them with graphs in different dimensions via Mathematica 10.4 to get more understanding to observe the behavior of different new dynamical shapes of solutions.
Vector fields localization on brane worlds
Authors: Guerrero R. , Rodríguez R. Omar , Carreras F.
Published: May 2021

To confine vector bosons in the four dimensional sector of a domain wall spacetime, we propose a mechanism in which the interaction among vectors is propagated via the self-interaction of the scalar wall.  In the process, the vector acquires an asymptotic mass, defined by the bulk cosmological constant, and it ends up coupled to the wall by the tension of the brane. The mechanism is applied on the Randall Sundrum scenario and regular versions of it, and on singular domain walls. In any case, the  electrostatic potential between two charged particles is defined by both the vector state attached to the wall and a continuous tower of massive vector states that propagate freely along the scenario's extra dimension.
Factorization method for some inhomogeneous Lienard equations
Authors: Cornejo Perez Octavio , Mancas Stefan C , Rosu Barbus Haret-Codratian , Rico Olvera Carlos
Published: May 2021

The factorization of inhomogeneous Li\'enard equations is performed showing that through the factorization conditions involved in the method one can obtain forcing terms for which closed-form solutions exist. Because of the reduction of order feature of factorization, the solutions are simultaneously solutions of first-order differential equations with polynomial nonlinearities. Several illustrative examples of such solutions are presented, generically having rational parts and consequently singularities.
A study on microstructure and magnetic properties of nanostructured CoxNi1-xMn0.5Fe1.5O4(x=0,0.25,0.5,0.75,1) spinel ferrites
Authors: Hussain A. , Tahir S. Akbar , Ahmad N. , Hashim M. , Ziya A. Bashir , Noreen S.
Published: May 2021

A low-temperature synthesis of novel nanostructured CoxNi1-xMn0.5Fe1.5O4(x=0,0.25,0.5,0.75,1) ferrites was carried out by sol-gel auto-combustion technique. The obtained nanostructured ferrites were investigated by employing the techniques of powder X-ray diffraction (XRD), scanning electron microscopy (SEM), transmission electron microscopy (TEM), energy dispersive X-ray spectroscopy (EDX) and vibrating sample magnetometry (VSM). The XRD diffractograms of the prepared ferrites revealed the formation of a spinel phase with face centered cubic (fcc) structure belonging to Fd- m space group.  The average lattice parameter ‘a’ of ferrites exhibited a rise versus a rise in Co2+ concentration in accordance with the Vegard’s law. The SEM investigation of NiMn0.5Fe1.5O4 powder revealed an existence of octahedral-shaped morphology of ferrite grains. The TEM investigation of NiMn0.5Fe1.5O4 powder showed nanostructures of ferrite particles with sizes consistent with the crystallite sizes as estimated by Debye-Scherer’s formula. An EDX spectrum of NiMn0.5Fe1.5O4 powder confirmed its elemental composition. The M-H hysteresis loops recorded by VSM at room temperature revealed a dependence of coercivity (Hc), maximum magnetization (Mmax) and retentivity (Mr) on Co2+concentration. Due to the shape dependence of M-H loops on Co2+ concentration in compounds enabled their candidature for applications in memory devices and magnetic sensors.
EXTRATERRITORIAL APPLICATION OF THE EU GENERAL DATA PROTECTION REGULATION: AN INTERNATIONAL LAW PERSPECTIVE
Authors: Md. Toriqul Islam  , Mohammad Ershadul Karim
Published: May 2021

