bluuebunny/crossref_metadata_2025 huggingface dataset:
Herbalizmi dentar
Authors: Amuli Xhuena , Disha Valbona
Published: February 2022

Kurimi i patologjive të ndryshme shëndetësore nëpërmjet bimëve tashmë njihet në të gjithë botën. Janë të njohura efektet e tyre antimikrobiale, antifungal, antivirale etj., veti këto që mund të shfrytëzohen për të trajtuar patologji edhe në kavitetin oral. Nga ana tjetër, kur krahasohen me medikamentet, bimët janë më të sigurta në përdorim dhe më me pak efekte anësore.

Qëllimi. Si ndikon në reduktimin e pllakës dentare dhe kariesin dentar përdorimi i disa bimëve (kanellës, stivias, propolisit dhe lëkurës së portokallit).

Materiale dhe metoda. Ky studim është një rishikim literature, në vetvete kualitativ, duke qenë se është bazuar në literaturë ekzistuese. Duke përdorur fjalët kyçe për kërkimin e artikujve në lidhje me temën, u shfaqën rreth 500 artikuj. Nga këto u zgjodhën 8 artikuj që u shfrytëzuan për qëllimin e studimit. Artikujt e përzgjedhur përfshinin studime në lidhje me bimët e interesit dhe me efektet që ato kanë në pllakë dhe inhibimin e evolucionit të kariesit. Artikujt i përkasin viteve të fundit dhe trajtojnë studime in vivo/in vitro që janë kryer duke përdorur bimët e interesit.

Rezultate. Aprovimi i potencialeve në frenimin e aktivitetit mikrobial dhe reduktimin e akumulimit të pllakës patogjene në kavitetin oral, janë disa nga rezultatet e këtij studimi. Interesant është fakti që studiues të ndryshëm kanë nxjerrë rezultate të përafërta me njëri tjetrin lidhur me vetitë pozitive të bimëve të interesit.

Konkluzione. Është i padiskutueshëm fakti që bimët kanë pranueshmëri më të mirë nga ana e pacientit dhe më pak efekte anësore. Studimet e kryera kanë lënë rrugë të hapur drejt mundësive të përfshirjes së bimëve të interesit në produktet e higjenës orale. Mungesa e standardizmit të kësaj disipline dhe e një instituti kërkimor përbën kufizim për këtë punë kërkimore.
Aneurizma gjigande e aortës ascendente torakale
Authors: Kaçani A , Aliu A , Kuçi S , Mile E , Veseli A , Dibra A , Prifti E
Published: February 2022

Aneurizmat gjigande e Aortës Ascendente (AAA) bashkëshoqëruar me zgjerim shumë të madh të rrënjës së aortës, janë të raportuar shumë rrallë. Ne do paraqesim rastin e një AAA gjigande tek një pacient 68 vjeçar i cili iu nënshtua një interventi kirurgjikal të suksesshëm të zëvendësimit të aortës ascendente dhe rrënjës së saj duke përdorur teknikën e modifikuar të Bentall nëpërmjet një konduiti të kompozuar me valvë mekanike dhe shoqëruar me implantim të arterieve koronare.
Roli i shërbimit psikologjik në menaxhimin e Çrregullimit të Stresit Pandemik dhe ruajtjen e mirëqenies emocionale gjatë periudhës së Covid-19.
Authors: Kafia Elisabeta , Ibrahimi Silva
Published: February 2022

"Fokusi i këtij artikulli është të propozojë një psikopatologji të re: Çrregullimin e Stresit Pandemik. Objektivi tjetër është të shfaqë një pikëpamje të gjerë dhe mbështetëse të asoci- meve, sfidave dhe strategjive të përballimit psikologjik ndaj Covid-19 me fokus në masat e prevenimit psikik dhe jo vetëm social. Sot shihet një shtim i besimeve patogjenike të lidhura me virusin, frika dhe paniku te specialistët e shëndetit dhe grup-moshat e ndryshme që mund të preken nga virusi. Informacionet e përditësuara mbi mutacionet e virusit shtojnë edhe më tepër shtresat e gjendjeve emocionale negative të akumuluara. Në komorbiditet me vetë stresin pandemik dhe me çrregullimet e tjera, këto qendrime patogjenike e vënë në pikëpy- etje stabilitetin psiko-emocional dhe sjelljen e shëndetshme sociale të individit.Sot, individët-pacientë të frikësuar nga Covid-19 jo vetëm luftojnë për rritjen e sig- urisë së tyre por edhe me shtimin e mendimit supersticioz, ashpërsinë dhe kompleksitetin e sëmundjes me komorbiditete të tjera, që ulin nivelin e mirëqenies psikologjike . Për të përballuar në mënyrë të suksesshme këto sfida, është e domosdoshme të ri-përcaktohet roli i Psikologut të shëndetit dhe i të gjitha figurave shëndetësore në komunitet, si për studimin e dukurisë, zhvillimit, faktorëve dhe pasojave, ashtu edhe në psikoedukimin për menaxhim të ankthit e panikut dhe në trajtim profesional të personit me Çrregullim të Stresit Pandemik (traumatik)."
Deklarata e dhjetorit 1942 e tre të mëdhenjve për njohjen e shtetit të pavarur shqiptar dhe statusin e ardhshëm të tij
Authors: Babameto Etleva , Taraj Gentjana
Published: February 2022

