bluuebunny/crossref_metadata_2025 huggingface dataset:
Chest-Based Wearables and Individualized Distributions for Assessing Postural Sway in Persons with Multiple Sclerosis
Authors: Meyer Brett , Cohen Jenna , Donahue Nicole , Fox Sam , O'Leary Aisling , Brown Anna Jane , VanDyk Tyler , DePetrillo Paolo , Ceruolo Melissa , Cheney Nick , Solomon Andrew , McGinnis Ryan
Published: February 2023

Typical assessments of balance impairment are subjective or require data from cumbersome and expensive force platforms. Researchers have utilized lower back (sacrum) accelerometers to enable more accessible, objective measurement of postural sway for use in balance assessment. However, new sensor patches are broadly being deployed on the chest for cardiac monitoring, opening a need to determine if measurements from these devices can similarly inform balance assessment. Our aim in this work is to validate postural sway measurements from a chest accelerometer. To establish concurrent validity, we considered data from 16 persons with multiple sclerosis (PwMS) asked to stand on a force platform while also wearing sensor patches on the sacrum and chest. We found five (five) of 15 postural sway features derived from chest (sacrum) were significantly correlated with force platform-derived features, which is in line with prior sacrum-derived findings. Clinical significance was established using a sample of 39 PwMS who performed eyes-open, eyes-closed, and tandem standing tasks. This cohort was stratified by fall status and completed several patient-reported measures (PRM) of balance and mobility impairment. We also compared sway features derived from a single 30-second period to those derived from a one-minute period with a sliding window to create subject-specific distributions of each postural sway feature (SSD method). We find traditional computation of sway features from the chest is sensitive to changes in PRMs and task differences. Distribution characteristics from the SSD method establish additional relationships with PRMs, detect differences in more tasks, and distinguish between fall status groups. Overall, the chest was found to be a valid location to monitor postural sway and we recommend utilizing the SSD method over single-observation analyses. 
Taxa de falha em enxertos de pele em pacientes queimados e fatores relacionados
Authors: Xavier Lais Lara Silva , Silva Erilane Soares da , Silva Ana Caroliny da , Porto Priscilla de Souza , Sousa Thais Vilela de , Félis Keila Cristina , Moraes Filho Iel Marciano de , Melchior Lorena Morena Rosa , Fernandes Marcos Rassi
Published: February 2023

Objetivo: Estimar a taxa de falha dos enxertos de pele em pacientes com queimaduras e os fatores relacionados. Método: Trata-se de um estudo de abordagem quantitativa, longitudinal, do tipo coorte prospectiva, realizado com pacientes vítimas de queimadura submetidos a procedimento cirúrgico de enxertia de pele. A coleta de dados foi realizada por meio de entrevistas, análise de prontuário e avaliação dos enxertos. Resultados: O tempo médio de acompanhamento foi de 20,7 dias. Na amostra estudada 41,67% dos pacientes apresentaram falha na adesão da enxertia de pele e os fatores que se mostraram significativos para o sucesso foram: alteração de níveis séricos de albumina; presença de sangramento; presença, quantidade e aspecto de exsudato e presença de odor. Conclusão: Pode-se constatar que aspectos relacionados às condições do leito da ferida são determinantes no sucesso do enxerto de pele.
Descritores: Transplante de Pele; Queimaduras; Cuidados de Enfermagem.
Morphine Spinal Anesthesia for Cesarean Section at the Regional Hospital of Saint Louis in Senegal: About 119 Cases Collected
Authors: Sarr Ndiamé , Diedhiou M , Bombo B M , Ba E B , Gaye I , Barboza D , Diop B , Faye I , Ndong A , Leye P A , Fa M L
Published: February 2023

Introduction: Post-operative pain management has been the subject of several studies worldwide. Cesarean section is a commonly performed procedure and can lead to severe pain. This study aimed to determine the quality of post-cesarean analgesia by intrathecal administration of 100 micrograms of morphine. Patients and Methods: We conducted an analytical and descriptive study with prospective data collection during one month. We included all women who underwent a spinal caesarean section. Results: During the study period, a total of 119 women were enrolled. The mean age of the parturients was 27.85. High blood pressure and obesity were the most common comorbidities in 9.242% and 5.09% of the women respectively, and 31.93% had a history of caesarean section. Cesarean sections were performed according to the level of urgency based on the colour code. Scheduled caesarean sections were performed in 64.7% of cases. Women had an APFEL score of 3 in 95% of cases. Bupivacaine 7.5mg was administered in 96.63% of cases. The average dose of ephedrine administered before fetal extraction was 3.96mg. Oxytocin was the most administered uterotonic in 73.94%. The APGAR score at birth was greater than 7 in 95.79% of cases. No patient expressed a need for additional analgesics after lifting the motor block. No respiratory or neurological complications of morphine were noted. Pruritus was present in 24.36% of cases, whereas nausea and vomiting were reported in 17.64%. There were no cases of acute urine retention. The average time for the resumption of bowel movement was 13.67 hours. Discussion and Conclusion: Morphine spinal analgesia is an effective technique for the management of post-cesarean pain. The reduction of the morphine dose to 100 micrograms and the preventive addition of dexamethasone are two key factors in accelerated rehabilitation after surgery.
Growth Kinetics of Bacteria Isolated from Laboratory Prepared Cheese Made From Different Milk Sources
Authors: Oleghe Peace Omoikhudu , Oshoma Cyprian , Agholor Kin
Published: February 2023

