bluuebunny/crossref_metadata_2025 huggingface dataset:
Health profile of workers in an industrial area of Thrissur district: a cross-sectional study
Authors: Abraham Ruth , Abraham Ruth , Vijayan Sajna Mathumkunnath
Published: April 2021

Background: Rapid unplanned industrialization is creating serious problems for the human environment. Worse and directly affected in this process are the industrial workers. The purpose of the study is to assess the health profile of workers in an Industrial area of Thrissur district and to compare the morbidity profile of industrial workers from native Kerala and migrants.Methods: A cross-sectional study was conducted in the industrial area of Thrissur district for a period of six months. Cluster sampling was done. Among the total industries in the industrial area of Thrissur, one industry was selected using the lottery method. All the workers in that industry were included in the study. After establishing a rapport, data was collected using a semi-structured interview schedule from the participant using questionnaires.Results: Among 246 workers interviewed, 79.3% were males. 43.9% of participants were from Kerala, 37.4% Orissa, 10.4% Bihar and the rest from other states of India. 30.9% of participants were obese, 17.9% overweight and 8.5% underweight. Other morbidities were refractory error (46.7%) and hypertension (30.5%). Overweight and obesity were significantly more among workers from native Kerala compared to migrants (p=0.001). History of injuries was reported by 10.6% of workers.Conclusions: The high proportion of obesity and hypertension detected among workers was alarming. Interventions at various levels (host, vector, and environment) are likely to produce a lasting impact on industrial worker's health.
Situation analysis of medical laboratories in primary health centres
Authors: Suberi Radhika S.
Published: April 2021

Background: This study was conducted with the objective to assess the medical laboratories attached with primary health centres (PHCs) focusing on the current needs, gaps and to understand the utilization pattern of the laboratory services. There are hardly any relevant studies that are known to have investigated the functioning of laboratories attached with PHCs based on quality of service they are providing.Methods: This study was a cross sectional study based on observations and assessment made at 33 randomly selected medical laboratories attached with PHCs in Ahmedabad district, Gujarat. Checklist adapted from National Quality Assurance Standards (NQAS) and Indian Public Health Standards (IPHS) were used as a tool for data collection.Results: Though all the laboratories have been found to be functioning effectively based on the indicators in this study, some of the laboratories were not performing basic important tests like rapid plasma reagin (RPR) (18%) and hepatitis B surface antigen (HbSAg) (21%). None of the laboratories attached to the PHCs under study performed Widal test. There was very low utilization of urinary pregnancy test (UPT) (1.81%) in the first quarter of the year.Conclusions: Although most of the indicators reflect satisfactory performance of the laboratories, there exists certain gaps and needs that are essential in provision of quality laboratory services in the primary level of health care. The laboratory information management system (LIMS) was the major issue in the laboratories.
Associates of prevalence of depression among urban elderly of Kendujhar district: a study in Odisha, India
Authors: Barik Debasmita , Panda Bharati
Published: April 2021

Background: There is wide variation in the estimated prevalence of depressive disorder among older in India. The estimated prevalence of depression in India is ranging from 6 to 80% depending on various factors of population studies. The present research is an attempt to assess the factors associated with depression among elderly in urban area.Methods: A descriptive study was carried out among older in urban area of Kendujhar district of Odisha, India with sample size 150 by random sampling method. A pre-structured questionnaire containing socio-demographic data sheet and geriatric depression scale (GDS) was used.Results: The overall depressive symptom among elderly was reported to be 66%. Socio-demographic factors such as 70-75 age group, female sex, illiteracy, low education, widowhood and no personal income were significantly associated with depression (p<0.05), where no significant association existed between depression and family income as well as family type. The results showed high significant association of meditation, yoga and exercise with depression. Activity such as marketing and record keeping were positively associated with depression (p<0.05), where no significant association of depression with gardening, cooking and cleaning (p>0.05). Health problems such as weakness, leg pain, knee pain and medical illnesses such as cataract and tuberculosis were positively associated with depression. The findings show depression was not significantly associated with gardening, cooking, cleaning back pain, shoulder pain, headache and asthma (p>0.05).Conclusions: A majority of participants are having depression (66%). There is need to identify and diagnose the problems of aged in urban area and start treatment earlier as possible.
Physical health impairment, disability and suicidal intent among self-harm survivors in South India
Authors: Majgi Sumanth Mallikarjuna , Jones Steven , Taylor Lou , R. Somashekar , Nagaraj Santhosh , U. Bharath D. , Krishna Murali
Published: April 2021

Background: Suicide is major public health concern in India. There are limited data examining the relationship between health impairment, disability and severity of suicidal intent. The aim of the study was to examine the associations of health impairment and disability with severity of suicidal intent among survivors following an act of self-harm.Methods: A pilot exploratory study of 453 self-harm survivors from a specialist hospital in South India. Socio-demographics, physical health impairment, disability (WHO Disability Schedule-II), suicidal intent, (Pierce suicide intent scale) and mental disorders were studied.Results: Arthritis was the most common physical impairment among self-harm survivors followed by gastrointestinal, sensory impairment and difficulty with mobilization. Nearly 10% of participants had some degree of functional impairment, with 38% experiencing severe physical pain in the week prior to self-harm. Past history of depression treatment, age, education and occupation influenced positively PSIS scores. There were significant associations between suicidal intent and disability.Conclusions: Indian self-harm survivors indicated complex relationships between physical health, disability and suicidal intent. Understanding these associations may help to develop suicide prevention strategies. Our findings suggest a need for integrating a comprehensive of physical health assessment in self harm survivors.
Pharmacoepidemiological assessment of endocrine disorders in a tertiary care teaching hospital
Authors: M. Binu K. , Johny Jenil , Hiremath Doddayya
Published: April 2021