Lufta e Dytë Botërore përbën një nga ngjarjet më të mëdha e të rëndësishme në historinë botërore. Në këtë kuadër, rrugëtimi i Shqipërisë, karakterizuar nga faktorë specifikë të brendshëm dhe të jashtëm, kaloi në një sërë fazash deri në fund të Luftës që dimensionuan rezultatet e luftës dhe fatin e statusit të saj të ardhshëm. Qëllimi i këtij studimi është të hulumtojë rrethanat, faktorët, zhvillimet që çuan në Deklaratat e Dhjetorit 1942 të Britanisë së Madhe, SHBA-së dhe BS-së, si forcat e Koalicionit Antifashist që ndikuan në pozitën e Shqipërisë në zhvillimet e mëtejshme të luftës. Studimi mbështetet në metodologjinë e njohjes dhe vlerësimit të dokumenteve e materialeve historike ekzistuese, zhvillimin e një analize objektive dhe kritike, përqasjen me burime arkivore vendase dhe të huaja, për të arritur në analiza, interpretime e vlerësime objektive të ngjarjeve të kohës. Studimi arrin në konkluzionin se me Deklaratat e tyre, Fuqitë e Mëdha e njihnin luftën heroike që bënte populli shqiptar dhe kontributin në luftën kundër fashizmit, si edhe të drejtën e tij për të jetuar i lirë dhe i pavarur, por lanë të pazgjidhur çështjen e ekzistencës së shtetit shqiptar pas lufte.
Derogimi nga të drejtat e njeriut
Authors: Sheqi Enea
Published: February 2022

Objektivi: Objektivi i këtij punimi është të trajtojë në mënyrë të detajuar rastet e derogimit nga të drejtat e njeriut. Në këtë trajtesë synohet që të trajtohen kujfitë e lejimit nga derogimi i të drejtave të njeriut në rastet e gjendjes së jashtëzakonshme, procedura dhe përjashtimet nga ky nen. Metoda: Metodologjia e përdorur në këtë artikull synon që të analizojë ligjin ndërkombëtar për të drejtat e njeriut, në një vështrim krahasimor me ligjin shqiptar. Gjithashtu, shpesh është ndërthurur me raste të praktikës gjyqësore të Gjykatës Europiane për të Drejtat e Njeriut, për të bërë më të kuptueshëm këtë studim. Rezultatet: Artikulli paraqet disa gjetje mbi ligjin shqiptar për të drejtat e njeriut, si dhe rastet e shpalljes së gjendjeve të jashtëzakonshme, duke i paraprirë rasteve të mundshme të derogimit nga të drejtave të njeriut. Kështu analiza e Konventës Europiane të të Drejtave të njeriut i lejon shteteve palë që të marrin masa që i shmangen detyrimeve të konventës në përputhje me të drejtën ndërkombëtare. Përfundimet: Në përfundim të punimit u vu re se Shqpëria ka një legjislacion të përafruar tërësisht me atë ndërkombëtar mbi të drejtat e njeriut. Mbi rastet kur mund të lejohet derogimi nga të drejtat e njeriut praktika e Gjykatës Europiane të të Drejtave të Njeriut ka unifkuar qëndrimin, duke dhënë kështu ide të qarta se kur duhet lejuar derogimi nga të drejtat e njeriut dhe kush është procedura që duhet ndjekur.
Droni e ardhmja në dorën tënde
Authors: Qyra Ervis , Prendi Artur
Published: February 2022

Një dron është një makinë pa pilot e përdorur nga njerëzit përmes kontrolluesve. Integrimi i droneve dhe teknologjisë në internet (IoT) ka krijuar raste të shumta të përdorimit të tyre në aktivitete të ndryshme. Në këtë projekt, ne do të përdorim sensorin me shpejtësi të thjeshtë dhe lehtësisht të disponueshëm mikrokontrolluesin STM32 32-bit, që funksionon në 90MIP me 128KB Flash dhe RAM 20KB. Me këto parametra, droni do të jetë në gjendje të njohë statusin e vërtetë të mjedisit ku do të përdoret. Gjithashtu, do të bëjmë të mundur edhe kontrollin automatik të dronit. Me ndihmën e një motori të vogël servo, droni skanon zonën si në të majtë, ashtu edhe në të djathtë për të gjetur mënyrën më të mirë për t’u kthyer. Përmes përdorimit të sensorit ultrasonik, droni do të kontrollojë prezencën e pengesave dhe do të vetë rregullojë lëvizjen e tij, duke dërguar komanda në bordin e Arduinos. Në varësi të sinjalit të pranuar të hyrjes, mikrokontrollori Arduino dërgon dronin ne një drejtim tjetër nëpërmjet drajverit të motorrit IC.
Kontrolli automatik në robotikë
Authors: Kote Enea , Prendi Artur
Published: February 2022

Robotika është shkenca dhe teknologjia e robotëve, dizenjimit, prodhimit dhe përdorimit të tyre. Roboti është një manipulator i riprogramueshëm i dizenjuar për të lëvizur në mënyrë të specifikuar nëpërmjet lëvizjeve të programuara. Në këtë projekt do të ndërtojmë një robot të lëvizshëm në mënyrë të pavarur, automatike. Kjo nënkupton që roboti do të jetë i aftë në njohjen e pengesave që do të hasë gjatë rrugës dhe shmangjen e tyre me sukses.
Faktorët etiologjikë, diagnoza dhe terapia e cirrozës hepatike të avancuar në Shqipëri në krahasim me të dhëna europiane
Authors: Tata Xhimi , Baiocchi Leonardo , Kondili Loreta , Babameto Adriana
Published: February 2022

