bluuebunny/crossref_metadata_2025 huggingface dataset:
Problemática de la gestión de las Áreas Naturales Protegidas de México: un análisis en las Reservas de la Biosfera de los Tuxtlas y los Petenes
Authors: Neger Christoph , Crespo Guerrero José Manuel
Published: December 2021

A nivel global, México es de los países con mayor biodiversidad, pero también de los que soporta una destacada explotación de sus recursos naturales. La declaración de áreas naturales protegidas se ha convertido en una de las principales estrategias mexicanas para conservar la naturaleza. El artículo analiza los desafíos de esta herramienta de gestión territorial partiendo de la capacidad de gestión. Para alcanzar este fin, se realiza la oportuna revisión bibliográfica y el análisis de cuestionarios semiestructurados aplicados a actores clave de dos casos de estudio: las reservas de la biosfera Los Tuxtlas y Los Petenes. Los resultados demuestran que, si bien los espacios protegidas han contribuido a disminuir la destrucción del patrimonio natural, éste aún sigue sufriendo graves afectaciones a causa de los insuficientes recursos destinados a las políticas ambientales, lo que debilita la capacidad de gestión y, consiguientemente, dificulta alcanzar los objetivos de conservación.
Women Empowerment and Utilization of Maternal Health Care in Pakistan
Authors: Khan Muhammad Mohsin Latif
Published: December 2021

The impact of women's empowerment is examined on the utilization of maternal health care services in Pakistan. The empirical analysis based on logistic regression shows that women's education is the most important factor to improve maternal health among women. Other predisposing factors like parity and health belief are also contributing factors. Household wealth status turned out to be the most significant factor among other enabling factors like ease of access and source of information. Death of the child in previous pregnancies is the only need factor and we have found it statistically significant in the case of postnatal care.
'Introduction'
Authors: Mann Jatinder
Published: December 2021

The aim and scope of the Journal of Australian, Canadian, and Aotearoa New Zealand Studies (JACANZS) is to publish articles in various disciplines (history, politics, literature, law, anthropology, and Indigenous studies) on one or more of the following countries: Australia, Canada, and Aotearoa New Zealand, with a core focus on articles that are comparative in their geographic remit, for example Australia and Aotearoa New Zealand, or Australia and Canada. The creation of the journal responds to a lack of journals that collectively publish across the fields of Australian, Canadian, and Aotearoa New Zealand studies from multi and interdisciplinary perspectives. It also followed the creation of the Australian, Canadian, and New Zealand Studies Network (ACNZSN) to reflect the work and membership of the network.
CURRICULUM MANAGEMENT IN IMPROVING COMPETITIVE ADVANTAGE IN MADRASAH
Authors: Amir Amir
Published: December 2021

This study aims to find and analyze curriculum management in increasing competitive advantage in Madrasah Aliyah Nurul Jadid, Paiton, Probolinggo, East Java. This study uses a qualitative case study approach. The data collection technique is done through interviews, observation, and documentation. The results showed that curriculum management in increasing competitive advantage at Madrasah Aliyah Nurul Jadid was carried out through; 1) planning, which includes analyzing activities for students, processing material content, analyzing learning techniques or methods, documenting learning components, providing motivation to students; 2) Implementation of the planning design that has been determined together by integrating the government curriculum and pesantren; 3) Evaluation of the implementation of the curriculum, both on the process and its outputs and outcomes, with the principle of continuous improvement.
Örgüt Kültürünün Örgütsel Bağlılık Üzerindeki Etkisinde Yetenek Yönetiminin Aracılık Rolünün İncelenmesi
Authors: DİNÇER Evren , ERSOY KART Müge
Published: December 2021

İnsan kaynakları, diğer üretim faktörlerine göre açıkça daha stratejik bir nitelik taşımaktadır. Özellikle günümüz iş dünyasında, teknoloji/bilgi kaynakları, doğal kaynaklar, finansal kaynaklar ve girişimciliğin etkinliği, insan kaynaklarının yetkinliğine yüksek düzeyde bağlıdır. Öte yandan, işletmenin nesilden nesile aktarılan ve paylaşılan ortak değerleri olan örgüt kültürü de örgütlerin varlıklarını sürdürebilmeleri ve rekabet edebilmelerinin temel unsuru niteliğindedir. Bu çalışmanın temel amacı, örgüt kültürünün örgütsel bağlılık üzerine etkisinde yetenek yönetiminin aracılık rolünün incelenmesi olarak ifade edilebilir. Araştırma kapsamında Adana, Konya, Kırşehir ve Bursa illerinde faaliyet gösteren otomotiv yan sanayi üretim işletmelerinden kolayda örneklem yöntemi ile veri toplanmıştır (n=715). Veri toplama araçları olarak, örgüt kültürü eksojen değişkeni, yetenek yönetimi aracı değişkeni, örgütsel bağlılık endojen değişken kullanılmıştır. Demografik verilerin frekans ve yüzde dağılımları SPSS programı ile analiz edilmiştir. Ölçeklerin güvenilirlik ve geçerlilikleri ile hipotez testleri için Kısmi En Küçük Kareler Yapısal Eşitlik Modeli (KEKK-YEM) tercih edilmiş ve bunun için SmartPLS3 yazılımı kullanılmıştır. Yapılan analizler sonucunda, ölçeklerin güvenilir ve geçerli olduğu, örgüt kültürünün örgütsel bağlılığı artırdığı ve bu ilişki üzerinde ise yetenek yönetiminin aracı etkiye sahip olduğu tespit edilmiştir.
فلسفة النظام القانوني الإسلامي في تحريم جرائم تعاطي الخمور و المشروبات الكحولية مقارنة بالنظام القانوني الأنجلوسكسكوني
Authors: طارق حسن بن عوف
Published: December 2021

فلسفة النظام القانوني الإسلامي في تحريم جرائم تعاطي الخمور و المشروبات الكحولية مقارنة بالنظام القانوني الأنجلوسكسكوني

This research aims to identify alcohol and alcoholic beverages consumption according to Islamic scholars and legislators especially Anglo-Saxon.

