bluuebunny/crossref_metadata_2025 huggingface dataset:
DESIGN AND EVALUATION OF A HIGHER EDUCATION DISTANCE EAP COURSE BY USING THE ADDIE MODEL
Authors: Koc Ebru
Published: January 2020

Due to inadequate support, most university students have difficulty
with writing academic texts, such as research articles and dissertations.
Therefore, the aim of this research is to design a web-based academic writing course
for university students by using the ADDIE (Analysis, Design, Development,
Implementation and Evaluation) model, which is supported by individual
instructional and socio-cultural theories on the design of online instruction.
The first group of participants in the study included undergraduate and
graduate students studying in a variety of departments at a state university in
Turkey. The second group of participants included university instructors. To
diagnose the needs of the students, semi-structured questions were asked in
interview sessions. Additionally, a questionnaire was used. After
diagnosis of the students’ academic writing needs, course content and
materials were designed for topics such as formality, paraphrasing, and the
IMRaD (Introduction, Method Results and Discussion) model. The data collected with
the questionnaire were analysed through item analysis. The frequencies and
percentages of responses to each item in the questionnaire were calculated.
Content analysis was used to analyse the transcribed interview data. The
findings elucidate how the current academic online courses can be implemented more
efficiently.
Odins in the Palette of Diversity and Multiculturalism of Azerbaijan
Authors: Mobili R.
Published: January 2020

The article is devoted to the description of inter-religious and interethnic tolerance and diversity in the multiculturalism model of Azerbaijan using the example of the Udis, a small people who are the successors of autocephalous Christianity in Caucasian Albania and direct descendants of Caucasian Albanians. This article is intended to emphasize the historical roots that led to the birth and existence of religious tolerance in a multinational country. The model of the Udi phenomenon of selfpreservation of an ethnic group in a multicultural model of the world is also considered.
Conflicts in Educational Institutions. Causes of Conflict of Educational Environment
Authors: Kirsanov A.I.
Published: January 2020

The article discusses conflicts in the educational environment, their typology in the system of relations, conflict genes that encourage conflict, including erroneous use of phrases and speech turns
The Influence of the Leading Hemisphere on the Learning Foreign Language
Authors: Eremenko A.M.
Published: January 2020

The relevance of the chosen topic is determined by the interest of teachers in effective foreign language teaching in the conditions of modern globalization and intercultural interactions. For competent and effective language learning, it is necessary to take into account the leading hemisphere of the brain. Based on the functions of the hemispheres, it is possible to rationally draw up a training plan that will give results and facilitate the learning process of language acquisition.
The Study of the Author's Methods of Formation of a Language Picture of the World at Teaching Ballad Genre to Bilingual Students
Authors: Karelina A.V.
Published: January 2020

The article deals with the process of formation of the genre of Anglo-Scottish ballads and their structural, semantic and linguistic features. The material of the study are the ballads of the early and late Middle Ages: “The TwaCorbies” (“The Three Ravens”), “Lord Randall”, "The Two Sisters", “Clerk Colvill” (“Clerk Colven”, “George Collins”), “The Moon Shined on My Bed Last Night.
The Concept of "Family" in Russian and German Language Pictures of the World
Authors: Kiseleva I.D.
Published: January 2020

Abstract: the article considers the concept “family” in the Russian and German language world views. Also, it reveals the core differences and similarities of the universal cultural concept. The author of the article studies the semantics of the concept “family” and, moreover, the contextual meanings of the concept based on the proverbs of Russian and German.
From the Editors
Authors: Krzemińska-Adamek Małgorzata
Published: January 2020

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Knowledge attitude and practice on prevention of hepatitis B infection among medical students of a tertiary care centre in Tamil Nadu, India
Authors: M. C. Vasantha Mallika , S. Sivaanusuya
Published: January 2020

Background: Hepatitis B infection is a serious global public health problem. About two billion people are infected with hepatitis B Virus (HBV) all over the world. The prevalence of HBV infection in India is 4%(2%-8%) with more prevalence among health care workers. Medical students represent a group that is at high-risk for acquiring and spreading hepatitis B infection. Despite increasing prevalence of HBV infection, there is paucity of knowledge, attitude and practice on HBV among medical students. Objective of the study was to assess the knowledge, attitude and practices on prevention of hepatitis B infection among medical students of Sree Mookambika Institute of Medical Sciences, Kulasekharam.Methods: A cross sectional study was conducted among 205 MBBS students using a pretested self-administered questionnaire for assessing the knowledge, attitude, and practice on prevention of HBV infection after obtaining informed consent from the participants.Results: Among 205 MBBS students, correct response towards Knowledge, Attitude, and Practices were given by 77.07%, 77.56%, and 76.59% respectively, 79.5% of the students were fully vaccinated; 20.5% were partially vaccinated against Hepatitis B Virus infection.Conclusions: The medical students are at a very high risk of contracting HBV infection during their training period in view of low HBV vaccine uptake rate and high chance of accidental exposure to blood infected with HBV. Creating awareness among medical students on various aspects of Hepatitis B infection through health education programs before their exposure in medical colleges and subjecting them to active immunization against HBV are mandatory to control the spread of Hepatitis B viral infection.
Comparison of three different techniques of endotracheal tube cuff inflation: just seal, stethoscope guided and pressure volume loop: a prospective randomized study
Authors: Bhardwaj Mamta , Kaur Kiranpreet , Sharma Asha , Kumar Prashant , Tobria Raj , Saini Savita
Published: January 2020