Qëllimi i studimit 
Nuk ka të dhëna për epidemiologjinë e cirrozës hepatike në Shqipëri. Qëllimi i këtij studimi është të vlerësohet roli i faktorëve kryesorë shkaktarë të cirrozës, në pacientët e shtruar në spital për t’u fokusuar në fushën e parandalimit dhe mjekimit të saj. 
Metodat 
Të dhënat etiologjike, klinike si dhe të terapisë së pacientëve të shtruar në departamentin e gastro-hepatologjisë së Qendrës Spitalore Universitare në Tiranë u mblodhën në mënyrë konsekutive gjatë vitit 2019-2020. 
Rezultatet 
Nga 120 pacientë të shtruar në spital: 19% për ascit, 4% për hemoragji digjestive, 22% për encefalopati hepatike, 3% për HCC, 24% për diagnozë të parë të insuficiencës hepatike, 28% më shumë se një komplikacion të cirrozës. 56% ishin me cirrozë alkolike, 18% HBV, 7% HCV, 12% me etiologji virale dhe alkoolike, 7% me etiologji të tjera. Nga 11 pacientë me karcinomë hepatoqelizore (HCC), 73% kishin cirrozë HBV. Nga pacientët me cirrozë HBV, 19% mjekoheshin me tenofovir (mungonte testimi i HBV-DNA), 34% raportuan një trajtim të mëparshëm me lamivudine, pa mjekim aktual, 47% nuk raportonin mjekim antiviral. Nga 13 pacientë HCV+, 70% ishin HCV-RNA+, nga të cilët 23% nuk patën efekt nga trajtimet antivirale, 31% ishin HCV-RNA-.8 
Konkluzione 
Abuzimi i alkoolit është shkaktari kryesor i cirrozës në Shqipëri që kërkon një rritje të sensibilitetit për parandalimin e saj. Infeksioni nga HBV luan një rol të rëndësishëm, fakt që kërkon rritjen e vaksinimit dhe përdorimin efektiv të antiviralëve anti HBV. Është e nevojshme një screening për infeksionin nga HCV në popullatën me faktorë risku dhe në momentin e diagnozës duhet të fillohet mjekimi antiviral pavarësisht nga grada e dëmtimit të heparit.
Emigrantët dhe emigracionet në partnertetin e përtërirë euro-mesdhetar: një drejtim i re për BE-në?
Authors: Tomaselli Alessandro
Published: February 2022

Me rastin e 25 vjetorit të nënshkrimit të Deklaratës së Barcelonës, Bashkimi evropian po përgatitet të përfundojë një partneritet të rinovuar me vendet e bregut jugor të Detit Mesdhe, i cili përbëhet nga pesë pika kyçe: zhvillimi njerëzor, qeverisja e mirë dhe sundimi i shtetit të së drejtës, të drejtat e njeriut: rinovimi i përkushtimit të përbashkët për demokracinë, shtetin e së drejtës, të drejtat e njeriut dhe qeverisjen e përgjegjshme; elasticiteti, prosperiteti dhe tranzicioni digjital: mbështetja e ekonomive elastike, gjithëpërfshirëse dhe të lidhura që krijojnë mundësi për të gjithë, veçanërisht gratë dhe të rinjtë; paqja dhe siguria: ofrimi i mbështetjes për vendet për të adresuar sfidat e sigurisë dhe për të gjetur zgjidhje për konfliktet e vazhdueshme; migrimi dhelëvizshmëria: adresojnë së bashku sfidat e zhvendosjes së detyruar dhe migrimit të parregullt dhe lehtësojnë rrugë të sigurta dhe ligjore për migrimin dhe lëvizshmërinë; tranzicioni i gjelbër: elasticiteti i klimës, energjia dhe mjedisi. elasticiteti klimatik, energjia dhe mjedisi. Mbrojtja e burimeve natyrore të rajonit dhe gjenerimi i rritjes së sipërfaqeve të gjelbra duke shfrytëzuar potencialin e një të ardhmeje me mbetje karboni të reduktuara. Ndonëse kjo nismë është për t'u vlerësuar për iniciativat e shumta që parashikon dhe mbi të gjitha për marrjen në konsideratë të qenies njerëzore si prioritet në realizimin e objektivave ekonomike, do të duhet të verifikohet konkretisht nëse objektivat e vendosura mund të arrihen duke marrë parasysh vështirësitë e shumta që kanë karakterizuar gjithmonë territoret e vendeve të Afrikës Veriore dhe të Lindjes së Mesme të përfshira në këtë nismë, veçanërisht në lidhje me problemin e migracionit dhe mbrojtjen e të drejtave të njeriut. Cilat janë pikat e forta dhe mundësitë reale të suksesit të kësaj nisme?
Liberal democracy: absolutist eu rule of law conditionality or pluralistic bargaining chip?
Authors: Matwijkiw Anja , Matwijkiw Bronik
Published: February 2022

EU membership accentuates values. The current emphasis is a case of EU idealism, of stricter conditionality in response to political ideology and governance. Democracy is tantamount to liberal democracy, but at the same time pluralism is an integral part of the conditionality. This raises the question about the countryspecific maneuvering scope or – if EU candidate countries and Member States (are seen to) deviate from a non-negotiable ideal – inappropriate manipulation. While the authors do not address absolutism per se, they proceed on the premise that the “European perspective” disallows any value dilution, thereby maximizing theconflict and identity crisis which Poland and Hungary have caused and which have overshadowed accession talks for candidate countries. One intention is to contextualize the debate and dispute about values by incorporating interdisciplinary insights. Another is to challenge the (European perspective on the) rule of law cluster, inter alia, with the illiberal measures that Denmark has adopted.
Dalla giurisdizione della corte suprema alla competenza del tribunale speciale: la sfida del sistema giudiziario albanese contro la corruzione ad alto livello governativo
Authors: Tafani Ismail
Published: February 2022