Background: The endocrine disorders such as diabetes mellitus, hypothyroidism and hyperthyroidism along with world’s ageing population has increased the burden of health care systems. The present study aimed to assess the prescribing pattern of drugs in endocrine disease like diabetes and thyroid disorder and to evaluate the drug use in given healthcare against programmed criteria and standards.Methods: A prospective observational study was conducted in 220 patients over six months in a tertiary care teaching hospital. Patients who are diagnosed with endocrine disorder in various (general medicine, surgery and Orthopedics) inpatient departments of study hospital.Results: A prospective observational study was carried out by reviewing prescriptions of 220 patients with lifestyle disorders such as, DM (120), hyperthyroidism (50) and hypothyroidism (50). In diabetes, most of the patients were prescribed with biguanides 75 (47.17%) followed by sulfonylureas 56 (35.22%), alpha-glycosidase inhibitors 20 (12.58%), dipeptidyl peptidase 4 inhibitors 5 (3.14%), meglitinides 2 (1.26%) and thiazolidinediones 1 (0.63%). Most of the prescription containing insulin Actrapid and insulin Mixtard 14 (82.35%) followed by insulin Actrapid and insulin NPH 2 (11.76%), insulin Mixtard and insulin Glargine 1 (5.89%). In hypothyroidism most of the patients were prescribed with propylthiouracil 28 (56%) followed by methimazole 26 (44%). Levothyroxine is the best choice of drug for hypothyroid disorder.Conclusions: Our study found that treatment and management of endocrine disorders were not rational. There is a need of clinical pharmacist involvement for a better patient care in these disorders.
Post exposure prophylaxis for HIV among healthcare workers due to occupational exposure: a record based study at a tertiary care teaching hospital of Kolkata
Authors: Sarkar Paramita , Lahiri Saibendu Kumar
Published: April 2021

Background: Healthcare workers (HCWs) regularly face the risk of exposure to sharp injuries and splashes as an occupational hazard, which presents major risk for acquiring blood-borne infectious agents like human immunodeficiency virus (HIV) which can be minimized by taking post exposure prophylaxis (PEP) measures. There are limited studies from India documenting details of PEP for HIV. This record-based study aimed to determine the occurrence of needle stick injuries (NSIs) and other high-risk occupational exposures to blood and body fluids (BBFs) among HCWs in a tertiary care hospital, Kolkata. We aimed to study details of PEP regimens used among HCWs exposed to HIV.Methods: Hospital record was analyzed from reported incidences of occupational exposures to BBFs occurred during the period of October 2013 to March 2019. Information on self-reported incidence of occupational exposure, and post-exposure management were collected.Results: A total of 105 incidents of occupational exposure were registered during study period. Interns (37, 35.2%) were most frequently exposed, followed by physicians (22, 21.0%) and nurse (21, 20.0%). 88 (83.8%) of the personnel sustained NSIs, and 17 (7.2%) had splashes to skin, mucus membranes. There was no significant difference between subjects with splashes to skin, mucus membranes and needle-stick cases regarding discontinuation of post exposure prophylaxis (PEP) (11.8% versus 19.3%, p<0.548). No cases of sero-conversion were reported.Conclusions: In spite of high incidences of exposures to HIV source, good efficacy of PEP was observed with no sero-conversion. PEP for HIV was well tolerated. Study emphasized the need for creating awareness about timely reporting of incidence.
Patient’s experience of telemedicine during COVID-19 pandemic in a tertiary care centre in North India: a telephonic survey
Authors: Gupta Amit Kumar , Paul Sourabh , Soni Annanya , Kumar Pramod , Nath Banashree , Jotdar Arijit
Published: April 2021

Background: Unprecedented situation of COVID-19 pandemic and measures to contain spread of the disease has expanded the horizon of health care delivery utilizing the telemedicine into the clinical practice. To understand the patients’ preferences for future incorporation of telemedicine practice into the health care system, we conducted a survey via telephone/WhatsApp.Methods: A structured survey questionnaire was administered via telephone/WhatsApp to patients attending telemedicine consultation.Results: Total 463 patients participated in the survey. Participants having favorable attitude was 237 (51.3%) and not in favors were 225 (48.7%). Among the respondents, the most common reason to choose Telemedicine was due to COVID 19 risk (70%), whereas monetary benefits were reported by only 2% of respondents. 297 respondents were of the opinion that they will continue to use tele-consultation services even after the pandemic.Conclusions: Patients reported satisfactory response using telemedicine during COVID-19 pandemic, but felt the need of physical examination at least during first consultation. Telemedicine may be suitable for screening, medium-term and long -term follow up. Easy and cheap availability of internet is also an issue particularly in low income and rural population.
Difference between breast milk jaundice and breast-feeding jaundice: literature review
Authors: Shihab Rabie Abdul Hakim , Samman Ahmed Mohammad Bin , Aqeel Fotoun Abubaker , Ghabrah Ziyad Tawfik , Ghabrah Omar Tawfik , Ghannam Abdullah Nizar , Alasmari Abdulrahman Hassan , Abahussain Hessa Abdulkareem , Alsulami Abdulaziz Abdulrhman , Alamri Samia Mhros , Babader Rawan Abdulrahman , Aljehani Doaa Ahmed
Published: April 2021