Background: Cuffed endotracheal tubes not only ensure a proper seal during positive pressure ventilation, but at the same time also prevent aspiration of gastric secretions. The aim of this prospective, randomized study was to compare three methods of ETT cuff inflation-- palpation of the leak in suprasternal notch (Just seal), a stethoscope guided method of tracheal tube cuff inflation and PVL guided cuff inflation.Methods: After approval by institutional ethical committee, 192 patients of either sex in age group of 18-50 years belonging to ASA physical status I or II were enrolled. Each patient was randomly allocated into one of three groups: one group received standard 'just seal' method of tracheal cuff inflation (JS), the second group, the stethoscope-guided method (SG) and in third group cuff was inflated using Pressure Volume Loop (PVL). Volume of air introduced into the cuff and pressure within the cuff was recorded.Results: A total of 192 patients were recruited to the study. The median (IQR [range]) tracheal cuff pressure was 12 (10-22 [6-28]) cm H2O, 16 (12-24[6-38]) and 14 (10-22[8-32]) cmH2O in JS, SG and PVL group respectively. Cuff pressures within the recommended range of 20-30 cm H2O fell in 25% of the patients in both JS and SG group and 31% patients in PVL group. The mean volumes of air introduced in the cuff and the resultant mean cuff pressure in all groups was found to be statistically insignificant (p= 0.4, 0.18 respectively). Tidal volume discrepancy was more and 75% of cuff pressures were less than the recommended range in JS than the other two groups.Conclusions: Real time PVL displayed on most modern anaesthesia machine is a good alternative to check for proper ETT cuff inflation, avoid high cuff pressure and monitor air leak.
Awareness regarding emergency contraception among married women attending urban health centre, Berhampur, Odisha, India
Authors: Nayak Ranjeeta , Panda Manasi , Padhy Sarmistha , Mishra Kumar Guru
Published: January 2020

Background: In India unplanned pregnancy and illegal abortions still remains a problem. Unintended early pregnancy and frequent childbearing contribute to high pregnancy related morbidity and mortality which can be prevented by use of suitable contraceptives. In circumstances where women are unable to exercise sexual and reproductive decision making, introduction of emergency contraceptive pills may provide important back up option to enable women to control their fertility.Methods: A cross-sectional study was conducted between August- October 2016 among 215 married women of reproductive age group attending the Urban Health Center, Berhampur, to study the awareness about most common methods of contraception, decision-making regarding contraceptive and knowledge and practice of emergency contraceptive pills.Results: This study concludes that most commonly used method was Oral contraceptive pills (28.3%) and major source of information regarding different methods of contraception were through friends and relatives (44.6%). Awareness about emergency contraception mostly came through television. Of those aware of ECPs (14.4%) only 16.1% had used it in their lifetime.Conclusions: Although there is awareness about contraceptives methods, knowledge and practice of emergency contraception is low.
Seroprevalence of syphilis among pregnant females attending antenatal clinic at a tertiary care hospital in North India
Authors: Jahan Noor , Chandel Swastika Singh , Chopra Deepak , Khan Arshiya , Khatoon Razia
Published: January 2020

Background: Syphilis is a sexually transmitted disease caused by bacteria named Treponema palladium, subsp. pallidum. Nearly 1.36 million pregnant women are known to be affected by syphilis in the developing countries. When left untreated syphilis during pregnancy can result in adverse fetal outcomes such as spontaneous abortion and stillbirth. Objective of the study was present study was done to evaluate the seroprevalence of syphilis among pregnant females attending Antenatal Clinic (ANC).Methods: A hospital based cross-sectional study was done over a period of six months from January to June 2019. A total of 132 pregnant females were included in the study who attended Antenatal Clinic for routine checkup whose blood samples were sent to Microbiology Laboratory for screening for syphilis by Rapid Plasma Reagin (RPR) test.Results: Out of 132 samples of pregnant females screened for syphilis, none of the sample was found reactive for syphilis by RPR test. Maximum patients (57.6%) belonged to age group 20-25 years followed by (27.3%) of 26-30 years. 30.3% patients belonged to urban areas and 69.7% patients belonged to rural areas. Majority of patients (80.3%) belonged to first trimester, followed by (18.9%) patients to second trimester and (0.8%) patients to third trimester. 78.8% patients were from lower socio-economic class followed by 12.9% patients from middle class and 8.3% patients from upper class.Conclusions: Although zero percent syphilis prevalence was observed in this study, it is recommended that free screening for syphilis should be offered to all pregnant females visiting Antenatal Clinic.
Comparative lipid profile study between ischemic and haemorrhagic stroke
Authors: Singh Vijaiendre , Bajia Kamalesh Kumar , Ram Chaina , Kumar Ajay , Mathur Ajay , Bansal Pradeep Kumar
Published: January 2020