Background: Dairy food products constitute a major part of our routine diets and it is fundamental to the food industry globally. However, the need for quality control cannot be over-emphasized. A microbiological guideline must be used to define the differences between unacceptable and acceptable food products as food-borne related diseases have been associated with milk and dairy products. Aim of Study: The study aims to evaluate the growth kinetics of cheese prepared in the laboratory from different milk types over a 96 hour period in order to determine its bacteriological quality and assess the effect of storage time on the pH of the various cheeses. Methods: The laboratory cheese was prepared from fresh Goat, cow, sheep and soybeans using the traditional method. Thereafter, 10g of the cheese samples were stored in sterile 250 ml conical flasks at temperature of 28±2 oC for duration of 96 h. The samples were analyzed every 12-24 h interval using Nutrient Agar, MacConkey Agar, Mannitol Salt Agar and De Mann Rogosa and Sharpe Agar for their bacterial, coliform, staphylococcal and lactobacilli load respectively. Results: At 96 h the highest heterotrophic bacterial load, coliform, staphylococcal and lactic acid bacteria counts were observed in sheep milk cheese (8.27 ± 0.02 Log10cfu/g), (7.10 ± 0.33 Log10cfu/g), (7.40 ± 0.34 Log10cfu/g) and cow milk cheese (8.19 ± 0.05 Log10cfu/g) respectively. At 0 h the highest pH was recorded in Soybean milk cheese (5.76±0.01) while the least was cow milk cheese (4.97±0.11). The highest pH at 96 h was Soybean milk cheese (6.96±0.01) while the least pH was recorded in sheep milk cheese (6.12±0.00). Comparing results of this present study with that of the European Union microbiological regulations (EUMR) and the Gulf Standards Organization (GSO) for foods, the bacteria load of all cheese samples at 12 h was within the acceptable or permissible limit. Conclusion: The present study indicates that laboratory prepared cheese contains a repertoire of significant public health microorganisms in numbers above the permissible limit. It is recommended that appropriate aseptic procedures should be strictly upheld by dairy handlers across the entire chess production value chain.
OPTIMIZATION OF MICROALGAE PRODUCTION CONDITIONS USING GENETIC ALGORITHM AND RESPONSE SURFACE METHODOLOGY
Authors: G. M. Bonface , B. G. Benson , N. Paul , E. Bilhah , O. Stephen
Published: February 2023

Renewable biofuels are required as a substitute to fossil-derived transport fuels, which are of limited availability and contribute to global warming. Microalgae are a potential source of renewable energy, and they can be converted into energy such as biodiesel. The aim of this study was optimization of microalgae cultivation conditions in a Flat Plate Photobioreactor (FPPBR) for biodiesel production at pilot scale using Genetic Algorithm (GA) and Response Surface Methodology (RSM). The simulations were done at photon flux density of 70, 95 and 120 µmolphotonsm-2s-1 growth rates of 0.1, 0.2 and 0.3 h-1 and biomass concentration of 2, 2.5 and 3 gL-1. Design expert software was used to generate the experimental design, statistical analysis, and regression models. The results showed that the optimum point for growing microalgae in a FPPBR with RSM method can be achieved at photon flux density of 70 µmolphotonsm-2s-1, growth rate of 0.3 h-1   and biomass concentration of 3 gL-1. On the other hand, optimum point with GA method can also be obtained at 70 µmolphotonsm-2s-1, growth rate of 0.3 h-1 and biomass concentration of 3 gL-1. These results show that GA and RSM can be effectively used to optimize the cultivation conditions of microalgae in photobioreactors. Validation of the model should be done by physical experiments and further research should be done to improve the model and simultaneously study more regressor variables.
OPTIMAL MIX RATIO, TOTAL SOLIDS AND ORGANIC LOADING RATES FOR ANAEROBIC DIGESTION
Authors: C. M. Sheila , O. O. Booker , M. N. Daudi
Published: February 2023