The General Data Protection Regulation (the GDPR) of the European Union (EU) emerges as a hot-button issue in contemporary global politics, policies, and business. Based on an omnibus legal substance, extensive extraterritorial scope and influential market powers, it appears as a standard for global data protection regulations as can be witnessed by the growing tendency of adopting, or adjusting relevant national laws following the instrument across the globe. Under Article 3, of the GDPR applies against any data controller or processor within and outside the EU, who process the personal data of EU residents. Therefore, the long arm of the GDPR is extended to cover the whole world, including Malaysia. This gives rise to tension worldwide, as non-compliance thereof leads to severe fines of up to €20 million or 4% of annual turnover. This is not a hypothetical possibility, rather a reality, as a huge amount of fines are already imposed on many foreign companies, such as Google, Facebook, Uber, and Equifax to name a few. Such a scenario, due to the existence of state sovereignty principles under international law, has made the researchers around the world curious about some questions, why does the EU adopt an instrument having the extraterritorial application; whether the extraterritorial scope is legitimate under normative international law; how the provisions of this instrument can be enforced, and how these are justified. This article attempts to search for answers to those questions by analyzing the relevant rules and norms of international law and the techniques of the EU employed. The article concludes with the findings that the extraterritorial scope of the GDPR is justified under international law in a changed global context. The findings of this article will enlighten the relevant stakeholders, including Malaysian policymakers and business entities, to realise the theoretical aspects of inclusion of the extraterritorial feature of the GDPR, and this understanding may facilitate them to map their future strategies.
أثر اليقظة والذكاء الاستراتيجي في خلق الميزة التنافسية للمؤسسات العربية، دراسة تطبيقية على عينة من اتحاد أصحاب العمل السوداني
Authors: سعيد عثمان زبير علوية
Published: May 2021

هدفت الدراسة إلى معرفة مستوى الميزة التنافسية للمنتجات العربية وقياس مستوى الذكاء الاستراتيجي عند إدارة المؤسسات وتحديد العلاقة بين الذكاء الاستراتيجي والميزة التنافسية. اعتمدت الدراسة على المنهج الوصفي التحليلي لاختبار فرضية الارتباط بين اعتماد نظام الذكاء واليقظة على خلق التنافسية بالمؤسسات العربية وتحقيق الميزة التنافسية في الأسواق العالمية. تم اختبار الفرضية بعد تحليل البيانات التي تم جمعها باستخدام أداة الاستبانة من عينة مكونة من (50) مفردة من مديري مؤسسات سودانية يمثلون قطاعات الأعمال المسجلين بإتحاد أصحاب الاعمال بالسودان وباستخدام برنامج التحليل الاحصائي الحزم الإحصائية للعلوم الاجتماعية، تم التوصل لعدد من النتائج من أهمها: أسفرت الدراسة أنّ غياب نظام استراتيجي للذكاء واليقظة في إدارة المؤسسات العربية أعاقت تحقيق التنافسية في الأسواق العالمية. إلى جانب ضعف النظام الإداري وغياب القدرة على التنبؤ بالتغيرات المستقبلية في ظل عدم تخصيص الأموال الكافية لتعزيز البحث العلمي، وغياب الإدارة المتخصصة في البحث والتطوير مما يعيق التنافسية في هذه المؤسسات. وبناءً على نتائج الدراسة تم التوصل لعدة توصيات من أهمها: ضرورة تعزيز وتفعيل الأساليب الحديثة في الإدارة مثل الذكاء الاستراتيجي والعاطفي والإدارة بالتجوال لخلق أنظمة علمية مرنة لتمكّيين الموظفين وتقليل القيود المفروضة على الإدارة التقليدية، كما توصي الدراسة بفتح مؤسسات عالمية واعتماد مبدأ للشراكة لتبادل الخبرات مع كوادر عالمية ذات خبرة لديها نماذج إنتاجية عالمية من خلال التفكير المنهجي والاستخدام الأفضل للتكنولوجيا الحديثة في إنتاج المنتجات التي تراعي أذواق العملاء في الأسواق العالمية.
المستوى الخامس للقيادة: التناقض المؤدي إلى النجاح مع الإشارة إلى داروين سميث كمثال عن قادة المستوى الخامس (قراءة تحليلية)
Authors: شريفي مسعودة , مخلوفي عبد السلام
Published: May 2021