Background: Stroke is one of the major global health problems. Stroke is the most common clinical manifestation of cerebrovascular disease of which more than 99% are due to arterial involvement and less than 1% due to venous involvement in the form of Cerebral Venous Thrombosis (CVT). Among arterial causes 85% are due to infarction and 15% due to haemorrhage.1,2 There is  difference in serum lipid levels in subtypes of strokes to guide lipid-lowering therapy which can reduce incidence of stroke and stroke related mortality by adapting primary and secondary preventive measures.3,4  Authors have endeavoured to correlate severity of lipid derangement and stroke.Methods: In this study 64 consecutive eligible ischaemic stroke cases and 64 eligible hemorrhagic stroke cases would be included. Cases of strokes will be divided into ischaemic and hemorrhagic as per clinical features and with help of brain imaging by CT scan and MRI at the time of admission and 8 hour fasting lipid profile was collected from all cases. All this information will be filled in preformed format.Results: Serum lipid profile of two categories of stroke showed raised serum total cholesterol in 39.1% patients of ischaemic stroke in contrast to 18.8% patients with haemorrhagic stroke (p=0.019).Stroke patients showed raised in LDL cholesterol in 29.7% patients of ischaemic stroke in contrast to 9.4% patients with haemorrhagic stroke, (p=0.007).Conclusions: Based on the finding of our study we conclude that ischemic stroke patient had higher lipid derangement as compare to haemorrhagic stroke in terms of raise total cholesterol, LDL cholesterol and decrease HDL cholesterol.
Acromion, coracoid and glenoid processes of scapula: an anatomical study
Authors: Nayak Gyanaranjan , Panda Sitansu K. , Chinara Prafulla K.
Published: January 2020

Background: Acromion morphology has an important role in impingement syndrome and pathogenesis of rotator cuff diseases. Coracoid process is involved in many surgical procedures of shoulder joint. Dimensions of glenoid process are essential in designing glenoid components for total shoulder replacement. Aim of the study was to measure the various dimensions and note the morphology of acromion, coracoid and glenoid processes of scapula.Methods: Fourty two scapulae (24 right, 18 left) were used and the dimensions of the three processes were measured with digital Vernier calipers.Results: The findings were as follows- length of acromion- 43.57±5.13 mm; width of acromion- 25.03±3.57 mm; acromio-coracoid distance- 33.09±7.02 mm; acromio-glenoid distance- 25.24±4.05 mm; height of coraco-acromial arch- 15.17±3.8 mm; length of coracoid- 38.73±3.72 mm; width of coracoid- 14.28±2.36 mm; tip thickness of coracoid- 8.61±1.89 mm; height of base coracoid- 12.91±2.88 mm; width of base of coracoid- 22.31±3.54 mm; height of glenoid- 34.18±3.53 mm; superior antero-posterior glenoid length- 15.35±2.35 mm and inferior antero-posterior glenoid length- 23.9±2.52 mm.Conclusions: The results will be highly relevant in orthopaedic surgery and manufacturing shoulder prosthesis.
Prevalence of pulmonary tuberculosis in patients with diabetes mellitus and lower respiratory tract infection
Authors: Kale Pradnya S. , Kanade Swapna R. , Nataraj Gita , Mehta Preeti R.
Published: January 2020

Background: Pulmonary Tuberculosis (PTB) still remains a global public health problem. Diabetes Mellitus (DM), is a metabolic disorder characterized by hyperglycaemia. Diabetes along with poor glycaemic control leads to an immune compromised state. As prevalence of both TB and DM is increasing in India, this association of PTB and DM may prove a threat to TB control program. Aims and objectives of the study was to detect prevalence of pulmonary tuberculosis in patients with DM and Lower Respiratory Tract Infection (LRTI).Methods: Sputum specimen from consecutive 250 known diabetic adult patients with type 2 diabetes and clinical evidence of LRTI were processed for microscopy, solid culture and Xpert MTB/RIF assay. Clinical findings, duration of DM, regularity of treatment and recent fasting blood glucose level were noted.Results: TB was detected in 31(12.8%) patients. Microscopy, culture and Xpert assay were positive in 14(5.6%), 29(11.6%) and 24(9.5%) cases respectively. Culture detected seven cases more than Xpert assay. Two additional cases were detected by Xpert assay than culture. Rifampicin resistance was detected in seven (29.17%) cases by Xpert assay. TB detection rate was higher in patients with more than two weeks of cough (14.38%), history of tuberculosis (15.9%), hyperglycemia (13.9%) and significantly higher in those with irregular anti-diabetic treatment (35.7%).Conclusions: Irregular anti-diabetic treatment, hyperglycaemia and history of tuberculosis were strongly associated with pulmonary TB. Xpert assay should be used as the initial diagnostic test for detection of tuberculosis as well as rifampicin resistance in diabetic patients by TB control programme.
Influence of obesity on serum levels of thyroid hormones among Indian adult population
Authors: Bhandari Vinod , Kosta Susmit , Bhandari Mahak , Behl Simran
Published: January 2020

Background: Obesity and thyroid dysfunction are two most common clinical conditions that have been linked together closely in adult. The link has become more relevant in the context of an unprecedented rise in the prevalence of obesity worldwide. Obesity is normally observed by patients as being secondary dysfunction on serum levels of thyroid hormones. Objective: The Purpose of this study to assess serum thyroid hormones levels (fT3, fT4, TSH) variation in patients with obesity and normal thyroid function among Indian adults and to correlate serum levels of thyroid hormones with their classes of Body Mass Index (BMI).Methods: Authors performed a retrospective study of adult patients who were examined and analyzed serum levels of thyroid hormones at authors centre between February 2018 to November 2019.Results: A total of 231 adult patients were included. 122(52.8%) were males, mean age was 35.4±10.4 and mean BMI 34.2±5.8 respectively. Obesity was found higher in female 58(53.2%) than male 37(30.3%) participants (p<0.001), respectively. The mean TSH serum levels were significantly increased with increased BMI (2.04±1.19,2.51±1.22 and 3.39±1.19; p=<0.001).  No association was found of serum fT4 (p=0.227) and serum fT3 (p=0.063) with BMI.Conclusions: Mean TSH serum levels showed a significantly increased with increased BMI. BMI was negatively associated with serum fT4 but had no association with serum fT3.
Study of microalbuminuria in essential hypertension patients with target organ damage
Authors: Bakhtar Vijay , Bakhtar Niyati , Pandey Kirit , Pandey Neha
Published: January 2020

