bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of rapid antigen test (RAT) screening test among people attending fever clinic of Shimoga Institute of Medical Sciences, Shivamogga: An analytical cross-sectional study
Authors: Darshitha Rajanna  , Shashi Kiran Guttinadu Mallikarjunappa  , Kanchana Nagendra  , Raghavendraswamy Koppad  , Anitha Bheeme Gowda Padma
Published: October 2022

Background: COVID-19 pandemic continues to be a public health threat. Rapid antigen tests (RATs) for the detection of SARS-CoV-2 infection will help in formulation of clinical and public health strategies for the control of transmission. In India, 49% of COVID-19 tests done are RATs.1 The sensitivity of RAT is 50.6–84%. RAT has specificity ranging from 99.3% to 100%.2 The present study aims at evaluating the RAT screening test done on people attending fever clinic of Shimoga Institute of Medical Sciences, Shivamogga.
Aims and Objectives: The objectives of the study were to evaluate the COVID-19 RAT screening test with reverse transcriptase-polymerase chain reaction (RT-PCR) as the gold standard test done at fever clinic of SIMS, Shimoga.
Materials and Methods: An observational, cross-sectional analytical study was conducted for a period of 1 month, May 2021. The study participants included all the people attending fever clinic of SIMS, Shimoga. Assuming the sensitivity of RAT to be 85%, power of 80%, and precision of 5%, the calculated sample size was 204. Considering non-response rate of 10%, the final sample size was 224. Secondary data regarding contact number of the people attending fever clinic were collected from the COVID-19 test register. Oral consent was taken after explaining about study and assuring confidentiality. Telephonic interview was done to collect relevant information. Analysis was done using Epi Info software version 7.2.4.0. Descriptive statistics such as percentages and analytical statistics such as Student’s t-test and Chi-square test were used.
Results: Overall positivity rate was 43.7%. About 71% of people had contact history. Sensitivity and specificity of RAT test were found to be 64.2% and 97.2%, respectively, and were comparable with the previous studies. Significant difference was found (P<0.05) between RAT and RT-PCR results.
Conclusion: Significant difference was found between RAT and RT-PCR results which indicate that RAT is not diagnostic for people who test positive in RT-PCR. Sensitivity of RAT is relatively less in our study (but crucial in detecting disease early) and hence we strongly recommend that RT-PCR for those who test negative for RAT test.
Comparative status of syncope among voluntary blood donors with and without prior water administration: A Randomized Study in a Medical College from North India
Authors: Shailesh Kumar Mishra
Published: October 2022

Background: Blood center rely heavily on young donors to meet blood demand, but syncope is more frequent in younger donors. Studies have suggested administration of water before donation may reduce syncope related complications in this group.
Aims and Objectives: The aim of the study was to compare status of syncope among voluntary blood donors with and without prior water administration.
Materials and Methods: This study was conducted to establish the effect of pre-loading with 500 ml of water on the rate of syncope in young blood donors who came for blood donation voluntarily in outdoor blood donation camp organized by the department. Nearly Fifty percent of blood donors received water and another Fifty percent were not given water pre donation and the effect of water on blood donors studied. Incidence of syncope was compared between randomization groups using multivariable logistic regression.
Results: Out of 2345 study participants, 1172 received water, and 1173 did not; groups differed slightly by gender and number of donation. Syncope was seen in 3 (0.25%) in the test group (who received water before donation) and 39 (3.32%) of the control subjects (who were not given water before donation). After adjusting for, gender, age, and donation history, there was significant difference in outcome between the water versus no water administration (adjusted odds ratio [OR] = 0.80 [95% CI 0.42–1.53]).
Conclusion: Preloading young donors with 500 ml of water have a major effect in reducing syncope related complications among young and 1st time blood donors.
Quantification of sleep architecture in different grades of apnea hypopnea index in patients having obstructive sleep apnea
Authors: Nyrvan Balen Baishya  , Vrunda Vishal Joshi  , Amita Umesh Athavale
Published: October 2022

Background: Optimum sleep architecture is important from the point of view of optimum physiological functions. Sleep is qualitatively as well as quantitatively affected in patients of obstructive sleep apnea (OSA). Male gender and obesity are associated with increased risk of OSA. It is being increasingly recognized due to increased awareness not only among treating physicians but also in general population. We undertook this study to do quantification of sleep in individuals diagnosed with apnea/hypopnea syndrome and having different grades of apnea/hypopnea index (AHI).
Aims and Objectives: The aims of this study were to analyze sleep pattern in individuals diagnosed with obstructive sleep apnea having different grades of AHI.
Materials and Methods: This was a retrospective analytical study, in which data were collected from polysomnography reports of 92 patients having obstructive sleep apnea. The study was conducted in the Pulmonary Medicine, Seth GS Medical college and KEM Hospital Mumbai. Ninety-two patients diagnosed to be having OSA were included in this study on the basis of a predefined inclusion and exclusion criteria. The sleep parameters included in the study were total sleep time, percentage of time spent in rapid eye movement (REM), percentage of time spent in non-REM (NREM) Stage I, percentage of time spent in NREM Stage II, percentage of time spent in Stage III, percentage of time spent in stage NREM IV, N2 sleep, and wake after sleep onset (WASO) Index. P<0.05 was taken as statistically significant.
Results: Among the 92 studied cases, there were 66 (71.74%) males and 26 (28.26%) females with a M: F ratio of 1: 0.39. Most of the patients belonged to age group between 35–50 years (39.13%) and 51–70 years (42.39%). Most of the patients with obstructive sleep apnea were either obese (59.78%) or overweight (27.17%). AHI was found to be mild, moderate, and severe in 32 (34.78%), 15 (16.30%), and 16 (17.39%) patients, respectively. Percentage of NREM I, NREM II and NREM IV, and N3 SL was foundto be comparable across groups of different AHI (P>0.05). The median AHI of the patients with underweight, healthy weight, overweight, and obese individuals was found to be 7.6, 5.5, 11.6, and 6.9, respectively, and it was found to be comparable with no statistically significant difference (P>0.05).
Conclusion: Obstructive sleep apnea affects sleep pattern qualitatively as well as quantitatively and is more likely to affect NREM I and WASO.
Prevalence of multidrug resistant non-fermenters in a tertiary care centre
Authors: Manjunath Veena , Vadnal Revanappa Shwetha , Bullappa Asha , Vedalaveni Lakshminarayana Jayasimha
Published: October 2022