يحاول البحث التركيز على واحد من الأساليب القيادية الحديثة. والتي ترجع فكرته للأبحاث التي قام بها كل من جيم كولينز وفريقه حول إمكانية تحويل الشركات الجيدة إلى شركات عظيمة. يقدم كولينز هذا المستوى من القيادة كأعلى مستوى يمكن أن يصل إليه القادة. حيث يتنازل فيه القائد عن دور البطل -رغم أنه يستحقه- ويتراجع للخلف ليظهر في المقدمة فريق العمل كصانع لنجاح الشركة. هذا المستوى يقدم القائد في خلطة تجمع مزيجاً متناقضاً لأنه يجمع بين التواضع الشخصي الشديد والإرادة المهنية العالية. وحتى تتضح الصورة أكثر، يحاول البحث عرض مثال ناجح عن قادة المستوى الخامس، وهو داروين سميث الذي استطاع بفضل أسلوبه القيادي تحويل شركة كيمبرلي -كلارك من مجرد شركة ورق عادية إلى شركة عظيمة ورائدة في مجال المنتجات الورقية الاستهلاكية على مستوى العالم.
أثر التشارك المعرفي في تحقيق التنمية المهنية "دراسة ميدانية على أعضاء هيئة التدريس في جامعة نجران"
Authors: حمد محمد اليامي رحمه , محمد إبراهيم الدوعان حامد
Published: May 2021

لقد تمثل الهدف الأساسي من الدراسة في توضيح تأثير سلوكيات التشارك المعرفي في تحقيق التنمية المهنية لأعضاء هيئة التدريس بجامعة نجران؛ وذلك من خلال تحديد تأثير الخصائص الديموغرافية لأعضاء هيئة التدريس والمتمثلة في (إدارة فريق العمل- التدريب والتطوير المستمر- إدارة الاجتماعات- التفويض)، وقد تم التركيز بالأساس على مجموعة من الأبعاد للتشارك المعرفي والمتمثلة في (السلوك- الثقافة التنظيمية- تكنولوجيا المعلومات والاتصالات)، بينما تم التركيز على أبعاد (إدارة فريق العمل- التدريب والتطوير المستمر- إدارة الاجتماعات- التفويض) للتنمية المهنية، ولتحقيق هذا الهدف تم الاعتماد على المنهج الوصفي بما يساعد على وصف الظاهرة ودرجة وجودها، وذلك من خلال تطبيق أداة الدراسة (الاستبانة) على عينة عشوائية من (317) عضو من أعضاء هيئة تدريس جامعة نجران من الذكور والإناث البالغ عددهم (1464)، وتم الاعتماد على أساليب التحليل الإحصائي (SPSS) لتحليل بيانات الدراسة. وقد تم التوصل لمجموعة من النتائج من أهمها: وجود أثر عند مستوى دلالة ( 0.05≥α) للتشارك المعرفي بأبعاده المتمثلة في (السلوك،الثقافة التنظيمية،تكنولوجيا المعلومات والاتصالات) على التنمية المهنية من وجهة نظر أعضاء هيئة التدريس في جامعة نجران ، وفي ضوء النتائج التي تم التوصل إليها أوصت الدراسة بالعديد من التوصيات من أهمها: ضرورة التواصل بين أفرادالعمل لتبادل الآراء والأفكار، عقد الندوات والمؤتمرات العلمية للمشاركة في تبادل المعرفة بين أعضاء هيئة التدريس، تشجيع العاملين على المشاركة المعرفية بتقديم الدعم اللازم ، تقديم الدعم الكافي للتشجيع على العمل كفريق، تشجيع إدارة الجامعة أعضاء هيئة التدريس على بذل جهودهم الذاتية لتطوير مهاراتهم وقدراتهم، ضرورة قيام إدارة الجامعة بمسح دوري للاحتياجات التدريبية لأعضاء هيئة التدريس لتلبيتها.
Segmental Arteries and Veins at Higher Lumbar Levels Can Intersect the Adjacent Caudal Intervertebral Disc in the Anterior Part of the Spinal Column: A Cadaveric Analysis
Authors: Yagi Kiyoshi , Suzuki Nobuyuki , Mizutani Jun , Kato Kenji , Kondo Akira , Waseda Yuya , Goto Yuta , Murakami Hideki
Published: May 2021