It also defines wine in modem medicine as well as prohibition of alcohol in the Islamic law and the evidence contained in it.

Research illustrates steps made by the Islamic legislator to prohibit alcohol because drinking wine was familiar to pre- Islamic society; hence, gradual prohibition has helped them to give up wine.

Research also discusses the wisdom behind prohibition of wine as Islamic legislator targets the advantages for the benefit and good of community members.

Research also clarifies the elements of the crime of drinking wine and evidences of committing this crime, as well as clarifying the penalty determined for wine and alcohol takers in Islamic legislation and compares the situation with positive laws.

This comparison points up the superiority of Islamic law in its ability to combat these crimes.

Research also illustrates removal of the penalty in the Islamic jurisprudence in case of suspicion.

This explains the greatness of this legislation by considering the doubts and evidences so that accusation should not be based on suspicion.

Researcher concludes by the necessity of raising awareness and insight among people to the danger of alcohol consumption that may lead to loss of innocent lives in addition to the great health risks that may cause definite death.

Families should also raise their children in a sound way so that they become good members in their families and communities as well.

Governments should also maintain their obligations towards their citizens and concern about of youth
RISK FACTORS FOR COMPLICATIONS AFTER OPEN ADENOMECTOMY IN BENIGN PROSTATIC HYPERPLASIA IN A PATIENT WITH DIABETES MELLITUS
Authors: Толегенов Е.Б. , Коныров Е.М. , Даулетбаев Ж.К. , Байрамов Р.С. , Ташкеева М.Ж. , Тулепбергенов Г.К. , Сейтбек Е.А.
Published: December 2021

Наиболее часто пациенты с наличием симптомов нижних мочевых путей тяжелой степени (по шкале IPSS), которые резистентные к консервативной терапии, а также пациенты с наличием аденомы размерами 80 см3 и более, являются кандидатами на оперативное лечение.[1] Долгие годы трансуретральная резекция гиперплазии предстательной железы является «золотым стандартом» оперативного лечения (с точки зрения эффективности), однако возникновение осложнений стимулировали исследователей к разработке новых методов лечения.[2] Открытая аденомэктомия (чаще всего чрезпузырная), рекомендованная Европейской Ассоциацией Урологов как эффективный метод лечения пациентов с объемом железы >80 см3, характеризуется длительным пребыванием в стационаре и серьезными осложнениями, такими как кровотечение из послеоперационной раны, инфекция, образование рубцов в мочевыводящих каналах, временное недержание мочи, стриктура уретры[3].

Most often, patients with severe lower urinary tract symptoms (according to the IPSS scale) who are resistant to conservative therapy, as well as patients with adenomas of 80 cm3 or more, are candidates for surgical treatment.[1] For many years, transurethral resection of prostatic hyperplasia has been the "gold standard" of surgical treatment (in terms of effectiveness), but the occurrence of complications has stimulated researchers to develop new treatment methods.[2] Open adenomectomy (most often percutaneous), recommended by the European Association of Urologists as an effective treatment method for patients with a gland volume >80 cm3, it is characterized by a long hospital stay and serious complications, such as bleeding from a postoperative wound, infection, scarring in the urinary channels, temporary urinary incontinence, urethral stricture.
TRANSIENT ISCHEMIC ATTACKS: ETIOPATHOGENESIS, CLINIC. (Literature review)
Authors: Жакенова Г.Ж. , Нуржанова Р.Б. , Сраилова К.Б. , Шерияздан Ж.С. , Ташманова А.Б. , Раимкулов Б.Н.
Published: December 2021

В данной статье представлен обзор литературы по транзиторным ишемическим атакам: эпидемиология, этиология, патогенез, классификация, основные характеристики с учетом факторов риска, визуализационных признаков МРТ и КТ, клинических проявлений и дифференциальной диагностики данного заболевания на основе современных исследований.

This article presents a review of the literature on transient ischemic attacks: epidemiology, etiology, pathogenesis, classification, main characteristics taking into account risk factors, imaging signs of MRI and CT, clinical manifestations and differential diagnosis of this disease based on modern research.
CONVALESCENT PLASMA TRANSFUSION FOR THE TREATMENT CRIMEAN-CONGO HEMORRHAGIC FEVER (REVIEW)
Authors: Абуова Г.Н. , Полукчи Т.В. , Бердалиева Ф.А. , Алиев Д.С. , Алиев Э.Ю.
Published: December 2021

Проведен анализ литературных данных о применении плазменной терапии при лечении Конго-Крымской геморрагической лихорадки в мире. Данный обзор проведен для оценки эффективности плазменной терапии у пациентов с Конго-Крымской геморрагической лихорадкой на основе научных данных, опубликованных до настоящего времени. В последние годы отмечается определенный интерес к изучению плазменной терапии при лечении пациентов с Конго-Крымской геморрагической лихорадкой, хотя в литературе имеются лишь ограниченные данные по эффективности иммунотерапии и применения рибавирина при Конго-Крымской геморрагической лихорадке, при этом действенность рибавирина остается еще не доказанной. Однако можно предположить, что помимо противовирусных препаратов, применение плазменной терапии у больных с Конго-Крымской геморрагической лихорадкой может быть эффективным способом лечения, улучшающим клинические симптомы у пациентов, прогноз и снижающим смертность.