Background: Infections due to multidrug resistant organisms especially Gram-negative non-fermenting bacteria such as Acinetobacter baumannii and Pseudomonas aeruginosa are increasing, ultimately leading to shortage of clinically effective antibiotics. Indiscriminate use of antibiotics is the key factor influencing the prevalence and distribution of drug resistance in any community or nosocomial setting.
Aims and Objectives: The objectives of the study are as follows: (1) To know the antibiotic susceptibility pattern of commonly isolated non-lactose fermenters. (2) To know the prevalence of multidrug resistant P. aeruginosa and A. baumannii.
Materials and Methods: Clinical samples from various departments were processed using standard isolation and identification procedures. Only non-lactose fermenting colonies were processed further and only those isolates that were identified as P. aeruginosa and A. baumannii. were considered and their antibiotic susceptibility testing by disk diffusion method was carried out. Results were tabulated and analyzed.
Results: Among 558 non-lactose fermenting Gram-negative bacilli isolates, P. aeruginosa (355) and A. baumannii. (203) were the most common isolates. Resistance to commonly used drugs such as aminoglycosides, cephalosporins and inhibitor combinations, and fluoroquinolones ranged from 40% to 65%. Carbapenem resistant isolates were around 24–25%. Multidrug resistant isolates and extensively drug resistant accounted for 17.4% and 9.1%, respectively.
Conclusion: Increasing multidrug resistance and extensive drug resistance resistance among non-fermenters are on the rise leaving a very small window of treatment options. This is an alarming situation that needs strict antibiotic policy and a robust antimicrobial resistance management plan.
Study of anxiety disorders and its association with quality of life in patients of oral cancer
Authors: Archanaben Surajprasad Kantak  , Kinjal Bhupendrasinh Chauhan  , Ashokkumar Ukabhai Vala  , Bharat Navinchndra Panchal
Published: October 2022

Background: Anxiety is a response to a threat that is unknown/known, internal/external, vague, or conflictual, cancer is threatening and so many patients are anxious.
Aim and Objectives: The present study was performed to assess the prevalence of anxiety disorders (AD) and quality of life (QoL) and its association in patients of oral cancer.
Materials and Methods: There were 62 patients attending cancer OPD of tertiary care center was assessed for cross-sectional, observational, and questionnaire-based study. Patients those diagnosed with oral cancer were included in our study. They were diagnosed for AD by clinical interview using DSM-5 diagnostic criteria. We assessed QoL in patients with oral cancer by scale of Functional Assessment of Cancer Therapy-Head and Neck (FACT-H&N Version 4). Patients were further assessed for demographic details. Statistical analysis was done using SPSS version 15, proportions were compared using Chi–square test, FACT H&N QoL scores were compared by Mann–Whitney U test. P<0.05 was considered to be statistically significant.
Results: We found that 17.74% had AD and those patients who were diagnosed of AD have poorer QoL in all domains of FACT H&N QoL.
Conclusions: QoL was found to be poor in patients with oral cancer who had diagnosed with AD then those without AD.
Placenta percreta with bladder invasion – a novel approach for management: A case report
Authors: Sushila Kharkwal  , Divya Jain  , Manish Jain  , Shitangsu Kakoti  , Divya Pandey
Published: October 2022

Placenta percreta is an obstetric emergency often associated with massive hemorrhage, emergency cesarean section, and peripartum hysterectomy. We present a case of a 30-year-old woman, G4P1L1A2 with placenta percreta managed by an alternative approach. The placenta was left in situ along with B/L internal iliac artery ligation during cesarean section and later on delayed subtotal hysterectomy with bladder repair was successfully performed. Placenta percreta spectrum is an obstetricians dilemma associated with massive hemorrhage and is a potential life-threatening condition for both mother and the baby. Cesarean section with B/L internal iliac artery ligation and delayed hysterectomy may be a reasonable strategy in the most severe cases.
Comparison of norepinephrine and phenylephrine boluses during spinal anesthesia for cesarean delivery
Authors: Chandraleela Sundararajan  , Chinthavali Sujatha  , Arthi Asokan
Published: October 2022