Study Design: A cadaveric study.Purpose: To investigate the anatomical features of segmental arteries and veins in the anterior part of the spinal column to prevent segmental vessel injury.Overview of Literature: The lateral transpsoas approach to the lumbar intervertebral discs (IVD) is associated with the risk of segmental vessel injury. Previous studies have described the vascular anatomy on the lateral part of the vertebral body. However, there are no studies that describe the segmental vessels on its anterior aspect. Here, we report the important anatomical features of the segmental arteries and veins that can intersect the anterior part of the IVD. These vessels are considered at risk of vascular injury when placing the anterior retractors during lateral lumbar interbody fusion or cutting the anterior longitudinal ligament during anterior column realignment.Methods: Five formalin-embalmed human cadavers were used. We assessed the proportion of segmental arteries and veins that intersected the IVD in the L2–L5 range and their course on the anterior part of the spinal column.Results: The segmental arteries and veins commonly intersect the anterior part of the IVD (artery, 28.1%; vein, 42.1%). Seven of 10 (70%) segmental arteries at L2 intersected the IVD, but only one artery intersected the IVD at L3 and L4. The proportions of segmental veins that intersected the IVD were 60%, 50%, and 16.7% at L2, L3, and L4, respectively.Conclusions: The segmental arteries and veins frequently intersect the IVD in the anterior part of the spinal column. Therefore, it is necessary to consider these individual anatomical features to prevent vascular damage during lateral lumbar interbody fusion surgery.
Separation surgery for metastatic epidural spinal cord compression: comparison of a minimally invasive versus open approach
Authors: Echt Murray , Stock Ariel , De la Garza Ramos Rafael , Der Evan , Hamad Mousa , Holland Ryan , Cezayirli Phillip , Nasser Rani , Yanamadala Vijay , Yassari Reza
Published: May 2021

OBJECTIVE

The aim of this study was to compare outcomes of separation surgery for metastatic epidural spinal cord compression (MESCC) in patients undergoing minimally invasive surgery (MIS) versus open surgery.

METHODS

A retrospective study of patients undergoing MIS or standard open separation surgery for MESCC between 2009 and 2019 was performed. Both groups received circumferential decompression via laminectomy and a transpedicular approach for partial corpectomy to debulk ventral epidural disease, as well as instrumented stabilization. Outcomes were compared between the two groups.

RESULTS

There were 17 patients in the MIS group and 24 in the open surgery group. The average age of the MIS group was significantly older than the open surgery group (65.5 vs 56.6 years, p < 0.05). The preoperative Karnofsky Performance Scale score of the open group was significantly lower than that of the MIS group, with averages of 63.0% versus 75.9%, respectively (p = 0.02). This was also evidenced by the higher proportion of emergency procedures performed in the open group (9 of 24 patients vs 0 of 17 patients, p = 0.004). The average Spine Instability Neoplastic Score, number of levels fused, and operative parameters, including length of stay, were similar. The average estimated blood loss difference for the open surgery versus the MIS group (783 mL vs 430 mL, p < 0.05) was significant, although the average amount of packed red blood cells transfused was not significantly different (325 mL vs 216 mL, p = 0.39). Time until start of radiation therapy was slightly less in the MIS than the open surgery group (32.8 ± 15.6 days vs 43.1 ± 20.3 days, p = 0.069). Among patients who underwent open surgery with long-term follow-up, 20% were found to have local recurrence compared with 12.5% of patients treated with the MIS technique. No patients in either group developed hardware failure requiring revision surgery.

CONCLUSIONS

MIS for MESCC is a safe and effective approach for decompression and stabilization compared with standard open separation surgery, and it significantly reduced blood loss during surgery. Although there was a trend toward a faster time to starting radiation treatment in the MIS group, both groups received similar postoperative radiotherapy doses, with similar rates of local recurrence and hardware failure. An increased ability to perform MIS in emergency settings as well as larger, prospective studies are needed to determine the potential benefits of MIS over standard open separation surgery.
Carbon fiber–reinforced PEEK instrumentation in the spinal oncology population: a retrospective series demonstrating technique, feasibility, and clinical outcomes
Authors: Neal Matthew T. , Richards Alexandra E. , Curley Kara L. , Patel Naresh P. , Ashman Jonathan B. , Vora Sujay A. , Kalani Maziyar A.
Published: May 2021

OBJECTIVE

The authors aimed to demonstrate the feasibility and advantages of carbon fiber–reinforced PEEK (CFRP) composite implants in patients with both primary and secondary osseous spinal tumors.