The analysis of the literature data on the using of plasma therapy in the treatment of Congo-Crimean hemorrhagic fever was carried out. This review was conducted to evaluate the effectiveness of plasma therapy in patients with Congo-Crimean hemorrhagic fever on the basis of publications published so far. In recent years, there has been some interest in studying plasma therapy in the treatment of patients with Congo-Crimean hemorrhagic fever, although there are only limited data in the literature on the effectiveness of immunotherapy and the use of ribavirin in therapy, while the effectiveness of ribavirin remains not yet proven. However, it can be assumed that in addition to antiviral and antibacterial drugs, the use of plasma therapy in patients with Congo-Crimean hemorrhagic fever can be an effective treatment method that improves clinical symptoms in patients and reduces mortality.
ORGANIZATIONAL ISSUES OF MEDICAL REHABILITATION OF PATIENTS WITH CARDIOVASCULAR DISEASES WHO HAVE UNDERGONE COVID-19
Authors: Смагулов Д.К. , Хабиева Т.Х.
Published: December 2021

Данная статья посвящена изучению организации медицинской реабилитации пациентов с сердечно-сосудистой патологией, перенесших COVID-19. Авторами статьи приводятся примеры реабилитационных программ в странах далёкого, близкого зарубежья и в Казахстане.

This article is devoted to the study of the organization of medical rehabilitation of patients with cardiovascular pathology who have undergone COVID-19. The authors of the article give examples of rehabilitation programs in the countries of far and near abroad and in Kazakhstan.
DYNAMICS OF PERINATAL LOSSES IN ALMATY
Authors: Бодыков Г.Ж. , Курманова А.М. , Оспангалиева С.М. , Жаналиева Ж.Р. , Аманжолова Б.К. , Умбетов Б.У. , Джамаева Г.А. , Тургынбаева У.А.
Published: December 2021

Динамика и уровень перинатальной смертности за последние десятилетие свидетельствовали о том, что в г. Алматы имеет устойчивую тенденцию к снижению до 8,8‰ к 2019 году. В структуре перинатальной смертности большая часть приходится на антенатальную (5,5-6,5‰); около трети - на раннюю неонатальную смертность (3,2 до 2,3‰). В структуре причин неонатальных потерь наблюдалось устойчивое снижение дыхательных и сердечно-сосудистых нарушений в 2,3-3,8 раза - с 5 до 1,3‰, врожденных аномалий с 4,4 до 0,9‰, неонатальные потери от инфекционных болезней остаются стабильными. Сохраняющие риски инфекционной патологии, особенно в беспрецедентной ситуации в период пандемии диктуют необходимость пересмотра подходов к оказанию перинатальной помощи населению и разработкой новой концепции перинатальной помощи с существенными изменениями в подходах инфекционного контроля, развития превентивной перинатологии с более эффективной антенатальной охраной здоровья плода.

The dynamics and level of perinatal mortality over the past decade testified to the fact that in Almaty it has a steady downward trend to 8.8 ‰ by 2019. In the structure of perinatal mortality, most of it falls on antenatal (5.5-6.5 ‰); about a third - for early neonatal mortality (3.2 to 2.3 ‰). In the structure of the causes of neonatal losses, there was a steady decrease in respiratory and cardiovascular disorders by 2.3-3.8 times - from 5 to 1.3 ‰, congenital anomalies from 4.4 to 0.9 ‰, neonatal losses from infectious diseases remain stable. The persisting risks of infectious pathology, especially in an unprecedented situation during a pandemic, dictate the need to revise approaches to providing perinatal care to the population and develop a new concept of perinatal care with significant changes in approaches to infection control, thedevelopment of preventive perinatology with more effective antenatal fetal health care.
POSSIBILITIES OF USING EDOXABAN IN STROKE PREVENTION IN PATIENTS WITH ATRIAL FIBRILLATION
Authors: Айдаргалиева Н.Е. , Доскулова А.О. , Шерияздан Ж.C. , Рамазанов М.Е.
Published: December 2021

Применение антикоагулянтов у пациентов с фибрилляцией предсердий (ФП) - краеугольный камень профилактики инсульта. Обзор включает современные данные доказательной медицины по эффективности и безопасности применения Эдоксабана - ингибитора Xa фактора - для предупреждения инсульта при ФП, включая больных с чрескожными коронарными вмешательствами.

The use of anticoagulants in patients with atrial fibrillation (AF) is the cornerstone of stroke prevention. The review includes modern evidence-based medicine data on the efficacy and safety of the use of Edoxaban, a factor Xa inhibitor, for the prevention of stroke in AF, including in patients with percutaneous coronary interventions.
METAPHYLAXIS OF UROLITHIASIS BY VEGETABLE MEDICINES
Authors: Шалекенов Б.У. , Куандыков Е.А.
Published: December 2021

Мочекаменная болезнь является одной из главных проблем современной урологии как наиболее часто встречающаяся патология органов мочевой системы и составляющая 30 - 50% всех больных урологических стационаров. Целью настоящего исследования явилось изучение эффективности применения препарата «Фитолизин» у больных мочекаменной болезнью. В основу исследования положены результаты лечения 160 (85 женщин и 75 мужчин) пациентов, находившихся на стационарном лечение, средний возраст больных составил 42,2±12,4 года, длительность заболевания от 1-3 до 72 часов, размер конкрементов, в том числе и дезинтегрированных фрагментов после дистанционной ударно-волновой литотрипсии и контактно-лазерная литотрипсия варьировал от 0,4 до 0,8 см. Все больные были разделены на две группы. В основную группу вошли 70 больных, получавших помимо традиционной симптоматической терапии (спазмолитики и водная нагрузка) «Фитолизин» по 43 мл 3 раза в день. В контрольной группе (90 больных) проводилась только традиционная терапия. При включение в терапию препарата «Фитолизин» самостоятельное отхождение отмечено у 64(91,4%) больных, частота возникновения почечной колики имело место у 7(10%), лейкоцитурия - у 14(20%), бактериурия - у 10(15%). Применение фитопрепарата «Фитолизин» в составе комплексной терапии, является эффективным методом консервативного лечения больных мочекаменной болезнью и после после дистанционной ударно-волновой литотрипсии и контактно-лазерная литотрипсия в 90,9% случаев в отношении самостоятельного отхождения конкрементов.