Background: Cesarean sections are frequently carried out under spinal anesthesia (SA) to reduce the risk of neonatal drug transfer and airway difficulties associated with general anesthesia. Maternal hypotension is a typical consequence following SA, despite sufficient fluid loading.
Aims and Objectives: The aim of this study was to evaluate the efficacy of norepinephrine and phenylephrine in treating spinal hypotension caused by cesarean delivery.
Materials and Methods: This hospital-based interventional study was carried out at Sri Venkateswaraa Medical College Hospital and Research Centre, Ariyur, Puducherry from February 2020 to March 2022. Eighty patients were included in our trial and were split equally into two groups at random following approval by an ethical committee and written informed consent. Age, weight, height, and American Society of Anesthesiologists physical state of the patients was equivalent across the two groups.
Results: In our study, mean age found in N group (25.96±2.046) and P group (24.84±1.748) which were insignificant. Vasopressor bolus dose needed for the treatment of hypotension was considerably less inGroup N patients (1.71±0.77 vs. 2.43±1.01, P=0.024). Group P had a higher incidence of bradycardia, although the difference was statistically insignificant (four patients vs. eight patients P=0.242). The fetal parameters such as birth weight, umbilical PH, PCO, PO2, and Apgar 1 and 5 min were comparable across the two groups, and no statistically significant differences were found.
Conclusion: Intermittent norepinephrine boluses are a successful treatment for spinal hypotension during cesarean delivery. We found no evidence that norepinephrine had a detrimental effect on the newborn outcome as compared to phenylephrine, when used to maintain blood pressure during spinal and combined spinalepidural anesthesia for cesarean birth.
Inter-art Relationship in Sujan Chitrakar’s Artworks
Authors: Sharma Yam Prasad
Published: October 2022

Sujan Chitrakar’s visual arts present inter-art relationship among various art genres like photography, painting, literature and sculpture. Within a single artwork, there are the elements of two or more art genres. Chitrakar uses photographs as references and integrates them in canvas in the renewed form. Some of his works present poem and painting in the same canvas. Both verbal and visual arts are integrated in the same artwork. Similarly, three dimensional objects are installed on the two dimensional surface of the canvas. Three dimensions are the special characteristics of sculpture whereas painting has only two dimensions. Chitrakar’s creative impulse breaks the boundaries of conventional art genres. His artworks provide social and political commentary responding to the contemporary context.
Some Philosophical Paradigms and their Implications in Health Research: A Critical Analysis
Authors: Pathak Krishna Prasad , Thapaliya Samjhana
Published: October 2022

There are five common philosophical paradigms used in the research and they are: Positivism, Post- Positivism, Interpretivism, Criticalism and Post modernism. Each paradigm has different research methods and analyses. The aim of this paper is to reveal the philosophical underpinning of Positivism, Post- Positivism, Interpretivism, Criticalism and Post modernism paradigms in health education research. In this review, each paradigm has been explained properly with reference to health education research based on the literature reviews available in peer-reviewed academic articles and books. This paper helps researcher especially health education researcher to identify paradigm and their implication in health education. Positivism is a science-based empirical method which yields singular reality used in scientific research. Post-positivism deal with multiple reality which asserts that every theory is revisable and that is used in social science especially in quantitative research. Interpretivism is the study of social phenomena to find out the hidden reality which is within the society and it is one of the main philosophies of qualitative research. Criticalism is considered one of the best methods to use in health education research to liberate people from social injustices through consciousness gained through health education. Post-modernism rejects the all-existing assumptions, beliefs and values and give an emphasis on qualitative research method that is appropriate to carry out the research study.
Online Learning Experience in Nepal: An Observation during Covid-19 Pandemic
Authors: Chaudhary Manoj Kumar , Chaudhary Rajesh Kumar
Published: October 2022

An online learning has debatable issue since 1990s, though it entices the attention of entire globe throughout the pandemic covid-19. It this context, the considerable aim of this research work is to look over theprevalence of online learning in Nepal. Also, the paper inclined to know the experiences of Nepalese management graduates towards online learning vs physical classes and its effectiveness. This study has applied descriptive method for backing the purpose of this research. A purposive technique has been implanted to select the respondents. A survey based, the research instrument used consist of structured questionnaire. Dataprocessing with application of SPSS and MS excel for data analysis. This paper found that learning experience of both learning approach is determined by the way of takin and making an infrastructure for learning environment. Thus, it concludes that measuring the quality of these approach are largely depends on the operating capacity of individual and institutions as well in Nepalese climate as these approaches has their own strength and limitations. The educational stakeholders of Nepal have been experiencing dilemma of coping the challenges of new learning approach put forward by the covid-19. In this environment, this paper comprehends such issues and filled the gap in Nepalese context. Therefore, findings of this study would be important to all the academic players for their future survival strategies. Finally, there is big place available for further exploration for future researches as this paper has only considered the descriptive analysis.
Gendered Impact of Financial Inclusion on Climate Change Adaptation among Rural Rice Farmers in Nepal
Authors: Joshi Sanchita , Devkota Niranjan , Puri Vaibhav
Published: October 2022

