bluuebunny/crossref_metadata_2025 huggingface dataset:
Myopia prevalence in a population-based childhood visual impairment study in North India - CHVI-2
Authors: Wadhwani Meenakshi , Vashist Praveen , Singh Suraj Senjam , Gupta Vivek , Gupta Noopur , Saxena Rohit
Published: February 2022

Purpose:

The aim of the study was to determine the prevalence of myopia at the community level.

Methods:

A population-based, cross-sectional study was planned in 40 clusters among children identified with subnormal vision in the urban community of Delhi. House-to-house visits were conducted for visual acuity screening of 20,000 children aged 0–15 years using age appropriate visual acuity charts. All the children with visual acuity of < 6/12 in any eye in the age group between 3 and 15 years and inability to follow light in age group 0–3 years were referred for detailed ophthalmic examination.

Results:

A total of 13,572 (64.7%) children belonged to the age group of 6–15 years. Of these, a total of 507 (3.7%) were found to be having myopia (spherical equivalent of -0.50 DS or worse in one or both eyes) with positive association with higher age groups.

Conclusion:

The estimated prevalence of myopia is 3.7%; the proportion of uncorrected myopia was 45%, which reflects that refractive error services need to be improved further.
Awareness of cataract and glaucoma in two rural districts of Telangana, India
Authors: Marmamula Srinivas , Boopalan Dharani , Khanna Rohit C , Hassija Neha , Keeffe Jill
Published: February 2022

Purpose:

To determine the level of awareness of cataract and glaucoma and identify the determinants of awareness in two rural districts of Telangana, India.

Methods:

A population-based cross-sectional study was conducted using the rapid assessment of visual impairment (RAVI) methodology in Khammam and Warangal districts. A validated questionnaire was administered to participants aged 40 years and above to assess the level of awareness of cataract and glaucoma.

Results:

The awareness questionnaire was administered to 3273 participants of whom 1433 (43.8%) were men, 1985 (60.6%) of them had no education, and 1645 (50.3%) were from Khammam district. In total, 2539/3273 (77.6%; 95% confidence intervals (CI): 76.1– 79.0%) participants reported awareness of cataract. Awareness of cataract was higher in Khammam compared to that in Warangal (84.4% versus 70.6%; P < 0.01). Only 41/3273 (1.25%, 95% CI: 0.90–1.69%) participants were aware of glaucoma. Awareness of glaucoma was also higher in Khammam (1.88% versus 0.61%; P < 0.01). Younger age groups, men, any level of education, and residing in Khammam were factors associated with awareness of cataract. Only having any level of education and residing in Khammam were associated with awareness of glaucoma.

Conclusion:

Awareness of cataract was high, but awareness of glaucoma was very poor. There is a need to spread awareness about these potentially blinding conditions. Moving forward, this can be a critical step in developing a preventive eye care strategy to achieve universal eye health in India.
Three Indian Siblings Affected with Progressive Myoclonic Epilepsy due to Unverricht–Lundborg Disease
Authors: Srivastava Kavita , Thakor Bina Mahendrasinh , Roy Shuvendu , Rajadhyaksha Surekha , Datar Chaitanya
Published: February 2022

Background:

Progressive myoclonus epilepsy (PME) is a group of heterogeneous genetic disorders characterized by action myoclonus, epileptic seizures, and progressive neurologic deterioration with onset of symptoms in adolescence and adulthood. Unverricht–Lundborg disease (ULD) is the most common type of PME in high-income countries; however, it is under-reported from India due to challenges in clinical recognition and establishment of diagnosis due to lack of availability of genetic studies.

Clinical Description:

We herewith report three siblings (two girls and a boy) born out of a third-degree consanguineous marriage, with onset of “difficult-to-treat” seizures since early adolescence, with concurrent action myoclonus and ataxia. All three had a waxing and waning course. Electroencephalography exhibited generalized spike-wave and polyspike-wave discharges with photosensitivity while neuroimaging was normal.

Management and Outcome:

The possibility of PME was considered in view of the clinical phenotype and strong family history. Following detailed elicitation of history, focused physical examination, and rational investigative work-up specific molecular genetic testing were planned for ULD. This showed homozygous expansion of dodecamer (set of 12 nucleotides) repeat in the cystatin B gene in all the three affected siblings. The parents were heterozygous carriers. Genetic counseling was undertaken and anticonvulsant drugs (ACDs) modified accordingly. The definitive diagnosis helped in accurate prognostication and management to improve the quality of life of all three siblings.

Conclusion:

Clinicians should consider a specific epilepsy syndrome in patients with onset of symptoms in adolescence. ULD is a type of PME with a relatively better course of illness. Establishing the diagnosis has implications on the extent of investigative workup, choice of ACD, and prognosis.
Implications of CYP21A2 Gene Duplications in Carrier Screening and Prenatal Diagnosis of Congenital Adrenal Hyperplasia due to 21 Hydroxylase Deficiency
Authors: Dubey Sudhisha , Saxena Renu , Puri Ratna Dua , Verma Ishwar Chander
Published: February 2022

Background:

Congenital adrenal hyperplasia (CAH) is an autosomal recessive disorder that presents as salt wasting or simple virilization (SV). It is due to biallelic mutations in the CYP21A2 gene that encodes the 21-hydroxylase enzyme. This gene is susceptible to deletions and duplications due to the presence of a homologous pseudogene and its location in the RCCX module. This complicates the interpretation of molecular analysis of the CYP21A2 gene.