The Constitution of the Republic of Albania, adopted in 1998, provided that the Supreme Court had primary and cassation jurisdiction. Primary jurisdiction referred to the obligation attributed to this Court to judge at first instance, the most important figures of the political and judicial power. Although there is a perception of the corruption of the subjects of this jurisdiction, which was an exception to the right of the second instance court of law, the Supreme Court had not shown itself to be independent in the judicial processes of high-level officials. In 2016, when the constitutional reform of the judicial system in Albania was adopted, the provision that created hope for the fight against corruption at high levels of government was the establishment of the Special Tribunal against corruption and organized crime and the Special Investigative Structure (SPAK). The latter is required by the constitutional reform to independently investigate senior state officials, unlike what the Attorney General had done before the reform. The implementation of the reform, in this respect, is ongoing, however, yet has not been presented an outcome of the judicial reform, but what deserves attention is an analysis of the expectations of the Special Court, unlike the jurisdiction of the first instance of the Supreme Court. The question that arises is whether this constitutional change will transform the approach of the judicial system or will it remain yet another reform written on paper. The doubts, in this context, arise from the fact that five years have passed since the reform started and the challenge of defeating corruption and strengthening the rule of law still remains an illusion that it is expected to turn into delusion.
Back to the basics: election integrity as a eu accession criteria for the western balkan countries
Authors: Dimitrieva Jasmina
Published: February 2022

The Global Commission on Election, Democracy and Security defines election integrity as “election that is based on the democratic principles of universal suffrage and political equality as reflected in international standards and agreements, and is professional, impartial, and transparent in its preparation and administration throughout the electoral cycle”. Elections with integrity are the keyto preserving stability, peace and security not only at a national, but also at European level. The perspectives of the EU integration of the Western Balkans have been continuously viewed through the lens of the European security and stability. From the viewpoint of election integrity, the 1993 Copenhagen accession criteria require from the candidate countries to achieve stability of institutionsguaranteeing democracy and the rule of law. The Western Balkan countries are experiencing a long-time struggle to satisfy the said EU democratic criteria. The paper aims to shed light on the 1993 Copenhagen criteria with respect to the obligation to conduct elections with integrity and discusses the EU support modalities for ensuring election integrity in the Western Balkans, as well assynergies created with other regional organizations in this regard. The paper concludes that regardless of the EU integration perspective of the Western Balkan countries, the citizens of the region deserve elections with integrity comparable to those of the EU countries.
Beyond mutual recognition: the rules of joint investigation teams
Authors: Geraci Rosa
Published: February 2022

The “Joint Investigation Teams” (JITs) are a new and effective tool for cooperation in criminal matters, based on a “spirit of solidarity” in carrying out cross-borders criminal investigations: synergistic forms of cooperation between both judicial andpolice authorities of the different Member States (or even non-EU Countries, if there are legal bases), which coordinate their actions and share the results obtained. JITs constitute an unprecedented form of judicial assistance: “non-rogatorial”, “hybrid”, “operational” and “self-sufficient” from an organizational point of view. Based on an agreement between competent authorities – both judicial (judges, prosecutors, investigative judges) and law enforcement – of two or more States, JITs are established for a limited duration and for a specific purpose, to carry out criminal investigation in one or more of the involved States. Despite the many advantages, the critical issues are not few: the balance between fight against international crime and right of defense; the lack of proper measures to approximate EU Member State’s criminal law and the resulting problem of admissibility of evidence collected abroad in the national trial; the interactions with other new cooperation tools, (MAE, EIO, etc.), with respect to which JITs can often act as an initial mechanism for an investigative activity that can be developed more widely.
Asset recovery: nuova enfasi da parte delle nazioni unite nella lotta alla corruzione
Authors: Busillo Stefano
Published: February 2022

The United Nations are long-term active in the fight against corruption, a phenomenon troubling developed and undeveloped nations alike. Quite recently, through GA Resolution no. 75/194, asset recovery eventually gained new momentum, with a series of recommendations towards the UN Member States. Hence, this article serves the double purpose to look into said Resolution in the first place, highlighting what’s new and, on the contrary, what can be considered an inheritance from previous attempts addressing the matter; secondly, to discern whether and where the measures auspicated by the General Assembly are already in place, and in what degree of implementation. In particular, the article aims at laying emphasis on the many differences between the attitude of the involved countries and regional organizations.
Preventive Maintenance for Mortgage Loans of Low-Income Borrowers
Authors: Xu Feng , Wu Dazhong , Hua Jian , Tan Tih Koon
Published: February 2022

For borrowers with financial troubles in the mortgage market, current practice is to offer loss mitigation options only after mortgage defaults occur. Researches in this area focused on borrower’s post-default options and the effectiveness of different mitigation tools and servicers’ practices to prevent foreclosure. Same as researchers, practitioners and policy makers are interested mainly in determining when and how to provide interventions for delinquent loans. Some studies pointed out the cost saving effect by providing preventive services to borrowers in early delinquency stage, while others claimed the effects from altering the terms of modifying the loan contracts. In this paper, we present preventive loan maintenance models and argue that it is more cost effective by applying pre-default mitigation strategies before a borrower becomes delinquent and before the occurrence of defaults from a specific proportion of loans in a mortgage pool.   
The Effect of Integrative Therapies Based on the Regulation of Cognitive, Emotional, and Behavioral Mediators on Marital Adaptation: A Systematic Review
Authors: Solat Petloo Ahad , Vaziri Shahram , Lotfi Kashani Farah
Published: February 2022