Evidence shows that the different etiologies of neonatal jaundice, including breastfeeding and breast milk jaundice, have many different aspects. Therefore, the present study aims to conduct a literature review to compare breastfeeding and breast milk jaundice, ehich will furtherly help physicians and healthcare practitioners to have adequate information to properly establish an accurate diagnosis. The precise cause of breast milk jaundice is unclear. The majority of the suggested etiologies include factors found in human breast milk. Other theories point to possible genetic defects in the infected neonates. It has been reported that pregnane-3a,20ß-diol, epidermal growth factor, interleukin (IL)1ß, alpha-fetoprotein, and ß-glucuronidase are several factors that are solid constituents of the breast milk which may attribute to the development of this jaundice. Reports showed that breast milk jaundice usually develops in 20-30% of U.S. neonates, and most of whom are breastfed. Moreover, studies showed that more than one-third of infants on breastfeeding will eventually have high serum bilirubin levels that are ≥5 mg/dl. Evidence showed that the diagnosis should be considered when the levels of serum bilirubin exceed 5 mg/dl. Breast milk jaundice will usually fade away with no interventions, and in some cases, phototherapy inauguration and breast milk discontinuation might be needed. In breastfeeding jaundice, serum bilirubin levels usually peak within the first five or six days of life due to wrong or inadequate breastfeeding practices, and the management should be done by correcting these habits, while phototherapy might be applied when the bilirubin levels exceed 18-20 mg/dl.
Psychology of pandemics and fear of epidemic
Authors: Uddin M. Naveed , Uddin Mohsin
Published: April 2021

Infectious outbreaks have stirred the psychological health and mental wellbeing of individuals on a global basis. It is evident from the 1918 influenza in addition to the current COVID-19. Psychological factors are significant for comprehension and overseeing cultural issues related with pandemics, like the spreading of extreme dread, anxiety, and xenophobia that happen when individuals are compromised with infection. The research aims to identify how the COVID-19 pandemic has affected individual’s psychological wellbeing and how the psychodynamic approach can resolve such an issue. Developing a sense of detachment from oneself and the growing fear of being infected significantly affects an individual psychological wellbeing. This analysis concentrates predominantly on applying the psychodynamic approach to ascertain individual’s psychological threats during the COVID-19 crisis. This research focuses on revealing the variations generated from the psyche of individuals due to the COVID-19. It also aims to highlight the impact that COVID-19 have created on the mental health of individual beings. Moreover, the pandemic consequence on the individual’s overall lifestyle has discussed in the study.
Bone and mineral disorders among Saudi diabetics
Authors: Akhtar Muhammad Mahmood , Alghamdi Abdulaziz Saad , Alshehri Abdulrahman Mohammed , Alfaraj Hussain Zaki , Alshamrani Abdullah Mohammed , Althagafi Anoud Abdulrazzag , Bahanshel Elaf Abdulqader , Aljunaid Muataz Abdulmoghni , AlAjlani Mohammad Abbas , Al-Khathami Mohammed Ali , Alqahtani Mohammed Mana
Published: April 2021

Increasing bone and mineral changes which caused by both diabetes type 1 and type 2 can raise fracture risks for a period of time during illness and low blood sugar levels. The connection between diabetes and bone fragility is further complicated by the variable effects on the skeleton by various diabetic medications. Diabetic patients are at a higher risk of bone and mineral density alterations, osteoporosis and fragility fractures. Diabetic patients are often susceptible to develop various conditions due to malnutrition, uncontrolled blood sugar and lack of proper follow up regiment. Diabetics should be tested for osteoporosis risk and given effective prevention strategies. Preventing osteoporosis would require interventions such as sufficient vitamin D and calcium intake, physical exercise and exposure to sunlight.
Awareness about the carcinoma breast and the practices related to self- breast examination among women in developing countries
Authors: . Shipra , Kumari Reema , Singh G. N.
Published: April 2021

The aim of this review article was to evaluate the awareness of carcinoma breast and practices related to self- breast examination among women in developing countries. The study included the exploration of databases and journal websites, pub med, google scholar, and medline. The articles studied for the review were focused on english language articles from the year 2013 to 2019. This review focused on knowledge of breast cancer and its risk factors among women. Fifteen articles were reviewed on this topic from the year 2013 to 2019 in which general awareness level of breast cancer was probably better than the knowledge of risk factor, sign and symptoms. It also shows that although awareness and knowledge regarding Breast cancer was satisfactory but the knowledge of self-breast examination was low and practice of self-breast examination was least in developing countries. So, awareness programs related to breast cancer should be planned, to ensure early detection and timely treatment for better outcome.
Effectiveness of hand splints on upper limb skills and functional activities in children with cerebral palsy: a review
Authors: Kumari Rohina , . Surbhi , Saharawat Sakshi
Published: April 2021

