bluuebunny/crossref_metadata_2025 huggingface dataset:
QTc Prolongation to Predict Mortality in Patients Admitted with
COVID-19 Infection: An Observational Study
Authors: Sartorio Andrea , Burrei Giulia , Cristin Luca , Zoncapè Mirko , Carlin Michele , Tadiello Enrico , Minuz Pietro , Dalbeni Andrea , Romano Simone
Published: December 2023

Background:

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) causes
Coronavirus disease 2019 (COVID-19), characterized by pulmonary infection ranging from asymptomatic
forms to respiratory insufficiency and death. Evidence of cardiac involvement in COVID-19
is increasing, and systemic inflammation or direct heart damage by SARS-CoV-2 can prolong the
corrected QT interval (QTc).

Methods:

In this observational study, a total of 333 consecutive patients admitted to the Covid Center
of Verona University Hospital from November 2020 to April 2021 were included. Patients with bundle
branch block, pacemaker-controlled heart rhythm and heart rate >120 beats/min were excluded. A
complete electrocardiogram (ECG) was performed at admission, and QTc values of ≥440 ms for
males and ≥460 ms for females were considered prolonged.

Results:

Overall, 153 patients had prolonged QTc (45.5%). In multivariate logistic regression analysis,
male sex (odds ratio (OR)=6.612, p=0.046), troponin (OR=1.04, p=0.015) and lymphocyte count
(OR=3.047, p=0.019) were independently associated with QTc prolongation. Multivariate logistic
regression showed that QTc was independently associated with mortality (OR=4.598, p=0.036). Age,
sex, the ratio between the partial pressure of oxygen (PaO2) and the fraction of inspired oxygen
(FiO2) (P/F), and fibrosis-4 index for liver fibrosis (FIB-4) were also independently associated with
mortality.

Conclusion:

QTc interval prolongation appears to be a frequent finding in patients with COVID-19.
Moreover, prolonged QTc may be predictive of more severe forms of COVID-19 and worse outcome.
Effects of Kojic Acid-mediated Sonodynamic Therapy as a Matrix
Metalloprotease-9 Inhibitor against Oral Squamous Cell Carcinoma: A
Bioinformatics Screening and In Vitro Analysis
Authors: Pourhajibagher Maryam , Alaeddini Mojgan , Etemad-Moghadam Shahroo , Parker Steven , Bahador Abbas
Published: December 2023

Background:

Oral squamous cell carcinoma (OSCC) is a type of cancer that is responsible
for a significant amount of morbidity and mortality worldwide. Researchers are searching for promising therapeutic methods to manage this cancer. In this study, an in silico approach was used to
evaluate the activity of sonodynamic therapy (SDT) based on the use of Kojic acid as a sonosensitizer
to inhibit matrix metalloprotease-9 (MMP-9) in OSCC.

Materials and Methods:

The three-dimensional structure of MMP-9 was predicted and validated by
computational approaches. The possible functional role of MMP-9 was determined in terms of Gene
Ontology (GO) enrichment analysis. In silico, molecular docking was then performed to evaluate the
binding energies of Kojic acid with MMP-9, and ADME parameters and toxicity risks were predicted.
The pharmacokinetics and drug-likeness properties of Kojic acid were assessed. Moreover, after the
determination of the cytotoxicity effect of Kojic acid-mediated SDT, the change of mmp-9 gene expression was assessed on OSCC cells.

Results:

The results of the study showed that Kojic acid could efficiently interact with MMP-9 protein with a strong binding affinity. Kojic acid obeyed Lipinski’s rule of five without violation and
exhibited drug-likeness. The cytotoxic effects of Kojic acid and ultrasound waves on the OSCC cells
were dose-dependent, and the lowest expression level of the mmp-9 gene was observed in SDT.

Conclusions:

Overall, Kojic acid-mediated SDT as an MMP-9 inhibitor can be a promising adjuvant
treatment for OSCC. The study highlights the potential of in silico approaches to evaluate therapeutic
methods for cancer treatment.
Some Versatile Medicinal Plants for Healing Wounds: A Review
Authors: Kumari Raj , Sharma Meenakshi , Mittal Abhilasha , Goel Gauri
Published: December 2023

The cellular and biochemical stages of the wound-healing process are interrelated and work to repair the wound. The body heals wounds in stages,
and each stage that is postponed raises the risk of microbial infection. The time needed for healing can be sped up, and unwanted events can be
reduced to improve wound healing. To aid in the healing of the wounds, the medications are administered locally or systemically. In order to
promote wound healing, antibiotics, antiseptics, desloughing agents, extracts, etc. have been employed. Due to their adverse effects, several
synthetic medications are subject to restrictions. Investigation, identification, and formulation of plants or plant-derived combinations are required
for the management and therapy of wound healing. Because they have fewer adverse effects and have been used to treat wounds for a longer
period, medicinal plants are becoming more popular for use in wound healing. According to studies, medicinal herbs help diabetic, infected, and
opened wounds heal more quickly. It has been claimed that medicinal herbs can speed up wound healing through a variety of processes. Many
medicinal plants, including Allium sativum, Commiphora myrrha, Curcuma longa (L.), Rauwolfia serpentia, and Vateria indica, have
demonstrated the ability to treat wounds.
Cost-effectiveness of Dementia Medication
Authors: Khera Nikita , Raj Rojin G. , Kumar Ranjeet , Bajaj Megha , Sharma Bintoo , Tyagi Harsh , Job Josmy Maria
Published: December 2023

Aim::

This review has examined and organized the available research on dementia medication care costs. Although the accessible database in this area is
growing and is still quite limited, there are many clear scientific methods.

Objective::

The use of Memantine, a non-competitive antagonist with low to moderate affinity for the NMDA (N-methyl-D-aspartate) receptor, has been
approved for the treatment of mild to moderately severe Alzheimer's disease (AD). The efficacy of cholinesterase inhibitors (ChEIs) in the
treatment of dementia varies depending on the drug type and ease of administration. Numerous techniques have been employed to evaluate the
quality of life (QOL) of individuals suffering from dementia. QOL data is a well-established measure of an intervention's effectiveness. Up to now,
cost-effectiveness studies have concentrated on both pharmaceutical and non-pharmacological therapy. Each unit of QoL-AD improvement costs
USD27.82578 at mean values.

