bluuebunny/crossref_metadata_2025 huggingface dataset:
A Survey on Singaporean Women’s Knowledge, Perception and Practices of Mammogram Screening
Authors: Lim Siew Kuan , Teo Xin Ling , Ng Jia Lin , Li Fay X , Tan Su Ming
Published: July 2022

Introduction: Singapore is the first Asian country to establish a nationwide breast screening programme, but our breast cancer screening uptake lags behind the Western countries. This survey focused on the subject of screening mammography, to assess the reasons for non-attendance and explore ways to improve our screening uptake. Materials and Methods: Females ≥21 years old were approached at primary healthcare clinics to participate in this survey, which questioned their knowledge, perception and expectations of breast screening. Results: There were 1011 respondents. Of the 740 respondents ≥40 years old, 332 respondents (45.5%) went for regular mammogram screening. Women who had lower household incomes [<$2000 (OR 0.49; 95% CI, 0.28 to 0.85); $2000 to $3999 (OR 0.59; 95% CI, 0.36 to 0.97)], did not know anyone with breast cancer (OR 0.62; 95% CI, 0.42 to 0.92), did not perform breast self-examination (OR 0.42; 95% CI, 0.28 to 0.62), had lower knowledge scores (OR 0.34; 95% CI 0.22 to 0.51), did not attend other health screening (OR 0.14; 95% CI, 0.05 to 0.41), and perceived mammography as embarrassing (OR 0.55; 95% CI, 0.31 to 0.96), were less likely to attend mammographic screening. Many did not know that screening is for the asymptomatic (51.2%), or the age to start screening (46.3%). Most respondents preferred to have their mammograms in the polyclinics (62.2%) and their screening reminders to be through short messaging service (SMS) (46.0%). Conclusion: Our results show the current influences on Singapore women’s screening practices, and also revealed that their understanding of mammogram screening is limited despite a high level of breast cancer awareness.

Key words: Breast screening, Breast cancer, Asian women
El Estado como sujeto obligado al pago de los costos procesales en los procesos laborales y contencioso-administrativos laborales: un espacio de quiebre y afianzamiento de las prerrogativas administrativas
Authors: Huamán Ordóñez Luis Alberto
Published: July 2022

En el presente estudio, el autor se aboca al desarrollo de los costos procesales que deben ser asumidos por el Estado como parte del proceso, con especial incidencia en los litigios laborales y contencioso-administrativos laborales. Luego realiza un necesario recorrido por las nociones de Estado moderno y autotutela con el propósito de entender cómo es que esta organización se encontraba inicialmente abstraída del control judicial y cómo fue posible que sea llevada a juicio. Para explicar este escenario, el autor recurre a los veredictos del Tribunal de Conflictos y el Consejo de Estado francés, así como a las decisiones de la Corte Suprema de Justicia de la Nación Argentina. Posteriormente, se dedica al estudio del Código Procesal Civil como regulación adjetiva general, y establece el carácter primordial de la teoría del resarcimiento (mal llamada del vencimiento) con notas mínimas de la teoría subjetiva y de la discrecional moderación judicial, para lo cual invoca a la jurisprudencia judicial y administrativa para entender dicha recepción procesal hasta llegar al estudio de la Ley n.o 26636 y la Ley n.o 29497. Finalmente, responde a la interrogante acerca de si el Estado, a través de la administración, puede o debe ser condenado al pago de costos en los procesos laborales. Para ello introduce algunas propuestas, a manera de lege ferenda, que fundamenten dicha obligación, con el propósito de que los jueces motiven adecuadamente sus decisiones sobre el pago de honorarios.
La variación de la demanda dentro de la audiencia de juzgamiento: ¿se puede negar todavía su validez?
Authors: Baldeón Bedón Luis Jesús
Published: July 2022

El autor considera que la validación de la modificación de la demanda dentro de la audiencia de juzgamiento, con base en las actuales circunstancias, debería ser el objeto de evaluación inmediato entre los autores procesales nacionales. Esto a razón de que las actuaciones postulatorias en la actualidad se manejan dentro de los conductos de la oralidad, los cuales permiten identificar con mayor facilidad el objeto de la demanda con los hechos materiales que la han sustentado. Por ello, nuestro sistema procesal laboral ya no cuenta desde hace más de diez años con un modelo estático o escrito, en donde solamente las formulaciones entre las partes se realizaban de manera escrita, sino que ahora la interrelación es dinámica entre las partes (de manera virtual o presencial), mediante el respeto del derecho de la contraparte a la defensa.
Hyperglycemia as an Independent Predictor for Covid-19 Morbidity and Mortality
Authors: Abuzaid Mohamed Sulaiman , Ali Alqatarneh Ali Kathm Mohammad , Shafaqouj Zaid Majed , Alshadid Intisar  Jum'ah Ghadfan , AL-Shawabkeh Audai Ali Sulaiman , Alshawabkeh Amani Daoud
Published: July 2022