Background: Urinary albumin excretion has been purported to be strongly linked to cardiovascular events in hypertensive patients. The prevalence of microalbuminuria in patients with essential hypertension and its relationship with target organ damage was evaluated with the present study, as the correlation of microalbuminuria and target organ damage except cardiovascular events has not been deliberated upon much in the past.Methods: One hundred and twenty cases of essential hypertension were enrolled sequentially. Prevalence of urinary albumin excretion and its correlation with target organ damage (left ventricular hypertrophy, retinopathy and stroke) was analyzed. Urinary albumin excretion was assessed by turbidimetry method, while microalbuminuria was calculated by urine albumin to creatinine ratio.Results: Microalbuminuria was observed in 57.7% cases of essential hypertension. Target organ damage was observed in 62.5% (75) patients, out of which 78.66% patients had associated microalbuminuria (p<0.05). Higher prevalence was observed in patients with longer duration and greater severity of hypertension, increased body mass index and dyslipidemia.Conclusions: The assessment of microalbuminuria in hypertensive patients is a great value addition for the evaluation of target organ damage. Prompt control of hypertension and lipid levels along with weight management may lead to decreased risk of microalbuminuria.
Clinical, etiological and laboratory profile of febrile thrombocytopenia and correlation of platelet count with outcome in a South Indian tertiary hospital
Authors: Kakanale Mahesh , G. Manoj A. , K. Prabhakar , A. Raveesha
Published: January 2020

Background: Febrile thrombocytopenia is commonly encountered by doctors especially during monsoon and peri-monsoon period, many of these patients have a turbulent cthisse with multi organ dysfunction and might land up in ICU with significant morbidity and mortality. Infections are the commonest causes of thrombocytopenia and they vary with season and geographical location. A systematic approach, carried out with an awareness of causes, clinical presentation and laboratory profile of febrile thrombocytopenia can shorten the duration of investigations and bring out the diagnosis early, reducing morbidity and mortality of patients and reducing burden on hospital resthisces. The objective of the study is to study the underlying etiology, the various clinical presentations, laboratory profile and complications of fever with thrombocytopenia in this community during monsoon period and to correlate thrombocytopenia with outcome, co morbidities and its etiology.Methods: The prospective observational study was conducted in tertiary centre in Kolar between June-December 2017. Patients meeting inclusion and exclusion criteria were grouped into 4 groups based on platelet counts, and correlated with comorbidities, etiology and outcome. Detailed clinical and laboratory examination were done in all patients and p value of <0.05 was considered statistically significant.Results: Among 465 patients were included in the study. Dengue was the most common cause for febrile thrombocytopenia and mortality. Hepatic complications and petechiaes were the most common complications and bleeding manifestations. 135 patients received platelet transfusion but there was no relationship between platelet transfusion and outcome, there were 9 deaths in the study and there was no association between death and platelet count at admission.Conclusions: There was no relation between platelet count on admission and mortality and also there was no relationship between platelet transfusion and outcome. Knowing the clinical presentation, etiology, complications and its monitoring can significantly reduce the morbidity and mortality due to febrile thrombocytopenia.
Doctors'self-prescribing behavior: an exploratory study
Authors: Mir Shakeel Ahmad , Ahangar Junaid Ahmed , Shakeel Danish
Published: January 2020

Background: Self-prescribing among doctors is common. But the General Medical Council (GMC) and American Medical Council recommend that doctors should avoid prescribing for themselves, and close family members. Self-prescribing can lead to serious consequences.  The present study reports the prevalence and pattern of self-prescribing among doctors working in various healthcare facilities of Kashmir Valley.Methods: Pre-validated questionnaires were sent to 200 doctors selected by convenience sampling. Only 184 returned the completely filled questionnaires.Results: At which 95.7% male doctors and 97.8% female doctors were self-prescribing. 100% doctors above the age of 40 years were self-prescribing. 100% post graduate students and consultants were practicing self-prescribing. 98.0% of those active as doctors for 1-5 years and 95.1% of those active for more than five years were self-prescribing. 60.7% doctors cited convenience, 40.4% time saving, 27.0% quick relief, 60.7% confidence, 14.6% low cost of treatment, and 15.7% crowd avoidance as a reason for self-prescribing. Major diseases self-treated were: headache (78.7%), respiratory symptoms (79.8%), fever (53.9%) and pain syndromes (31.5%). Major drugs used were: analgesics (80.9%), antipyretics (68.5%), antibiotics (58.4%), decongestants (49.4%) and antispasmodics (33.7%).Conclusions: The observed prevalence of self-prescribing was very high in this study. The issue of self-prescribing is common and requires attention.
Awareness of post partum intra uterine contraceptive device and reasons for its low acceptance in an urban Indian population
Authors: Chawla Raina , Ahuja Rashmi , Sharma Priyanka
Published: January 2020