Cerebral Palsy is a non-progressive neurological disorder in which children may experience similar physical limitations, including those related to upper limb skills that affect the child's ability to participate in age-specific activities. The use of hand-splints in children with neurological conditions is little reported, they continue to be widely used to improve upper limb skills and functional activities. This review was done to investigate the use and effects of hand splints in Cerebral Palsy patient as orthotic treatment found to be very positive result in correcting and maintaining the achieved results. Electronic database search was conducted using Google scholar, Science direct, Pub Med, Cochrane Library and reference lists from all retrieved articles. Common problems in upper limb due to CP are flexion contractures of the fingers and wrist due to spasticity, pronation deformity of the forearm, thumb-in-palm deformity and hand-related disabilities, all lead to decrease in grip and muscle strength. Hand splints are often used to help a weak or ineffective joint or muscle to enhance a person's arm or hand posture, mobility, quality of motion, and function. The findings suggest that children with CP experience increased grip strength and fine motor dexterity when using different hand splints. This review summarizes the present state of understanding the extent to which orthotic management in CP can improve in the patient’s skills and functional activities by improving the muscle strength and hand function, also offers clinical suggestions for prescribing orthosis in order to optimize efficacy.
Trend in the variation of sensitization of the European standard battery allergens over 26 years
Authors: Brahem Aïcha , Gaddour Asma , Bouhlel Mohamed , Chouchane Asma , Aloui Asma , Kacem Imen , Maoua Maher , Kalboussi Houda , ElMaalel Olfa , Chatti Souhaeil , Mrizek Najib
Published: April 2021

Background: Epidemiological monitoring of sensitization rates to common allergens and identification of emerging allergens are needed to assess preventive measures. The aim of this study was to assess trends in the frequencies of sensitization to the different allergens in the European standard battery over a 26 year period from 1989 to 2015.

Methods: It’s a descriptive study of the trend of sensitization to BSE allergens over a period of 26 years, at the dermato-allergology unit of occupational medicine department of Farhat Hached university hospital-Sousse (Tunisia), based on the results of patch tests of all patients who consulted the unit between 1989 and 2015.

Results: During the study period, 1716 patients were patch tested, 48048 patch tests were performed with 886 positive tests to at least one allergen (51.6%). Between 1989 and 2015, the number of positive patch tests has shown a significantly positive trend with an annual percentage change (APC) of 10.03% (p<10-3). However, the overall frequency of sensitization to BSE allergens decreased with an APC of -0.87%, p=0.2. The APC of chromium sensitization was -2.57% (p<10-3). The frequency of cobalt sensitization showed a non-significant decrease (APC=-0.28%, p=0.9). The frequency of nickel sensitization increased with an APC of +2.7%, p=0.1). Overall, there was a statistically significant growth between 1989 and 2015 in the BSE preservatives sensitization trend with an APC of +5.54% per year (p<10-3). The frequency of sensitization to mix fragrances increased from 2004 to 2015, with a significantly positive trend (APC=+24.33%, p<10-3).

Conclusions: Although the frequency of some BSE allergens sensitization tends to decrease, it remains high. Consistent preventive measures should be focused, mainly on sensitization to perfumes and preservatives used in the cosmetic industry.
A comparative study of efficacy of oral itraconazole, terbinafine and fluconazole: a clinical trial
Authors: Koregol Savita C. , Naik Soumya R. , Hosthota Abhineetha , Koregol Arati C.
Published: April 2021

Background: Keeping in view the rising number of cases of dermatophyte infections and also poor response to topical drugs, this study was conducted with the intention to arrive at a conclusion regarding the best available systemic drug.

Methods: A total of 270 patients were selected for the study. 90 patients were assigned to each group under itraconazole, terbinafine & fluconazole.

Results: It was found that itraconazole was the most effective drug which led to a considerable decrease in erythema, peripheral spread, scaling and spread to other body sites. Next drug to be the most effective was terbinafine, which was followed by fluconazole.

Conclusions: We finally arrived at a conclusion that itraconazole is the most effective drug for all types of superficial fungal infections. It was followed by terbinafine & fluconazole in terms of drug effectiveness. Hence in this study we advocate the use of itraconazole as first line of drug in all patients of tinea infections.

 
Clinico-epidemiological study of chronic leg ulcers in a tertiary care referral center from Tamil Nadu, India
Authors: Kaliyaperumal Damayandhi , Jagadeeshkumar Govardhan , Kanagaraj Preethi , Chandran Vijayabhaskar
Published: April 2021

Background: Leg ulcer is a common ailment of elderly presented with complex dermatological conditions. It may occur as a sequel to infection, malignancy, adverse drug reaction, trauma and hematological disorders. The paucity of data on the prevalence and outcome of the chronic leg ulcer in India served as a basis to conduct this clinico-epidemiological study. To study the prevalence of leg ulcers in a tertiary care referral hospital.

Methods: In this cross-sectional study, 100 patients with leg ulcer attending the dermatology OPD at Madras medical college, Chennai, were enrolled after obtaining their consent. Detailed case history of each patient was recorded. Routine clinical investigations, Doppler study and culture were done to detect associated complications. In this study, 58 males and 42 females, with the mean age of 42.01±14.302 years, mean duration of leg ulcer of 17.79±29.87 months were recruited.

Results: Venous ulcer (37%) was the most prevalent type of leg ulcer recorded in our study. Doppler study revealed that the 31% of venous ulcers patients developed perforator incompetence.  Staphylococcus aureus was the major microbe isolated from the lesions (27%).