Clinical Description:

During preconception counseling and subsequent workup of a couple, the wife (who had been diagnosed with simple virilizing CAH at the age of 14 years, based on clinical and metabolic profile) was identified with c.373C >T variant on one and a deletion on the other allele of CYP21A2. Her asymptomatic husband harbored a novel c. 939+5G>A variant in intron 7 of CYP21A2. Prenatal diagnosis by Sanger sequencing revealed the presence of both maternal (c.373C>T) and paternal (c. 939+5G>A) variants in the fetus, indicative of SV form. After genetic counseling, the parents decided to continue with the pregnancy.

Management and Outcome:

A baby boy was born who underwent investigations according to the standard protocol. However, a diagnosis of CAH could not be established conclusively. The molecular diagnosis of both baby and parents was revisited. It was found that the baby harbored a duplication of CYP21A2 (inherited from his father) along with a novel variant. The duplication neutralized the paternal variant, and thus the baby was not affected, but a carrier.

Conclusion:

Evaluation of duplication in parents is crucial before prenatal testing, as duplications have important bearing on the carrier status.
Conn's Syndrome
Authors: Sivadas Suchitra , Bhavani Nisha , Bhaskaran Praveena , Panicker Jayakumar Chandrasekhara , Viswanath Naveen
Published: February 2022

Background:

Acute flaccid paralysis is a medical emergency. Hypokalemia secondary to an aldosterone-secreting adrenal adenoma or Conn's syndrome is a rare cause of hypokalemic paralysis. There are very few case reports from the pediatric population of the same.

Clinical Description:

We report the case of a 17-year-old girl, previously asymptomatic, who presented with sudden-onset, progressive weakness of all four limbs. There was no history of altered sensorium, cranial nerve involvement, or abdominal complaints. On examination, she was found to be hypertensive. Preliminary investigations revealed severe hypokalemia and metabolic alkalosis. There was no history suggestive of gastrointestinal potassium losses. Hence, a possibility of renal losses was considered and she was found to have kaliuresis.

Management and Outcome:

In view of hypokalemia, with hypertension with increased renal potassium loss, a possibility of hyperaldosteronism was considered. Plasma aldosterone concentration was elevated with levels of 20.3 ng/dl (normal <15 ng/dl). The direct renin concentration was <0.5 μIU/l (normal 5–14 μIU/l). This confirmed a diagnosis of primary hyperaldosteronism. Contrast-enhanced CT of the abdomen showed an adrenal adenoma. She electively underwent a laparoscopic adrenalectomy after her motor power improved with potassium replacement. Currently, she remains normotensive, asymptomatic, and off medications.

Conclusion:

The case highlights that Conn's syndrome though rare is an important cause that a high index of suspicion is necessary in young hypertensive patients to make an early diagnosis of this potentially treatable condition.
Tackling Nail Injury in a Primary Care Setting
Authors: Sharma Nikita , Kumar Manish , Vashist Sanket
Published: February 2022

Toenails provide stability to the foot. A stubbed toe may result in nail injury or fracture. Toe injuries are often ignored, leading to inappropriate or delayed management. The COVID-19 pandemic has badly affected the health services leading to further delay in treatment. We present a case report of an adult male who presented with an injured toe at a primary care clinic in India. Due to the apprehension of contracting severe acute respiratory syndrome coronavirus 2 infection and lockdown restrictions, the patient neither wanted to go to a higher center or get investigations done. The case report discusses the management and ways to handle such cases for primary care doctors in a resource-constrained setting.
Diagnostic utility of chest computerized tomography in the diagnosis of recurrence among sputum scarce and sputum negative previously treated pulmonary tuberculosis suspects
Authors: Bharath BG , Ray Animesh , Jorwal Pankaj , Vyas Surabhi , Soneja Manish , Biswas Ashutosh , Sinha Sanjeev , Khan Maroof A
Published: February 2022

Objective:

The objective was to study the sensitivity, specificity, and diagnostic accuracy of various computed tomography (CT) chest findings in diagnosing recurrence among pulmonary tuberculosis (PTB) suspects.

Materials and Methods:

A prospective observational study was conducted in a tertiary care hospital in New Delhi. A total of 130 suspects with a past history of treatment for PTB, who presented with any of the symptoms suggestive of recurrence were included. Sputum-positive, HIV-positive patients, pregnant females, and patients aged <18 years were excluded. Patients underwent CT chest followed by bronchoalveolar lavage (BAL).

Results:

A total of 62 patients were there in the final analysis. The median age of the patients with recurrent PTB was 27.5 years. Cough was the universal symptom in all these patients (>90%). Hemoptysis was the predominant symptom among patients with chronic pulmonary aspergillosis (66.6%). Necrotic mediastinal lymph nodes had good diagnostic accuracy of 88.71% with area under the curve of 0.806, P < 0.001 in diagnosing recurrent TB. BAL GeneXpert and mycobacteria growth indicator tube had good sensitivity (83.33% and 84.62%, respectively), specificity (100% for both), and excellent diagnostic accuracy (95.16% and 96.36%, respectively) for diagnosing recurrence in sputum negative and sputum scarce patient, (P < 0.001) when compared with composite reference standard. For culture-positive cases, BAL GeneXpert MTB/RIF had 100% sensitivity and 97.73% specificity in diagnosing recurrent PTB patients.