Background: The safety and efficacy of the Post-Partum Intra Uterine Contraceptive Device (PPIUCD) has been documented worldwide. With increasing institutional deliveries and greater sensitization, the aim is to increase PPIUCD insertions. Many areas still report poor acceptance.  Objectives of this study to determine the proportion of antenatal women willing to accept PPIUCD insertion and the reasons behind refusal to accept this method.Methods: A prospective questionnaire study was done between January 2019 to June 2019 of 200 women. Inclusion criteria were antenatal women in the 2nd/3rd trimester. Exclusion criteria were those opting for a permanent method of contraception and those with a contra-indication.Results: Eighty-four women (42%) had never used any method of contraception. Earlier Intrauterine device (IUD) use (including both interval and PPIUCD) was in only 18.9% of all contraceptive users. Only 2 women in the group had ever used PPIUCD. 79% of women were aware of IUDs. Those unaware were mainly nulliparous. Amongst those aware of an IUD, 88 (56%) were aware it could be inserted postpartum. Only 18% were aware it could be inserted intra-cesarean. All women who participated were offered the option for a PPIUCD. Fifty-nine (29.5%) of all women expressed their willingness but on follow up till delivery only 18 of these women got a PPIUCD inserted.  Amongst those not willing for the PPIUCD insertion the commonest reason was general apprehension (39%) followed by partner refusal (33%) and fear of complications (31%). Six women (4.2%) gave history of complications following earlier use and were unwilling for its repeat use. Conclusion: The large unmet need for contraception in India can be solved through repeated counselling and discussions with the woman during her antenatal visits. Alleviating apprehension and addressing concerns of the couple will increase PPIUCD acceptance.
Effects of total parenteral nutrition on postnatal growth in very low birth weight and extremely low birth weight newborns
Authors: Ahuja Divya , Srivastava Pritosh , Srivastava Anshuman
Published: January 2020

Background: Prematurity is the most important cause of mortality in Under-5 children responsible for one million deaths/ year. Premature babies are not able to store enough nutrients for their optimal survival; it is essential to provide them total parenteral nutrition. Intravenous lipid infusion in neonates is linked with high risk of sepsis and thrombocytopenia. PN with amino acids and glucose can be imparted to achieve nutritional goal. This trial was intended to assess the effects of various components of amino acid PN on postnatal growth in VLBW and ELBW newborns.Methods: A prospective observational study was conducted from January 2018 - May 2019 in NICU of TMMC and RC which included preterm newborns with birth weight of less than 1500gms who received aminoven infusion. Anthropometric measurements, incidence of hypo/hypercalcaemia, hypo/hyperglycaemia, direct hyperbilirubinemia, incidence of sepsis were evaluated.Results: Out of 22 patients, 12 neonates received high dose aminoven therapy whereas 10 neonates received low dose aminoven therapy. It was seen that rapid rate of increment of amino acids had adequate weight on discharge, 72.72% have adequate growth among the rapid group compared to 36.36% among slower group. No significant changes in calcium metabolism or glucose metabolism were seen in both the groups.Conclusions: In resource limited settings, parenteral nutrition with intravenous amino acids have a better effect on the weight of preterm newborns at discharge when high doses of amino acids infusion started early with rapid increment in the dose.
Diffuse large B-cell lymphoma in a patient with chronic myelogenous leukemia on accelerated phase with bilateral pleural effusion: a case report
Authors: Zukhrufan M. Huki , Faheri Eifel
Published: January 2020

Chronic Myelogenous Leukemia (CML) is a myeloproliferative disorder of pluripotent stem cells. The pathogenesis of CML is known to be related to mutations in the form of Philadelphia chromosomes. The incidence of CML constitutes 20% of all cases of leukemia in adults. The current gold standard for CML therapy is using tyrosine kinase inhibitors (TKI), Imatinib. Non-Hodgkin Lymphoma (NHL) is a malignancy that develops from lymph nodes. In NHL the formation of malignant cells is in the form of lymphocytes that are at one of the differentiation levels of either T lymphocytes or B lymphocytes. Diffuse large B cell lymphoma is the most common NHL, representing about 40% of all lymphoma cases. NHL management is targeted chemotherapy using rituximab combined with cyclophosphamide, doxorubicine, vincristine and prednisone. A Thirty-four year-old female patient has been reported with the main complaint of fatigue and pale weakness accompanied by an enlarged abdomen. Complaints are also accompanied by a lump in the right neck, fever, productive cough and shortness of breath. The patient has been known to suffer from CML with BCR-ABL (+) since five years ago and received Imatinib therapy, but then the patient stopped treatment himself. On physical examination found anemic, multiple enlargement of the neck lymph nodes, wet crackles soft and loud in the basal of both lungs and splenomegaly. On investigations found severe anemia, thrombocytopenia and blast 13%, increased d-dimer, bronchopneumonia-compliant infiltrate and bilateral pleural effusion on chest x-ray, results of exudate pleural fluid analysis with the cytology of a malignant smear metastasis of lymphoma to the pleura, histopathology of the neck lymph nodes with chest x-ray, analysis of exudate pleural fluid with the cytology of a malignant smear metastasis of lymphoma into the pleura, histopathology of the neck lymph nodes with the results of diffuse large B-Cell lymphoma, as well as enlargement of paraaortic lymph nodes, hepatosplenomegaly and chronic pancreatitis on abdominal ultrasound. Patients was given antibiotics, transfusion of packed red cells and platelets, pleural tap and chemotherapy. The patient was planned to undergo chemotherapy for 6 cycles of 21 days, and a CD20 examination was performed. The incidence of NHL in patients with good CML in imatinib therapy is not yet certain whether there is a direct relationship.
The flickering jaundice
Authors: Amrutha Cynthia , Rai Shipra
Published: January 2020