Conclusions: Chronic leg ulcers are very common in elderly patients and venous ulcer being the most common. Doppler is an effective tool for the assessment of disease severity of venous ulcers and aided in offering the adequate management of the disease. Diagnosis of underlying causes such as pyoderma gangrenosum, autoimmune diseases, malignancies and bacterial culture from the wound will be helpful for the management of the disease.
Visible disability as a presenting feature of leprosy: a rare but real concern in post-elimination phase in India
Authors: Belgaumkar Vasudha A. , Chavan Ravindranath B. , Deshmukh Nitika S. , Gangode Dhanshri D.
Published: April 2021

Leprosy (Hansen's disease) is a chronic infectious disease caused by Mycobacterium leprae, affecting mainly peripheral nerves and skin. Delayed diagnosis contributes to sensory-motor impairment leading to deformity and disability, thereby imposing a major impact on the physical, social, economic and psychological domains of the quality of life of affected individuals. Deformities and disabilities are largely preventable complications associated with tremendous social stigma and discrimination, assuming public health significance. India declared elimination of leprosy more than a decade and half ago in 2005. Hence, grade 2 disability is expected to be a rare manifestation in the post-elimination era. However, to the contrary, the proportion of new leprosy patients with visible disability recorded in India exceeds the global rate. Herein we report a middle-aged female presenting with saddle nose, bilateral fixed ulnar and mobile median claw hands (grade 2 disability) with multiple trophic ulcers. This case emphasizes that clinical suspicion after careful examination of skin and neural manifestations is of utmost importance for the early diagnosis of leprosy. Timely self-reporting and management with WHO-multi drug therapy (MDT) remains the key to minimize the risk of deformity and disability. Above all, it is essential to create awareness amongst the community regarding prompt recognition of symptoms and easy access to appropriate care along with intensified efforts to address the associated stigma.
A review of literature of polymorphic eruption of pregnancy
Authors: Vadakkumpadam Mohammed Haneefa , Abualiat Abdullah Saeed , Sabrah Tameem Abdullah
Published: April 2021

Polymorphic eruption of pregnancy (PEP), also known as pruritic urticarial papules and plaques of pregnancy [PUPPP] is the most common of all the specific dermatoses of pregnancy. It is a benign, self-resolving, pruritic disorder of pregnancy, usually affecting primigravida during the last trimester of pregnancy or immediately postpartum. Its exact pathogenesis is still unknown, and its clinical presentations are variable. It may mimic many common dermatoses. In PEP, the histological findings are non-contributory and the laboratory results, including direct and indirect immunofluorescence are negative. Diagnosis mainly depends on clinical findings. Significant diagnostic confusion may occur with early lesions of pemphigoid gestationis, which needs to be differentiated from PEP as the former may have a bad fetal outcome. PEP is not associated with any fetal or maternal risk, and symptomatic treatment is all that is usually required. The awareness of this condition helps the physician recognize this entity, reassure the patient, and avoid unnecessary investigations. This review focuses on etiology, various clinical presentations, differential diagnosis, and management of PEP.
Ubicación de empresas del sector comercio en Bogotá en 2015:
Authors: Cabrera-Moya Diego Rafael Roberto , Prieto-Rodríguez Germán Alfonso
Published: April 2021

El texto se basa en la tesis doctoral adelantada por uno de los autores en el marco del Doctorado en Ciencias de la Dirección de la Universidad del Rosario en Bogotá, Colombia. En la investigación se estudió la relación entre el desarrollo del sistema de transporte BRT de la ciudad y las decisiones de localización que toman las empresas en Bogotá. Allí se comprueba la dinámica evolutiva de la ubicación de las empresas y la morfología urbana de la ciudad durante los años 2005, 2010 y 2015.
En este artículo se presentan los resultados de la evaluación del índice I de Moran como evidencia de la tipología de distribución para las empresas del sector comercial en el año 2015. Esta evaluación analizada en conjunto con resultados obtenidos mediante el uso de otros indicadores de distribución espacial permite afirmar que, la figura de distribución urbana que en la década de los años 70´s del siglo XX correspondía a la categoría de monocentrismo y que al inicio de los años 2000 correspondía a la categoría de policentrismo, en al año 2015 se había transformado respondiendo a los principios de la categoría que en la literatura se conoce como policentrismo especializado. Esta categoría se considera como un indicador de presencia de dinámicas de aglomeración empresarial en la ciudad.
Como conclusión se destaca que los resultados el estudio demuestran la hipótesis cuya verificación se anuncia en el título y que a su vez se convierte en el planteamiento del problema: la ciudad de Bogotá y en particular las empresas del sector comercio evidencia la presencia de dinámicas de aglomeración, respondiendo a los principales postulados de esta teoría.
A Dual Frequency Compensation Technique to Improve Stability and Transient Response for a Three Stage Low-Drop-Out Linear Regulator
Authors: Slamti Anass , Mehdaoui Youness , Chenouni Driss , Lakhliai Zakia
Published: April 2021