Methods::

Searches were conducted to observe studies of the pharmacoeconomic impact of dementia medications with the help of previous articles published
in journals and collected from Google Scholar with name search dementia or Alzheimer's cross-referenced with pharmacoeconomic or costs and
effectiveness.
Repertoires plurilingues e a enunciação de pontos de vista e de emoções em Português um projeto exploratório em Macau
Authors: Fernandes Anabela
Published: December 2023

This article presents initial reflections on an exploratory project within the discursive practices of Portuguese as an additional language learners in Macao, when expressing subjectivity and emotions of nostalgia, alegria and espanto expression. Given the linguistic and cultural diversity in Macao, a model for analyzing the social organization of difference in multilingual communities is considered, as well as the key concept of plurilingual repertoires. After reviewing the research on the expression of emotions in additional languages, we proceed to explain the methodology of the exploratory project, considering the ongoing study of the expression of points of view and emotions in Portuguese as an additional language, in an endolingual context. The proposal contemplates a plural approach to the didactics of additional languages, configured by intercultural pragmatics, on the one hand, and the central role of lexical-grammatical associations in discourse, on the other.
Macau no século XVIII coexistência e interculturalidade
Authors: Cosme Marco
Published: December 2023

In the 18th century, Macao was a microcosm with very specific dynamics, where different authorities and varied powers converged resulting from the coexistence of two sovereignties in a single territory. The chronology under analysis is assumed to be a period of mutations for Luso-Chinese coexistence, coinciding with the strengthening of Qing dynasty tutelage, or even the creation of the “Canton System” which worsened the conditions of the city. However, the Portuguese community in Macao, represented by a mercantile oligarchy that controlled and governed the institutions of local power, such as the Senado da Câmara, managed to create and exploit several opportunities, playing with its marginal situation in the face of two empires in order to permanently renew their sense of existence. Thus, the analysis of attitudes, strategies, and permanent adjustments on the part of this local elite, especially in the face of the growing exercise of imperial influence, is essential for understanding the relations of coexistence and interculturality between the Portuguese-Asian community of Macau and the Chinese civilization during this period.
Increasing Realism and Variety of Virtual Patient Dialogues for Prenatal Counseling Education Through a Novel Application of ChatGPT: Exploratory Observational Study
Authors: Gray Megan , Baird Austin , Sawyer Taylor , James Jasmine , DeBroux Thea , Bartlett Michelle , Krick Jeanne , Umoren Rachel
Published: December 2023

Background

Using virtual patients, facilitated by natural language processing, provides a valuable educational experience for learners. Generating a large, varied sample of realistic and appropriate responses for virtual patients is challenging. Artificial intelligence (AI) programs can be a viable source for these responses, but their utility for this purpose has not been explored.

Objective

In this study, we explored the effectiveness of generative AI (ChatGPT) in developing realistic virtual standardized patient dialogues to teach prenatal counseling skills.

Methods

ChatGPT was prompted to generate a list of common areas of concern and questions that families expecting preterm delivery at 24 weeks gestation might ask during prenatal counseling. ChatGPT was then prompted to generate 2 role-plays with dialogues between a parent expecting a potential preterm delivery at 24 weeks and their counseling physician using each of the example questions. The prompt was repeated for 2 unique role-plays: one parent was characterized as anxious and the other as having low trust in the medical system. Role-play scripts were exported verbatim and independently reviewed by 2 neonatologists with experience in prenatal counseling, using a scale of 1-5 on realism, appropriateness, and utility for virtual standardized patient responses.

Results

ChatGPT generated 7 areas of concern, with 35 example questions used to generate role-plays. The 35 role-play transcripts generated 176 unique parent responses (median 5, IQR 4-6, per role-play) with 268 unique sentences. Expert review identified 117 (65%) of the 176 responses as indicating an emotion, either directly or indirectly. Approximately half (98/176, 56%) of the responses had 2 or more sentences, and half (88/176, 50%) included at least 1 question. More than half (104/176, 58%) of the responses from role-played parent characters described a feeling, such as being scared, worried, or concerned. The role-plays of parents with low trust in the medical system generated many unique sentences (n=50). Most of the sentences in the responses were found to be reasonably realistic (214/268, 80%), appropriate for variable prenatal counseling conversation paths (233/268, 87%), and usable without more than a minimal modification in a virtual patient program (169/268, 63%).

Conclusions

Generative AI programs, such as ChatGPT, may provide a viable source of training materials to expand virtual patient programs, with careful attention to the concerns and questions of patients and families. Given the potential for unrealistic or inappropriate statements and questions, an expert should review AI chat outputs before deploying them in an educational program.
Penatalaksanaan Anestesi pada Operasi Orif E.C Fraktur Ankle pada Pasien dengan Fraktur Servikal
Authors: Zaenal Arifin  , IG Ngurah Rai Artika
Published: December 2023

Latar Belakang. Fraktur cervical kira-kira terjadi ada 5-10% pasien yang datang ke Instalasi Gawat Darurat dalam keadaan tidak sadar. Kebanyakan fraktur cervical tersebut terjadi pada 2 level. Sepertiga dari fraktur terjadi pada level C2 dan 2/3 lainnya terjadi pada level C6 atau C7.Kasus. Dilaporkan penatalaksanaan anestesi pada operasi ORIF terhadap seorang laki-laki umur 22 tahun dengan fraktur terbuka bimaleoler dari ankle kiri, dengan oedem cerebri dan fraktur cervical IV.