Benign Recurrent Intrahepatic Cholestasis (BRIC) is a rare autosomal recessive disorder characterized by intermittent episodes of jaundice and pruritus. It is also known as Summerskill-Walshe-Tygstrup syndrome. It is a benign disease with no progression to end stage liver disease.. The first episode of cholestatic jaundice occurs early in life and there are asymptomatic periods between attacks lasting weeks to years. This case report presents a young male who presented with severe pruritus and acute onset jaundice. He had his first episode of jaundice at the age of twelve and had several intermittent episodes since then. Diagnosis was made by the unique clinical presentation with exclusion of other causes of cholestatic jaundice. This case report highlights the importance of detecting such cases of rarity and preventing unnecessary invasive diagnostic procedures on such patients.
Myelomatous pleural effusion as an initial presenting sign in a case of multiple myeloma
Authors: Sharma Dinesh Chandra , Sharma Deepanjali
Published: January 2020

Multiple Myeloma (MM) is a neoplastic disease which mainly affects bone marrow but rarely may infiltrate extramedullary tissues as well. Myelomatous pleural effusions (MPE) develop due to extension of plasmacytoid cell lesions of thoracic bones into pleural tissue and directly presenting as an initial sign in a case of MM is exceedingly rare. It indicates poor prognosis, resistance to treatment and more chance of relapse in spite of aggressive chemo-radiotherapy. The effusions of serous cavities in MM generally develop as a late complication of the disease like heart failure, renal failure, pneumonia and amyloidosis. We are reporting a rare case of IgG subtype myelomatous pleural effusion demonstrating abundance of plasmacytoid cells in pleural fluid. Bone marrow smear examination favoured the diagnosis of multiple myeloma with the presence of predominant population of plasma cells with high cellularity. There were also presence of a heterogenous myelomatous mass lesion in the right infratemporal fossae, multiple erosive lesions in ribs, vertebral bodies, skull and pelvic bones. Pleural fluid and serum protein electrophoresis demonstrated the presence of gamma monoclonal protein peaks confirming the diagnosis.
Evaluate the adequacy of disclosure as a solution to the problem of conflict of interest in medical research
Authors: Moklif Alanazi Mansour , Ratoubi Alanazi Mohammed
Published: January 2020

A potential risk of conflict of interest currently exists in research.  The financial considerations play a greater role in the decisions that are necessary in the process of research. Traditional pharmaceutical companies began to invest, not just in the commercial development of biomedical discoveries for the marketplace, but in the research centres that could deliver the discoveries.  Cooperation and interdependence between industry and research institutions is not inherently wrong, but these unions must be regulated and managed through regulatory mechanisms. When a financial relationship is been disclosed, it would be closely evaluated in order to determine the risk of an undue influence leading to bias, or loss of scientific objectivity. To sum up, a conflict of interest is a potential, but not a certain occurrence. Banning funding for university research by industry is unrealistic.  The only effective way to proceed is to implement oversight and regulation that makes both industry funding entities and researchers aware that their activities will be monitored for the benefit of public safety as the more valued concern.
Flunarizine: a review of its role in migraine prophylaxis
Authors: Francis M. V. , Singh Sumit , Goyal Vishal , Keny Mukundraj
Published: January 2020

Flunarizine, a potent calcium channel blocker has been used for more than three decades for the prophylactic management of migraine. Theories suggest that flunarizine may act through multiple mechanisms such as inhibition of cortical spreading depression, neurogenic inflammation and channelopathy. Flunarizine is efficacious in the management of various types of migraines such as common, classical, vestibular, abdominal, hemiplegic and pediatric migraine. It has a manageable safety profile with weight gain and drowsiness being commonly reported.
Early and late outcomes of total extra peritoneal and Lichtenstein repair for recurrent inguinal hernia repair in men: a comparative study
Authors: Shaker Nassar Mohammed Nazeeh , H. S. Abou Ashour , Amar Mohamed Sabry
Published: January 2020

Background: Repair operation for recurrent inguinal hernia is a more exigent than the primary inguinal hernia. Open hernia repair associated with lower recurrence and fewer complications while the Laparoscopic repair associated with less pain postoperatively, early recovery time with subsequent earlier return to activity and better results regarding the wound.Methods: From November 2015 to March 2019, a total of 86 patients were randomized. 42 patients were recruited to total extra-peritoneal repair (TEP) group and 44 patients for Lichtenstein group. Overall, 86 were operated in general surgery department, Menoufia University hospitals.Results: The mean age of patients was 41.3±14.4, range from (25-55 years). One conversion occurred in the TEP group to Lichtenstein. Operative time was significantly low in TEP group (82.7 min) compared to Lichtenstein group (108 min). Hospital stay was significantly less in TEP group (1 day) compared to Lichtenstein group (1.8 days). Patients undergoing Lichtenstein repair have significant earlier oral intake than TEP group (3.7 vs. 6.6 hours). 12 cases developed seroma in Lichtenstein group with significant p value (0.001). This study showed less immediate and early VAS score in TEP group (2.3) versus high VAS score in Lichtenstein group (5.9) with highly significant p value (0.0001).Conclusions: TEP offer excellent results than LR for treatment of unilateral or bilateral recurrent inguinal hernia with lower morbidity and less incidence of post-operative pain with subsequent earlier return to normal activities.
Reducing ultrasound in diagnosing deep vein thrombosis by using clinical scores and D-dimer testing
Authors: Zaid Nehad Abdou , El Desoky Mahmoud S. , F. Attia Seham
Published: January 2020