Biogas technology is a sustainable and valid alternative to fossil fuels. It reduces greenhouse gas (GHG) emissions and can enhance energy security. pH, temperature, retention time, particle size, volatile solid content, inoculums, mix ratios (MR), total solid (TS) and organic loading rate (OLR) are among the factors that influence biogas production. Some studies have been done to determine optimal values of these factors for various feedstocks. The aim of this work was to determine the dependency of mix ratios (MR), total solids (TS) and organic loading rate (OLR) and their corresponding optimal values during anaerobic co-digestion of cow dung (CD), pig (PM) and sheep manure (SM). Tests were done using a 0.15m3 fixed dome laboratory reactor under a constant temperature of 35±1℃, 20 days operation period and gas yield was measured using water displacement method. A mix ratio of 1:1:2 (CD: PG: SM) lead with yield rate of 1.707m3/m3day followed by 3:1:3 with 1.300, then 1:1:3 with 0.782 and lastly 1:0:0 with 0.314m3/m3day. These values were significantly different at α=0.05 (LSD=0.392).  There was an increase in biogas yield as TS increases from 6 to 8% followed by a decrease from 8% to 12%. Mean gas yields for 6, 8, 10 and 12% TS were 0.782, 0.644, 0.511 and 0.301m3/m3day respectively. TS 6 and 8%, 6 and 10%, 10 and 12 % were not significantly different from at α=0.05 but for 8 and 10% and 8 and 12% were significantly different (LSD=0.212). The biogas production rate for 1, 2, 3 and 4kgVS/m3day OLR were 0.599, 0.671, 0.769 and 0.386m3/m3day respectively. Mean yields for 1 and 2, 1 and 3, 1 and 4 and 2 and 3kgVS/m3day were not significantly different at α=5% but for 3 and 4, 2 and 4kg/m3day were significantly different (LSD=0.2417). It was then concluded that 1:1:3, 3:1:3 and 1:1:2 resulted in an increase in biogas production rate of 0.468, 0.986, and 1.393 respectively compared to pure cow dung. There was a 21.43% increase in biogas yield as TS increases from 6 to 8% followed by a 61.48% decrease from 8% to 12%. Increasing loading rate from 1-3kg VS/m3 resulted in 29% increase in biogas production rate and further increase from 3 to 4 kg VS/m3 day decreases biogas production rate by 50%. Mix ratio of 1:1:2, TS 6 and 8% and OLR 2 and 3kgVS/m3day were then recommended.
XBOX: THE ULTIMATE STRATEGIC MANAGEMENT AND MARKETING SURVIVAL TOOLS
Authors: Prima Anton , Bielova Olena
Published: February 2023

The paper provides a review of theoretical and practical elements of strategic and marketing aspects for international companies in business. For this purpose, essence and characteristics of main ultimate strategic management and marketing survival tools in international business were analyzed. Features and peculiarities of ultimate strategic management and marketing survival tools in international business including SWOT-analysis and PESTLE-analysis were suggested. Recommendations of strategic and marketing aspects of international companies’ activities in business were provided.
‘‘A STUDY OF FACTORS DETERMINING SELECTION OF ONLINE RETAIL APPLICATIONS FOR BUYING FASHION PRODUCTS.”
Authors: Raghani Priyanka , Jadvani Juee
Published: February 2023

Internet and IT technologies have empowered consumers and marketers in a global marketplace to participate and offer a variety of products. Electronic marketplaces are created where information systems serve as the primary means of communication between sellers and buyers. Many companies are integrating technological innovations into their websites and creating a virtual store that is indistinguishable from a traditional store, providing the same facilities and feelings. As a result, this study attempts to find out the factors that influence a consumer's decision to choose an online retailer. Respondents who live in Ahmedabad, Gujarat, were surveyed using a Likert scale-based structured questionnaire. Out of 350 respondents, 308 valid responses were analysed using factor analysis and confirmatory factor analysis. The result identified Product Assortment, Pricing, Promotional Offers, Application Interface, brands and After sales services leads to the Purchasing Intention of the buyers in online shopping of fashion products
The Church, Digital Technology and Media: A Biblical Reflection on Romans 8:19-23
Authors: Nyarko Ernest
Published: February 2023

This paper seeks to shed light on the author’s perspective as far as the interplay between the church especially in Ghana, digital technology, and media is concerned. The study was done mainly through literary activity in existing sources from Biblical and materials on technology and media. It employed such methodological tools as descriptive and theological in discussing the subject at hand. It briefly looked at the basic meaning of the church. It then continued by highlighting what technology and media are and discussed how the church, especially in Ghana, can use them in these contemporary times. Through some biblical passages, the study demonstrated that technology and media are part of God’s creation. However, since technology and media are products of human ingenuity and natural resources, they like other creations as Paul argues in the selected passage (Rom. 8:19-23), are also subject to the present corruption of the creation as a result of sin or futility. In other words, technology and media are not excluded from the effects of humanity’s fall into sin. They are also groaning from the pain of sin and waiting eagerly for their redemption from the bondage of decay.

Keywords: Church, Technology, Media, Creation
Effect of Using Different Primary Crown Materials on the Retention of CAD/CAM Telescopic Partial Dentures
Authors: Abdallah Hebatallah Tarek , Elsaeid Soha , Thabet Yasmine
Published: February 2023

AIM: This study compared the effect of using different primary crown materials (zirconia and cobalt-chromium) on the retention of telescopic retained removable partial dentures.
MATERIALS AND METHODS: A maxillary Kennedy class I stone model was prepared and scanned. The virtual cast was adjusted to create four abutments at the positions of the canines and the first premolars. Primary crowns were designed and then milled. In Group I, seven primary crowns were milled out of zirconia, and in Group II, seven primary crowns were milled from cobalt-chromium blanks. Cobalt-chromium telescopic partial dentures were milled. The universal testing machine was utilized to apply vertically dislodging static forces. Initial retention values were recorded. Then, the chewing simulator (CS) was used to apply dynamic cyclic loading to each partial denture. And after, 50,000 cycles and 270 attempts of insertion and removal final retention values were recorded. The data were collected and statistically analyzed.
RESULTS: A significant decrease in retention in both groups after simulation of 3 months of partial denture function was recorded. It was found that after simulation of 3 months of function Group I (zirconia) recorded a statistically significant higher mean value; (1.935 ± 0.268 N) than Group II; (0.583 ± 0.018 N) as indicated by student t-test (p ≤ 0.0001 < 0.05).
CONCLUSION: Zirconia primary crowns attain higher retention values than cobalt-chromium with cobalt-chromium telescopic partial dentures after simulation of 3 months of function.
Genetic analyses reveal a complex introduction history of the globally invasive tree Acacia longifolia
Authors: Vicente Sara , Trindade Helena , Máguas Cristina , Le Roux Johannes J.
Published: February 2023