METHODS

Twenty-eight spinal tumor patients who underwent fixation with CFRP hardware were retrospectively identified in a Spine Tumor Quality Database at a single institution. Demographic, procedural, and follow-up data were retrospectively collected.

RESULTS

The study population included 14 females and 14 males with a mean age of 60 years (range 30–86 years). Five patients had primary bone tumors, and the remaining patients had metastatic tumors. Breast cancer was the most common metastatic tumor. The most common presenting symptom was axial spine pain (25 patients, 89%), and the most common Spine Instability Neoplastic Score was 7 (range 6–14). Two patients in this series had anterior cervical procedures. The remaining patients underwent posterior thoracolumbar fixation. The average fusion length included 4.6 vertebral segments (range 3–8). The mean clinical follow-up time with surgical or oncology teams was 6.5 months (range 1–23 months), and the mean interval for last follow-up imaging (CT or MRI) was 6.5 months (range 1–22 months). Eighteen patients received postoperative radiation at the authors’ institution (16 with photon therapy, 2 with proton therapy). Eleven of the patients (39%) in this series died. At the last clinical follow-up, 26 patients (93%) had stable or improved neurological function compared with their preoperative status. At the last imaging follow-up, local disease control was observed in 25 patients (89%). Two patients required reoperation in the immediate postoperative period, one for surgical site infection and the other for compressive epidural hematoma. One patient was noted to have lucencies around the most cephalad screws 3 months after surgery. No hardware fracture or malfunction occurred intraoperatively. No patients required delayed surgery for hardware loosening, fracture, or other failure. Early tumor recurrence was detected in 3 patients. Early detection was attributed to the imaging characteristics of the CFRP hardware.

CONCLUSIONS

CFRP spinal implants appear to be safe and comparable to conventional titanium implants in terms of functionality. The imaging characteristics of CFRP hardware facilitate radiation planning and assessment of surveillance imaging. CFRP hardware may enhance safety and efficacy, particularly with particle therapy dosimetry. Larger patient populations with longer-term follow-up are needed to confirm the various valuable aspects of CFRP spinal implants.
Falcine chondroma: illustrative case
Authors: Chua Melissa M. J. , Bazarek Stanley F. , Meredith David M. , Hsu Liangge , Saris Stephen C.
Published: May 2021

BACKGROUND

Chondromas are benign cartilaginous tumors that are rarely seen in the brain.

OBSERVATIONS

A 58-year-old woman had undergone routine brain imaging after a motor vehicle accident and was incidentally found to have a right falcine lesion. Contrast magnetic resonance imaging showed a mostly nonenhancing mass with discontinuous rim enhancement. She was taken to the operating room and pathology revealed a chondroma.

LESSONS

Falcine intracranial chondromas are rare and typically misdiagnosed as meningiomas. Chondromas should be in the differential for patients presenting with nonenhancing falcine lesions.
Bone formation in custom-made cranioplasty: evidence of early and sustained bone development in bioceramic calcium phosphate implants. Patient series
Authors: Sundblom Jimmy , Xheka Fabjola , Casar-Borota Olivera , Ryttlefors Mats
Published: May 2021

BACKGROUND

Implant failure (IF) rates in cranioplasty remain high despite efforts to reduce the incidence. New biomaterials may be part of the solution for this problem. Formation of autologous bone in implants may reduce rates of infection and subsequent failure.

OBSERVATIONS

Four patients with calcium phosphate implants supported by titanium mesh and undergoing surgery for reasons unrelated to IF were included in this series. Samples from the implants were microscopically examined. Pathological studies proved the formation of autologous bone in the calcium phosphate implants.

LESSONS

Bone and blood vessel formation in the implants and diminished foreign body reaction to autologous bone may reduce the rates of IF.
Lumbar facet cyst tuberculosis: a rare cause of cauda equina compression. Illustrative case
Authors: Pedro Karlo M. , Torio John Emmanuel R. , Rivera Jonathan P. , Sih Ibet Marie Y.
Published: May 2021

BACKGROUND

Spinal tuberculosis may present in atypical form to involve only the posterior spinal element with relative sparing of the anterior vertebral body and intervertebral disc. Recognition of this unusual pattern is important to avoid delay in diagnosis and treatment.