The present paper examines the gendered impact of financial inclusion on climate change adaptation among rural rice farmers across seven Nepalese districts through an odds-ratio-based binary logistic regression analysis. Primarily the study indicates that the availability of loans makes female farmers 7.6 times (significant) more likely to adopt climate change adaptation, whereas, in the case of male farmers, access to loans does not have a significant impact; and access to phone plays a significant role (odd ratio of 1.9) in encouraging female farmers to undertake climate change adaptation. Thus, from a policy perspective, there is need to increase loan availability to rural Nepalese female rice farmers to facilitate climate change adaptation. Specific schemes targeting this section need to be formulated and implemented. Moreover, mobile phone-based innovative applications could be used as a potent tool by banks for achieving financial inclusion along with significant associated positive externalities for the environment.
Nonlinear Impact of Inflation on Economic Growth in Nepal: A Smooth Transition Regression Approach
Authors: Paudel Hari Prasad , Raut Nirmal Kumar
Published: October 2022

Macroeconomic stability is one of the most important macroeconomic goals for all countries. In recent years, the Nepalese economy has been experiencing inflation twice the economic growth rate, posing a threat to macroeconomic stability. Thus, careful investigation of the relationship between inflation and economic growth is required. This study assesses the existence of a nonlinear relationship between inflation and economic growth in the Nepalese context. The assessment is performed by considering the possibility of smoothly changing slope parameters to maximise economic growth or minimise growth losses and to determine the optimal inflation level along with the speed of inflation response to economic growth. The study applies a Logistic Smooth Transition Regression model that Terasvirta (1998, 2004) developed to estimate an optimal inflation rate using annual time-series data from 1976 to 2019. The study finds a nonlinear relationship between inflation and economic growth and estimates an optimal inflation threshold of 6.38±1.36 per cent for the Nepalese economy. It also shows that inflation positively correlates with economic growth up to the threshold level and that the association becomes negative beyond that level. This study suggests that inflation beyond the threshold level harms economic growth, while inflation below has a favourable effect. The findings assist policymakers in making an informed decision, providing leverage in inflation control and creating an atmosphere encouraging economic growth.
हाम्रो निर्वाचन प्रणाली र सुधारका सम्भावनाहरू {Our electoral system and prospects for reform}
Authors: Paudel Madhav
Published: October 2022

निर्वाचन प्रणाली लोकतन्त्रको आधार स्तम्भ हो l निर्वाचनको आवधिक अभ्यासमार्फत नागरिकले सार्वभौम अधिकारको प्रयोग गर्ने अवसर प्राप्त गर्छन्, संवैधानिक विकासले गतिशीलता प्राप्त गर्दछ र मुलुकको शासनले वैधानिकता प्राप्त गर्दछ । आवधिक निर्वाचनको अभ्यासबाट लोकतन्त्र जीवन्त हुन्छ । यस अर्थमा निर्वाचन लोकतन्त्रको प्राण वायु हो । विश्वमा विभिन्न प्रकृतिका निर्वाचन प्रणाली पाइन्छन् तापनि तिनले अङ्गीकार गरेका सारतत्व र आधारभूत मान्यता शाश्वत र विश्वव्यापी प्रकृतिका छन् l सम्बन्धित मुलुकको संवैधानिक संरचना, राजनैतिक शक्ति सन्तुलन र ऐतिहासिक परम्परा अनुसार विकसित हुने भए पनि आम रूपमा निर्वाचन प्रणालीहरू तीन प्रकारका पाइन्छन्  - पहिलो हुने निर्वाचित हुने प्रणाली, समानुपातिक प्रतिनिधित्वको प्रणाली तथा मिश्रित प्रणाली । नेपालमा अन्तरिम संविधानबमोजिम गठन भएको संविधान सभाको प्रयोजनका लागि तत्काल कायम रहेको द्वन्द्व व्यवस्थापन तथा  मुलुकका सबै जात, जाति, समुदायको प्रतिनिधित्व सुनिश्चित गर्न समानुपातिक प्रतिनिधित्वलाई बढी भार दिई समानुपातिक प्रतिनिधित्व र पहिलो हुने निर्वाचित हुने समानान्तर मिश्रित निर्वाचन प्रणाली अपनाइएको थियो । त्यस यता, नेपालले अपनाएको निर्वाचन प्रणाली आफ्नै विशिष्टतासहितको मिश्रित छ । यो सैद्धान्तिक रूपमा सरल देखिन्छ l तर कानुनी, प्रक्रियागत, मत भार तथा क्लष्टर व्यवस्थापनको दृष्टिले अत्यन्त जटिल झन्झटिलो  छ । यो प्रणालीअन्तर्गत सबै तह र संरचनाको पहिलो निर्वाचन सम्पन्न भई स्थानीय तहको दोस्रो कार्यकालका लागि पनि निर्वाचन भइसकेको छ l  अन्य जनप्रतिनिधि संस्थाको निर्वाचन हुने अवस्था छ । यो अवधिमा निर्वाचन प्रणालीका सबल पक्ष र कमजोर पक्षको पहिचान भइसकेको छ l सुधार गर्नुपर्ने विषय स्पष्ट भएका छन् । यो सिकाइ र अनुभवको आधारमा निर्वाचन प्रणालीको नियमित सुधार गर्नु प्रत्येक लोकतान्त्रिक मुलुकको राष्ट्रिय एजेन्डा हुनु पर्दछ ।  