Urolithiasis is one of the main problems of modern urology as the most common pathology of the urinary system and makes up 30 - 50% of all patients in urological hospitals. The purpose of this study was to study the effectiveness of the use of the drug "Phytolysin" in patients with urolithiasis. The study is based on the treatment results of 160 (85 women and 75 men) patients who were hospitalized, the average age of the patients was 42.2 ± 12.4 years, the duration of the disease from 1-3 to 72 hours, the size of the stones and disintegrated fragments after remote shock wave lithotripsy and contact laser lithotripsy ranged from 0.4 to 0.8 cm. All patients were divided into two groups. The main group included 70 patients who received in addition to the traditional symptomatic therapy (antispasmodics and water load) "Phytolysin" 43 ml 3 times a day. In the control group (90 patients), only traditional therapy was performed. When "Phytolysin" was included in the therapy, independent discharge was observed in 64 (91.4%) patients, the incidence of renal colic occurred in 7 (10%), leukocyturia in 14 (20%), bacteriuria in 10 (15%). The use of the phytopreparation "Phytolysin" as a part of complex therapy is an effective method of conservative treatment of patients with urolithiasis and after remote shock-wave lithotripsy and contact laser lithotripsy in 90.9% of cases with regard to self-discharge of calculi.
MEDICAL ERRORS: ANALYSIS, CAUSES, WARNING
Authors: Махамбетчин М.М.
Published: December 2021

Изучение и совершенствование теории ошибок врачей всегда было важно, а сегодня это стало особенно актуальным. В статье указаны три разные позиции во врачебной среде в отношении ошибок врачей. Показаны последовательные изменения в уголовном кодексе в отношении «причинения вреда здоровью» и тенденция криминализации врачебных ошибок. Приводятся сравнение проблемы ошибок в западных странах и СНГ, и меры контроля ошибок. Аргументируется положение о том, что теория врачебных ошибок - отдельный раздел науки. Указаны причины отсутствия теории врачебных ошибок как отдельной науки. В статье перечислены основные положения разработанного варианта теории ошибок врачей.

Studying and improving the theory of doctors' mistakes has always been important, and today it has become especially relevant. The article indicates three different positions in the medical environment regarding the mistakes of doctors. Consistent changes in the Criminal Code in relation to "harm to health" and the tendency to criminalize medical errors are shown. A comparison of the problem of errors in Western countries and the CIS, and error control measures are given. The position that the theory of medical errors is a separate branch of science is argued. The reasons for the absence of the theory of medical errors as a separate science are indicated. The article lists the main provisions of the developed version of the theory of doctors' errors.
Once vueltas y muchas más: proyecto para la mejora del bienestar psicológico a través del tejer
Authors: Yanguas León N.
Published: December 2021

El objetivo de este proyecto es ser una herramienta más para el control del estrés y mejorar el bienestar psicológico. Está ampliamente documentado cómo el realizar cualquier tipo de manualidad, reporta beneficios psicológicos: alivia el estrés, ayuda a controlar pensamientos negativos, favorece la atención, la memoria, la creatividad, mejora la autoestima… De entre las distintas manualidades a desarrollar en el proyecto, se eligió el tejer porque, además de poder realizarse sin visión, se puede hacer en solitario, no ensucia, no ocupa mucho espacio y no necesita materiales complejos ni caros. Pero, tejer por tejer no era motivación suficiente, por eso se contactó con la Asociación IAIA, asociación de tejedoras solidarias, para unirse a su proyecto de mantas solidarias. La actividad en sí consiste en realizar cuadrados de punto o ganchillo, con cualquier lana, dibujo o color, de 20 x 20 cm que, posteriormente, se unen y forman una manta que, a través de la Asociación IAIA, se dona para diversos proyectos solidarios. Se comenzó trabajando con las personas afiliadas a la ONCE del País Vasco, atendidas por el servicio de apoyo psicosocial, con síntomas ansioso-depresivos, sentimientos de soledad, baja autoestima y que supiesen o quisiesen aprender a tejer. Una vez iniciada la actividad, se abrió a cualquier persona afiliada. Después de un año de funcionamiento, todas las participantes comentan lo gratificante que está siendo para ellas. Están más entretenidas y relajadas, se sienten útiles, capaces y participes de la sociedad, y, por ende, su estado de ánimo ha mejorado y, con ello, su autoestima y hasta su ajuste a la discapacidad visual.
El ciclo de las rocas en las manos del alumnado con discapacidad visual. Taller de geología inclusiva «Ahora toca… la roca»
Authors: Muñiz Guinea F. , Martín Oria M. , Durán Labrador M. V. , Narváez Vargas M. J. , Belaústegui Barahona Z. , González-Neira I. , Barba Brioso C. , Romero Baena A. , Martinell Callicó J.
Published: December 2021

En este trabajo se describe el taller de geología inclusiva «Ahora toca… la roca», realizado en el marco colaborativo entre la Universidad de Sevilla (US), la Universidad de Barcelona (UB) y la Organización Nacional de Ciegos Españoles (ONCE). La actividad se realizó en el Centro de Recursos Educativos de la ONCE de Sevilla (CRE) para estudiantes con discapacidad visual (DV) de secundaria y bachillerato pertenecientes a las comunidades autónomas de Andalucía y Extremadura. La experiencia se desarrolló dentro del Servicio de Educación Combinada Grupal (SECG) «¡Ponte a punto!» que ofrece la ONCE. El taller trató sobre el ciclo de las rocas; en particular, los procesos geológicos por los que atraviesan las rocas para transformarse en alguno de los tres tipos básicos: ígneas, sedimentarias o metamórficas. El alumnado participante en el taller, a través de la manipulación sistemática y dirigida pudo comprobar y así afianzar mejor los conocimientos acerca de la transformación que sufren las rocas. El alto grado de participación y la positiva valoración por parte del alumnado estuvieron motivados por el detallado diseño, la adaptación de los contenidos desde la perspectiva de la percepción háptica o tacto activo, la motivación del equipo educativo y su carácter multidisciplinar.
Jornadas de Ajuste a la Discapacidad: una perspectiva transversal
Authors: Lafuente de Frutos M. Á.
Published: December 2021