Acacia longifolia (Sydney golden wattle) is considered one of the most problematic plant invaders in Mediterranean-type ecosystems. In this study, we investigate the species’ invasion history by comparing the genetic diversity and structure of native (Australia) and several invasive range (Brazil, Portugal, South Africa, Spain, and Uruguay) populations and by modelling different introduction scenarios using these data. We sampled 272 A. longifolia individuals – 126 from different invasive ranges and 146 from the native range – from 41 populations. We genotyped all individuals at four chloroplast and 12 nuclear microsatellite markers. From these data we calculated diversity metrics, identified chloroplast haplotypes, and estimated population genetic structure based on Bayesian assignment tests. We used Approximate Bayesian Computation (ABC) models to infer the likely introduction history into each invaded country. In Australia, population genetic structure of A. longifolia appears to be strongly shaped by the Bass Strait and we identified two genetic clusters largely corresponding to mainland Australian and Tasmanian populations. We found invasive populations to represent a mixture of these clusters. Similar levels of genetic diversity were present in native and invasive ranges, indicating that invasive populations did not go through a genetic bottleneck. Bayesian assignment tests and chloroplast haplotype frequencies further suggested a secondary introduction event between South Africa and Portugal. However, ABC analyses could not confidently identify the native source(s) of invasive populations in these two countries, probably due to the known high propagule pressure that accompanied these introductions. ABC analyses identified Tasmania as the likely source of invasive populations in Brazil and Uruguay. A definitive native source for Spanish populations could also not be identified. This study shows that tracing the introduction history of A. longifolia is difficult, most likely because of the complexity associated with the extensive movement of the species around the world. Our findings should be considered when planning management and control efforts, such as biological control, in some invaded regions.
Comparison of the efficacy of one, two, and third doses of BNT162b2 in patients suffering from cardiovascular diseases, respiratory diseases, and diabetes against COVID-19
Authors: Jaber Saif Aldeen , Saadh Mohammad
Published: February 2023

The COVID-19 pandemic has had a major impact on human health around the world. Given the speed of the spread of the disease and its impact on people’s lives, different countries including Jordan issued approval for the emergency use of the mRNA vaccine BNT162b2 for COVID-19. This respiratory disease has led to an increased risk of complications and significant mortality in patients with pre-existing medical conditions such as respiratory disease, cardiovascular disease, and diabetes. Vaccination against COVID-19 is recommended for people with chronic diseases to reduce the risk of infection, hospitalization, and death. The BNT162b2 vaccine has shown high efficacy in healthy adults. The results of our study suggest a high efficacy of the BNT162b2 vaccine in patients with diabetes and cardiovascular after the second and third doses compared to the first dose of the vaccine. Vaccine efficacy for the third dose was similar to that for the third dose while the effectiveness did not change between the first, second, and third doses in respiratory diseases.

In conclusion, receiving second and third doses of the COVID-19 vaccine was associated with a decreased risk of mortality and hospitalization compared with the first dose. Unfortunately, the efficacy of the first, second, and third doses was similar in respiratory patients.
Godard et l’archive
Authors: Vergnioux Alain
Published: February 2023

Le cinéma de Godard est traversé par une question : quels rapports les images entretiennent-elles avec l’histoire ? De sorte qu’il se caractérise par un incessant travail d’archivage, de l’histoire du cinéma, de la grande histoire et de sa propre histoire, depuis ses premiers films au monument final des Histoire(s) du cinéma .
« J’ai été éduqué à mort ». Lire Mars de Fritz Zorn
Authors: Statius Pierre
Published: February 2023

Il s’agit, dans ce texte, de lire le livre extraordinaire de Fritz Zorn Mars , afin de mieux comprendre notamment ce qui se dissimule sous l’expression d’une « éducation à mort ». Le texte de Zorn ressortit pour partie à la rhétorique antimoderne. Mais il est aussi porteur d’une vision nietzschéenne de la volonté de puissance qu’il convient d’interpréter. Il sera donc question à la fois de maladie, de mort, de renaissance et de joie. J’ajoute enfin que ce livre, lu dans mon adolescence, me hante depuis plus de quarante années, la dimension personnelle n’est donc pas absente de ce texte de facture universitaire.
Qualitative Research in Healthcare: Data Analysis
Authors: Im Dasom , Pyo Jeehye , Lee Haneul , Jung Hyeran , Ock Minsu
Published: February 2023