Background/Aim: A wealth of immunological evidence points out that hyperglycemic status (regardless of diabetes) makes individuals more susceptible to infection as well as higher in-hospital complications. In this study, we primarily aimed to identify the clinical and biochemical negative impacts of hyperglycemia risk factor across the two comparative cohorts. Secondly, we also explored the prognosticating utilities of three proposed BG related prognosticators in moderate-severe admitted SARS-CoV-2 infected patients. Methods: This study was retrospectively between Mar 2020 and Sep 2021. All retrievable and calculated variables were thereafter divided into two studied cohorts, Survivors Cohort (Cohort I) and Non-Survivors Cohort (Cohort II). Independent and One-Sample T-Tests and Chi-Square Test were used for comparative analysis and relative risk estimation. The Receiver operating characteristic analysis was used to explore the area under the curve and the sensitivity analysis was also performed to investigate the optimal cutoff values for the BG related prognosticators. Results: The mean age of the whole study cohort was 59.40±10.60 years, and the Non-Survivors Cohort were insignificantly younger than the Survivors Cohort. Survivors Cohort had insignificantly higher average blood glucose level than Non-Survivors Cohort. Oppositely, Survivors Cohort had significantly lower average total daily insulin dosing compared to Non-Survivors Cohort. The overall hospital length of stay (LOS) which it was significantly lower in Non-Survivors Cohort compared to Survivors Cohort. Conclusion: As there were many cconcerns for the effect of hyperglycemia on immune cells and subsequently the overall clinical impacts, there is an urgent necessity to track the daily blood glucose levels, the changes in blood glucose from baseline, or alternatively the insulin infusion rate to keep their averages around 149.9 mg/dl, -38%, and 1.35 IU/hr.
Consumer Buying Decision Making Models In Terms Of Covid 19
Authors: Išoraitė Margarita
Published: July 2022

The article analyses the definition of consumer decision-making, theoretical aspects of the consumer purchasing decision model, traditional consumer purchasing decision model, consumer purchasing decision model according to COVID 19. The article is based on the analysis of scientific literature and case studies. The study includes theoretical analysis of the literature, as well as case studies and comparative analysis. A consumer purchasing decision model has been developed in line with COVID 19.
Potential Market Countries for Indonesia’s Tourism
Authors: Maulana Addin , Priyatmoko Rakhman , Oktaviyanti Dini
Published: July 2022

This study aims to describe the potential of a country in terms of tourism demand. This study uses a quantitative descriptive method by normalizing secondary data to identify the size of the market potential of a country. Based on the analysis carried out, two countries fall into the category of very high potential, namely Singapore and Hong Kong, two countries that are classified in the category of high potential, including Malaysia and China, while four countries that fall into the category of medium potential, namely Australia, Netherlands, Russia, and Sweden. It is important for the Indonesian government to further optimize countries with high gross travel propensity to increase tourist visits, while a good tourism product development strategy is carried out to keep tourists from staying longer and spending more money while in Indonesia. This study succeeded in describing the potential of the Indonesian tourism market based on four tourism indicators, namely the number of visits, length of stay, average tourist spending during their visit, as well as gross travel propensity.
Sustainable Entrepreneurship Development Model of Liberica Coffe in West Tanjung Jabung Regency
Authors: Wahyuni Ira , Suandi Suandi , HD Ernawati
Published: July 2022

The research objectives are to (1) analyze the sustainable entrepreneurship of liberica coffee, and (2) analyze and simulate the model of sustainable entrepreneurship development of liberica coffee in West Tanjung Jabung Regency. The research was conducted in West Tanjung Jabung Regency by selecting one sub-district, namely Betara District. The research period was eight months. The research objects are Liberica coffee sustainable entrepreneurship (farmer’s welfare and global competitiveness). Research data was sourced from primary data and secondary data. Primary data was taken by means of observation, direct interviews, in-depth interviews, and Focus Group Discussions (FGD), while secondary data were obtained from related government agencies/other institutions, and jounrals. Respondents or household units of analysis were taken by simple random sampling in each village of as many as 35 farmer respondents, totaling 105 households. Data were analyzed by descriptive, multiple regression statistical test and Structural Equation Modeling (SEM) through the Linear Structural Relationship (LISREL) program. The results showed the sustainable entrepreneurship of Liberika coffee. Liberica coffee entrepreneurship in the research area has a high level of sustainability, both ecological sustainability, economic sustainability, and social sustainability. The results of the analysis show that the sustainable entrepreneurship of Liberica coffee has a highly concrete and significant positive effect on the welfare of farmers, but sustainable entrepreneurship does not have a significant effect on global competitiveness.
Estimating Conditional Correlations among Subgroups of Service Sector in Vietnam Stock Exchanges
Authors: Do Giam Quang , Phuong Nguyen  Van , Hai Vu Thi
Published: July 2022