Las Jornadas de Ajuste a la Discapacidad Visual, bajo el lema «Ajustándose a la vida: un proceso continuo que nos implica a toda la comunidad», se celebraron en el Centro de Recursos Educativos (CRE) de la ONCE en Sevilla con el objetivo de realizar un encuentro de profesionales de los servicios sociales de la ONCE para reflexionar sobre la situación actual del ajuste a la discapacidad y analizar la intervención realizada al respecto desde la mirada de cada uno de los perfiles profesionales que intervienen. Es decir, cómo abordar la intervención desde la transversalidad del trabajo en equipo, las necesidades de la población con discapacidad visual en este aspecto y, por último, la puesta en común de las experiencias y buenas prácticas realizadas en cuanto al proceso de ajuste a la discapacidad visual.
Case Report of Tuberous Sclerosis with early West Syndrome
Authors: Moura Ludmila Sandy Alves , Arruda André Taumaturgo Cavalcanti , Silva Júnior Mário Luciano de Melo
Published: December 2021

Context: We present a patient diagnosed with Tuberous Sclerosis (TS) who developed West Syndrome (WS) early on. Early diagnosis of TS is important for genetic counseling and WS requires early intervention to avoid neurodevelopmental deficits. Case report: Y.S.L.C., female, 45 days old, presented cardiac rhabdomyoma and 9 hypomelanotic lesions, being diagnosed with TS. At 2 months old, she presented epileptic seizures of flexion spasms, which progressed in 1 week to neuropsychomotor development (NP) regression and hypsarrhythmia. She was diagnosed with WS and treated with vigabatrin. There was suppression of hypsarrhythmic pattern at 8 months old. Currently 8 years old, she has hypochromic stains, hemangiomyolipomas in the right kidney, bilateral renal cysts, sebaceous adenomas, facial angiofibromas, cortical tubers, subependymal nodules, Intellectual Disability and Focal Epilepsy. Conclusions: ET is an autosomal dominant disease caused by mutations in TSC1 and TSC2 genes leading neurodevelopmental changes and cellular hyperplasias. TE diagnosis is clinical, based on major (such as facial angiofibromas, nail fibroma and hypopigmented macules) and minor criteria and molecular tests in doubtful cases. TE is associated with epilepsy in 80-90% of cases (30 to 50% of infantile spasms). WS is an encephalopathy of infantile spasms, NP arrest/regression and hypsarrhythmia. Early diagnosis and use of anti-epileptic drugs are necessary to avoid cognitive impairment.
Ataxic syndrome in a chronic phenytoin user
Authors: Delfim William de Souza , Curti Nayara Christina de Lima , Silva Marília Pires de Souza e , Araújo Lorena Dias , Pastorio Indianara Keila , Domingos Francine de Paula Roberto , Hirayama Sayuri Aparecida , Almeida Rafael de , Filgueiras Raquel de Mattos , João Rafael Batista
Published: December 2021

Introduction: Phenytoin is an anticonvulsant used routinely for about eight decades. However, depending on the dose and plasma concentration, its use may be associated with side effects due to toxicity, such as ataxic syndrome. Case report: We attended a 37-year-old patient, epileptic since childhood, who had been using Divalproate Sodium 250mg 8 / 8h, Phenobarbital 150mg once a day and Phenytoin 100mg 8/8 for a long time. He denied smoking and drinking. He was admitted due to acute rotational vertigo, nausea, motor incoordination and impaired speech and gait, progressing for 7 days. Neurological examination revealed drunken dysarthria, pendular patellar reflexes, signs of axial and appendicular incoordination and ataxic gait. Cranial nerves: there was decomposition of the eye movement and hypometric saccades to the vertical upward look, horizontal nystagmus with alternating phases to the extreme looks. Laboratory exams, cranial tomography with and without contrast, brain magnetic resonance with gadolinium): within the normal range. Given the above, our diagnostic hypothesis was Phenytoin Poisoning. After gradually replacing it, there was a progressive improvement in the neurological condition. His serum level was not determined due to the unavailability of this test in our service. Conclusion: In view of its routine use, excluding other etiologies, this diagnosis should always be remembered.
Thrombolytic Therapy for Acute Bilateral Carotid Artery Occlusion
Authors: Nascimento Igor Abrahim , Disserol Caio Cesar Diniz , Lange Marcos Christiano
Published: December 2021

Context: Acute bilateral internal carotid artery occlusion is a rare condition which is frequently associated with prolonged coma or brain death. There is no consesus on which is the optimal therapy for this condition, although there are reports of clinical improvement after mechanical thrombectomy. We present a case report of a patient treated with intravenous thrombolytic therapy. Case Report: A 82 year-old woman with previous history of hypertension and coronary artery disease presented with seizures, followed by coma. There was no description of focal neurological deficit. On examination, patient was comatous, with decebrate posturing after painful stimulus, bilateral myosis, showed absent oculocephalic reflex and absent corneal reflex on the left eye. CT scan showed diffuse hypodensities on the frontal and parietal lobes and on the superior temporal lobes. CT angiography showed occlusion of the right internal carotid artery and of the left common carotid artery. The patient was treated with 72mg of IV alteplase within 4 hours after symptom onset. There was no improvement after 24 hours. A new CT scan showed infarction of all anterior circulation territory. Diagnosis of brain death was made after 48 hours. Conclusions: Acute bilateral carotid artery occlusion is usually associated with poor outcome despite treatment. Endovenous thrombolytic therapy did not lead to clinical improvement on the presented patient. There is limited data on the efficacy of IV thrombolysis and other recanalization therapies for acute bilateral carotid artery occlusion.
The Effect of Caffeine Consumed Before Competition on Heart Rate, Trigger Squeeze Time and Shooting Score in Air Pistol Athletes
Authors: Diler Kadir , Erikoğlu Örer Gamze
Published: December 2021