Context: Marital adjustment is necessary for ensuring the well-being and continuity of mutual relationships. It encompasses a wide range of experiences required for cohabitation, such as satisfaction, agreement, and expressing emotions. The importance of marital adjustment has been the focus of various therapeutic approaches, and it has been long considered by researchers in the context of communicative skills. Evidence Acquisition: Due to the inter-theoretical and multi-dimensional nature of marital communication and adaptation, this study was conducted to investigate the effectiveness of integrative therapies based on the regulation of the cognitive, emotional, and behavioral mediators on marital adaptation. Data Sources: In this systematic review, English articles published from March 2005 to March 2021 in databases including Google Scholar, ScienceDirect, PubMed, Web of Science, and Cochrane Library were extracted. Also, to find the articles published in Persian, databases including Scientific Information Database (SID) and Magiran were searched from January 2021 to April 2021. Results: A total of 20 studies were included for analysis. The results of the systematic review showed the usefulness of integrative couple therapies with the continuation of therapeutic effects in more than two months of follow-up. Conclusions: Although the effectiveness of integrative approaches in improving the couple's adaptation and communication components were confirmed in the reviewed studies, most of the studies provided no evidence regarding the effective variables in the therapeutic interventions and the related procedure. Therefore, more precise studies are required to make a more accurate judgment on their credibility.
Healing Hope: A Response to Peter Iver Kaufman
Authors: Roberts Ogle Veronica ,   Philosophy Documentation Center
Published: February 2022

This is the second of two responses to Peter Kaufman’s article “Hopefully, Augustine.” Veronica Roberts Ogle, author of Politics and the Earthly City in Augustine’s City of God, probes the degree to which her articulation of Augustinian political activity—and any hopes that might accompany it—overlaps or contrasts with Kaufman’s more minimalist conception.
Hopefully, Augustine
Authors: Kaufman Peter Iver ,   Philosophy Documentation Center
Published: February 2022

When Augustine wrote about having discovered a hope (diuersa spes) different from the political ambitions that drew him to Rome then Milan (spes saeculi), he referred to Christians’ hopes for celestial reward. But several colleagues suggest that he also harbored hopes for a kinder political culture. Discussions of Augustine’s hopes have enlivened the study of political theory and political theology for several generations. During the twenty-first century two influential volumes took him as their inspiration for “hopeful citizenship” and “democratic citizenship.” Recently, two perceptive studies propose variations on the themes introduced there. What follows deploys several of Hannah Arendt’s observations about Augustine to suggest that his political hopes were somewhat more restricted but more radical than the latest contributions to his political theology suggest.
Schelling and the Philebus
Authors: Fisher Naomi , Fisher Jeffrey J. ,   Philosophy Documentation Center
Published: February 2022

Schelling’s 1794 commentary on the Timaeus makes extensive use of Plato’s Philebus, particularly the principles of limit and unlimited. In this article, we demonstrate the resonances between Schelling’s 1794 treatment of the metaphysics of the Philebus and his 1798 philosophy of nature. Attention to these resonances demonstrates an underexplored but important debt to Plato in Schelling’s philosophy of nature. In particular, Schelling is indebted to Plato’s late metaphysics in his model of the iterative combination of two basic principles: a productive, positive principle, akin to Plato’s unlimited, and a limiting, negative principle, akin to Plato’s limit. In Schelling’s philosophy of nature, the iterative interaction of these principles both provides a common ground for and accounts for the differences between inorganic and organic nature.
The “Asian question” in Kenya: history and new trends
Authors: Karpov Grigory
Published: February 2022

  This article explores the history of the emergence, development and current state of the discourse dedicated to the “Asian question” in Kenya. The emphasis is placed on active participation of the immigrants from British India in many key spheres of Kenyan society – business, public service, medicine, publishing industry, and anticolonial movement. Special attention is given to examination of the “Indian question” in the colonial era of Kenyan history as one of the crucial factors of the emergence of the ”Asian question” during the period of independence of the country. Assessment is conducted on the current status of South Asian diaspora in Kenya. Research methodology leans on the comparative-historical and civilizational approaches. In the 1960s –1970s, the Kenyan government pursued the policy of “Africanization” aimed at excluding Indians and their descendants from the economic and social sphere of the country. This approach induced mass emigration of the Indian population from Kenya to the United Kingdom and other Western countries. The “Asian question” has become a peculiar response of the Kenyan society to socioeconomic and financial problems of the 1980s – 1990s, an attempt to find positive aspects in the activity of South Asian capital in history of the country. Despite the challenging interethnic situation, the immigrants from South Asia have formed an ethnic community in Kenya and maintain close ties with the Indian diaspora abroad.  
Design and research of a broadband mode-division multiplexer based on three-core photonic crystal fiber
Authors: Wang Xiao-Kai , Li Jian-She , Li Shu-Guang , Guo Ying , Meng Xiao-Jian , Wang Guo-Rui , Wang Lu-Yao , Li Zeng-Hui , Zhao Yuan-Yuan , Ding Yu-Xin ,   Department of State Key Laboratory of Metastable Material Preparation Technology and Science, School of science, Yanshan University, Hebei Key Laboratory of Microstructure Materials Physics, Qinhuangdao 066004, China,   School of Information Science and Engineering, Northeastern University, State Key Laboratory of Integrated Automation of Process Industry, Shenyang 110004, China
Published: February 2022