The paper explores the time-varying correlations among five subgroups of the service sector i.e., CONSTRUCTION, ENERGY, TECHOLOGY, TRANSPORT and TOURISM, and market index ‘VNINDEX’ in the Vietnam stock exchanges. Two multivariate GARCH models namely the CCC and DCC were employed to examine how closely returns of each pair correlate with each other. The estimates of conditional correlations reveal low to relatively high [0.1958; 0.6720] between the selected indexes, of which the subgroup ‘TECHNOLOGY’ exhibits low correlations with the others, while the remaining subgroups show medium interdependence from each other and relatively high with the market index. Moreover, the estimates of the DCC model show the time-varying patterns in the pair correlation paths among the selected indexes. The findings provide a crucial background for investors, capital investment funds, listed firm owners and market managers in the Vietnam stock exchanges in fore-seeing long-run and short-run investment, portfolio selection and risk management in the selected indexes.
Flexible Leadership and Human Resources Role in Managing Change in the Post-Covid Era: Experience from the University System
Authors: Ologun Olubunmi Veronica , Ilaboya Ofuan James
Published: July 2022

This paper focuses on flexible leadership and human resources management roles in organizational change, particularly in the post-covid era and post-covid change management in the university system. An extensive review of the literature was done to identify the various leadership styles, the role of human resources management in the selection, development, and deployment of the appropriate organization leadership, and the leadership role in effective change management. Flexible leadership was identified as strategic and capable of effectively implementing the needed change to manage business operations in the post-covid era. Flexible leadership involves consistent organizational change management to remain relevant in the face of competitive forces and contemporary issues, like the COVID-19 pandemic. The university system also requires flexible leadership for the desired change, not only in identifying the needed human resources but also in the required quantum and appropriate mix of the human and infrastructural resources, to enable it to continue to compete well in the furtherance of its knowledge dissemination goal. This paper concludes that flexible leadership seems to be the best form of leadership required to manage unforeseen continuous change effectively. The role of human resources management is also crucial in identifying and developing employees with such leadership traits.
A Comprehensive Study on Common Infectious Diseases in Particular Hospital - Acquired Infections in Any Healthcare Facility - An Analysis
Authors: Avadhani C. L. , Udayasuriyan G. , Rao K. Viyyanna
Published: July 2022

Healthcare Facility Associated/Acquired infections are one of the biggest challenges that healthcare providers face in the patients safety, quality care. These healthcare associated infections acquired during stay in the healthcare facility especially in intensive care units, critical care units, neonatal care units are more compared to other areas of the healthcare facility. Hence it is obligatory on the part of the healthcare professionals and providers to follow the Disinfectant Programs strictly and also the hygienic conditions and guidelines imparted by the healthcare providers as self regulated guidelines in accordance with the facility i.e. in question. Of these, frequent hand washing remains the single most important in infection control program. However identifying mechanisms to ensure compliance of healthcare professionals, Para medical staff remains a perplexing problem. The covid-19 pandemic has given a big lesson for the healthcare providers in strictly following healthcare facility infection control that have surfaced during this Pandemic period. Gloves, Gowns, PPE Kits, masks have played a major role in preventing infections and maintaining physical distance in preventing infections caused due to contacts. In this article, an honest attempt is made in identifying the healthcare facility infections, their symptoms, cause of infections, and remedial measures that are to be followed not only by the healthcare professionals, Para medical staff, providers but the patients and the visitors. These infections place havoc in increasing procedural costs to the patients extra stay than the normal procedural stay in the facility, use of heavy antibiotics that causes loss of immunity in the patient and thereby prolong the recovery time. These infections that are contracted during healthcare facility stay in addition to the above losses the patient lose his/her earnings if he/she is an earning person and at times if the infection is severe and any permanent disablement will lose his/her earnings, finally death will jeopardize the families existence. The regulatory authorities like World Health Organization, NABH in India, JCI, National guidelines for infection, prevention and control in healthcare facilty’s (NGIPCHC) etc are playing an important role not only in the preparation of guidelines but also to improvise them with the help of statistical material that are being collected from time to time. Whatever may be regulatory authorities’ guidelines people associated with the healthcare and the patients should maintan personal hygienic, frequent handwashing and maintaining physical distance is more and more important.
CAD/CAM – Historical Aspects, Processing and Various Systems: A Literature Review
Authors: Singh Irina , Singh Kavipal , Sethi Nimish
Published: July 2022