Conclusion:

The presence of mediastinal necrotic lymph node is the most accurate CT finding that can differentiate recurrent TB from post-TB sequelae. No other single chest CT scan finding had reliable diagnostic accuracy in comparison to microbiological tools in diagnosing recurrence among sputum negative or scarce previously treated PTB suspects.
Genetic cause of pulmonary veno-occlusive disease
Authors: Mohite Kaustubh , Sapare Anil Kumar
Published: February 2022

Pulmonary veno-occlusive disease (PVOD) is an important cause of pulmonary arterial hypertension (PAH) and is classified under idiopathic cause of PAH. Over a period of time, PVOD has been studied in detail in the western countries and various diagnostic criteria are formulated. Being a rapidly progressive disease, early diagnosis is of utmost importance which helps to initiate appropriate treatment. Recent studies suggest that PVOD has a genetic predisposition and has an autosomal recessive pattern of inheritance. Here, we discuss the case of siblings diagnosed with PVOD to have such genetic predisposition for this disease.
Asthma phenotype: Clinical, physiological, and biochemical profiles of North Indian patients
Authors: Vennilavan R Naveen , Spalgais Sonam , Kumar Raj
Published: February 2022

Background and Objectives:

Asthma is a common, chronic and heterogeneous disease with various phenotypes. The clinical phenotypes has aided in revealing the genetic heterogeneity, provide education, life style advice and novel biological treatments. The few common factors associated with phenotypes are smoking, rhinitis and obesity. The present study was thus planned to analyse and correlate the clinical, physiological, biochemical and serological parameters of asthma and to study the phenotypic characteristics in different asthmatic.

Methods:

This was a prospective observational study of 120 patients with 30 each in BA-rhinitis, BA, BA-obesity and BA smoker phenotypes. All the enrolled patients were assessed by SGRQ, Mini-AQLQ, GINA with ACE, chest X ray, Spirometry, SPT against common aero-allergens, FENO, hsCRP, vitamin-D, IgE, and Interleukins (IL) including IL-5, IL-6, IL-8, IL-13, IL-17 and IL-33. The mentioned profiles of each phenotype correlated and characterized among different phenotypes.

Results:

The majority of patients 78(65%) were female with mean BMI of 24.07±4.73kg/m2. Majority of the patient in BA and BA-rhinitis phenotype are in mild severity and young compared to majority in BA-obesity and BA-smoker are moderate to severe severity with older. (p<0.001) The SPT and FENO level were highest among BA-rhinitis phenotype with significant difference among phenotypes. (p<0.001) Similarly the most of inflammatory markers were significantly different in various phenotypes. The FEV1 showed correlation with most of parameters with statistically significant correlation with IL-5, IL-8 and FENO.

Conclusion:

The majority of parameters were significantly different among various phenotypes. We advise to phenotypic classification of asthma whenever possible for better management and quality of life.
Spatial analysis of chronic obstructive pulmonary disease and its risk factors in an urban area of Trivandrum, Kerala, India
Authors: Surendran Sethulekshmi , Mohan Ananth , Valamparampil Mathew Joseph , Nair Sanjeev , Balakrishnan Sreekanth Karthikeyan , Laila Achu Asokan , Reghunath Rajesh , Jose Chinu , Rajeevan Amjith , Vasudevakaimal Prasannakumar , Surendrannair Anish Tekkumkara , Nujum Zinia Thajudeen , Varghese Sara , Mohan Alladi
Published: February 2022

Background:

Chronic obstructive pulmonary disease (COPD) is the second leading cause of death in India. The objective of this study was to map COPD cases and its risk factors and to determine the association between them using geographic information system (GIS) in a semi-urban area of Trivandrum, South India.

Materials and Methods:

This community-based cross-sectional, descriptive study (n = 494) was conducted in a subcenter area of a primary health center. Location was mapped and COPD population screener questionnaire was administered to all the study subjects enrolled by census method. Lifetime firewood exposure (person-hours) and tobacco smoking were enquired and distance from road was mapped using portable differential global positioning system. The association with COPD was assessed by kriging and hotspot analysis using ArcGIS software.

Results:

The prevalence of COPD (6.5%) was comparable to national prevalence estimates. Spatial maps showed COPD case clustering in areas with higher firewood exposure, greater smoking exposure, and in households with closer proximity to local roads. A particular high-risk cluster was obtained which had a significant association with all the risk factors.