Qualitative research methodology has been applied with increasing frequency in various fields, including in healthcare research, where quantitative research methodology has traditionally dominated, with an empirically driven approach involving statistical analysis. Drawing upon artifacts and verbal data collected from in-depth interviews or participatory observations, qualitative research examines the comprehensive experiences of research participants who have experienced salient yet unappreciated phenomena. In this study, we review 6 representative qualitative research methodologies in terms of their characteristics and analysis methods: consensual qualitative research, phenomenological research, qualitative case study, grounded theory, photovoice, and content analysis. We mainly focus on specific aspects of data analysis and the description of results, while also providing a brief overview of each methodology’s philosophical background. Furthermore, since quantitative researchers have criticized qualitative research methodology for its perceived lack of validity, we examine various validation methods of qualitative research. This review article intends to assist researchers in employing an ideal qualitative research methodology and in reviewing and evaluating qualitative research with proper standards and criteria.
Une cartographie de conflits socio-écologiques associés à l’extractivisme dans une perspective critique d’éducation relative à l’environnement
Authors: Orellana Isabel , Larrea Burneo Andres , Poisson Gabriel , Brière Laurence , Jurado Cerdas Lil , Roy-Grégoire Gabrielle , Moreau Guillaume
Published: February 2023

Nous rapportons ici le processus collaboratif de construction d’une cartographie de conflits socio-écologiques associés à l’expansion de l’extractivisme au Québec et au Chili, développée dans le cadre du projet de recherche Resistaction1. Nous situons d’abord quelques repères théoriques principaux sur la cartographie participative et décrivons ensuite sommairement notre recherche, le contexte dans lequel elle s’inscrit et ses choix, nous attardant sur les particularités et les enjeux de la démarche cartographique réalisée. Quelques résultats préliminaires sont présentés et mis en évidence au regard des contextes des deux réalités étudiées. Finalement, nous abordons la signification du processus cartographique dans une perspective d’éducation relative à l’environnement socialement critique.
Impact of Moonlighting on the Earning Differentials in Sri Lanka
Authors: Samaraweera G. R. S. R. C.
Published: February 2023

Holding more than one job is called moonlighting. This creates both positive and negative impacts on individual workers as well as on the economy. This paper limits itself only to the impacts on the individual worker. This study examines the impacts of moonlighting on workers’ per-hour total earnings and wage differentials. The Sri Lanka Labour Force Survey conducted by the Department of Census and Statistics of Sri Lanka in 2017 has been used for the study. The study uses 28,671 employed persons, and 2,351 are holding secondary employment. The Endogenous switching regression model has been used for the analysis. The Endogenous switching regression allows the comparison of the factors associated with total log-hourly earnings between moonlighters and non-moonlighters with and without moonlighting. Moonlighters are generally a disadvantaged group when compared with non-moonlighters. However, moonlighting facilitates the reduction of the wage gap between moonlighters and non-moonlighters. Moonlighting by moonlighters and moonlighting by non-moonlighters are economically optimal solutions for both groups. Therefore, it is evident that moonlighting has increased economic welfare. Further, it reduces wage disparities among workers in terms of ethnic groups and gender and thus leading to increased gender and ethnic welfare, while it causes to expand earning disparities by residential sectors leading to reduce their economic welfare. Creating formal opportunities for moonlighting, encouraging moonlighting among females, minor ethnic groups etc. Through micro-financing programmes would be important policy options for empowering vulnerable groups in the labour market of Sri Lanka, according to the findings of this study.
Study the Nature of the Need for a Passenger Information Management System for the Department of Railways in Sri Lanka: In Passengers’ Perspective
Authors: De Silva W. A.C. E. , Manel D. P. K.
Published: February 2023

Sri Lanka South Asian country has a high demand for railway services as public passenger transportation. Although more than 3.7 million passengers use the railways daily, the lack of a Passenger Information Management System (PIMS) for the Sri Lanka Railways (SLR) is still a problem. Therefore, this study's main objective is to identify the need for a PIMS in SLR. A cluster sampling technique was applied to select a sample of 327 passengers serviced from the Colombo Fort Railway Station, the premier central railway station in Sri Lanka. An interviewer-administered questionnaire was used to collect data. Descriptive Statistics, one-way ANOVA, and multiple regression were used as analytical techniques. According to the analysis, the average value of the index related to the need for a PIMS is 39.18. Most passengers need a PIMS index value higher than the average value. It reveals the majority need for a PIMS. Computer knowledge, online knowledge level, knowledge of electronic card usage, the primary purpose of using the train service, train service usage frequency, and satisfaction with the M-ticketing service were identified as the factors affecting the need for a PIMS for the SLR using one-way ANOVA. Regression analysis proves that the attitude towards an online ticketing procedure, the service at the ticket counter, and the ease of knowing about the train schedule have a significant effect on the need for a PIMS. It implies that the need for a PIMS will decrease if the service at the ticket counter is more efficient and if there is an easy way for train passengers to get information about the train schedule quickly. It is suggested that the SLR should establish an easy-to-use, secure PIMS covering all sectors, using a simple interface that is tailored to the individual at all levels and further demonstrated that the government and the SLR should pay special attention to the issue.
Coagulation abnormalities and their relationship with bleeding manifestations in patients with dengue-A single center observational study
Authors: Patel Govind R. , Thanvi Indu , Nadeem Mohammad , Kanwaria Rahul
Published: February 2023

Objective:

To evaluate coagulation abnormalities and their relationship with bleeding manifestations among patients with dengue.

Methods:

This observational study was conducted on 292 adult dengue patients who were admitted to a tertiary care hospital of Western India from July 2021 to June 2022. Coagulation tests including prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (aPTT), fibrinogen, and D-dimer were performed. Patients were monitored for bleeding manifestations.