A broadband mode-division multiplexer based on asymmetric three-core photonic crystal fiber is proposed in this paper. The device is mainly composed of a central core, which can provide the transmission of fundamental mode and higher-order mode, and two side cores providing fundamental mode transmission. According to the theory of optical coupling, the LP01 mode light is input to the three fiber cores at the initial port separately, and in the transmission process the LP01 mode on the left side core will be coupled and converted into the LP21 mode light in the central core gradually. Similarly, the LP01 mode of the right side core is transformed into the LP31 mode of the center core. By optimizing the structural design and selecting the length of optical fiber, the best conversion from side core into central core can be completed at the output end simultaneously, thereby realizing the multiplexing of LP01, LP21 and LP31 modes in the central core. In the opposite direction, if the output end of the device is used as the initial port, the demultiplexing of three modes of light from the central core to the three cores can be realized. In thiswork, the finite element method and beam propagation method are used to optimize the simulation, and the optical coupling theory and supermode theory are combined to conduct analysis and calculation. The results show that at wavelength band from 1.49 μm to 1.63 μm, the maximum insertion loss of the device is 0.72 dB, and the lowest insertion loss is 0.543 dB at 1.55 μm, which is far lower than the general evaluation standard of 1 dB insertion loss. The low insertion loss also makes it possible to design cascaded multi-core photonic-crystal-fiber mode-division multiplexer. Compared with the existing mode-division multiplexing scheme, the device is more integrated and less affected by the external environment. When it is used with multi-core space division multiplexing fiber, it can better improve the mode-conversion efficiency and mode purity, reduce the coupling complexity and expand the communication capacity.
Congenital Absence of Stapedius Muscle and Tendon: Case Report with Review of Literature
Authors: Dey Samyadipta , Dutta Mainak , Misra Saibal
Published: February 2022

Absence of stapedius muscle and its tendon is an extremely rare congenital anomaly, with only nine indexed reports in live patients. It presents with non progressive, occasionally bilateral conductive deafness, although this cannot be confirmed from Pure Tone Audiometry (PTA) and High Resolution Computed Tomography (HRCT). This makes it one of the least probable differential diagnosis of conductive deafness with unremarkable tympanic membrane. The definitive diagnosis is made only at time of surgery. The condition often co-exists with other genetic/acquired disorders of the middle/inner ear (otosclerosis, tympanosclerosis, etc.,). In absence of standardised, evidence based management protocol, diagnosis and appropriate treatment become challenging, and are predominantly situational. Its occurrence follows complex embryologic sequences where the internal portion of the interhyale- the mesenchymal condensation separating the cranial mesenchyme of the second pharyngeal arch (stapedial anlage) from Reichert’s cartilage- remains either absent or undergoes regression. Here, authors presents a case of 19-year-old female with congenital absence of stapedius muscle and tendon. She presented with congenital, bilateral, non progressive, moderate conductive hearing loss, and was diagnosed with this condition at surgery. There was co-existent tympanosclerosis in the middle ear that resulted in ossicular chain fixation and absence of round window reflex. The tympanosclerotic plaques were meticulously removed, ossicular chain mobility was restored, and a type II ossiculoplasty was done, along with reconstruction of the posterosuperior bony canal wall with cartilage perichondrium complex. Apart from the clinical presentation and its management, the present report also emphasises the plausible theories on relevant embryology explaining such an unusual event.
Robot Assisted Laparoscopic Repair of Vesicovaginal Fistula: A Retrospective Study at a Tertiary Care Centre, Chennai, India
Authors: Quadri Mohsin , Thirumalai G , Kumar B Arun , Ramesh K , Raghavan Deepak , Ananth KS , Jain Nitesh
Published: February 2022

Introduction: Vesicovaginal Fistula (VVF) is the most common acquired fistula of the urinary tract in women. Robotic surgery is recently introduced for VVF repair and has benefits over conventional methods. Aim: To describe experience with robot-assisted laparoscopic repair of VVF in patients. Materials and Methods: This was a retrospective observational study conducted from February 2014 to February 2018, at Department of Urology, Apollo Main Hospital, Chennai, Tamil Nadu, India. The study included 24 patients who underwent robot-assisted laparoscopic VVF repair. After cystoscopy ureteric catheter was passed through the fistula and retrieved through vagina. Bilateral ureteric catheters were placed simultaneously with vaginal packing. Da Vinci Si robot was docked with patient in trendelenburg position. After trocar placement transperitoneally the fistula was approached. Through vertical or transverse cystotomy, fistula was identified. With the circumferential incision around the fistula, both the bladder and vagina was separated and the fistulous tract was excised. Bladder was closed vertically and vaginal opening was closed transversely interposing the Omentum. Statistical analyses were performed using the Statistical Package for Social Sciences (SPSS) version 20.0. Results: The mean age of participants was 40.33 years. Elective hysterectomy done for benign conditions (91.67%) was the major cause of VVF in patients followed by emergency hysterectomy (8.33%). All of the patients underwent adhesiolysis while two patients performed right ureteric re-implantation additionally. The median operative time was 127.50 minutes. The median duration of drain and hospital stay was three days each. Urethral Foley’s catheter removal done at 2-3 weeks based on operating surgeon’s preference and the mean duration of follow-up was 26 months. Conclusion: Robot-assisted laparoscopic VVF repair is convenient and an effective approach in the successful management of VVF in complex fistulas and recurrent cases.
Infective Endocarditis of Native Valves due to Aspergillus in an Immunocompetent Host: A Rare Presentation
Authors: Patil Pratik , Nambi P Senthur , Kumar Pramod , Salgunan N , Reddy Haripriya
Published: February 2022

Aspergillus endocarditis is a rare entity in an immunocompetent host with native valves. Late or misdiagnosis leads to increased morbidity and mortality. In this report authors present a case of native valve Aspergillus endocarditis, in 30-year-old male immunocompetent patient with no co-morbidities. The patient also had a parietal glioma. He underwent four surgeries including valve replacement during the course of illness. Patient improved with appropriate antifungal therapy and surgeries. He was on suppressive antifungals and continued to do well. Aspergillus endocarditis is to be considered in culture negative endocarditis. The optimal management includes adequate surgical debridement in conjunction with prolonged antifungal therapy.
Foetomaternal Outcomes in COVID-19 Positive Obstetric Patients: An Observational Study
Authors: Gowda Sahana , Suma KB
Published: February 2022