A novel internal compensation technique named dual frequency compensation is proposed to improve the stability and the transient response of the on-chip output capacitor three stage low-drop-out linear voltage regulator (LDO). It exploits a combination of amplification and differentiation to sufficiently separate the dominant pole from the first non-dominant pole so that the latter is located after the unity gain frequency regardless of the load current value. The proposed LDO regulator is analyzed, designed, and simulated in standard 0.18 µm low voltage CMOS technology. The presented LDO regulator delivers a stable voltage of 1.2 V for an input supply voltage range of 1.35-1.85 V with a maximum line deviation of 4.68mV/V and can supply up to 150mA of the load current. The maximum transient variation of the output voltage is 54.5 mV when the load current pulses from 150mA to 0mA during a fall time of 1µs. The proposed LDO regulator has a low figure of merit compared with recent LDO regulators.
Finite Element Simulation for Electric-Car Chassis Development from Scratch
Authors: Wikarta Alief , Shiddieqy Rizaldy Hakim Ash , Khosmin  , Sidharta Indra
Published: April 2021

Indonesian engineers need to design and build their electric car chassis from scratch. These cars need to possess high torsional stiffness and maximum Von Mises Stress value. Therefore, this determines the value of Torsional Stiffness and Von Mises Stress from an electric car scratch chassis using Finite element simulation. A twist load was placed in front, with back support used to determine the torsional stiffness. The stress was analyzed using three types of loading, namely; vertical, lateral, and braking. Meanwhile, the JIS G 3141 galvanized plate with a thickness of 1 mm and 1.2 mm from Indonesia's marketplace was the chassis material used. The simulation results showed that the maximum Von Mises Stress value with a thickness of 1.2 mm produces safe strength, with a torsional stiffness of 11735 Nm/deg. In conclusion, the rigidity and strength of the chassis with a plate thickness of 1.2 mm is in a proper category. Furthermore, this chassis can be used for the development from scratch of an electric car.
Derecho a la salud: un modelo para la determinación de los contenidos mínimos y periféricos
Authors: Ronconi Liliana M.
Published: April 2021

El derecho a la salud ha sido fuertemente reconocido por los tribunales argentinos, pero lo cierto es que solo goza de dicho derecho quien tiene posibilidad de acceder a la justicia. Por lo tanto, los grupos tradicionalmente excluidos, que por diferentes motivos no pueden hacer oír sus reclamos en sede judicial, no se benefician con el reconocimiento logrado hasta ahora en las diferentes resoluciones judiciales. Teniendo en cuenta estas prácticas desigualitarias institucionalizadas se plantea aquí un modelo que implica entender el derecho a la salud como verdadero derecho. Para esto se realiza una distinción entre el derecho a la salud como regla (en lo que se refiere al contenido mínimo o esencial de dicho derecho) y el derecho a la salud como principio (respecto del contenido periférico), demostrándose así cómo el derecho a la salud considerado como regla y como principio podría llegar a otorgar mayor igualdad en el reconocimiento de este derecho respecto de los grupos desaventajados, que carecen de acceso a la justicia.
Notas sobre infancia y teoría: un enfoque latinoamericano
Authors: Bustelo Graffigna Eduardo
Published: April 2021

Este trabajo tiene como objetivo introducir y revisar algunas alternativas teóricas históricamente relevantes y plantear ciertos delineamientos que permitan desarrollar un enfoque teórico latinoamericano basado en un nuevo discurso sobre la infancia y la adolescencia. Para comenzar a elaborar un enfoque latinoamericano, entendiendo la categoría infancia como una construcción histórica y social, se parte de las aportaciones del enfoque estructural (en particular, el carácter de categoría permanente, su dimensión relacional respecto de la adultez y su dimensión histórica e intercultural) y las contribuciones de Foucault y Deleuze con el concepto de sociedad de control asociado a la categoría de dominación, muy propia del pensamiento latinoamericano. El texto corresponde a la conferencia presentada en el V Congreso Mundial por los Derechos de la Infancia y la Adolescencia realizado en San Juan, Argentina, entre el 15 y el 19 de octubre de 2012.
Tendencias sociales de la enfermedad de Chagas para las próximas décadas
Authors: Pinto Dias João Carlos
Published: April 2021

La existencia de la enfermedad de Chagas humana se considera el resultado de un conjunto complejo de determinantes bioecológicos y sociales. Su cumbre de incidencia se produjo entre los años 1950 y 1970, observándose una tendencia a la disminución en las décadas siguientes. Innumerables elementos socioculturales y políticos están presentes también en la expansión geográfica de la enfermedad, en su prevención y en la atención médica a los infectados. Para las próximas décadas se espera una mayor reducción de la transmisión, especialmente vectorial y transfusional, como producto de las acciones de control y de los cambios en el sistema de producción, en paralelo con la urbanización y con las acciones antrópicas extensivas en las áreas endémicas. Se espera también una reducción en la morbilidad, dependiente de un mejor acceso a los sistemas de salud y de los constantes avances en la medicina. Sin embargo, la enfermedad seguirá siendo muy importante por dos o tres décadas más, dejando como principales desafíos la vigilancia sobre su transmisión y la atención a los individuos ya infectados. Está prevista una disminución en la visibilidad de la enfermedad, con reflejos negativos en la prioridad política de las acciones sobre su atención y control.
Sustancias consideradas adictivas: prohibición, reducción de daños y reducción de riesgos
Authors: Menéndez Eduardo L.
Published: April 2021