Abstract in English   An electoral system is the foundation of democracy. Its periodic exercise enables citizens to realize their sovereign rights, enhances the legitimacy of governance and helps democracy to remain healthy from within. The design of a country’s electoral system depends on its constitutional arrangement, political power balance and historical tradition. It is also expected to embrace certain norms being practised universally. Among prominent electoral systems in the world are the first-past-the- post system, the proportional representation system and the mixed electoral system. Nepal has pursued the mixed electoral system, which in principle is simple and straight. However, it is very complex in terms of legal and procedural management. Following the completion of a round of elections to all levels and structures, the second round of local elections has also been completed. Preparations are on for the election to other representative bodies, including the Federal Parliament. In the process, electoral authorities have come across ample evidence of what works, what does not and where changes are needed. These lessons and experiences should drive the periodic reform of the electoral system in order to reinvigorate the democratic exercise.
Editorial: Triggering a Paradigm Shift in Public Policy Making in Nepal
Authors: Upreti Bishnu Raj , Acharya Bikram
Published: October 2022

When we launched ‘Nepal Public Policy Review (NPPR)’ as a policy journal last year, we were not sure how the stakeholders – academic researchers and the policy community in particular – would react to it. A year down the line, NPPR has been a platform to engage academic researchers and the policy community in critical discussion and reflection on how Nepal’s public policy discourse should be reimagined and restructured. We are happy that a frank and honest discussion has started. We hope the discussion will trigger a paradigm shift in the way public policies are envisioned, developed and implemented. Such a shift is long overdue in Nepal.
Trends in Disinvestment of Government’s Equity: An Explicatory Study of Public Sector Enterprises in India
Authors: Ghosh Sudipta , Aithal P.S.
Published: October 2022

A Public Sector Enterprise (PSE) is an enterprise which is owned and proscribed by the Local, or State or Central Govt. In a civic enterprise, the investment is either entirely or partially made by the Govt. Under PSEs, the Central Public Sector Enterprises (CPSEs) occupy an important position in the economy. They were set up to achieve fiscal development, self-support in manufacturing, intemperance equilibrium of expenditure, and controlling the deflationary and inflationary trends. These macro-economic objectives are taken as an instrument for structural change of the nation with equality and social fairness. Disinvestment is a process in which the Govt. equity fund is introverted either in fraction or in totality. The Govt. of India introduced the process of disinvesting its equity shares in Indian PSEs in the fiscal year 1991-92.  The prime tenet at the back of disinvestment is to boost prosperity, endorse public partaking at wider scale and to bring improved market answerability. In this backdrop, the present study is an attempt to analyze the trends in disinvestment of Government’s equity in Indian PSEs during the period 1991-92 to 2019-20. For this purpose, secondary information has been sourced from the available yearly reports of the Public Enterprises Survey, Govt. of India. Overall, a low level of disinvestment is observed during the initial years (i.e., up to 2008-09). Thereafter, more or less an increasing trend is observed in actual disinvestment as compared to actual disinvestment in the earlier years. The real proceeds from disinvestment have fluctuated at certain point of time during the period under study. Furthermore, actual receipts from disinvestment are less than that of the budgeted receipts in most of the years under study.
A Review on Complete Freund’s Adjuvant-Induced Arthritic Rat Model: Factors Leading to its Success
Authors: Ismail Che Aishah Nazariah , Mohd Noh Ain' Sabreena , Tan Dai Chuan , Mohamed Khir Nurul Ajilah , Shafin Nazlahshaniza
Published: October 2022

Arthritis-induced adjuvant (AIA) is an established animal model reflecting several clinical manifestations of human arthritis. It provides more understanding of pathogenesis and pathways involved in arthritic development and for testing various treatment modalities. Complete Freund’s adjuvant (CFA) is one of the most known algogenic agents used to develop AIA rodent model. Its wide application increases understanding of CFA effects locally and systemically following adjuvant-containing mycobacterium exposure in-vivo. This study aims to review possible factors involved in producing a successful CFA-induced arthritic rat model. We conducted a review of previous studies to determine critical factors to be emphasized. Since arthritis can be classified as gout, osteoarthritis, and rheumatoid arthritis, among others, factors that should be assessed include different dosage and volume, injection site, remission, arthritic and animal gender, and strain selections to successfully develop an arthritic rat model.
Brain Wave Changes during Cognitive Task Performance in Uncomplicated Diabetic Adults: An Exploratory Study
Authors: Sim Sze Kiat , Ahadon Madzlifah , Mushtaq Sohail
Published: October 2022