Background: Caffeine consumption may adversely affect the performance of athletes in some sports. Aim: The aim of this study was to investigate the effects of caffeine drink consumed before competitions by air pistol athletes on their heart rate, trigger squeeze times and shooting scores. Methods: : In the study, caffeinated and caffeine-free measurements were applied on the same athletes. Following the evaluation, a total of 20 elite athletes, including 10 women with a mean age of 23.6±4.7 and 10 men with a mean age of 25.9±4.8 who had at least 2 years sports history, participated voluntarily in the study. The study was planned as a single blind. All athletes shot 10 times before both measurements. By random method, the athletes consumed Coffee with 3mg/kg caffeine or decaf coffee before the measurement. After 1 week, the same athletes were given coffee which was not given in the previous measurement before the measurement. A total of 80 shots were fired at 15, 30 and 60 minutes after both measurements. Following the evaluation, heart rates, trigger squeeze times and shooting scores of the athletes were recorded. Wilcoxon test to compare the differences between the measurements at two different times on the same group and Mann-Whitney U test to examine the differences in independent groups were used. Results: When the differences between the measurements of all male and female athletes were examined, it was found that there was an increase in their heart rate and trigger squeeze times 15, 30 and 60 minutes after caffeinated coffee consumption, and this difference was statistically significant (p<0.05). Besides there was a significant decrease in 15, 30 and 60 minute shooting scores of female athletes, and 15 and 30 minute shooting scores of male athletes (p<0.05). Conclusion: As a result of the study, it was observed that the use of caffeine had a negative effect on the performance of air pistol athletes. Therefore, it can be said that people interested in air pistol discipline should not consume coffee or caffeine-containing beverages within 1-2 hours before the competition, if they consume, their heart rate will increase and their aiming during shooting will be more difficult and trigger-squeezing times will be extended. Keywords: Air pistol, Caffeine, Heart rate, Shooting
Work Related Physical Health Challenges Faced by Physical Therapists
Authors: Zahid Amna , Rizwan Muhammad , Afzal Farjad , Latif Waqas , Laique Talha
Published: December 2021

Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. Objectives: To find the prevalence of work related musculoskeletal problems among the physical therapist. Study Design: Associational, correlational, causal-comparative. Methodology: The Physical therapists from clinical setups (private and public) in Lahore, Pakistan, were enrolled taking a sample size of 131. The sample size calculated was by keeping margin of error equal to 13% and level of significance equal to 5%. Statistical analysis: Data was analyzed by SPSS software, version 25 as qualitative variables were expressed as frequencies and percentages. Results: There was a significant relation of physical problems related to work of physical therapist as per daily routine of repetitive movements while giving a treatment to the patient. Conclusion: We concluded that experts of the field either switch to the academic side or more preventive nature of job to manage the economic needs along with their profession. Keywords: Work Related Musculoskeletal Disorders and Physical Health Problems.
Prevalence and Risk Factors of Oral Mucosal Lesions: A Retrospective Study of Patients Attending Oral Diagnosis Department of Siohs Karachi, Pakistan
Authors: Akhlaq Humera , Ullah Khan Muhammad Sibghat , Nasir Muhammad , Sheikh Hifza , Mehmood Nosheen , Sajjad Isma
Published: December 2021

Background: The present study was conducted to evaluate the frequency of different types of Oral Mucosal Lesions (OMLs) and to identify the associated risk factors. Methodology: A retrospective study was conducted at the Department of oral diagnosis in collaboration with the department of oral pathology SIOHS, Karachi Pakistan between January 2017 to December 2020. All cases of lesions and ulcers of the oral cavity were included in the study. Missing data were excluded. Diagnosed cases of oral mucosal lesions were documented. The data was then stratified according to the age groups, gender, symptoms, comorbidities, marital status, etc. Results: A mean age of 38.3 ± 11.86 years was observed. The subjects manifested multiple lesions with OSF standing as the most prevalent one at 29%, followed by aphthous ulcers at 20.2%, candidiasis at 14%, and nicotinic stomatitis at 10.4%. The majority of the patients with aphthous ulcers were significantly associated with young age while frictional keratosis was significantly associated with elderly age (p=0.002), respectively. 15 (93.8%) patients who were married were diagnosed with squamous cell carcinoma (p<0.004) and stiffening of the mouth was significantly associated with squamous cell carcinoma (p<0.0001). Conclusion: In conclusion, the increased occurrence of oral mucosal lesions with age is most likely attributable to an age-related decline in health status and is highly correlated to substance abuse; its amount, duration, type, and regularity. Keywords: oral mucosal lesion, carcinoma, gingiva, buccal, maxillofacial, tumor
Change in Glomerular Filtration Rate with Febuxostat in Patients with Advanced Chronic Renal Failure
Authors: Alam Ishtiaq , Usman Sulehri Faheem , Abdul Azim Baig Muhammad , Bhatti Maira , Perveen Fouzia , Arjumand Sabeen
Published: December 2021