América Latina es actualmente la región con mayor tasa de homicidios a nivel mundial, y gran parte de los asesinatos están vinculados al denominado crimen organizado, especialmente al narcotráfico. El narcotráfico es producto de la ilegalización de ciertas sustancias, la cual -por lo menos en la actualidad- está basada y legitimada en criterios biomédicos que convierten la producción, comercialización y frecuentemente el consumo de ciertas sustancias consideradas adictivas en "delitos contra la salud". En este texto se analizan en forma sucinta las dos políticas formuladas y aplicadas hasta ahora en términos prohibicionistas y de reducción de daños, considerando el fracaso del prohibicionismo, así como las limitaciones de las propuestas de reducción de daños. Respecto del prohibicionismo se señalan sus múltiples y constantes incongruencias y contradicciones, lo cual implica que tomemos con cautela los reiterados señalamientos sobre su "fracaso". El texto propone la aplicación de una política de reducción de riesgos que incluya no solo los comportamientos de sujetos y grupos, sino también la dimensión estructural tanto en términos económico-políticos como culturales.
Reactions to institutional violence: patient strategies for facing infringements of the right to health in Brazil
Authors: Fleury Sonia , Bicudo Valéria , Rangel Gabriela
Published: April 2021

In this article we identify evidences of inequalities, prejudices and discrimination in the access and utilization of public health services belonging to the Brazilian Unified Health Care System, considering them to be institutional violence and a negation of rights, in order to look at the reactions of the subjects victimized by this process. This research study utilized different methodologies, articulating participant observation, semi-structured interviews, focus groups and dramatization. The results highlight the trajectory in seeking health care as the main expression of inequalities, strengthened by structural factors such as the precarious condition of health care services, which potentiate power asymmetries, and the presence of discrimination derived from stigmas and prejudices. Most patients' reactions to the situation of institutional violence seek an individual solution to the problem, often reaffirming the conditions that generate rights violations. Few patients' reactions question the systemic conditions that determine the continued discrimination.
El tratamiento del dolor por cáncer en el final de la vida: estudio de caso en un servicio de cuidados paliativos de la Ciudad Autónoma de Buenos Aires
Authors: Alonso Juan Pedro
Published: April 2021

La prevención y el alivio del dolor por cáncer, definidos en las últimas décadas como un desafío para la salud pública a nivel internacional, han sido planteados recientemente en los debates públicos como una cuestión de derechos humanos. Pese a ello, existen importantes barreras para la provisión de tratamientos adecuados. El artículo analiza el tratamiento del dolor por cáncer en un servicio de cuidados paliativos de la Ciudad Autónoma de Buenos Aires, poniendo el foco en la forma en que profesionales y pacientes instrumentan y negocian los términos y la adherencia al tratamiento del dolor. A partir de un abordaje cualitativo, que triangula datos de entrevistas semiestructuradas y observaciones etnográficas, el artículo describe la forma en que el dolor es objetivado y medido, y las estrategias de los profesionales para consensuar los protocolos de tratamiento. Asimismo, se describe el modo en que los profesionales construyen en la práctica una retórica del derecho al alivio del dolor y se discuten sus límites.
Determinantes sociodemográficos del acceso a la detección del cáncer de mama en México: una revisión de las encuestas nacionales
Authors: Agudelo Botero Marcela
Published: April 2021

El objetivo de este artículo es identificar los factores que explican el acceso a la detección del cáncer de mama en México en función de las características sociodemográficas de las mujeres, de acuerdo con tres encuestas representativas en el ámbito nacional. Se realizaron estadísticas descriptivas y se emplearon técnicas de análisis de clasificación múltiple. Las variables dependientes fueron que las mujeres se hubieran realizado: 1) la autoexploración, 2) el examen clínico de mamas, o 3) la mamografía; las covariables fueron: grupos de edad, escolaridad, tipo de localidad (urbana/rural), estado conyugal, número de hijos, derechohabiencia y estrato socioeconómico. Se encontró una cobertura de detección baja y se observaron brechas entre distintos grupos femeninos según las características sociodemográficas. Por lo general, las mujeres de estratos económicos más bajos, sin derechohabiencia y con menores niveles educativos, registraron prácticas de detección inferiores a la media nacional.
Comparative Evaluation of Intra-Operative Adhesions in Post-Caesarean and Repeat-Caesarean Cases
Authors: Mahata Fuleswari , Poddar Suman
Published: April 2021

BACKGROUND Adhesions after Caesarean section often create difficulties in subsequent Caesarean deliveries. Intra-operative adhesions result in delayed entry into the uterine cavity & subsequently baby-delivery, affecting neonatal morbidity; and on the other side – bladder / bowel injury, wound extensions, difficulty in uterine wound repair and uterine atony, affecting maternal morbidity. The study was conducted to comparatively evaluate the extent of intra-operative adhesions in post and repeat Caesarean cases and their impact over maternal and neonatal morbidity. METHODS The present prospective observational study consecutively recruited equal number (102) of post and repeat Caesarean cases, elective or emergency, over 10 months. Primary outcome measure was the presence & nature of intra-operative adhesions, evaluated with a pre-designed adhesion scoring system. Secondary outcome measures included baby delivery time, total operating time, neonatal Apgar-1, incidence of post-partum haemorrhage, bladder / bowel injury and Caesarean wound extension. P < 0.05 was considered significant for comparative evaluation. RESULTS Adhesions were found more significantly in post-Caesarean cases (χ 2 = 23.2385, P < 0.0001), and most were (59.1 %) of filmy type. Adhesion score was significantly higher in repeat-Caesarean group (P = 0.00694) because adhesions were mainly dense-type (59.5 %). In either group, however, adhesions between uterus and bladder were found predominant. In cases with adhesions, postCaesarean group shows significantly lesser Apgar-1 score (P < 0.0001), although median baby-delivery time was found comparable (P = 0.74896). Median total operating time was more in repeat Caesarean group, though not statistically significant (P = 0.11876); yet causing significantly more complications (P = 0.0252). CONCLUSIONS Intra-operative adhesions were more common in post-Caesarean cases, significantly affecting neonatal morbidity. Adhesions in repeat-Caesarean cases were mostly dense, significantly increasing total operating time and thereby maternal morbidity. KEYWORDS Intra-Operative Adhesions, Maternal and Neonatal Morbidity
Clinical and Laboratory Profile of Diabetic-Hypertension, Kidney Disease Syndrome - A Hospital Based Study in South India
Authors: Angadi Naveen , Bellad Adarsh , Badiger Raju H. , Narasimha Abhiram , B.C. Pavan Kumar , Sharma Gayatri , Agarwal Rishabh , Chowdary Sreekant N.
Published: April 2021