Conclusion:

GIS technology is useful in identification of spatial clustering of COPD cases and its environmental risk factors, making it an important tool for targeted interventions for COPD.
Lower respiratory tract sampling in COVID-19 acute respiratory distress syndrome: A focus on microbiology, cellular morphology, cytology, and management impact
Authors: Bansal Sameer , Kalpakam Hariprasad , Kumar Ashwin , Varsha Amogha , Thorbole Anmol , Mehta Ravindra M.
Published: February 2022

Background:

Lower respiratory tract (LRT) sampling through bronchoscopy has been done sparingly in COVID-19 acute respiratory distress syndrome (ARDS) due to the high aerosol risk for the health-care workers (HCWs). Valuable information can be gained by a detailed evaluation of bronchoscopic LRT samples.

Methods:

LRT samples were obtained by bedside bronchoscopy severe COVID-19 ARDS patients on mechanical ventilation. Microbiological, cellular, and cytological studies including LRT COVID-19 reverse transcription-polymerase chain reaction were analyzed.

Results:

A total of 100 samples were collected from 63 patients, 53 were males (84%). Forty-three patients (68%) had at least 1 comorbidity. 55% of cases had a secondary bacterial infection, commonly with multidrug-resistant organisms (94.5%). The most common organisms were Klebsiella
pneumoniae and Acinetobacter
baumannii in 56.3% and 14.5% of cases, respectively. Fungal superinfection was observed in 9 patients (14.3%). Bronchoscopy helped confirm COVID-19 diagnosis in 1 patient and helped rule out COVID-19 in 3 patients. The median bronchoalveolar lavage fluid (BALF) white blood cell (WBC) count was 953 (inter quartile range; 400–2717), with mean neutrophil count 85.2% (±13.9) and mean lymphocyte count 14.8% (±13.9). Repeat sampling done in some patients showed a progressive increase in the total WBC count in BALF, an increase in neutrophil percentage, and a higher chance of isolating an organism on the culture. Rate of superinfection increased with a longer duration of illness. Bronchoscopic LRT sampling contributed significantly to modifying antibiotic coverage and discontinuing steroids in 37% of cases.

Conclusions:

Our study provides a detailed analysis of bronchoscopic LRT sampling in critically ill COVID-19 patients, augmenting disease understanding and contributing to clinical management.
Awareness of forensic odontology among general dental practitioners in Mumbai
Authors: Mistry Rishabh G. , Pereira Treville , Shetty Subraj , Gotmare Swati , Anjali A. K. , Vidhale Rutuja
Published: February 2022

Introduction:

Forensic odontology is the application of dental knowledge in human identification. It has major implications in criminal investigation, and human remains identification.

Objective:

The aim of this study is to introspect the attitude and knowledge of forensic odontology among general dental practitioners (GDPs) in Mumbai.

Materials and Methods:

A cross-sectional study was conducted in a sample size of 225 GDPs of Mumbai with the help of an online questionnaire comprising 11 questions.

Results:

GDPs were found to have a lack of exposure and poor knowledge regarding the subject of forensic odontology. Only 13.3% of dentists have had a formal training in the subject. About 29.3% are unaware that they can testify in the court and support the investigation.

Conclusion:

The lack of awareness and knowledge among dentists will hinder the criminal investigation. Hence, awareness should be created among young dentists and more courses should be available in the field.
“Cultural Diversity” from the Perspective of Human Rights, Media, and Trade Law: Cross-Fertilization or Conflict?
Authors: Polymenopoulou Eleni
Published: February 2022

Over the last twenty years, a number of high-level policy meetings have emphasized the significance of cultural diversity in all matters related to international cultural cooperation. Instruments negotiated both in the context of the UNESCO and other agencies of the United Nations demonstrate the pervasive interest of the international community in strategies enhancing cultural diversity. Yet the concept of diversity is a particularly broad one, entrenched on a variety of rationales for its protection, such as the promotion of human rights and democratic participation; sustainable and human development; protection of cultural industries vis-à-vis the liberalisation of audio-visual services and free trade; promotion of intercultural and interreligious dialogue; as well as protection of cultural rights and cultural heritage. As this article submits, the promotion of cultural diversity is a laudable cause in and of itself, and a first step towards achieving equality. Its omnipresence, however, taken in conjunction with its imprecise content and function in the cultural market (in accordance with the 2005 UNESCO Convention on the Promotion of Cultural Expressions) runs the risk of downplaying its significance and effectiveness.
Rethinking church polity structure in pluralism for the 21st century: A case study of the Reformed Churches in South Africa (GKSA)
Authors: Zgambo Rev. Dr. Humphreys Frackson
Published: February 2022

The rise of neo-radical nationalism, racism and ethnicity in many churches in the 21st century is an unexplainable reality. It is becoming difficult for churches to maintain their denominational identity to a high degree without adjusting its liturgy, traditions and church polity according to new context (Koffeman, 2014:164). In the process of reformation and restructuring to integrate pluralism and ethnic diversity, the church could begin with an understanding of the basic Scriptural doctrines, the implications of the doctrine, definitions and images of the church in the New Testament and apply them to contemporary life (Sanou, 2015:101). In the pluralistic approach, it will be a new identity of the church rooted in a shared faith, hope and fellowship with the living God. For the people of God, there must be a new theory of interdisciplinary concept for political, psychological, theological and spiritual reality.
Human Body Donation to Anatomy Laboratory for Educational Purpose: Legal, Ethical and Religious points of view
Authors: Shrestha Sunil , Shrestha Shamsher , Amgain Kapil
Published: February 2022