Introduction: In Coronavirus Disease-2019 (COVID-19) pandemic, a serious concern has been raised regarding the health of the newborn and the pregnant mother. Limited data is available on the foetomaternal outcomes in this pandemic. Aim: To assess the foetomaternal outcomes in COVID-19 positive pregnant patients. Materials and Methods: A prospective cohort study was conducted from October 2020 to December 2020, at JSS medical college, Mysuru, Karnataka, India, on 27 COVID-19 positive obstetric patients admitted to the ward who had confirmed COVID-19 on the basis of Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) or lung opacities. The study period belonged to first wave of COVID-19. The foetomaternal outcomes such as mode of delivery, abortions, foetal admission in Intensive Care Unit (ICU) and mortality among the mother and the baby were recorded. The data was collected and tabulated in Microsoft Excel sheet and frequency (n) and percentages (%) were calculated. Results: Total of 27 COVID-19 positive obstetric patients (age 19-37 years; mean gestational age 34.84±7.75 weeks) formed the sample of the study. The mean age of the study patients were 27.11±4.5 years. The primary symptoms included cough (18.52%) and breathlessness (11.11%). After diagnosis, seven cases (25.92%) continued pregnancy and were lost to follow-up while among those who delivered (n=20), the mode of delivery was Lower Segment Caesarean Section (LSCS) in 12 (44.44%), normal vaginal 6 (22.22%), emergency laparotomy in 1 (3.7%) and incomplete abortion in 1 (3.7%) women. Among the 20 who delivered, 1 was Intrauterine Death (IUD) and the rest of the 19 foetuses were negative for COVID-19. Of the total 20 foetuses delivered, 10 required Neonatal Intensive Care Unit (NICU) admission where one died. Repeat testing was done in 13 female subjects, all of them were negative, while rest of the seven patients did not turn in for repeat testing and were lost. Among the pregnant women, one patient died secondary to COVID-19 bronchopneumonia in the postpartum period. Conclusion: If managed properly without any complications, the outcomes are good for the mother and the baby without a significant risk of transmission. However, the long-term follow- up is needed to assess the mortality of the patients.
Real-world Retrospective Assessment of Initiation and Effectiveness of Dual Combination Therapy with Metformin and Teneligliptin in Drug Naïve Indian Type 2 Diabetes Mellitus Patients (INITIATE)
Authors: Chadha Manoj , Banzal Subodh , Sridhar S , Goswami Soumik , Barkate Hanmant , Suryawanshi Sachin , Jadhav Mayur , Brid Manasi
Published: February 2022

Introduction: Diabetes Mellitus (DM) has become the leading health concern worldwide over the last few decades. But despite advances in both understanding of the pathophysiology of Type 2 Diabetes Mellitus (T2DM), and the development of new treatment strategies, current management of patients with T2DM remains suboptimal. Initial monotherapy is frequently inadequate in patients with high baseline Glycated Haemoglobin (HbA1c). Thus, initial combination therapy has emerged as an alternative approach. Aim: To assess INItiation and effecTiveness of dual combInation therapy with metformin And Teneligliptin in drug naïvE T2DM patients (INITIATE). Materials and Methods: In this retrospective, multicentre study, newly diagnosed drug naïve T2DM patients failed with diet and exercise prior to screening and initiated with dual therapy of metformin and teneligliptin were enrolled. Data of all the patients prescribed with any therapeutic dose of metformin (250 mg, 500 mg, 750 mg, 1000 mg, 1500 mg, 2000 mg) and teneligliptin (20 mg, 40 mg) was considered. The data was analysed to assess change in glycaemic parameters from baseline to 12 weeks. Paired t-test was applied for statistical results. Results: Data of 7857 patients were analysed. The mean change of Fasting Plasma Glucose (FPG) from baseline {202.29±52.2 mg/dL (11.23±2.89 mmol/L)} to 12 weeks {142.57±34.5 mg/dL (7.91±1.91 mmol/L)} was -59.72±17.7 mg/dL (-3.31±0.98 mmol/L) (p-value <0.0001). The absolute change in mean Postprandial Plasma Glucose (PPG) from baseline {(286.26±80.43 mg/dL (15.89±4.46 mmol/L)} to 12 weeks {(198.30±42.24 mg/dL (11±2.34 mmol/L)} was -87.96±38.19 mg/dL (-4.88±2.12 mmol/L) (p-value <0.0001). Mean HbA1c level was 8.11%±1% (65±10.9 mmol/mol) at baseline and decreased significantly to 7.15%±0.94% (55±10.3 mmol/mol) (p-value <0.0001) with a mean change of -0.96±0.06 (-10.5±0.7 mmol/mol) at 12 weeks. Total 42.83% (n=3365) patients achieved target HbA1c (<7%) at 12 weeks. Conclusion: Initiation of dual therapy with metformin and teneligliptin in drug naïve Indian T2DM patients significantly improved glycaemic control.
Clinicopathological Parameters of Haemolytic Anaemia in COVID-19 Infection: A Series of Three Cases
Authors: Kumar Rabish , Singh Sarika , Daga Mradul Kumar , Jhamb Urmila
Published: February 2022