Background: Chronic kidney disease (CKD), is defined as progressive loss in kidney function. The study evaluated the mean change in estimated glomerular filtration rate (eGFR) with febuxostat in patients of advanced chronic kidney dysfunction with hyperuricemia. Methodology: A prospective observational study was conducted at the department of Nephrology, Sheikh Zayed Hospital, Lahore for 6 months, from January 2019 to October 2019. At baselines, the blood sample was obtained and sent to the laboratory for assessment of serum creatinine level. The eGFR was calculated by using the MDRD formula. Patients were then advised to take one oral Febuxostat 40 mg daily for 6 months. After 6 months, the blood sample was obtained for assessment of serum creatinine level. Results: The mean age of the patients was 40.72±14.90 years, male to female ratio was 1:1. The mean value of eGFR at baseline was 23.53±11.09 and its mean value at 6th month was 34.28+12.31, which was significant (p<0.001). Conclusion: Febuxostat effectively improved estimated glomerular filtration rate (eGFR) in patients presenting with advanced chronic kidney dysfunction with hyperuricemia. Keywords: Hyperuricemia, Kidney, Disease, Febuxostat, Dysfunction, Glomerular, Filtration
Knowledge & Usage of Personal Protective Equipment for Prevention of Infection Among Frontline Health Care Workers During Covid – 19 Pandemic
Authors: Mahmood Nosheen , Aamir Saima , Akhlaq Humera , Sajjad Isma , Hanif Sajid , Iqbal Kefi
Published: December 2021

Background: The risk of transmission of novel SARS CoronaVirus-2 among health care workers can be reduced using personal protective equipment. It is critical to follow guidelines for appropriate use of protective gear to avoid its wastage. This study aimed to evaluate frontline healthcare workers’ understanding of effective donning and doffing of protective equipment in the wake of recent emergence of corona virus disease.Physical impacts due to its prolonged usage were also identified. Material and Methods: A cross sectional survey was conducted targeting frontline health care workers from June till July 2021. Data was analyzed using SPSS version 24. Descriptive analysis was performed for qualitative variables.Chi-square test was utilized to determine association between qualitative variables and p <0.05 was considered to be statistically significant. Results: A total of 204 responses were received. Surgical masks (53.9%), gloves (51.5%), gowns (46.1%) and N95 respirator (40.7%) were most frequently used. Physicians had better knowledge on correct utilization of protective equipment as compared to non-physicians, p<0.001.Only 55.9% and 47.1% participants knew correct donning and doffing sequence respectively.The most prevalent mistakes while doffingwere touching front of mask and potentially contaminated surfaces followed by incorrect doffing sequence.Mostrespondentsmentioned scarcity of protective gear. Around 53% participants did not attend any training session on utilization of personal protective equipment. Prolonged exposure to masks and gloves led to acne, facial marks and itching. Frequent practice of hand hygiene was linked with skin dryness and cracking, p<0.001. Conclusion: We observed lack of expertise in donning and doffing technique. Mostly mistakes occurred during doffing, so interactive workshops are required to train health care workers.Most common dermatological manifestationsdue to use of masks and gloves included acne, facial markings, and itching. Adverse effects of prolonged use of PPE can be avoided by having shorter duration of working hours and giving rest during the shifts. Keywords: COVID-19; personal protective equipment; skin manifestation; pandemics.
Secretion of Atrial Natriuretic Peptide (Anp), Heart Reconditioning and Remolding in Elite Endurance Trained Athletes
Authors: Wazir Ali Hafeezullah , Aslam Mohammad , Aziz Sohail , Mazhar Hussain Muhammad
Published: December 2021

Aim / Objective: The aim of this study was to evaluate the effect of maximal exercise on the level of cardiac remolding and Atrial Natriuretic Peptide (ANP) in elite athletes as compared to sedentary healthy subjects and correlation of ANP with the adaptation of athlete’s heart and cardiac remodeling (if any) Place and Duration of Study: The present study was carried out at the Department of Physiology, Army Medical College, with collaboration of Armed Forces Institute of Cardiology (AFIC) Rawalpindi from June 2003 to May 2004. Methodology: A total number of 44 subjects were included in this study. These comprised of 22 elite endurance athletes and 22 healthy sedentary volunteers as controls. All subjects were examined clinically to rule out the cardiovascular and pulmonary diseases on the basis of medical history, physical examination, and echocardiography. All the selected subjects were examined on a Toshiba Power Vision 6000 echocardiograph for assessing and measuring their LV end-diastolic internal diameter (LVIDd), Diastolic interventricular septal thickness (IVSTd), diastolic posterior wall thickness (PWTd). The left ventricular mass was (LVM) was calculated by using the Devereux formula. They were subject to go for ergometer cycle exercise before breakfast. The Blood samples were drawn before and after exercise to assess the level of ANP in their samples. Results: It was found that LVIDd, IVSTd, PWTd, LVM were higher in athletes as compared to their age, sex and BMI matched controls. The ANP levels in athlete’s plasma were also high in post and pre exercise sample as compared to controls. Conclusion: Systolic blood pressure, Diastolic Blood Pressure and heart rate are lower in endurance elite athletes than matched sedentary controls. The maximal Exercise increases the level of Atrial Natriuretic Peptide (ANP) in elite athletes significantly as compared to sedentary healthy controls. There was a Positive correlations between ANP and LVIDd, IVSTd, PWTd, and LVM while there was negative correlation between ANP and heart rate, ANP and Blood pressure. However, none of correlation was found to be statistically significant. Keywords: Athlete’s Heart, ANP, Cardiac remodeling in athletes, Echocardiography of heart
Harapan dan Tantangan Implementasi Pembelajaran IPA dalam Konteks Kompetensi Keterampilan Abad 21 Di Sekolah Menengah Pertama
Authors: Andayani Yayuk , Sridana Nyoman , Kosim Rernat , Setiadi Dadi , Hadiprayitno Gito
Published: December 2021