Anestesi dilakuan dengan teknik blok saraf perifer yaitu kombinasi blok nervus femoralis dan blok nervus sciatik distal. Pada blok nerfus femoralis digunakan obat anetesi local berupa lidocaine 1% 20 cc dan pada blok nervus sciatik distal diberikan obat anestesi local berupa bupivacaine 0,5% isobaric 25 cc.Operasi berlangsung selama 3 jam 20 menit. Durante operasi hemodinamik stabil. Tekanan darah sistolik berkisar 100-125 mmHg, diastolic 65-80 mmHg, frekuensi jantung 70-95 x/menit. Perdarahan sekitar 100 cc dan urine output 200 cc. Post operasi pasien kembali ke bangsal
Blok Femoral pada Operasi Orif Tibia Fibula Proksimal pada Pasien dengan Subdural Hematoma
Authors: Fakhrudin N Rifdhani , Sudadi  , Mahmud
Published: December 2023

Telah dilakukan penatalaksanaan anestesi regional berupa blok femoral pada seorang wanita usia 60 tahun yang didiagnosis fraktur terbuka sepertiga proksimal tibia fi bula sinistra dengan subdural hematoma dan edema serebri, status fi sik ASA II yang akan menjalani operasi ORIF.Pasien dipremedikasi dengan diazepam 5 mg peroral, midazolam 2 mg dan fentanyl 50 mcg intravena. Blok femoral dilakukan dengan teknik nerve stimulator menggunakan pendekatan dari ligametum inguinalisdan lipatan paha. Agen yang digunakan adalah lidokain 1% sebanyak 10 ml dan bupivakain 0,5% isobarik sebanyak 10 ml. Selama operasi pasien disedasi dengan midazolam 2 mg intravena bolus intermitten.Operasi berlangsung selama dua jam dengan hemodinamik pasien stabil.Pasca operasi pasien diobservasi di ruang pulih sadar selama 2 jam. Status kesadaran dan hemodinamik selama observasi baik. Skala nyeri menggunakan VAS menunjukkan angka 1-2. Pasien kemudian diperbolehkan kembali ke bangsal.
Korelasi Nilai Central Venous Pressure (CVP) dengan Inferior Vena Cava Distensibillity Index (IVC-DI) pada Pasien ICU RSUP Dr. Sardjito
Authors: Frisianto Rinaldi Tri , Sudadi  , Sari Djayanti
Published: December 2023

Latar belakang : Penilaian status volume intravaskular merupakan bagian yang penting dalam manajemen pasien kritis. Penilaian CVP sering dilakukan pada pasien kritis di ICU untuk menilai status cairan intravaskuler. CVP memerlukan tindakan invasif yang menimbulkan kemungkinan komplikasi dankebutuhan waktu yang relatif lebih lama. Pemeriksaan variasi diameter IVC dengan USG dapat digunakan untuk menilai status cairan intravaskuler dan tidak bersifat invasif. Nilai CVP dan variasi diameter IVC dipengaruhi oleh beberapa faktor yang sama.Tujuan : Penelitian ini bertujuan untuk mengetahui korelasi nilai CVP dengan IVC distensibillity index (IVCDI) pada pasien yang dirawat di Instalasi Rawat Intensif RSUP Dr.Sardjito.Metode : Rancangan penelitian adalah potong lintang (cross sectional). Jumlah sampel pasien 22 pasien. Kriteria inklusi pada penelitian ini: pasien ICU RSUP Dr.Sardjito, berusia ≥ 18 tahun, terpasang central venous catheter (CVC) atas indikasi medis sesuai standar pelayanan medis RSUP Sardjito dengan tempat puncture vena subclavia atau vena jugularis interna. Kriteria eksklusi penelitian ini: pasien dengan hematotoraks,pneumotoraks, hematomediastinum, pneumomediastinum, paska laparotomi eksplorasi, dengan trauma abdomen dan tumor intraabdomen. Setiap sampel dilakukan pengukuran CVP dan IVC-DI kemudian dilakukan analisis korelasi Pearson atau Spearman. Analisis data menggunakan program SPSS 19.0.Hasil : Nilai CVP dan nilai IVC-DI memiliki korelasi yang kuat, dengan arah korelasi negatif, dan hasilnya signifikan secara statistik (r=-0,768, p < 0,05). Pada sampel pasien dengan ventilator, hasil analisis menunjukkan koefi sien korelasi (r) -0,820 (p < 0,05) dengan kekuatan korelasi sangat kuat. Hasil analisiskorelasi pada pasien respirasi spontan menunjukkan korelasi negatif yang kuat namun tidak signifikan secara statistik (r = -0,750, p > 0,05).Kesimpulan : Nilai CVP dan nilai IVC-DI pada pasien di ICU memiliki korelasi kuat dengan arah korelasi negatif.
Perbandingan Lama Blok Sensorik dan Motorik pada Anestesi Spinal dengan Bupivacaine 0,5% Hiperbarik 7,5 mg Ditambah Fentanyl 25 μg dan Sufentanil 2,5 μg pada Operasi Transurethral Resection
Authors: Anwar Yusuf ‘Alim Musthofa , Pratomo Bhirowo Yudo , Sari Djayanti
Published: December 2023

Penelitian ini bertujuan untuk membandingkan lama blok sensorik dan motorik pada anestesi spinal dengan bupivacaine 0,5% hiperbarik 7,5 mg ditambah fentanyl 25 μg dan sufentanil 2,5 μg pada operasi reseksi transuretra.Penelitian dengan menggunakan metode uji acak buta ganda terkontrol pada pasien yang menjalani operasi TUR elektif di GBST RSUP Dr. Sardjito, IBS RSST Klaten, dan IBS RSKB Diponegoro Klaten. Subjek berjumlah 70 pasien yang dibagi dalam dua kelompok perlakuan, masing-masing 35 pasien. Kelompok BF adalah yang mendapatkan bupivacaine 0,5% hiperbarik 7,5 mg ditambah fentanyl 25 μg sedangkan kelompok BS adalah yang mendapatkan bupivacaine 0,5% hiperbarik 7,5 mg ditambah sufentanil 2,5 μg.Dilakukan pengamatan onset, tingkat, dan lama blok sensorik dengan metode pinprick test serta tingkat dan lama blok motorik dengan bromage score.Kelompok BF memiliki lama blok sensorik 95,06 ± 35,13 dan kelompok BS 116,86 ± 31,27 menit. Kelompok BS memiliki lama blok sensorik yang lebih panjang dibanding kelompok BF yang bermakna secara statistik dengan p < 0,05. Lama blok motorik pada kelompok BF 112,43 ± 30,42 menit dan kelompok BS 108,71 ± 36,53 menit. Keduanya tidak menunjukkan perbedaan yang bermakna dengan p > 0,05.Kelompok BS memiliki lama blok sensorik yang lebih panjang dibandingkan kelompok BF dengan tanpa perbedaan blok motorik di antara dua kelompok.
PERBANDINGAN KADAR SEVOFLURANE DAN NITROUS OXIDE (N2 O) SELAMA ANESTESI DI RUANG-RUANG OPERASI DENGAN FILTER HEPA (High Efficiency Particulate Air) DAN TANPA FILTER HEPA
Authors: Husein Akhmad Syaiful Fatah , Pratomo Bhirowo Yudo , Suryono Bambang
Published: December 2023