Introduction: Diabetes mellitus (DM) is a chronic disease associated with cognitive decline and dementia in the elderly population. This exploratory study analysed the brain wave changes during cognitive task performance in working adults with and without type 2 diabetes mellitus (T2DM). MATERIALS AND Methods: The Mini-Mental State Examination was used to screen subject’s cognitive function and quantitative electroencephalography was used to analyse subject’s brain waves at rest and whilst performing the serial seven test. Results: When performing the serial seven test, the diabetic group showed a higher absolute power of theta waves in the left frontal (Fp1, 16.22 ± 3.81 vs 3.75 ± 1.69; p = 0.022) and temporal regions (T3, 24.27 ± 3.69 vs 7.92 ± 2.17; p = 0.045), but lower absolute power of beta waves in both the frontal regions (Fp1, 27.35 ± 3.67 vs 41.14 ± 5.67; p = 0.029; Fp2, 23.01 ± 3.31 vs 39.05 ± 2.64; p = 0.041) and left temporal region (T3, 37.93 ± 4.64 vs 50.94 ± 3.56; p = 0.046) when compared to those of the control group. The diabetic group took longer to complete the task (127.9 ± 8.3 s vs 95.6 ± 5.9 s; p = 0.032) than the control group, despite no statistically significant difference in correct response rates. Diabetes duration was positively correlated with the theta/alpha ratio in the left frontal (Fp1, r = 0.525; p = 0.041) and temporal (T3, r = 0.618; p = 0.037) regions. Conclusions: T2DM may affect cognitive function in patients before clinical manifestation.
Repair of buckled steel braces via buckling zone relocation method
Authors: Demir Serhat
Published: October 2022

In this study a new repair method, called buckling zone relocation, for buckled steel braces is presented. In this method, buckled zone of the steel brace is wrapped with steel plates to relocate the buckling zone toward the undamaged locations of the brace. Thus, the brace can be reach buckling load again. The effectiveness of the proposed method was experimentally investigated. To do this, 2 tubular brace specimens, each have 2000 mm length and 70×70×3 mm cross section, were subjected to quasi-static cyclic loadings. First specimen were loaded until global buckling and then unloaded to repair with the proposed method. The length of the buckling zone to be repaired with steel plates was determined with finite element analysis. When the repair process completed, the specimen reloaded until collapse. The second specimen was loaded until collapse to be used as reference member. As a result, it was determined that the buckled steel brace tested in this study could been effectively repaired via buckling zone relocation method without any significant decrease in its performance.
An investigation of the effect of structural parameters on the impact properties of sandwich-structured shock absorbers
Authors: Yalçın Enis İpek , Sezgin Hande
Published: October 2022

The purpose of this study is to develop an impact absorber with a core made of sustainable textile waste as an alternative to the conventional honeycomb structure. In this case, the core structure is made of cotton fiber webs recycled from denim waste, and the outer shell is made of polypropylene plates reinforced with carbon, jute, and E-glass woven fabrics. Production of the sandwich structure is carried out using the hot press method. In addition to the fabric types and layer sequences utilized in the outer shell, the geometry of the core structure is altered, and their effect on the drop-weight impact resistance is examined. The prominent results emphasize that the use of high-performance fabrics in the outer shell facing the outer surface increases the impact resistance, and the sizes of the holes to be obtained in the core structure should be optimized in order to be effective in energy absorption. The results reveal that these developed sandwich structures can constitute a promising alternative for the automotive industry.
Les deux voies d’approche de l’électromyographie échoguidée du muscle tibial postérieur
Authors: Elleuch W. , Elleuch F. , Zribi Y. , Elleuch M. , Ghroubi S. , Elleuch M.H.
Published: October 2022

Le muscle tibial postérieur (MTP) est le principal inverseur du pied et peut aider à une puissante flexion plantaire. Son évaluation fonctionnelle est particulièrement utile chez les patients présentant un steppage pour différencier une atteinte du nerf fibulaire d’une radiculopathie L5. Deux voies d’insertion de l’aiguille de l’électromyographie (EMG) dans le MTP ont été rapportées : une approche antérieure et une autre postérieure. Cependant, plusieurs auteurs considèrent toujours que le placement de l’aiguille de l’EMG dans ce muscle difficile, avec moins de 10 % de précision même avec une stimulation électrique. Le but de ce manuscrit est d’illustrer et de comparer les approches antérieure et postérieure de l’EMG échoguidée du MTP qui est considéré comme un muscle clé dans le diagnostic étiologique du step-page. Les deux approches antérieure et postérieure pour effectuer l’EMG échoguidée du MTP sont valides et sûres. Avec le contrôle échographique, le praticien doit clairement identifier ce muscle et devrait éviter de piquer les structures neurovasculaires de la jambe ainsi que les autres muscles adjacents. Cela nécessite non seulement une bonne connaissance de l’anatomie échographique de la jambe, mais aussi une technique rigoureuse de manipulation bimanuelle et d’insertion aseptique de l’aiguille de l’EMG.
Focal cortical dysplasia pathology: diagnostic difficulty, classification, and utility for pathogenesis
Authors: Kapar Ozge , Gurkan Zahide Mail , Dolgun Muge , Sencer Altay , Gürses Candan , Bilgic Bilge
Published: October 2022

OBJECTIVE

In the histopathological examination of treatment-resistant epilepsy, focal cortical dysplasia (FCD) is the most common diagnosis in the pediatric group. FCD is classified histopathologically according to the International League Against Epilepsy (ILAE) classification. In the last decade since the ILAE classification has been released, molecular genetic studies have revealed mTOR pathway–related mutations as a major etiology. The objective of this study was to determine the incidence of FCD in treatment-resistant epilepsy patients, explore histomorphological and immunohistochemical features, examine clinicopathological correlation, demonstrate mTOR pathway activation using a pS6 antibody immunohistochemically, and try to introduce a candidate for possible targeted therapies.

METHODS

Paraffin blocks and slides of tissue from patients with treatment-resistant epilepsy were reexamined retrospectively. Histopathological subtypes of FCD were determined according to the ILAE classification. NeuN and neurofilament H (NF-H) staining were performed, and additionally a pS6 antibody was used to demonstrate mTOR pathway activation.