Body donation refers to whole body donation for teaching and learning processes considered a noble act. In most religions, body donation law, organ transplantation act, tissue act permits body donation for medical and research purposes. In the current article, we have discussed mainly body donation laws of different countries along with necessary criteria that should be fulfilled by body donors along with the law that is necessary to claim the unclaimed bodies and give consent for the body donation. The article also includes a brief view regarding the religious perspective of major religions about human body donation.
The health and well-being of female labour migrants from: A Qualitative Study of Stakeholder Views
Authors: Simkhada Padam , Khatri Rose , Van Teijlingen Edwin
Published: February 2022

Female labour migration from the global south to the Middle East has increased in recent times. The rights and health of these women are often severely affected during and post migration. The aim of this study was to provide a clearer understanding of the process and context of female labour migration from Nepal. This included reasons for female labour migration, the risks, benefits, health impacts and measures to better support and protect women before, during and post migration.Data in this paper is based on semi-structured interviews conducted with ten key stakeholders (staff working with support organisations, policy-makers and researchers in the field) all with a professional interest in female labour migration from Nepal.It was found that government restrictions on female labour migrants working in the domestic sector increased undocumented migration through India, increasing the risk of trafficking and exploitation. Despite these risks, migration is attractive to many Nepalese women as it offers an opportunity to improve livelihood for them and their family. In addition, it can provide a ‘window to empowerment’. The study concludes that restricted migration, implemented in the name of protection, has undermined the rights, security and health of many Nepalese women.
Acolhimento familiar, articulação de rede e reintegração familiar: reflexões a partir da prática
Authors: Matinatto Salvagni Julia , Sucupira Pedroza Regina Lúcia
Published: February 2022

Este artigo discute a importância da garantia do direito a convivência familiar e comunitária de crianças e adolescentes no contexto das Políticas de Assistência Social, em especial nas situações de afastamento do convívio familiar devido à medida protetiva de acolhimento. A partir dessa contextualização, discute-se os resquícios e impactos do histórico menorista do Brasil, mesmo que com a instauração da doutrina da proteção integral e, nesse sentido, como possibilidade de romper com a hegemonia do aparelho institucional da proteção à infância, o investimento em outras modalidades de acolhimento, como o Serviço de Acolhimento em Família Acolhedora (SFA). Coloca-se o SFA como via para a garantia do direito à convivência familiar e comunitária, bem como suas potencialidades para trabalhar de forma efetiva a articulação de rede, enquanto instrumento dos processos de reintegração familiar. Nessa perspectiva, é descrito um caso que elucida os principais pontos da discussão proposta e a partir dele, reflexões a respeito da temática estudada.
Trying to Keep It Real: My Experience in Developing Clinical Approaches to the Treatment of DID
Authors: Kluft Richard
Published: February 2022

In contrast to those who have attempted to accommodate DID and its treatment within extant paradigms, extend extant paradigms to encompass DID, infer treatment approaches from theoretical models and research in areas thought capable of offering relevant perspectives, and promote particular treatment techniques as complete psychotherapies, I have endeavored to develop methods of treatment derived from the study of DID itself and the monitoring of ongoing DID psychotherapies. The result, a flexible and pragmatic therapeutic stance, has demonstrated considerable effectiveness. Here I trace and explain the evolution of selected aspects of my thinking and describe some of the strategies and tactics that have emerged from that effort. I illustrate my ongoing learning process by discussing how my study of two new potential strategies convinced me to adopt one as an elective modification of my practice and to reject the second.
The Case of the Shaking Legs: Somatoform Dissociation and Spiritual Struggles
Authors: Martinez-Toboas Alfonso
Published: February 2022

Psychogenic non-epileptic seizures (PNES) are episodic behavior that resembles epileptic seizures but without epileptiform activity in the brain. They are expression of psychological conflict. From the perspective of theory, research, and clinical experience, many authors have conceptualized PNES as a kind of somatoform dissociation. This article presents a clinical case study of a young and very religious woman who suffered episodes of marked seizure-like movements in both legs. These episodes began when the time approached to keep her earlier commitment to dedicate herself to a nun’s life in a convent. While in psychotherapy, she revealed and deliberated tremendous spiritual struggle about keeping that commitment. She acknowledged great fear of rejection by her church, family and friends, if she chose to pursue, instead, her newfound desire for a mate and a family. Therapy helped Nancy with psychoeducation about PNES, gaining insight about her spiritual conflict, validation of her authentic desires and assertiveness training. It helped her reason with her family and friends for their approval and to begin dating. While taking those steps for resolution of her spiritual conflict and approached termination of therapy, Nancy’s episodes of PNES abated steadily. This case study illustrates that dissociative somatoform symptoms are manifestation of powerlessness to cope with grave danger, in Nancy’s case, danger of losing relationships she needed to live an authentic life. It also illustrates the effectiveness of psychotherapy that helps end that powerlessness.
Attachment as a Second Language: Treating Active Dissociative Identity Disorder
Authors: Sachs Adah
Published: February 2022