Results:

Coagulation abnormalities were reported in 42.8% of the patients. Overall, prolonged aPTT was the most common coagulation abnormality (40.8%), followed by low fibrinogen (38.7%), raised D-dimer (31.2%), raised INR (26.0%) and prolonged PT (19.2%). Bleeding manifestations were present in 19.9% patients. PT, INR, aPTT and D-dimer levels were significantly higher (P<0.01) and fibrinogen level was significantly lower (P<0.001) in patients with bleeding compared to patients without bleeding. Patients with bleeding had a significantly higher rate of all coagulation abnormalities than patients without bleeding (P<0.01).

Conclusions:

Patients with bleeding showed a significantly higher frequency of coagulation abnormalities compared to patients without bleeding. Patients with dengue should be assessed for coagulation abnormalities.
Insulin autoimmune syndrome
Authors: Deshmukh Shweta , Purandare Vedavati B , Pakale Ashutosh , Unnikrishnan Ambika G
Published: February 2023

Insulin autoimmune syndrome (IAS), also known as Hirata's disease, is a rare endocrine disease. It is a form of autoimmune endogenous hyperinsulinemic hypoglycemia, which develops when genetically predisposed individuals get exposed to triggering factors such as viral infection or certain medications containing sulfhydryl groups. It is important to consider IAS in the differential diagnosis of hypoglycemia as its incidence seems to be increasing worldwide. In this article, we summarize a report of two cases of IAS and their clinical manifestations, biochemical characteristics, their step-by-step diagnosis, and also prompt utilization of continuous glucose monitoring system as a monitoring tool for appropriate management. The first patient who presented with hypoglycemic episodes had recently suffered from a viral pneumonia, which probably acted as a superantigen and triggered development of IAS. The second patient also had hypoglycemic episodes, which used to recover after intake of glucose-containing liquids. Alpha-lipoic acid containing multivitamin may have triggered the development of IAS in the second patient. The tests performed showed high serum insulin and C-peptide levels along with insulin autoantibody positivity confirming the diagnosis of Hirata's disease. Immunosuppression therapy was not required as both the patients responded well to diet modification and corticosteroid therapy. It is important to be mindful while prescribing alpha-lipoic acid-containing supplements though it has good antioxidant properties, as it is presumed to be associated with increasing number of IAS cases.
Comparative evaluation of visual analogue scale and pupillary diameter for post-operative pain: An observational study
Authors: Shukla Bharat Bhushan , Malviya Deepak , Kumar Sumit , Misra Shilpi , Kumar Suraj , Parashar Samiksha
Published: February 2023

Background and Aims:

An objective understanding of pain guides the effectiveness of various postoperative pain management strategies. The measurement of pain by the visual analogue scale (VAS) is dependent on the individual’s cognitive and emotional ability. Pupillary dilatation has been successfully used to measure pain in quantitative terms. The present study was conducted to study the correlation between VAS and pupillary diameter in the evaluation of postoperative pain.

Methods:

This observational study was carried out on 85 patients 18–65 years of age, scheduled for lower abdominal surgical procedures under general anaesthesia. Postoperative pain assessment was done using the VAS at 6 h, 12 h, 18 h and 24 h. In addition, the pupillary diameter of both eyes was measured simultaneously. Paired t-test and analysis of variance (ANOVA) were used to compare the data, and Pearson’s correlation coefficient was calculated to assess the bivariate correlation between VAS score and pupillary diameter.

Results:

Mean ± standard deviation (SD) of VAS scores at baseline, 6 h, 12 h, 18 h and 24 h postoperatively were 0, 4.88 ± 0.88, 3.39 ± 0.86, 2.19 ± 0.66 and 1.40 ± 0.49, respectively. Mean change was significant at all time intervals (P < 0.001). The mean ± SD change in average pupillary diameter was 0.59 ± 0.64, 0.44 ± 0.54, 0.22 ± 0.34 and 0.07 ± 0.22 mm, respectively, showing a significant change from baseline (P < 0.05). On overall evaluation, mean pupillary diameter showed a significant incremental trend with an increasing VAS score (P < 0.001).

Conclusion:

Change in pupillary diameter correlated well with the pain scores (VAS) and thus pupillary diameter can be chosen as an objective measurement of postoperative pain severity.
Study of foetomaternal outcomes in COVID-19 afflicted parturients who underwent operative delivery - A retrospective analysis
Authors: Yadav Sandeep K. , Nath Soumya S. , Singh Neetu , Parashar Samiksha , Mishra Smarika , Malviya Deepak
Published: February 2023

Background and Aims:

Parturients with coronavirus disease (COVID)-19 are increasingly presenting for operative delivery. The aim of this study was to outline the foetomaternal outcome in COVID-19-afflicted pregnant women who underwent lower segment caeserean section (LSCS).

Methods:

Data of all COVID-19 positive pregnant females who underwent caesarean section surgery between 1 April and 30 June 2021 was collected. Clinical parameters, including oxygen requirement, laboratory investigations, treatment measures, complications, length of hospital and intensive care unit/neonatal intensive care unit stay, and outcome of parturients and neonates, were collected and analysed. All patients were followed up either during their visits to the obstetric outpatient department or by making phone calls between 1 and 2 months of discharge. Statistical Package for the Social Sciences statistical software 16.0 was used for analysis. Independent group t-test or Mann–Whitney test was used for mean of continuous data. Chi-square test or Fisher’s test was used for proportion of categorical data. A P value of <0.05 was considered significant.