Background: To reduce unnecessary venous ultrasound examination in cases suspected to have deep venous thrombosis (DVT) in emergency department by using D dimer and wells score. venous duplex is widely used to diagnose DVT increasing burden on ultrasound in overcrowded emergency department. Authors can decrease this burden by using clinical probability scores and D dimer.Methods: This is prospective study done on 50 consecutive patients suspected to have DVT represented to emergency department of   Menoufia University Hospital during the period from June 2018 to June 2019. Full history, physical examination, assessment of clinical probability score, d dimer level and results of venous duplex collection.Results: According to wells score, the majority of cases diagnosed as DVT were of high probability group 13(68.4%), 5 patients with moderate probability and only one patient with low probability was diagnosed as DVT. The mean of D dimer level in cases diagnosed as DVT is (4173.6±2173.1) and in cases without DVT is (927.4±1064.6). Using wells score and D dimer together, sensitivity is 100%, Specificity is 94%. PPV is 90%, and NPV is 100% in predicting DVT. All cases with negative d dimer and low risk probability do not have DVT.Conclusions: Based on this result, using wells score and d dimer level in early work up of patients suspected to have DVT will decrease overusing and cost of venous duplex.
A clinical study for preoperative prediction of cyst-biliary communications in hepatic hydatid cyst disease
Authors: Sharma Dharmanjai K. , Khedar Mukesh , Sukhadia Mukta , Sethi Deepak
Published: January 2020

Background: Cyst-biliary communication with hepatic hydatid cyst disease is responsible for postoperative bile leakage after surgical management. This study aims to detect various predictors of cyst-biliary communication and their predictive accuracy.Methods: This study was done in the patients of hydatid cysts who underwent surgical management for hydatid disease of the liver. Various factors were studied and their accuracy for preoperative prediction of cyst-biliary communication analyzed.Results: There were 38 (22 males, 16 females) patients with hepatic hydatid cysts with a mean age of 38.7±15.4 years. Cyst-biliary communications were detected in 12 patients (31.6%). Independent strong predictors were tenderness in right hypochondrium (p=0.035), total leucocyte count (TLC)>12,000/mm3 (p=0.0017),  eosinophil count >5 × 108/l (p=0.0086), red blood cell distribution width (RDW) >15% (p=0.014), segment IV,V,VII involvement and cyst size >10 cms (p=0.01) on multivariate analysis.Conclusions: Cyst-biliary communication is more common in patients presenting with tenderness in right hypochondrium, large cyst size, location in the central segments of liver close to biliary confluence, and with high values of TLC, Eosinophil count and RDW. The predictors demonstrated in this study should allow the likelihood of cyst-biliary communication to be determined preoperatively and, thus, indicate the need for additional procedures during operations to prevent the complications of biliary leakage.
A study of incidence and factors determining the occurrence of surgical site infection in abdominal surgeries
Authors: Save Maitreyee , Khadilkar Reina , Shah Priti , Shiva R.
Published: January 2020

Background: Surgical site infection (SSI) can be defined as infections which develops within 30 days after surgery involving the skin and subcutaneous tissue of the incision and/or the deep soft tissue and/or any part other than the incision handled during surgery. This study has been taken up to determine the incidence of SSI in abdominal surgery and to determine factors responsible for its occurrence.Methods: The study was conducted in Dr. D.Y. Patil Medical College, Hospital and Research Centre located in Pimpri, Pune between July 2017 to September 2019.It is a prospective longitudinal descriptive study. Information collected from the patients included patient’s age, gender, diabetes mellitus status, smoking status and haemoglobin and albumin levels.Results: Total 150 cases with abdominal operations were included in this study. Among them 29 patients developed SSI. Incidence of SSI among them was 19.3%. There was no significant difference among gender between both the groups. (p=0.172). Among 29 SSI cases, 10 (34.5%) had diabetes while 19 (65.5%) did not have diabetes. There was significant difference in diabetes status between both the groups (p=0.021). Patients having diabetes has more risk of getting SSI post operatively. Among 29 SSI cases, 8 (27.6%) were smokers while 21 (72.4%) were non-smokers.Conclusions: The incidence of SSI among cases underwent abdominal surgery was 19.3%. In our institute where most patients come from low economic state, poor hygiene and nutrition status, with current preoperative protocol for SSI prevention SSI rate is comparable to that of most developing countries.
Endoscopic assessment and Helicobacter pylori status evaluation in operated cases of peptic ulcer perforation
Authors: Rao Prashant , Mayekar Sarika , Pawar Vishwajit , Joshi Mohan Achyut
Published: January 2020

Background: Helicobacter pylori’s role in delaying ulcer healing after surgical repair for peptic ulcer perforation causing ulcer persistence hasn’t been definitively established as it has been for uncomplicated ulcers.Methods: Authors performed an endoscopy and H. pylori status evaluation in 30 patients at an average of 6.2 weeks after simple omental patch closure for perforated peptic ulcer.Results: A positive H. pylori status was found in 12 patients (40%) of which 9 had active ulcers. None in the negative group had an active ulcer. H. pylori infection was the only factor found to be responsible for ulcer persistence after surgery.Conclusions: A reasonable approach would thus be to perform an endoscopy 6 weeks after surgery to assess ulcer healing and H. pylori status. H. pylori eradication therapy should then be selectively initialled for patients with an active ulcer or positive H. pylori status.
Effect of laparoscopy on liver enzymes
Authors: Reddy Prajyoth , Srinivasan Siddharth , Rao Akshay , Patil Rajeev , Bansode Pankaj H.
Published: January 2020