BACKGROUND Diabetes mellitus and hypertension remain one of the most common causes of chronic kidney disease. Diabetes hypertension, kidney disease syndrome is a new term introduced in medical terminology. The present study was conducted to examine clinical & laboratory profile of diabetes hypertension kidney disease syndrome – “DHKD syndrome” over a period of one year. METHODS A hospital-based observational cross-sectional study was done in the Department of General Medicine and Nephrology, outpatient department (OPD), among 120 patients with diabetes & hypertension in combination with kidney disease, with duration of diabetes > 2 years and duration of hypertension > 2 years after obtaining ethical clearance. The patients were then scored based on modified diet in renal disease (MDRD) formula and chronic kidney disease epidemiology collaboration equation (CKD EPI) formula to calculate the estimated glomerular function rate & placed into various stages of CKD. RESULTS A total of 120 subjects were included in the final analysis. The mean age was 63.64 ± 10.80. In study population of no albuminuria group, 50 % had glomerular filtration rate (GFR) of 30 - 44 (grade 3 CKD) and 50 % had GFR of < / = 15 (grade 5), among microalbuminuria group, 4.45 % had GFR of 60 - 89 (grade 2) and 1 had GFR of 45 - 59 (grade 3a), 13.64 % had GFR 30 - 44 (grade 3b), 40.91 % had GFR 15 - 29 (grade 4), 36.36 % had GFR < = 15 (grade 5), among macroalbuminuria group, 4.6 % had GFR 45 - 59 (grade 3a), 9.2 % had GFR 30 - 44 (grade 3b), 13.79 % had GFR 15 - 29 (grade 4) and 72.41 % had GFR < = 15 (grade 5). Majority had macro albuminuria. The proportion of the difference between systolic blood pressure (SBP) and macroalbuminuria was statistically significant. (P-value < 0.05) as well as proportion of the difference between insulin usage with macroalbuminuria was statistically significant. (P-value < 0.05). CONCLUSIONS Our study delivers sufficient evidence endorsing high relationship between diabetes, hypertension, and kidney disease. KEYWORDS Diabetic Nephropathy, Macroalbuminuria, Hypertension, DHKD Syndrome
Relapse Pattern in Club Foot Treated with Ponseti Technique - A Prospective Observational Study from Kerala, India
Authors: M Vishnu , Mathew Jacob , Karuppal Raju , Prasad Amarnath
Published: April 2021

BACKGROUND Though the Ponseti method has become the popular and standard of care for clubfoot correction, relapse of clubfoot deformity following correction is not uncommon. The relapsed feet can progress from flexible to rigid if left untreated and can become as severe as the initial deformity. The purpose of this study was to analyse the relapse pattern in clubfeet that have undergone treatment with the Ponseti method. METHODS Between 2015 and 2017, 78 children (134 feet), 58 boys and 20 girls were included in this study. It was a prospective observational study of relapse patterns in idiopathic clubfoot after one year of completion of the Ponseti method of treatment. Pirani scoring system was used to identify the relapse. RESULTS Dynamic, fixed, and complete relapse patterns were observed in this study. Patients were categorised into two groups - bilateral and unilateral. In the bilateral group, 18 children (36 feet i.e. 23 %) had decreased ankle dorsiflexion, 5 had (10 feet i.e. 6 %) rigid equinus, 22 had (44 feet i.e., 29 %) dynamic forefoot adduction or supination and 5 had (10 feet i.e. 6 %) fixed adduction in forefoot and midfoot. Six children from the bilateral group showed complete relapse. Among the unilateral group, 8 children (8 feet i.e. 36 %) presented with decreased ankle dorsiflexion, 4 had (4 feet i.e. 18 %) rigid equinus relapse, 6 had (6 feet i.e. 27 %) dynamic forefoot adduction or supination and 4 had (4 feet i.e. 18 %) showed fixed forefoot adduction. CONCLUSIONS Dynamic forefoot adduction or supination pattern is common to relapse pattern in the bilateral group and dynamic hind-foot relapse was common in the unilateral group. Age at initial presentation, initial Pirani score, and the number of casts required were not significantly related to the incidence of relapse. KEYWORDS Club Foot, CTEV, Ponseti Method, Relapse Pattern