RESULTS

In 32 cases diagnosed with FCD, or 17.5% of 183 surgical epilepsy materials, there were no significant differences in the statistical analysis of clinical variables between the ILAE FCD subtypes. Recommended antibody NeuN revealed microcolumnar alignment in the FCD type Ia and IIIa groups and the loss of lamination in the type Ib group. Another recommended antibody, NF-H, was not found to be useful in discriminating between normal and dysmorphic neurons. pS6 expression, showing mTOR pathway activation, was observed in dysmorphic neurons and balloon cells in all FCD type II cases.

CONCLUSIONS

Significant pS6 expression in FCD type II represents the genomic nature of the disease noted in the literature. Nevertheless, the known MTOR gene and mTOR pathway–related mutations remain behind proportionally to explain the mTOR pathway activation in all FCD type II cases. Clinicopathologically and genetically integrated classification and usage of mTOR pathway inhibitors in treatment are expected as a recent evolution.
Deep brain stimulation in children and youth: perspectives of patients and caregivers gleaned through Twitter
Authors: Elkaim Lior M. , Niazi Farbod , Levett Jordan J. , Bokhari Rakan , Gorodetsky Carolina , Breitbart Sara , Alotaibi Fahad , Alluhaybi Abdulelah A. , Weil Alexander G. , Fallah Aria , Alotaibi Naif M. , Ibrahim George M.
Published: October 2022

OBJECTIVE

This study aims to glean patient and caregiver perspectives surrounding deep brain stimulation (DBS) in children and youth through an analysis of patterns of social media usage.

METHODS

The authors performed a comprehensive search of the Twitter Application Programming Interface (API) database for all tweets about DBS use in children and youth, with no date restriction. Data pertaining to each tweet were extracted for analysis. Results were analyzed using qualitative and quantitative methodologies. These included thematic analysis of tweets, accounts, and descriptive statistics. Sentiment analysis of extracted tweets was also performed. A multivariable regression model was used to identify predictors of higher engagement metrics (likes, retweets, and quotes).

RESULTS

A comprehensive search of the Twitter database yielded 877 tweets from 816 unique accounts meeting study inclusion criteria. Most tweets were from patients or caregivers, researchers, or news media outlets. The most common themes among analyzed tweets were research discussing novel findings (45.2%) or personal experiences of patients or caregivers (27.4%). Sentiment analysis showed that 54.5% of tweets were positive, 35.1% were neutral, and 10.4% were negative. The presence of pictures or videos increased the tweet engagement count by an average of 10.5 (95% CI 7.3–13.6). Tweets about personal patient experiences (β = 6, 95% CI 0.95–12) and tweets tagging other accounts (β = 3.2, 95% CI 0.63–5.8) were also significantly associated with higher engagement metrics.

CONCLUSIONS

The current study is the first to assess patient and caregiver perspectives surrounding pediatric DBS through a comprehensive analysis of social media usage. Given the nascent field, social media presents an opportunity to share experiences and promote patient and healthcare professional education surrounding pediatric DBS.
Spinal cord stimulation for treatment of chronic neuropathic pain in adolescent patients: a single-institution series, systematic review, and individual participant data meta-analysis
Authors: Bakr Salma M. , Knight James A. , Shlobin Nathan A. , Budnick Hailey , Desai Virendra , Hill Haley , Johnson Sarah K. , Williams Amy E. , Tolley James A. , Raskin Jeffrey S.
Published: October 2022

OBJECTIVE

Neuropathic pain is undertreated in children. Neurosurgical treatments of pediatric chronic pain are limited by the absence of both US Food and Drug Administration approval and pediatric-specific hardware, as well as weak referral patterns due to a lack of physician education. This study presents a single-institution retrospective case series of spinal cord stimulation (SCS) in children ≤ 19 years of age and a systematic review of SCS in children. The authors’ findings may further validate the role of SCS as an effective treatment modality for varied neuropathic pain syndromes found in pediatric patients.

METHODS

The study was a single-center, single-surgeon, retrospective case series of individuals treated between July 2017 and May 2022. The outcomes for pediatric patients with chronic neuropathic pain syndromes indicated by the multidisciplinary pain clinic for evaluation for SCS were cataloged. A systematic review and individual participant data (IPD) meta-analysis was performed for cases treated until May 2022, using PubMed, EMBASE, and Scopus to characterize outcomes of children with neuropathic pain treated with SCS.

RESULTS

Twelve patients were evaluated and 9 were indicated for percutaneous or buried lead trials. Seven female and 2 male patients between the ages of 13 and 19 years were implanted with trial leads. Eight of 9 (89%) patients went on to receive permanent systems. The average trial length was 6 days, and the length of stay for both trial and implant was less than 1 day. Complication rates due to CSF leaks were 22% and 0% for trial and implant, respectively. Visual analog scale pain scores decreased from 9.2 to 2.9 (p = 0.0002) and the number of medications decreased from 4.9 to 2.1 (p = 0.0005). Functional status also improved for each patient. A systematic review identified 13 studies describing pediatric patients with SCS, including 12 providing IPD on 30 patients. In the IPD meta-analysis, pain was reduced in 16/16 (100%) of patients following surgery and in 25/26 (96.2%) at last follow-up. Medication use was decreased in 16/21 (76.2%), and functional outcomes were improved in 29/29 (100%). The complication rate was 5/30 (16.7%).