Evidence is accumulating (Brand, Classen, McNary, & Zaveri, 2009, Brand, Loewenstein, & Spiegel, 2014; Brand et al., 2013; Brand et al., 2012; Dorahy et al., 2014) to show that by and large, Dissociative Identity Disorder (DID) is well amenable to psychotherapeutic intervention along the lines of the International Society for the Study of Trauma and Dissociation (ISSTD) Guidelines for treatment of DID in adults (ISSTD, 2011), based on the Three Phase Approach (Van der Hart, Nĳenhuis, & Steele, 2006). In this paper, however, I would like to draw our attention to those cases where improvement is not reached, despite high-quality, dedicated therapeutic efforts. I refer particularly to patients with Active DID (Sachs, 2013c, 2017): patients who remain persistently victimized and apparently unable to establish even the most basic safety needed for the therapeutic process (“phase one” of the threephase approach). I suggest that the therapeutic problem in these cases may lie in mis-attunement (Stern, 1998) between the therapist’s and the patient’s attachment language; and that this mis-attunement is due to a uniquely disordered attachment-pattern which characterises people with Active DID. I thus propose that, in these cases, phase one needs to be substantially modified and focus on therapeutic attunement rather than on safety. “Attachment as a second language” is proposed for treating people with persistent (“Active”) DID, while considering the clinical, theoretical and practical aspects of this therapeutic approach.
My First Case of DID: Learnings From Treatment Failure
Authors: MaMaugh Kate
Published: February 2022

This article describes working with a case, likely to have had undiagnosed Dissociative Identity Disorder (DID). It describes the struggles of a DID-naïve therapist in conceptualizing and treating the case. Learnings from the predictable unravelling of treatment are described. Suggestions for clinical training and supervision are outlined.
EMDR for Safe Desensitization of Memories and Fusion of Parts in DID. Conference Room Technique, Trauma Mapping and Management of Unplanned Abreactions
Authors: Shebini Neva
Published: February 2022

This paper explores the use of Eye Movement Desensitization and Reprocessing therapy (EMDR) in the treatment of Dissociative Identity Disorder (DID), in its most severe form. I discuss suggested modifications and applications for the safe use of EMDR, including the essential use of the conference room technique. I have described the concept of “trauma memory mapping” before EMDR is delivered. Additionally, this paper considers how parts may be created and the possible connections between parts within a trauma memory. Trauma memory desensitization, and the associated fusion of parts into the system, with the planned use of EMDR is described. Insights from the management of internal resistance to fusion are presented. A case example with safe management of an unplanned abreaction has been provided. A mention is given to the comparison of use between hypnosis facilitated abreaction and EMDR.
Environmental Safety: The Starting Point in the Treatment of Children with Dissociation
Authors: Baita Sandra
Published: February 2022

Lack of safety in the world surrounding the child is a major roadblock for the treatment of complex post-traumatic sequelae and dissociative manifestations. Unfortunately, this is a common situation in cases involving a parent being abusive towards the child—either sexually or physically— when the alleged offending parent is allowed and even encouraged to have contact with the child. Through the case of Ann, readers will follow the many pitfalls faced in the treatment of the traumatic consequences of the sexual abuse she suffered, until environmental safety was achieved. The role of the Justice system will also be discussed.
Implementación de los principios de distribución en planta en el área de acabados y almacén de una empresa de producción de partes ortopédicas
Authors: González Alejandro Lozano , Garza Luz Karina Hernández , Macías Marco Antonio Serratos , Chavarría José de Jesús Cabrera , García Julieta Carrasco , Orozco Roberto Huerta
Published: February 2022

Este trabajo de investigación está realizado para detallar el proceso de identificación y solución de problemáticas relacionadas a la distribución en planta en una empresa del giro ortopédico y como se puede eficientar los distintos procesos operativos que se llevan a cabo en dos áreas específicas. El análisis de las problemáticas llevó a determinar que las áreas de almacén y acabados de esta empresa necesitaban una nueva distribución que satisficiera las necesidades y requerimientos de la producción, es así, que se concluyó que las herramientas que podrían satisfacer estas necesidades sería la aplicación de los principios de la distribución en planta. Los principios de distribución en planta ayudaron de manera puntual a ordenar los espacios físicos, las herramientas y maquinarias, así como al personal, los cuales habían sufrido diversos movimientos en función de la necesidad de producción debido al impacto del crecimiento que ha tenido la empresa razón por la cual había imposibilitado la toma de decisiones justificadas en las necesidades de espacio y distribución. La aplicación de estos principios, dan como resultado un aumento significativo en la productividad de los operarios y las máquinas al reducir los tiempos de traslado y tiempos de búsqueda de materiales y productos.
Modification closed mouth functional impression technique for flabby and flat ridge: a case report
Authors: Chandra David , Chairunnisa Ricca , Nasution Ismet Danial
Published: February 2022