Results:

A total of 71 parturients delivered by caesarean section. 36.51% had mild COVID-19, and 87.5% had moderate COVID-19 at admission. One each with mild and moderate disease expired. The median (interquartile range) length of hospital stay was 7 (5–5.9) days for those with mild disease, and it was significantly longer for those with the moderate disease at 14 (9.5–17.5) days. Our study found that after a mean of 41.72 days of follow-up, of the 69 surviving mothers, 17 complained of fatigue, five complained of myalgia and one needed intermittent supplemental oxygen. Out of 74 babies born, seven died, which is 94.6 per 1000 live births.

Conclusion:

COVID-19 parturients delivered by LSCS stand a higher risk of maternal and neonatal mortality and adverse effects, including more hospital stay and increased mortality.
Pharmacological interventions for reducing catheter-related bladder discomfort in patients undergoing elective surgeries under general anaesthesia: A systematic review and meta-analysis
Authors: Ramesh Roopesh , Mittal Ankur , Agrawal Sanjay
Published: February 2023

Background and Aims:

Catheter-related bladder discomfort (CRBD) is identified as a major concern after surgery as it can lead to increased morbidity and prolonged hospital stay. A suitable agent to prevent and treat postoperative CRBD is not yet established, and the literature is scarce in this regard. So, we aimed to find the efficacy of various drugs in preventing CRBD after elective surgery.

Methods:

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed for the study, and electronic databases like PubMed Central, Cochrane database and Embase were searched. The methodological quality of selected studies was assessed by the Cochrane Collaboration risk of bias tool. Review Manager 5.4.1 was used for statistical analysis.

Results:

The meta-analysis revealed that antimuscarinic agents were able to lower the incidence of CRBD significantly at 0 hour, 1 hour, 2 hours and 6 hours (P < 0.01) after the surgery. Tramadol was effective at 1 hour, 2 hours and 6 hours postoperatively (P < 0.01), whereas ketamine was effective at 2 and 6 hours (P < 0.01) postoperatively. Antiepileptic drugs (pregabalin and gabapentin) were able to lower the incidence of CRBD at 0 hour (P < 0.01), 1 hour (P < 0.05), 2 hours (P < 0.05) and 6 hours (P < 0.01) postoperatively while dexmedetomidine at 0 hour (P < 0.01) and 2 hours (P < 0.01) after the surgery. Injections paracetamol, amikacin and diphenhydramine were also shown to reduce the incidence of CRBD in separate randomised controlled trials.

Conclusion:

The current meta-analysis showed that antimuscarinic agents, tramadol, pregabalin, gabapentin, paracetamol and dexmedetomidine are effective in significantly reducing the incidence of postoperative CRBD.
A comparative study of clinical effects and recovery characteristics of intraoperative dexmedetomidine infusion with ketamine versus fentanyl as adjuvants in general anaesthesia
Authors: Lodhi Mehershre , Sulakshana Sulakshana , Singh Anil P. , Gupta Bikram K.
Published: February 2023

Background and Aims:

Intraoperative dexmedetomidine infusion decreases the concurrent anaesthetic and analgesic requirement. However, because of slow onset and offset, it is often used with other drugs. Opioids have a depressant effect on the cardiorespiratory system while ketamine has the opposite pharmacodynamics. Hence, it was hypothesised that ketamine will have a better intraoperative haemodynamic profile compared to fentanyl. This study compared the clinical effects and recovery characteristics of ketamine versus fentanyl when used as an adjuvant along with dexmedetomidine infusion intraoperatively.

Methods:

A total of 80 patients (18-60 years) undergoing major surgeries were divided into two groups: Group (D + K) received an intraoperative infusion of ketamine 0.5 mg/kg/h, while group (D + F) received fentanyl 0.5 μg/kg/h along with intravenous dexmedetomidine 0.5 μg/kg/h. Intraoperative heart rate (HR), mean blood pressure, and oxygen saturation were recorded at 0 min, 10 min of induction, and thereafter every 30 min throughout the procedure. Ramsay sedation score (RSS) and visual analogue scale (VAS) score were measured at the end of the surgery, at 2 hours, 4 hours, and 6 hours.

Results:

Reduction in HR and mean blood pressure was more with a tendency of developing hypotension in the fentanyl group compared to the ketamine group. Post-anaesthesia care unit (PACU) stay, need for muscle relaxant and VAS score for pain were also significantly lesser in the ketamine group.

Conclusion:

Dexmedetomidine with ketamine provided better haemodynamic stability and reduced PACU stay compared to dexmedetomidine with fentanyl.
Recovery time in target controlled infusion versus manual infusion of propofol in total intravenous anaesthesia for endoscopic retrograde cholangio-pancreatography procedure using laryngeal mask airway-gastro: A randomised comparative study
Authors: Sahu Ayushi , Tripathy Debendra Kumar , Gupta Bhavna , Talawar Praveen , Gupta Rohit
Published: February 2023

Background and Aims:

This study aimed to compare manual infusion versus target-controlled infusion (TCI) in total intravenous anaesthesia (TIVA) utilising laryngeal mask airway (LMA)-gastro during endoscopic retrograde cholangio-pancreatography (ERCP) procedures.