Latar belakang. Semakin luasnya penggunaan sevofl urane sebagai zat anestesi inhalasi dan nitrous oksida (N2O) masih menjadi zat inhalasi umum karena memiliki efek anxiolitik, analgesi dan euforia. Sevofl urane dalam jangka panjang dapat menyebabkan gangguan ginjal akibat akumulasi metabolit dalam urin, sementara N2O berpotensi menyebabkan defisiensi neurologis, anemia megaloblastik hingga pemanasan global, tetapi keduanya tidak diukur secara rutin. Kadar keduanya sangat dipengaruhi oleh adanya instalasi HEPA, sistem penghisapan (exhausted) di ruang operasi dan sirkuit napas mesin anestesi.Tujuan. Penelitian ini bertujuan untuk mengetahui kadar Sevofl urane dan N2O di ruang-ruang operasi yang memiliki filter HEPA dibandingkan dengan ruang- ruang operasi tanpa filter HEPA yang berada di RSUP Dr. Sardjito Yogyakarta. Kadarnya dinilai keseuaiannya dengan standard National Institute of Occupational Safety and Health 1977 (NIOSH 1977).Metode. Dengan metode potong lintang, hasil penelitian diambil dari populasi seluruh ruang operasi yang digunakan operasi dengan anestesi umum lebih dari 2 jam dan menggunakan anestesi sevofl urane dan N2O selama operasi. Dari 18 ruang operasi didapatkan sampel sebanyak 7 ruang operasi dan diukur pada zona 4 dan zona 5 pada 30 menit sebelum anestesi dimulai, jam ke-2 anestesi, jam ke-4 anestesi dan30 menit setelah anestesi.Hasil. Hasilnya didapatkan rata-rata kenaikan kadar sevofl urane dan N2O di ruang-ruang operasi dengan sistem HEPA adalah 12,69 ppm (2,27 %) dan 17,53 ppm (2,70%). Kenaikan kadar sevofl urane dan N2O di ruang-ruang operasi tanpa fi lter HEPA adalah 168,46 ppm (3,45 %) dan 8,61 ppm (1,86 %).Kesimpulan. Ruang operasi yang menggunakan sistem fi lter HEPA kadarnya lebih rendah 65,5 % dibanding ruang operasi tanpa fi lter HEPA dan masih memenuhi standard NIOSH 1977.
SEPSIS-AKUT KIDNEY INJURY PADA UROSEPSIS
Authors: Palu Raphael Putra , Aditianingsih Dita , Sudarsono
Published: December 2023

Sepsis adalah penyakit yang mengancam jiwa yang disebabkan oleh disregulasi respon imun terhadap infeksi. Mortalitas sepsis meningkat dengan gangguan ginjal akut dan pasien dengan gangguan ginjal akut memburuk dengan sepsis. Menarik untuk dicatat bahwa sebagian besar uji klinis pada perawatan sepsis gagal dalam menerjemahkan hasil dari penelitian. Hal ini karena kompleksitas sepsis pada manusia dibandingkan dengan model hewan dan pencocokan model hewan yang tidak sesuai dengan individu pasien. Ada kemungkinan bahwa mekanisme utama induksi sepsis pada setiap pasien dengan variasi penyebab sepsis mungkin berbeda. Respon imun terhadap sepsis tergantung pada latar belakang genetik, rute dari aktivasi kekebalan tubuh dan organisme. Urosepsis adalah jenis infeksi yang menyebabkan terjadinya gangguan ginjal akut dan syok septik. Pengobatan spesifik gangguan ginjal akut akibat sepsis pada pasien individual sesuai dengan karakteristik respons imun spesifik mungkin merupakan strategi yang lebih tepat. Melaporkan kasus wanita, 50 tahun, masuk ke RSCM dengan keluhan utama tidak sadar dan didiagnosis dengan gangguan ginjal akut akibat urosepsis. Komplikasi gangguan ginjal akut, gangguan elektrolit dan pnemonia muncul. Pemantauan makrosirkulasi, parameter perfusi jaringan, antibiotik dan hemodialisis intermiten dilakukan pada pasien untuk pulih kembali.
EFEK PEMBERIAN KETAMIN DOSIS 0,5 mg/kgbb TERHADAP ONSET BLOKADE NEUROMUSKULAR OLEH ATRAKURIUM
Authors: Al-Hilal Said Rival , Sarosa H Pandit , Widodo Untung
Published: December 2023

Latar belakang. Atracurium merupakan salah satu agen pelumpuh otot non depolarisasi. Waktu onset obat ini lebih lama dibandingkan suksinilkolin sehingga membatasi penggunaannya. Berbagai usaha telah dilakukan untuk mengurangi waktu onset pelumpuh otot non depolarisasi. Berbagai laporan menyatakan bahwa ketamin berhubungan dengan kondisi intubasi yang lebih baik. Tujuan penelitian ini adalah untuk mengetahui efek pemberian ketamin dosis 0,5 mg/kgbb terhadap onset blokade neuromuskular oleh atracurium.Metode. Desain penelitian ini adalah Randomized Controlled Trial (RCT) dan dilakukan dengan pembutaanganda. Delapan puluh pasien dewasa usia 18-65 tahun dengan status fisik sesuai dengan kelas I dan II menurut klasifikasi dari ASA, yang menjalani operasi elektif dengan anestesi umum pada bulan November 2016 sampai dengan Januari 2017, pasien yang telah memenuhi kriteria inklusi dan eksklusi dibagi secara random menjadi dua kelompok yaitu kelompok K (Ketamin) dan kelompok S (Kontrol Salin). Kelompok K diberikan ketamin 0,5 mg/kgbb sedangkan kelompok S diberikan Salin. Delapan pasien dinyatakan drop outkarena error alat. Onset atrakurium diukur dengan menggunakan alat Train of Four.Hasil. Hasil penelitian ini didapatkan onset blokade neuromuskular oleh atrakurium pada kelompok ketamin lebih cepat secara bermakna (160,500±58,956 detik vs 288,750±135,038 detik; p=0,001). Perubahanhemodinamik (∆MAP : 6,500±7,965 mmHg vs 10,750±14,655 mmHg & ∆laju nadi : 3,737±11,700 x/menit vs 4,333±12,254 x/menit) secara statistik tidak berbeda bermakna (p=0,123 & p=0,831).Kesimpulan: pemberian ketamin dosis 0,5 mg/kgbb mempercepat onset blokade neuromuskular oleh atrakurium.
EFEK IMUNOLOGI PADA PENGGUNAAN OPIOID AKUT DAN KRONIS
Authors: Rahardjo Sri , Widyastuti Yunita , Rumpoko Triaji Mudo
Published: December 2023