In fabricating complete denture, flabby ridge and flat ridge require special impression technique. Pressure causes by impression in flabby ridge may compress the tissue. Ideally, modified open mouth impression technique is used to avoid compression in flabby area which cause denture base displacement. Flat ridge offers little possibility of retention, stability, and the muscle attachments are located near the crest of the residual ridge so there is more dislocating effect to horizontal and vertical movement. Closed mouth functional impression technique may produce a more retentive denture base for flat ridge because it record peripheral seal and denture bearing area with patient’s functional. The main problem arises when flat ridge is also accompanied by flabby ridge. Closed mouth functional impression technique in this case cause pressure on the flabby ridge. This case report discusses about the management of the case with modification to functional closed mouth impression technique using wax as a spacer which is covered with metal mesh on the flabby ridge. The function of closed mouth functional impression technique is to obtain optimal muscle trimming and impression with patient’s functional pressure and movement, to obtain the extension of the denture base to movable unmovable tissue during function. Modification with wax spacer in flabby area so that non-spacer area act as stopper during functional impression, and flabby ridge is free from pressure. Additional modification with metal mesh above the wax serves as escape holes, as well as scaffold for retention of impression material. Modification in this impression technique produce denture base which does not compress flabby ridge, and also obtain retentive, and stable base for flat ridge case.
PENGARUH PENDEMI COVID-19 TERHADAP KINERJA PERUSAHAAN (PROFITABILITAS, LIKUIDITAS, FAKTOR EKSTERNAL, DAN HARGA SAHAM) PADA PERUSAHAAN INDUSTRI OTOMOTIF DI BEI
Authors: Budiningsih Hastuti Sari Sari , Zulkifli Zulkifli , Rachbini Widarto
Published: February 2022

This research’s purpose is to determine the impact of the COVID-19 pandemic on the performance of automotive companies listed on the Indonesia Stock Exchange. In addition, this research is also conducted for determining the effect of the external factors (inflation, interest rates), liquidity (current ratio, cash ratio), profitability (ROI, ROA, NPM) and stock prices in automotive industry companies listed on the Indonesia Stock Exchange. The method used in this research is a quantitative method and uses Structural Equation Mode analysis. The sample used in this research are 5(five) automotive industry companies listed on the Indonesia Stock Exchange. The data used is quarterly financial report data of 2019 (before the COVID-19 pandemic) and 2020 (after the COVID-19 pandemic). Based on the research of the study indicate that external factors in this case inflation and interest rates have a significant positive effect on stock prices; Liquidity has a significant positive effect on profitability; Profitability has a significant positive effect on stock prices; External factors have no significant effect on stock prices; Liquidity has a significant negative effect on stock prices. The overall financial performance of automotive industry companies listed on the IDX decreased due to the COVID-19 pandemic, before the pandemic the average company performance was quite good, but with the COVID-19 pandemic the performance of the automotive industry companies decreased. A significant decrease in the level of sales resulted in a decrease in net income.
KEMAMPUAN BAHAN AKTIF EKSTRAK AEGLE MARMELOS DALAM PENGENDALIAN DENGUE HEMORRHAGIC FEVER
Authors: Prayogo Damar , Astuti Dumilah
Published: February 2022

Penyakit Demam Berdarah Dengue (DBD) merupakan penyakit yang ditularkan oleh nyamuk Aedes aegypti. Penggunaan insektisida yang berasal dari tumbuhan mojo (Aegle marmelos L.) mengandung senyawa tanin, saponin, alkaloid, flavonoid, terpenoid, dan steroid, yang berfungsi sebagai larvasida. Penelitian ini bertujuan untuk mengetahui kemampuan ekstrak daun mojo (Aegle marmelos L.) dalam mengendalikan nyamuk Aedes aegypti dengan metode elektrik dengan menggunakan 2 konsentrasi yaitu 60% dan 70%. Berdasarkan hasil penelitian diketahui kematian nyamuk rata-rata pada konsentrasi 60% ekstrak daun mojo (Aegle marmelos L.) sebesar 16%, dari 30  ekor sampel nyamuk, pada 240 menit waktu pengamatan, dan konsentrasi 70% ekstrak daun mojo (Aegle marmelos L.) sebesar 18%, dari 30 ekor sampel nyamuk, pada 240 menit waktu pengamatan. Memenuhi Lethal Consentration 50 (LC50) dimana nyamuk Aedes aegypti yang mati rata-rata mencapai 16 ekor (53%) dan 18 ekor (56%), sedangkan pada kontrol tidak terdapat nyamuk yang mati. Kesimpulan yang di peroleh dalam penelitian ini yaitu Pada konsetrasi 60 % dan 70 % ekstrak daun mojo (Aegle marmelos L.) mampu pada 240 menit dengan 240 menit waktu pengamatan, dimana rata-rata kematian nyamuk Aedes aegypti sebanyak 16 ekor (53%) dan 17 ekor (56%) dan telah mencapai LC50.
The moderating effect of employment status on the relationship between lifetime major depressive disorder and positive mental health
Authors: Sambasivam Rajeswari , Vaingankar Janhavi Ajit , Abdin Edimansyah , Devi Fiona , Chua Boon Yiang , Shafie Saleha , Chang Sherilyn , Shahwan Shazana , Chong Siow Ann , Subramaniam Mythily
Published: February 2022