Coronavirus Disease 2019 (COVID-19) patients show various haematological abnormalities like cytopenia and coagulation disorders. Corona virus can induce an inflammatory state, leading to extensive coagulation manifestations. Association between COVID-19, Autoimmune Haemolytic Anaemia (AIHA) and thrombotic state is still the subject of extensive research. In this study, three cases of haemolytic anaemia are discussed. First case was a 28-year-old female with a history of abruptio placentae who presented with complaints of generalised weakness and oliguria for five days. She was diagnosed as thrombotic microangiopathy based on peripheral smear finding of schistocytes and spherocytes and few polychromatophils and normal prothrombin time (International Normalized Ratio (INR)) with very high D-dimer levels on coagulation profile. Second case was of a 25-year-old female who presented with complaints of fatigue, rashes, dark urine, nausea and abdominal pain. She was diagnosed as a case of AIHA based on peripheral smear finding of Red Blood Cells (RBC) clumping and positive direct coomb test. Third case was of a two-month-old child who presented with respiratory distress and pallor. He was diagnosed as a case of haemolytic anaemia either due to direct effect of COVID-19 infection or Cytomegalovirus (CMV) and mycoplasma infection. Thus, COVID-19 infection can directly or indirectly lead of a wide spectrum of haemolytic manifestations and every patient with anaemia should be thoroughly investigated for early detection and treatment.
Comparison of PRISM III and PIM II Score in Predicting Mortality in Paediatric Intensive Care Unit: An Observational Study
Authors: Muthupandi V , Dianagrace R , Narayanan E , Sathya J
Published: February 2022

Introduction: Prognostic scores play a vital role in predicting the outcome of children admitted in Paediatric Intensive Care Unit (PICU) thereby reducing the mortality. For paediatric populations Paediatric Risk of Mortality (PRISM) and Paediatric Index of Mortality (PIM) are the principal scores. As limited PICU beds are available in many tertiary care centres, PRISM score helps in predicting mortality risk and admission to PICU. Aim: To compare PRISM III and PIM II in predicting the mortality in sick children in a PICU and their relation between observed and predicted mortality. Materials and Methods: This was a prospective observational study, conducted in Chengalpattu Medical College Hospital, Chennai, Tamil Nadu, India, from July 2018 to June 2019 that enrolled 102 children who were admitted to PICU. At first hour of admission, PIM score was assessed and at 24 hours of admission PRISM score was assessed and the mortality was predicted. Children were followed-up until discharge or death, and the predicted mortality was compared with actual mortality and validation of scores was done using Statistical Package for the Social Sciences (SPSS) version 16. Results: Mean age of the population was 37.6 months, and majority of the children were aged less than 12 months. Male children were predominant (52%). Major system involvement was respiratory system 38 (37.3%) and mortality was 18 (17.6%). The mean score for death in PRISM and PIM were 11.8 and 19.9, respectively. The mean score for survival in PRISM and PIM were 4.4 and 9, respectively. Total PRISM and PIM score was lower in children who survived and mortality has been observed with higher scores. On comparison PRISM score was better to predict the mortality than PIM. The Area Under Curve (AUC) and sensitivity for PRISM score were 0.881 with 95% CI (0.769 to 0.992) and 94.44% respectively versus the AUC and sensitivity for PIM score were 0.768 with CI (0.628 to 0.908) and 61.11%, respectively. Using logistic regression, risk of mortality was analysed and found that increase in one score has 0.62 times the increased risk of death in PRISM score and thus it predicts the mortality better. Conclusion: The PRISM score was better than PIM score for risk stratification and to optimise available limited resources. Both scores underestimate the predicted mortality in comparison to observed mortality
Disorders of Sexual Differentiation: A Clinicopathological and Histological Study
Authors: Mampill Neethu Tonyy , Ananthamurthy Anuradha , Mohanty Suravi , Das Kanishka
Published: February 2022

Introduction: The term ‘Disorders of Sexual Differentiation’ (DSD) is defined as a congenital discrepancy between external genitalia, gonadal and chromosomal sex. The Chicago consensus based on the primary genetic defect is used for current nomenclature and classification. A child with DSD, if identified and treated early, may grow to become a well-adjusted, functional member of the society. Patients with DSD carry a low but definite risk of developing germ cell tumours which necessitates a histological analysis in all cases. Aim: To describe the clinicopathological features of individuals with DSD and to classify the available cases according to the Chicago consensus which is based on karyotype and histopathology. Materials and Methods: The study was a retrospective descriptive study done at a tertiary referral centre in South India, for a period of four months from May to August 2016. Case charts and histopathology slides of cases received in the department of Pathology from January 2011 to May 2016 were included and reviewed. Cases where the histopathology slides/blocks were not retrievable/difficult to assess due to technical issues were excluded. Case charts and slides were reviewed retrospectively with a view to classify as per karyotypic or histological classification. The slides were reviewed by two pathologists to help in the classification wherever possible. Statistical measures like mean and percentages were used to describe the results. Results: A total of 22 cases of DSD were studied for which karyotype was available in 13 cases. Common clinical presentations were primary amenorrhoea, cryptorchidism and ambiguous genitalia. Age at presentation varied from nine months to 30 years. The initial diagnosis based on karyotype, clinical findings, hormonal assays and imaging were concordant with the final diagnosis in 11 cases. In two cases, histopathology was essential in arriving at a definitive diagnosis. Of the 13 cases with karyotype reports available, five were sex chromosome DSD, five were 46XY DSD and three were 46XX DSD. Gonadoblastoma was seen in three cases. Conclusion: Histopathological examination together with karyotype plays a crucial role in proper categorisation of disorders of sexual differentiation. A multidisciplinary team approach for early diagnosis and management of DSD is essential for the psychosexual development of these individuals.