Methods:

This was a single-blind randomised trial. Patients were randomly allocated into two groups. TCI group included 27 patients, where TCI of propofol was implemented with the Schnider pharmacokinetic model driven by a computer-controlled syringe pump. The TIVA group included 27 patients with a loading dose of 2 mg/kg of propofol, followed by manual infusion of 15 mg/kg/h for the first 15 min, 13 mg/kg/h for the next 15 min, then 11 mg/kg/h for 30 min and 10 mg/kg/h for 60 min and finally maintained at 9 mg/kg/h. The primary objective was to compare recovery time following cessation of propofol infusion in both groups. The difference in the total dose of propofol, time to achieve anaesthesia induction, first attempt success rate, ease of LMA-gastro insertion, ease of insertion, success rate of endoscope device and post-anaesthesia care unit (PACU) discharge time were the secondary objectives. T-test and Chi-square test were used for statistical analysis.

Results:

The time required for the recovery was significantly less in the TCI group than in the TIVA group (mean ± standard deviation; 11.60 ± 2.27 versus 15.4 ± 3.25 minutes, P < 0.001). The duration of ERCP, ease of LMA and endoscope insertion were comparable between the groups. There was no post-operative recall of intra-operative events in the groups.

Conclusion:

TCI offers earlier recovery than TIVA in patients undergoing ERCP procedures using LMA-gastro.
Intubation characteristics using modified USB videolaryngoscope: A prospective, randomised study
Authors: Ali Qazi E. , Nisanth N S , Amir Syed H. , Rahat Asma
Published: February 2023

Background and Aims:

Videolaryngoscopes with varying characteristics with regard to angulation of blades and video configurations are now available. However, the contribution of each of these in improving ease of intubation is quite different. We evaluated the role of video camera in the performance of laryngoscopy by using the universal serial bus (USB) videolaryngoscope in patients with predicted difficult airway.

Methods:

Sixty patients in the age group of 25 to 65 years having Mallampati grade III or IV were randomly allocated to two groups. All patients were American Society of Anesthesiologists physical status grade I or II and planned for elective surgical procedure under general anesthesia. USB videolaryngoscope or Macintosh laryngoscope was used for intubation as per group allotted. Comparison of time of endotracheal intubation was our primary outcome measure and it was calculated from the time the laryngoscope tip passes the incisors to the initial appearance of capnography wave. Rate of successful intubation, number of attempts needed for successful tube placement, optimisation manoeuvres used, changes in haemodynamic parameters and airway injuries were evaluated as secondary outcomes.

Results:

Time for intubation was shorter in the Macintosh group than the USB group (P = 0.024). The incidence of successful intubation was similar in both groups (P = 0.079). USB group required lesser number of attempts for tube placement (P = 0.047). The incidence of airway injuries was similar in both the groups.

Conclusion:

USB videolaryngoscope reduces the number of attempts required for successful endotracheal intubation compared to Macintosh laryngoscope though it increases the time for intubation in patients with predicted difficult airway.
Comparison of C-MAC Miller blade video laryngoscope with conventional Miller blade in infants undergoing elective surgery- A prospective randomised trial
Authors: Manhas Samriti , Agrawal Nidhi , Jain Swati , Sharma Ridhima , Choudhary Ripon
Published: February 2023

Background and Aims:

Endotracheal intubation (ET) in infants is considered a challenging task over the decades. Infants have short safe apnoea time, and this difficulty has been vanquished to some extent by using the videolaryngoscopes (VLs), but there exists a dearth of research particularly in this vulnerable subset. Therefore, this trial was conducted to evaluate intubation times obtained with C-MAC VL and conventional Miller laryngoscopes in infants.

Methods:

A total of 80 infants aged between 1 month and 1 year with American Society of Anesthesiologists physical status I-II requiring ET were randomised in two groups; the C-MAC VL or Miller laryngoscope ML. Anaesthesia was induced with sevoflurane 1–8% and atracurium 0.5 mg/kg IV. The primary outcome was evaluated as the total time taken to intubate. Secondary outcomes were time to achieve best glottic view (TBGV), tube insertion time (TIT), percentage of glottic opening (POGO) score, number of attempts and intubation difficulty score (IDS).

Results:

The median (interquartile range) of time taken for ET was less in VL; 22.5 (20.75–26) compared to ML; 26 (21.75–31). TBGV was achieved early in VL group than the ML group (6.03 ± 1.33s/7.88 ± 2.44) respectively (P-value < 0.001). POGO was better in VL (99.12 ± 4.795s) compared to ML (85.50 ± 31.13s). IDS was less in the VL group (0.07 ± 0.27) than in ML (0.70 ± 1.14). Other parameters, such as the number of attempts, bougie usage, adverse effects and TIT, were comparable across the two groups.

Conclusion:

When compared to the ML group, the C-MAC VL group exhibited a decreased intubation time, early TBGV, better POGO score, reduced IDS and subjective intubation difficulty. As a result, we consider VL to be a more efficacious device for intubating the trachea in infants.