Introduction: This paper aims to examine the (1) level of positive mental health (PMH), (2) identify the socio-demographic correlates of the PMH domains in the general population, and (3) establish if employment status moderates the relationship between major depressive disorder (MDD) and PMH among those with a lifetime prevalence of MDD. Methods: The Singapore Mental Health Study conducted between 2016 and 2018 included Singapore residents aged ≥18 years. The World Health Organization Composite International Diagnostic Interview version 3.0 was utilised to establish lifetime prevalence of MDD. Moderation analysis was conducted using SPSS PROCESS macro (Hayes, 2017) to assess if employment status moderated the relationship between MDD and PMH. Results: Significantly lower PMH total and domain scores were reported by respondents (n=2,270) who endorsed lifetime MDD compared to those who did not. Moderation analysis demonstrated that the effect of MDD on PMH total and domain scores varied considerably across employment status. Based on the interaction plots, the effect of MDD on both PMH total and domain scores was minimal among those employed than unemployed. Conclusion: Healthcare professionals should support the employment needs of those who report lifetime MDD to provide care for an individual’s mental well-being in a holistic manner. Acquiring or remaining in employment would be a priority depending on the PMH of the individual. Reducing barriers to employment for those with health issues or creating employment opportunities for this group are concerns that need to be addressed at a societal level. Keywords: Depression, employment, positive mental health, well-being
The role of nurses in the application of bedsores in palliative care
Authors: Andriulevičienė Lina
Published: February 2022

In palliative care, the role of the nurse is very important in the prevention of bedsores, as only by providing qualified care and early prevention can bedsores be prevented and thus improve the patient's quality of life in the last years of life. The role of nurses in the prevention of bedsores is mainly reflected in the use of bedding prevention and treatment mattresses and functional beds. Less than three-quarters of nurses often use biophysical agents, various bandages, auxiliary surfaces, heel guards, stationary lifts, flip-flops, transfer boards / stretchers / belts, and other positioning devices in palliative care. According to the recommendations of the EPUAP, almost half of nurses say that the most effective means of preventing bedsores in palliative care is flipping. Nurses perform many professional and effective actions, functions that improve the patient's health and well-being in the treatment of bedsores. Also, in the prevention of patients' bedsores and palliative care, nurses perform their work responsibly, reliably, and are able to empathize with patients.

The aim. To elucidate the role of nurses in the application of bedsores in palliative care.

Research methods: after analyzing the scientific literature, from 2021. A quantitative survey and an anonymous survey were conducted in November-December. The research data were analyzed by MS Office Excel 2016 data processing program. The research was conducted in accordance with ethical principles.

Results of the study: 64 nurses (women) participated in the study. The productive role of nurse in the prevention of bedsores is reflected in the use of EPUAP guidelines in the prevention of patient bedsores.

Conclusions: The study found that 94 percent. (n = 60) the role of nurses in the prevention of bedsores is reflected in the most common use of bedsores for the prevention and treatment of bedsores, 91%. (n = 58) - uses functional beds. On average, 67 percent. (n = 43) nurses often use biophysical agents, various bandages, auxiliary surfaces, heel guards, stationary lifts, flip-flops, transfer boards / boards / stretchers / belts and other positioning devices, with the least use of implants - 39%. (n = 25). According to the EPUAP, 46 percent. (n = 29) The most effective measures for nurses in the prevention of bedsores in palliative care are reversal, and 17%. (n = 11) - when more employees work, 11 percent. (n = 7) - patient hygiene and dry maintenance, 8 percent. (n = 5) - bed rest mattresses and functional beds.
Correction of mature skin with the help of decorative cosmetics
Authors: Jankauskaitė Gerda , Gierasimovič Zita
Published: February 2022

Beauty products are used to visually conceal visible aging of skin. The appropriate selection of makeup techniques and decorative cosmetics for mature age women help correct their features and conceal skin problems. 

Aim. The article deals with the effect of cosmetic products on mature face skin. 

Material and methods. In 2021, as many as 16 publications on the subject under discussion that appeared during the past decade, were analysed. Between 2012 and 2021, articles were published in the databases of the journals Skin Research and Technology, Psychology, Journal of Pharmaceutics, Dermatology, Cosmetics, Journal of Consumer Behaviour. All publications are in the English language, the texts are complete and easily accessible. The selected publications describe the skin aging process, the composition of beauty products, nanotechnology products and the application of cosmetic products to prevent the process of premature skin aging. Recommendations for mature skin care are provided.

Results. In the 21st century, cosmetics is widely used and is in great demand in the world market. Annually the demand increases by approximately 4.5 percent. Cosmetic products and make-up make mature face skin look more attractive. Attractive faces are perceived as much younger, the face contour is preserved, skin is firm, the size of the eyes and the area around them, and lip distraction remain unchanged. Cosmetic surgical procedures enhancing the appearance of face skin can improve psychological health of the patients; there is no evidence about how these changes effect a positive attitude of other individuals to their changed appearance, the status of an individual and his/her social wellbeing.

Conclusions. 1. Most often scientific literature is concerned with the effect of make-up on the psychological aspect – an individual’s attractiveness. 2. Beauty products and make-up techniques chosen for mature skin change the face in three directions: they change the contours of the face, skin homogeneity, contrast of the face and the size of facial features. 3. Innovative, biologically active cosmetic products have an external and therapeutic benefit to the appearance of face skin, are not only friendly to human skin and health but also are environmentally friendly.