Opioid telah menjadi agen andalan perawatan perioperatif modern dan manajemen nyeri. Kata opium modern berasal dari bahasa Yunani opion (“jus poppy”) atau opium poppy (Papaver somniferum) adalah sumber dari 20 alkaloid yang berbeda. Studi terbaru menunjukkan bahwa peran reseptor opioid terhadap fungsi kekebalan tubuh merupakan hal yang rumit, ternyata mereka bekerja melalui berbagai mekanisme yang berbeda. Pemberian opioid yang beragam menunjukkan berbagai efek yang berbeda pula pada sistem kekebalan tubuh: imunosupresif, imunostimulator, ataupun efek ganda keduanya. Sebelumnya diyakini bahwa sebagian besar opioid menekan sistem kekebalan tubuh, tetapi penelitian terbaru menunjukkan mereka mungkin memiliki efek ganda. Namun, mekanisme bagaimana opioid dan reseptor opioid bekerja dalam sistem kekebalan masih belum dipahami dengan jelas.
RAPID SEQUENCE INTUBATION PADA PASIEN HAMIL EKTOPIK DENGAN COVID-19 RINGAN YANG MENJALANI LAPAROTOMI HISTEREKTOMI
Authors: Wisudarti Calcarina Fitriani Retno , Adiyanto Bowo , Naomi Diah Anis
Published: December 2023

Pasien perempuan usia 27 tahun didiagnosis kehamilan ektopik terganggu di ampula vateri, syok hemoragik derajat II teratasi, G2P1A0 hamil 8 minggu 5 hari, COVID-19 ringan, menjalani operasi laparotomi eksplorasi dan histerektomi. Pasien tidak memiliki keluhan demam, batuk, sesak napas, dan gangguan menghidu. Pasien didiagnosis COVID-19 ringan karena hasil swab SARS-CoV-2 Qualitative PCR positif dan tidak ada pneumonia. Operasi dilakukan di ruang operasi khusus infeksi airborne dengan dipasang mesin filter HEPA. Pembiusan dengan anestesi umum intubasi menggunakan teknik RSI. Tidak ditemukan jalan napas sulit pada pasien. Tidak dilakukan manuver Sellick. Intubasi dengan laringoskop direk. Posisi ETT dikonfirmasi dengan kapnograf. Pascaoperasi, pasien diekstubasi dalam lalu kembali ke bangsal. Tidak terdapat penyulit perioperatif pada pasien ini.
EFEK PEMBERIAN PRIMING FENTANIL 1 ΜG/KGBB TERHADAP INSIDENSI BATUK PASCA-PREEMPTIF ANALGESIA FENTANIL 2ΜG/KGBB DI RSUP DR. SARDJITO
Authors: Prakosa Nur Hamam , Uyun Yusmein , Widyastuti Yunita
Published: December 2023

Latar belakang: Fentanil merupakan analgetik opioid yang hampir selalu digunakan pada pasien yang menjalani anestesi umum. Penggunaan fentanil intravena bisa menimbulkan efek batuk yang dikenal dengan istilah fentanyl– induced cough (FIC). Hingga saat ini belum ditetapkan terapi standar dalam mencegah terjadinya FIC.

Metode: Uji klinis randomisasi dengan pembutaan ganda. Sampel dipilih menggunakan metode non-probability sampling dengan cara konsekutif sampai terpenuhi jumlah sampel. Pasien dengan rentang usia 18-65 tahun, status fisik ASA I-II, bukan perokok aktif, yang menjalani operasi elektif dengan pembiusan umum di RSUP Dr. Sardjito, dikelompokkan menjadi 2 kelompok yaitu kelompok perlakuan dengan penggunaan priming fentanil 1 μg/kgbb dan kelompok kontrol tanpa priming fentanil. Kedua kelompok perlakuan tersebut mendapatkan total fentanil 2 μg/kgbb dengan kecepatan penyuntikan 0,5 cc per detik. Dinilai perbedaan insidensi batuk diantara kedua kelompok perlakuan dengan luaran berupa batuk ringan, batuk berat, maupun tidak batuk maka dilakukan dengan uji Chi-square. Luaran sekunder dan efek samping terhadap pemberian fentanil juga dinilai.

Hasil: Insidensi batuk pada kelompok perlakuan dengan penggunaan priming fentanil 1 μg/kgbb sebanyak 2 pasien (2,7%) sedangkan insidensi batuk pada kelompok tanpa pemberian priming fentanil sebanyak 11 pasien (15,1%) dengan p = 0,009 artinya ada perbedaan bermakna secara statistika. Pasien dengan insidensi batuk seluruhnya dalam kategori batuk ringan baik kelompok priming fentanil sebanyak 2 pasien maupun kelompok tanpa priming fentanil 11 pasien.