Background: Laparoscopic procedures have gained popularity in recent days because of advantages like small incision, less postoperative pain and discomfort, short hospital stay, early ambulation and early discharge. Very few studies are available to correlate Laparoscopic Surgeries and liver enzyme elevation. This effect may be due to either CO2 pneumoperitoneum, diathermy extruding liver, injury to branch of the hepatic artery or general anesthesia. This study was done to evaluate the changes in liver enzymes pre-operatively and post-operatively following laparoscopy.Methods: This prospective study included 103 patients who underwent various laparoscopic surgeries over a period of 2 years in Bharati Hospital & Research Centre, Pune, India. Serum AST, ALT and bilirubin levels were measured preoperatively and on post-operative day 1 and post-operative day 3. Patients with coexisting liver disease, Patients on long term use of hepatotoxic drugs, patients who developed complications such as CBD injury, obstruction, infection, leakage and high grade fever during surgery and in the post-operative period were excluded.Results: All laparoscopic procedures cause a transient elevation of serum bilirubin and liver enzymes. Elevation in the liver enzymes correlated directly with the duration of pneumoperitoneum. Elevation in the serum bilirubin but doesn’t correlates with the duration of pneumoperitoneum. These elevations do not have clinical significance in patients with normal hepatic function preoperatively.Conclusions: Duration of laparoscopic procedure should be kept to minimum and undue prolongation should be avoided. Decision to convert the operation to open surgery from a laparoscopic surgery should be prompt.
Hypertrophied reverse palmaris longus muscle: a rare cause of carpal tunnel syndrome
Authors: Sundaramurthy Narayanamurthy , Rao Venkata Mahipathy Surya Rao , Durairaj Alagar Raja
Published: January 2020

Carpal tunnel syndrome (CTS) is usually secondary to compression or irritation of the median nerve in the fibro-osseous canal formed by the flexor retinaculum (transverse carpal ligament) and the carpal bones. The prevalence of CTS in the general population is about 7 to 19%. Several causes both local and systemic have been described, but CTS due to aberrant musculature are rare. Here we report a case of a middle-aged female with paresthesia of the hand and a positive Phalen’s test with nerve conduction study of the median nerve showing sensorimotor neuropathy. The patient underwent surgery for open CTS release where we found a hypertrophied reverse palmaris longus muscle attached to the palmar aponeurosis which was excised along with its proximal tendon. On post-operative follow up all the symptoms of CTS were completely resolved. Muscle abnormalities concern three muscles: the palmaris longus, the flexor digitorum superficialis of index, and the lumbricals. These muscles can be hypertrophied, bifid, duplicated, digastric, inverted or have an abnormal insertion, thus creating a mechanical restriction of the carpal tunnel. Surgical resection of abnormal muscle provides excellent functional recovery.
Large retroperitoneal dermoid cyst in a 55 year old lady: a rare case report
Authors: Mehta Harsh Rajeev , Iyer Sriranjani , Jadhav Sarojini P. , Ansari Mohammed M.
Published: January 2020

Retroperitoneal cysts are usually rare asymptomatic lesions but may present with unspecific symptoms depending on the size, location and complications such as hemorrhage, infection, or rupture. A 55-year-old lady presented with complaints of non-obstructed umbilical hernia. CT scan of abdomen and pelvis was done suggestive of a large cystic non-enhancing thin walled lesion of size 27×15 cm in right lumbar region. Intraoperatively, there was a large mesenteric cyst from retroperitoneum of size 25×15 cm, extending from right iliac fossa up to right hypochondrium. A confirmatory diagnosis of dermoid cyst was made following histopathology. Retroperitoneum is a rare site for dermoid cyst. Retroperitoneal cysts which develop within the retroperitoneal space are rare intra-abdominal tumours with an incidence of 1 per 1,40,000. The incidence of recurrence for retroperitoneal cysts is higher than with other forms of cysts because their proximity to major blood vessels and other organs makes them difficult to completely excise. Surgical resection is indicated to establish a diagnosis and prevent eventual complications. Complete excision of tumour is necessary due to the risk of malignancy. After complete surgical resection the 5 years survival rate is nearly 100%.
Midline cervical cleft: a case report
Authors: Dhanraj Manivannan , Ravindra Chetna , Swamidurai Maniselvi , Ross Kannan
Published: January 2020

A 14-year-old boy presented with complaints of a sinus in the middle of neck, with mucoid discharge present since birth. MRI sinogram along with MRI neck was taken which revealed a sinus tract opening in midline, extending posteriorly and traversing inferiorly to end blindly above sternum. Patient was planned for an elective excision of sinus tract, with z-plasty for decreased scarring. Congenital midline cervical cleft is a rare entity that was first described in 1924. Subsequently there have been fewer than 100 cases reported in medical literature. It typically manifests at birth as a cleft at level of suprasternal notch with a pseudonipple above it. Pathogenesis of congenital midline cervical clefts remains speculative. Differential diagnosis includes thyroglossal duct cysts or branchial cleft anomalies.