OBSERVATIONS

The authors report a case of a 59-year-old woman with right-sided radiculopathy and motor weakness. Her lumbosacral magnetic resonance imaging showed a large heterogeneous cyst arising from the right L4–5 facet joint. Laminectomy with excision of the cyst was performed. During surgery, the cyst contained cheese-like material that, on histopathological examination, revealed focal aggregates of tuberculous granuloma. Postoperatively, the patient recovered remarkably with no interval development of instability or any deformity.

LESSONS

Facet cyst tuberculosis is rare but should be considered in the differential diagnosis in patients coming from endemic regions. Laminectomy with excision of the cyst along with concurrent antitubercular chemotherapy is a safe and durable treatment option in this case.
Person-in-the-barrel syndrome following cervical spine surgery: illustrative case
Authors: Shields Lisa B. E. , Iyer Vasudeva G. , Zhang Yi Ping , Shields Christopher B.
Published: May 2021

BACKGROUND

Person-in-the-barrel syndrome is characterized by bilateral brachial diplegia, intact cranial nerves, and preserved lower-extremity strength. Most cases are due to bilateral supratentorial brain lesions at the border zone of the anterior and middle cerebral artery vascular territories. This condition has been observed with spinal pathology, primarily involving vascular dissection and thromboembolism.

OBSERVATIONS

The authors’ case is the first in the literature to highlight person-in-the-barrel syndrome immediately following cervical spine surgery. Weakness of the deltoids, biceps, infraspinatus, and brachioradialis was observed bilaterally postoperatively. Electromyograph (EMG)-nerve conduction velocity (NCV) studies revealed a cervical radiculopathy involving C5 and C6 bilaterally with denervation of the deltoids, biceps, and brachioradialis. Within 8 months of cervical spine surgery, the patient regained improvement of the bilateral brachial diplegia.

LESSONS

EMG/NCV studies play a valuable role in detecting cervical radiculopathy after cervical spine surgery in patients with bilateral brachial diplegia. The authors postulate that this condition may have occurred following neck hyperextension during cervical cage placement, increasing the foraminal stenosis at C4–5 and C5–6 and worsening the C5 and C6 radiculopathy. Spinal surgeons should be cognizant of person-in-the-barrel syndrome that may ensue following cervical spine surgery and promptly identify and treat this condition to offer the best prognosis for a favorable patient outcome.
Surgical management for IgG4-related ophthalmic disease by a transcranial biopsy combined with extraorbital decompression: illustrative case
Authors: Noda Ryuichi , Inoue Tomohiro , Tsunoda Sho , Akabane Atsuya
Published: May 2021

BACKGROUND

Immunoglobulin G4–related ophthalmic disease (IgG4-ROD) accounts for 22% of Japanese lymphoproliferative orbital disease and occurs in 4%–34% of patients with IgG4-related disease, according to the largest case series published to date. Because the optic nerve mass often appears as a tumor-like lesion, it is important, although difficult, to differentiate IgG4-ROD from other orbital tumors and diseases, and biopsy is essential for diagnosis. Here, the authors describe the surgical management of an IgG4-ROD case.

OBSERVATIONS

A 63-year-old man presented to the authors’ hospital with proptosis and visual impairment. Ophthalmic examination revealed intraocular hypertension. IgG4-related disease with an ophthalmic lesion was suspected on the basis of a blood test and imaging studies. Transcranial biopsy with extraorbital decompression was performed. The patient’s symptoms, including visual impairment, improved 3 days after operation, and his IgG4-related disease resolved after corticosteroid treatment.

LESSONS

The standard treatment for IgG4-related disease is systemic corticosteroid therapy. However, this treatment should not be administered to patients with IgG4-ROD who a high risk of blindness. In this case, the authors completed a diagnostic and symptom-relieving transcranial biopsy without affecting the patient’s aesthetic characteristics. This is the first study, to our knowledge, to report extraorbital decompression via a transcranial approach as a surgical option for IgG4-ROD.