Kesimpulan: Penggunaan priming fentanil 1 μg/kgbb dapat mengurangi insidensi batuk secara bermakna pascapreemptif analgesia fentanil 2 μg/kgbb dengan kecepatan penyuntikan 0,5 cc per detik. Penggunaan priming fentanil 1 μg/kgbb mempunyai insidensi efek samping yang tidak bermakna dibandingkan tanpa pemberian priming fentanil pascapreemptif analgesia fentanil 2 μg/kgbb dengan kecepatan penyuntikan 0,5 cc per detik.
TATA LAKSANA BADAI TIROID DI INSTALASI GAWAT DARURAT
Authors: Sudadi  , Pratomo Bhirowo Yudo , Utomo Wandito Gayuh
Published: December 2023

Badai tiroid adalah kondisi kegawatdaruratan endokrin. Kasus ini jarang terjadi, namun angka mortalitasnya tinggi. Diagnosis harus ditegakkan secepat mungkin dan tatalaksana agresif harus dilakukan kepada pasien badai tiroid agar prognosisnya menjadi baik. Badai tiroid biasanya terjadi pada pasien dengan hipertiroidisme yang tidak mendapatkan terapi adekuat dan dicetuskan oleh infeksi, trauma, pembedahan tiroid, atau diabetes tidak terkontrol. Terapi di ruang Instalasi Gawat Darurat mencakup terapiawal stabilisasi ABCDE, rehidrasi adekuat, koreksi elektrolit, tatalaksana penyakit/ kondisi pencetus, serta pemberian terapi spesifik (obat anti tiroid/ Anti Thyroid Drugs [ATDs], iodin inorganik, kortikosteroid, dan beta-Adrenergik Agonis [beta-AAs]). Setelah mendapatkan terapi awal yang cukup, pasien sebaiknya dirawat di unit perawatan intensif (ICU) untuk pemantauan kondisi dan terapi secara kuat. Jika tidak didapatkan perbaikan klinis dalam 24-48 jam, setelah intervensi awal, maka harus dipertimbangkanterapi Plasmapheresis (PTE).
Penggunaan Non-Invasive Ventilation pada Pasien COVID-19
Authors: Kurniawaty Juni , Adiyanto Bowo , Sadewo Yuri
Published: December 2023

Pasien COVID-19 derajat berat dan kritis biasanya memerlukan rawat inap di rumah sakit dan dukungan ventilasi mekanis invasif dan/atau non-invasif. Non-Invasive Ventilation (NIV) digunakan pada kasus yang memerlukan ekalasi terapi oksigen standar ke tingkat yang lebih tinggi. NIV juga dapat digunakan untuk mengurangi intubasi dini, namun penggunaan NIV jangka panjang tidak direkomendasikan. NIV diketahui tidak menurunkan angka intubasi. Kami melaporkan pasien seorang perempuan berusia 52 tahun dengan diagnosis terkonfirmasi COVID-19 derajat berat. Pasien dirawat di ICU dengan penggunaan HFNC dan NIV selama perawatan. Penggunaan NIV pada pasien yang tepat dan waktu yang tepat dapat menetukan prognosis pasien. Penyapihan NIV secara bertahap dapat mempertahankan PO2 dan mengurangi kebutuhan fraksi oksigen pasien. Kondisi pasien dapat membaik dan menjadi survivor COVID-19.
GAGAL SPINAL PADA OPERASI SECTIO CAESAREA
Authors: Wisudarti Calcarina Fitriani Retno , Uyun Yusmein , Utomo F uad Cipto
Published: December 2023

Blok subarachnoid atau blok spinal merupakan teknik anestesi yang mudah dan aman untuk dipilih pada operasi sectio caesarea. Teknik ini menghasilkan anestesi yang baik, mengurangi resiko yang berhubungan dengan general anestesi dan menaikkna tingkat kepuasan pasien yang menjalani persalinan, berhubungan dengan rendahnya angka morbiditas intra operatif dan paska operatif. Teknik spinal sangatlah sederhana, memiliki onset blokade sensoris yang cepat, mudah untuk menghasilkan kondisi medan operasi yang optimal menjadi beberapa alasan pemilihan teknik anestesi spinal dibandingkan teknik anestesi yang lain. Meskipun demikian, teknik spinal anestesi juga memilki resiko kegagalan yang dilaporkan mencapai 1-17%. Gagal spinal anestesi dapat di artkan gagal parsial atau tidak lengkap terhadap blok yang dihasilkan setelah 15-20 menit obat di masukan dan membutuhkan tambahan berupa obat analgesic atau konversi menjadi general anesthesi. Gagal spinal anestesi menghasilkan rasa tidak nyaman terhadap pasien dan situasi yang rumit bagi ahli anestesi. Manajemen gagal spinal selama operasi sectio caesarea meliputi tindakan spinal ulang, memberi obat sedasi ataupun konversi menjadi general anestesi bisa berdampak negative terhadap pasien dan bayi yang dilahirkan. Hal ini dapat mengurangi tingkat kepuasan pasien, manajemen nyeri yang tidak adekuat, sedasi pada bayi (pada kasus konversi menjadi general anestesi), tidak optimal kondisi anestesi yang dihasilkan dan medan operasi.
ROTASI OPIOID DAN MANAJEMEN NYERI PADA PASIEN CANCER PAIN AKIBAT KANKER SERVIKS STADIUM 4 DAN FISTULA RECTOVAGINA
Authors: Mahmud  , Widyastuti Yunita , Atmanagara Dikho
Published: December 2023

Nyeri merupakan pengalaman tidak menyenangkan yang akan dirasakan oleh penderita kanker, yang dapat mengakibatkan berkurangnya kualitas hidup penderita kanker tesebut. Pemberian analgetik opioid dengan meningkatkan dosis untuk mencapai analgesi yang diharapkan dapat mengakibatkan terjadinya efek samping yang membahayakan pada pasien. Untuk keadaan seperti ini, perlu dilakukan adanya rotasi dari opioid untuk mendapatkan dosis analgesi yang adekuat tanpa meningkatkan resiko dari penggunaan opioid tersebut. Kami paparkan laporan kasus tentang nyeri kanker serviks derajat berat yang tidak terkontrol dengan pemberian opioid peroral. Pada pasien dilakukan penilaian derajat nyeri dan rotasi opiod untuk mengontrol nyeri kanker tersebut. Setelah dilakukan rotasi opioid, didapatkan bahwa nyeri terkontrol dengan pemberian jenis dan rute baru dari opioid tersebut
Peningkatan Pengetahuan dan Kesadaran Lingkungan Pesisir bagi Siswa SMPN 2 dan SMPN 3 Wedung Guna Membentuk Generasi Muda yang Cinta Lingkungan
Authors: Cahyo Wulandari
Published: December 2023