Ketrampilan Abad 21 yang dianggap bisa memperkuat modal social (social capital) dan modal intelektual (intellectual capital) ini, biasa disingkat dengan 4C: communication, collaboration, critical thinking and problem solving, dan creativity and innovation. Secara operasional, 4C ini dapat dijabarkan sebagai cara berpikir, termasuk berkreasi, berinovasi, bersikap kritis, memecahkan masalah, membuat keputusan, dan belajar pro-aktif. Juga termasuk cara bekerja, termasuk berkomunikasi, berkolaborasi, bekerja dalam tim sehungga dapa mendukung dan mengembangkan ketrampilan abad 21, yakni teknologi informasi, jaringan digital, dan literasi. Konsep 4C ini diharapkan dapat diimplementasikan di sekolah-sekolah dan para peserta didik Indonesia terbekali dengan keutamaan-keutamaan tersebut, yakni komunikasi, kolaborasi, berpikir kritis dan pemecahan masalah, serta kreatif dan inovatif. Kegiatan pembelajaran IPA di Sekolah Menengah Pertamadiharapkan mampu memberdayakan semua potensi peserta didik untuk mendorong pencapaian kompetensi dan perilaku khusus supaya setiap individu mampu menjadi pembelajar sepanjang hayat dan mewujudkan masyarakat belajar. Dengan demikianguru diharapkan mampu mengimplementasikan metode pembelajaran yang inovatif (students-centered), maka peran guru tidak lagi sebagai pentransfer ilmu, melainkan sebagai fasilitator atau membantu siswa agar siswa mampu menguasai berbagai kompetensi yang diharapkan.Kata Kunci: Pembelajaran IPA, kompetensi keterampilan abad 21, Kurikulum 2013
El metotrexato en uso compasivo mejoró la neumonía y miocarditis aguda en un paciente con COVID-19
Authors: Linarez Nery E. , Lavadie Rivas Francisco , Reyes Irma , Durón Reyna M. , Rodríguez Gaspar
Published: December 2021

Tomografía computarizada de tórax de un paciente hondureño de 26 años con COVID-19 y neumonía moderada (A). Por escasez de tocilizumab, se hizo uso compasivo de metotrexato (MTX) en dosis única intravenosa de 25 mg el día 11º de la enfermedad y bajo monitoreo de una comisión ética ad hoc. Dos semanas después de la mejoría clínica inicial, desarrolló miocarditis aguda con bloqueo auriculoventricular (B). Hubo remisión después de una segunda dosis del fármaco (C, D). El MTX es bien conocido por su uso en varias afecciones oncológicas y autoinmunes, así como por su potencial para reducir la fosforilación de JAK1/STAT3 y la expresión de la IL6. Varios reportes sugieren que el MTX podría reposicionarse como terapia para la tormenta de citocinas producida por el SARS-CoV-2.
Una guía para el diseño y evaluación de actividades de educación médica continua
Authors: Solano Velásquez Jhiamluka Zservando , Chang Montes Meihmy , Cruz Girón Victoria A. , Ramírez Óscar
Published: December 2021

Introducción. La Educación Médica Continua (EMC) consiste en un conjunto de actividades que permite a los profesionales actualizar sus competencias clínicas y mejorar su desempeño. Sin embargo, su metodología requiere de un proceso de actualización, con el fin de diseñar actividades que logren desarrollar nuevas competencias en los médicos que han concluido su formación de pregrado y postgrado. Métodos. Se llevó a cabo una revisión de la literatura, con el fin de diseñar una guía práctica metodológica para uso de todas las instituciones y asociaciones facilitadoras de actividades de EMC en Honduras. Se realizó búsqueda bibliográfica de artículos y estudios científicos en PubMed, The Lancet, SciELO y se utilizaron términos de búsqueda como educación médica, EMC, competencias médicas, entre otros. La búsqueda se limitó a los artículos en español e inglés publicados entre el año 2011 y noviembre del 2021, con excepción de un artículo que fue incluido por su relevancia en el tema. Desarrollo. Se definieron tres etapas para el diseño, desarrollo y evaluación de actividades de EMC. Estas tres etapas (pre-evento, evento, post-evento) se basaron en la pirámide de Miller que describe el proceso de desarrollo y evaluación de competencias en educación médica. Conclusión. La guía propuesta ilustra los pasos necesarios para planificar de manera efectiva, mediante diferentes etapas, actividades de EMC procurando lograr el impacto académico deseado. También puede ser utilizada por las diferentes instituciones académicas, servicios de salud y sociedades médicas para diseñar de manera efectiva sus programas académicos continuos del personal médico.
Escalando tecnologías de intensificación agrícola: un camino hacia la mejora de los sistemas de producción
Authors: Enríquez Jean Pierre , Ader David
Published: December 2021

Actualmente, el sistema de producción se ha caracterizado por estar integrado predominantemente de pequeños agricultores, en su mayoría de países en vías de desarrollo. Sin embargo, existe un gran porcentaje que no cuenta con acceso a servicios de extensión agrícola, insumos y crédito. Esto genera que el avance del proceso de desarrollo agrícola para el pequeño productor disminuya, incluso cuando ya existan tecnologías potenciales para su entorno. Un camino para volver más accesibles las tecnologías agrícolas es mediante el escalamiento tecnológico. Esto necesita la incorporación de los procesos de comunicación y extensionismo y así poder lograr la adopción de una innovación. Además, es oportuno interrelacionar dichos procesos con el objetivo de lograr una mayor participación de los productores. De esta manera se asegura que la información ha sido transmitida en términos conocidos para el productor. Las escuelas de campo son un medio educativo que ha servido para informar, generar interés y adoptar tecnologías facilitando la capacitación de los productores en su entorno habitual. Por lo cual, se necesita compartir y promover los conocimientos adquiridos en el campo y así abrir el camino a la innovación agrícola. Sin embargo, muchos de estos proyectos aún se encuentran en fase piloto y es necesario buscar su escalamiento para obtener mejoras en la cadena productiva.