CONCLUSIONS

SCS effectively decreases pain and medication use for pediatric neuropathic pain syndromes. Patients also report improved functional status, including improved matriculation, gainful employment, and physical activity. There is minimal high-quality literature describing neuromodulation for pain in children. Neuromodulation should be considered earlier as a viable alternative to escalating use of multiple drugs and as a potential mechanism to address tolerance, dependence, and addiction in pediatric patients.
Responsive neurostimulation for pediatric patients with drug-resistant epilepsy: a case series and review of the literature
Authors: Curtis Kendall , Hect Jasmine L. , Harford Emily , Welch William P. , Abel Taylor J.
Published: October 2022

OBJECTIVE

Responsive neurostimulation (RNS) is a promising treatment for pediatric patients with drug-resistant epilepsy for whom resective surgery is not an option. The relative indications and risk for pediatric patients undergoing RNS therapy require further investigation. Here, the authors report their experience with RNS implantation and therapy in pediatric patients.

METHODS

The authors performed a retrospective chart review to identify patients implanted with RNS depth or strip electrodes for the treatment of drug-resistant epilepsy at their institution between 2020 and 2022. Patient demographics, surgical variables, and patient seizure outcomes (Engel class and International League Against Epilepsy [ILAE] reporting) were evaluated.

RESULTS

The authors identified 20 pediatric patients ranging in age from 8 to 21 years (mean 15 [SD 4] years), who underwent RNS implantation, including depth electrodes (n = 15), strip electrodes (n = 2), or both (n = 3). Patient seizure semiology, onset, and implantation strategy were heterogeneous, including bilateral centromedian nucleus (n = 5), mesial temporal lobe (n = 4), motor cortex or supplementary motor area (n = 7), or within an extratemporal epileptogenic zone (n = 4). There were no acute complications of RNS implantation (hemorrhage or stroke) or device malfunctions. One patient required rehospitalization for postoperative infection. At the longest follow-up (mean 10 [SD 7] months), 13% patients had Engel class IIB, 38% had Engel class IIIA, 6% had Engel class IIIB, 19% had Engel class IVA, 19% had Engel class IVB, and 6% had Engel class IVC outcomes. Using ILAE metrics, 6% were ILAE class 3, 25% were ILAE class 4, and 69% were ILAE class 5.

CONCLUSIONS

This case series supports current literature suggesting that RNS is a safe and potentially effective surgical intervention for pediatric patients with drug-resistant epilepsy. The authors report comparable rates of serious adverse events to current RNS literature in pediatric and adult populations. Seizure outcomes may continue to improve with follow-up as stimulation strategy is refined and the chronic neuromodulatory effect evolves, as previously described in patients with RNS. Further large-scale, multicenter case series of RNS in pediatric patients with drug-resistant epilepsy are required to determine long-term pediatric safety and effectiveness.
Bilateral pallidotomy for acquired or heredodegenerative generalized dystonia in children
Authors: Garg Kanwaljeet , Singh Manmohan , Samala Raghu , Rajan Roopa , Gulati Sheffali , Goyal Vinay
Published: October 2022

OBJECTIVE

Dystonias are relatively rare disorders characterized by sustained or intermittent muscle contractions causing abnormal movements or postures. Generalized dystonia is a therapeutic challenge because medications are unable to control dystonia adequately in most patients. These patients may be candidates for surgical therapy. The commonly used surgical procedures in these patients are pallidotomy and deep brain stimulation. Limited studies are available on the role of pallidotomy in children with acquired/heredodegenerative generalized dystonia. The objective of this study was to describe the authors’ experience with bilateral pallidotomy in this group of patients.

METHODS

The authors retrospectively reviewed all pediatric patients (less than 18 years of age) with acquired/heredodegenerative generalized dystonia who underwent bilateral simultaneous pallidotomy at their center between January 2014 and January 2021. Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) scores before and after surgery were recorded. Complications arising after the procedure were recorded as well.

RESULTS

Ten patients (8 male and 2 female) with a mean (range) age of 11.1 (5–17) years were included in this study. The mean duration between disease onset and surgical intervention was 3.9 years. Two patients presented in status dystonicus. The mean ± SD (range) preoperative BFMDRS score of the patients without status dystonicus (n = 8) was 80 ± 18.9 (59.5–108). The mean ± SD BFMDRS score at the time of discharge from the hospital after surgery was 58.8 ± 37.9. Three patients had more than 20% change in BFMDRS score at the time of discharge from the hospital. The mean improvement was 25.5% at the end of 1 year. Of 5 surviving patients in the non–status dystonicus group, 3 patients had more than 40% change in BFMDRS score while the other 2 patients developed recurrence at the last follow-up (4.5 years). Status dystonicus abated after bilateral pallidotomy in both patients. Permanent bulbar complications were seen in 2 patients.

CONCLUSIONS

Bilateral pallidotomy may result in clinically significant improvement in children with acquired/heredodegenerative generalized dystonia, although the benefits should be closely weighed against the risk of irreversible bulbar dysfunction. It is a viable option for children in resource-limited settings.