Program Pengabdian Kepada Masyarakat Berbasis Pendidikan Bagi Pembangunan Berkelanjutan (PKM PBPB) yang bertemakan peningkatan kesadaran generasi muda mengenai lingkungan pesisir ini memiliki latar belakang permasalahan lingkungan di Kecamatan Wedung, Kabupaten Demak, Jawa Tengah. Terdapat beberapa permasalahan lingkungan sekaligus potensi di daerah tersebut, antara lain sampah dan limbah padat, ekosistem mangrove yang belum terawat dengan baik, eutrofikasi eceng gondok di badan air, serta kebutuhan air tawar untuk konsumsi sehari-hari. Hal tersebut mendorong kami untuk melakukan pengabdian sebagai implementasi ilmu pengetahuan yang bermanfaat secara langsung bagi masyarakat. Pengabdian masyarakat tersebut difokuskan untuk generasi muda, yaitu para siswa di SMP Negeri 2 dan SMP Negeri 3 Wedung. Metode yang digunakan dalam pengabdian ini berupa pengenalan awal mengenai lingkungan pesisir, asesmen awal, sosialisasi, edukasi, praktik lapangan, serta evaluasi dan asesmen di akhir kegiatan. Program pengabdian ini bertujuan untuk meningkatkan pemahaman dan kesadaran lingkungan pesisir bagi pelajar. Sosialisasi materi dan praktik yang telah dilakukan yaitu mengenai a) desalinasi air, b) teknologi pemanenan air hujan berupa lubang resapan biopori, c) pengenalan tanaman mangrove, d) pemanfaatan tanaman eceng gondok, e) pemilahan sampah dan penerapan zero waste, f) edukasi mengenai kesehatan masyarakat lingkungan pesisir, serta g) mitigasi bencana untuk masyarakat pesisir utara Jawa. Setelah dilakukan asesmen di awal program dan di akhir program, terdapat peningkatan pengetahuan siswa sebanyak 9% di SMP Negeri 2 Wedung dan sebanyak 14% di SMP Negeri 3 Wedung. Hal tersebut menandakan bahwa program yang dilaksanakan di kedua sekolah tersebut memberikan dampak terhadap pemahaman dan kesadaran mengenai lingkungan pesisir yang lebih baik oleh para siswa.
Evaluasi kapasitas masyarakat tangguh bencana di kawasan rawan erupsi gunung api merapi
Authors: Fahmi Wikan Amarudin , Hizbaron Dyah Rahmawati
Published: December 2023

Disaster events have become a national issue, one of the reasons is that Indonesia is crossed by a series of volcanoes, such as Merapi Volcano. It erupted back in 2010 and caused massive impact, especially at Kepuharjo Village, Sleman Regency, Yogyakarta. This research is intended to identify the capacity of community resilience due to the Merapi Volcano eruption at Desa Kepuharjo, Kabupaten Sleman. The study collects primary data from interviews and questionnaires from unit samples of Kepuharjo Village using simple random sampling techniques. The data collected from the modified version of the questionnaire were processed using scoring techniques and analyzed using descriptive frequency. The research revealed that the questionaire to capture capacity that generally employed are not fully compliant to be used at the research area. Overall, the questionaire able to capture to assess the capacity classification which are medium (the capacity achievement is comprehensive but not significant to reduce the impact of the disaster) and high ((the capacity achievement is comprehensive and there is a commitment between the government and the community). Kepuharjo Village is classified into classes of 3-5 with a percentage of 65%. Efforts to increase capacity have been carried out by the government, assisted by the community, both by establishing institutions, physical mitigation, and non-physical mitigation.
Combination effectiveness of glucomannan and moringa oleifera leaf extract on lipid profil of hypercholesterolemia rats
Authors: Wati Dini Prastyo , Setyaningsih Endang
Published: December 2023

cholesterol levels in the blood. This study aims to determine the effectiveness of the combination of glucomannan (Amorphophallus muelleri Blume) and Moringa oleifera leaf extract on the lipid profile of hypercholesterolemic Wistar rats. This research design used True experimental with a pretest-posttest control group design. The animal used in this study was 24 male Wistar rats (Rattus norvegicus) aged 8 weeks divided into 2 control groups and 6 treatment groups of glucomannan and Moringa oleifera leaf extract. The results of this study showed that there were significant changes in TC, TG, LDL-C, and HDL-C levels (p<0.05). It can be concluded that the combination of glucomannan (Amorphophallus muelleri Blume) and Moringa oleifera leaf extract can change the lipid profile effectively in the P5 (80mg/kgBW GAmB: 120mg/kgBW MoEL) and P4 (120mg/kgBW GAmB:80mg/kgBW MoEL ) as the most influential group in reducing TG, TC, LDL-C levels and increasing HDL-C levels.
Behaviour Based Malware Detection using Machine Learning
Authors: Reddy V. Jyoshita , Jyoshna R. , Jyothi B. , Poojari Rithika . J. , Kartheek N. , Goud B. Karthik , Karthik R.
Published: December 2023

Abstract: Considering all the researches done, it appears that over last decade, malware has been growing exponentially and also has been causing significant financial losses to different organizations. Thus, it becomes important to detect if a file contains any malware or not. The malwares can cause a lot of damage to the system such as slowing downthe system and also stealing sensitive information from the system. malware is a executable program specifically to destroy a genuine user's computer by spreading harmful virusin different ways .In the current times, one of the most important assets of the people is their data and information which needs to be protected. Hence, in order to protect the data and information, there is a need for software which couldperform this task and help in ensuring the integrity of our system. Our method for malware detection uses different machine learning algorithms such as decision tree, random forest etc. The algorithm which has the maximum accuracy gets selected which provides a great detection ratio for the system. Furthermore, the performance of the system is detected by calculating the false positive and false negative rates using the confusion matrix.
Standardized Precipitation Index for Metrological Drought Analysis In Kashmir Valley Of Jammu And Kashmir
Authors: Pandit Dr. Bashir Ahmad
Published: December 2023

Abstract: The term "drought" is multifaceted, with varying interpretations based on personal experiences. It is a natural disaster that is distinguished by a severe and ongoing precipitation deficit. The planning and management of freshwater resources as well as the forecasting of the arrival and intensity of droughts depend heavily on drought monitoring. A number of indices have been put forth over time to track and measure data related to droughts. The Standardized Precipitation index (SPI), which is based on the idea of probability, is the most commonly used index. The current study examines the possibility of analysing the temporal pattern and severity of drought in the Kashmir Valley (Jammu and Kashmir) using precipitation-based SPI. Utilizing the "DrinC" software application, the Indices were calculated. SPI values were calculated using monthly precipitation data for the IMD Srinagar 2003 to 2022. SPI series computations were carried out for short, moderate, and long time scales. Based on the data, the Kashmir region experienced four periods of moderate drought in the years 2007, 2009, 2012, and 2016. Additionally, there was no significant drought from 2003 to 2022. 2007 had the maximum intensity with an SPI value of -1.37 for a moderate drought.
1. Improving Care and Promoting Health in Populations: Standards of Care in Diabetes—2024
Authors:   American Diabetes Association Professional Practice Committee, ElSayed Nuha A. , Aleppo Grazia , Bannuru Raveendhara R. , Bruemmer Dennis , Collins Billy S. , Ekhlaspour Laya , Hilliard Marisa E. , Johnson Eric L. , Khunti Kamlesh , Lingvay Ildiko , Matfin Glenn , McCoy Rozalina G. , Perry Mary Lou , Pilla Scott J. , Polsky Sarit , Prahalad Priya , Pratley Richard E. , Segal Alissa R. , Seley Jane Jeffrie , Stanton Robert C. , Gabbay Robert A.
Published: December 2023

The American Diabetes Association (ADA) “Standards of Care in Diabetes” includes the ADA’s current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA’s clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at https://professional.diabetes.org/SOC.
10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2024
Authors:   American Diabetes Association Professional Practice Committee, ElSayed Nuha A. , Aleppo Grazia , Bannuru Raveendhara R. , Bruemmer Dennis , Collins Billy S. , Das Sandeep R. , Ekhlaspour Laya , Hilliard Marisa E. , Johnson Eric L. , Khunti Kamlesh , Kosiborod Mikhail N. , Lingvay Ildiko , Matfin Glenn , McCoy Rozalina G. , Perry Mary Lou , Pilla Scott J. , Polsky Sarit , Prahalad Priya , Pratley Richard E. , Segal Alissa R. , Seley Jane Jeffrie , Stanton Robert C. , Gabbay Robert A.
Published: December 2023

The American Diabetes Association (ADA) “Standards of Care in Diabetes” includes the ADA’s current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA’s clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
14. Children and Adolescents: Standards of Care in Diabetes—2024
Authors:   American Diabetes Association Professional Practice Committee, ElSayed Nuha A. , Aleppo Grazia , Bannuru Raveendhara R. , Bruemmer Dennis , Collins Billy S. , Ekhlaspour Laya , Hilliard Marisa E. , Johnson Eric L. , Khunti Kamlesh , Lingvay Ildiko , Matfin Glenn , McCoy Rozalina G. , Perry Mary Lou , Pilla Scott J. , Polsky Sarit , Prahalad Priya , Pratley Richard E. , Segal Alissa R. , Seley Jane Jeffrie , Stanton Robert C. , Gabbay Robert A.
Published: December 2023

The American Diabetes Association (ADA) “Standards of Care in Diabetes” includes the ADA’s current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA’s clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
Hydrographical Studies in the Nearshore Seawater of the Red Sea Coast of Al-Hodeida City, Yemen
Authors: Al-Hagibi* Hagib A
Published: December 2023

Hydrographic studies of nearshore seawater are important because they are sensitive to both natural and human influences. The hydrographic study is very important for nearshore waters because it is very sensitive to natural and human influences. In this research, an attempt was made to study the hydrographic properties of the nearshore water of the Red Sea coast of Hodeida city, Yemen. During the period from December 2021 to June 2022, to represent the two seasons of winter and summer. The water temperatures ranged from 30 to 34.5°C, salinity fluctuated from 39.3 to 42.4 psu, pH varied from 7.9 to 8.2 and dissolved oxygen ranged from 4.88 to 8.54 mg/l. The higher values of temperature and salinity were recorded during summer. In contrast, an increase in pH and dissolved oxygen were observed during winter. The present study confirmed that salinity has a negative correlation with pH and dissolved oxygen although it was not significant and also it showed significant positive correlation between pH and dissolved oxygen (0.828). Hydrographic parameters showed different patterns of spatial and temporal distributions. These current baseline data are useful for further environmental monitoring, assessment and management along Yemeni coastal beaches.
Accusations of Islamophobia and Radicalism Against Muslim Women in Hijab in Indonesia: A Bibliometric Analysis
Authors: Tamami Fauziyah , Rahmawati Siti , Maksum Muhammad Nur Rochim , Apriantoro Muhamad Subhi , Muchammad Taufiq Affandi  , Shaifurrokhman Mahfudz
Published: December 2023

This study aims to determine the mapping of the development and direction of research on allegations of Islamophobia and Radicalism against Muslim Women wearing hijab in Indonesia using articles indexed by Google Schoolar, WoS, and Scopus databases. This study uses a quantitative approach of bibliometric analysis method to explore all publications indexed in the Scopus database regarding allegations of Islamophobia and radicalism against Muslim women wearing hijab in Indonesia from 2008 to 2023. Data obtained and analyzed using Excel and R/R-Studio. VOSviewer is used to perform visual analysis of keyword occurrence and document citations in a stimulating manner. Researchers found 74 publications that fit the function, subject, and criteria set. The results of this study show an annual growth rate. The papers are analyzed in terms of publications by field of science, the number of studies published annually. The bibliometric analysis performed was limited to Scopus data. Other national and international databases were not taken into account in the study. The limitation of this study is only taking data sets or meta data in publications indexed by Scopus. This study presents a brief overview of the literature accessible to researchers working in the field of Accusations of Islamophobia and Radicalism against Muslim Women and provides recommendations for future research.