Computer Aided Design – Computer Aided Manufacturing (CAD/CAM) technology has already made significant strides in the field of dentistry. Several highly sophisticated in-office and laboratory CAD/CAM systems have been introduced or are under development. As a result of continual developments in computer hardware and software, new methods of production and new treatment concepts are to be expected, which will enable an additional reduction in costs. The advent of CAD/CAM has enabled the dentists and laboratories to harness the power of computers to design and fabricate esthetic and durable restorations.
Compassion Levels of Healthcare Workers in the Crowded ED
Authors: Çelik Serap , Özüçelik Doğaç Niyazi
Published: July 2022

Bacground: The aim of the study is to determine the level of compassion and affecting factors among Emergency Department (ED) health workers. Methodology: The Compassion Scale, which was developed by Pommier in 2011 and was adapted to Turkish, was used in the evaluation of the level of compassion of the Training and Research Hospital ED staff, who had more than 500 patient admissions per day. Results: The mean age of 84 ED health workers included in the study was 27.20±5.430, 32.2% were male and 67.8% were female. 41.7% (n=35) of the ED health workers were Emergency Doctors and 58.3% were Emergency Nurses. Women's "Kindness", "Common humanity" and "Mindfulness" compassion subgroup average scores were found to be higher than men (15.859±2.538 versus 15.000±3.637; 16.859±2.488 versus 16.037±3.345; 16.245±1.606 versus 14.777±3.467). Women's „‟Indifference‟‟, „‟Separation‟‟ and „‟Disengagement‟‟ compassion subgroup average scores were found to be lower than men (7.736±2.560 versus 8.740±3.323; 77.666±2.502 versus 9.222±2.939; 7.350±2.371 versus 9.407±3.388). Emergency Nurses' "Kindness", "Common humanity" and "Mindfulness" compassion subgroup scores were higher than Emergency Doctors (16.510±2.509 versus 14.285±3.044; 17.163±2.124 versus 15.800±3.411; 16.0816±2.0997 versus 15.3429±2.8382). Emergency Nurses' „‟Indifference‟‟, „‟Separation‟‟ ve „‟Disengagement‟‟ compassion subgroup scores were lower than Emergency Doctors (7.061±2.135 versus 9.457±3.146; 7.591±2.317 versus 8.971±3.082; 7.122±2.412 versus 9.257±3.061). Conclusion: The compassion levels of female ED health workers were higher than that of male ED health workers and the level of compassion of Emergency Nurses was higher than that of Emergency Doctors.
A Child with Megaloblastic Anaemia in Pre-Infantile Tremor Syndrome: A Case Report
Authors: Kumar Rajesh , Kumar Jitender , Gupta Atul
Published: July 2022

Pre-infantile tremor syndrome is a prodromal phase of infantile tremor syndrome affecting children between 5 months to 3 years. It is characterized by vacant look, mental or motor regression, and apathy, inability to recognize mother, lethargy and poor interest in the surroundings. Megaloblastic anemia due to vitamin B12 deficiency is a common feature of the disease. The case discussed presented in a regional healthcare institute with severe anemia. On workup she was diagnosed as pre-infantile tremor syndrome and managed accordingly.
Comparison of C-reactive protein and Vitamin D3 level among Patients of Allergic Rhinitis while on treatment with either Nasal Fluticasone or Combination Therapy of Montelukast and Levocetirizine: A Randomized Control Study
Authors: Chadha Rishabh , Kumar Jeevan
Published: July 2022

We conducted the present study to compare the vitamin D3 status and C-reactive protein (CRP) among allergic rhinitis patients who were on treatment with either intranasal Fluticasone or oral Levocetrizine and Montelukast therapy. Material and Methods: The study was a prospective randomized, single blinded, comparative, parallel group study, with two intervention groups conducted at Civil Hospital Jogindernagar of Himachal Pradesh, India. A total of Fifty patients diagnosed with allergic rhinitis was randomly allocated to either Group A receiving oral Montelukast and Levocetrizine or Group B receiving Fluticasone propionate aqueous nasal spray and followed up for 6 weeks. Vitamin D status and C-reactive protein (CRP) after 6 weeks was taken as primary outcome variables. Results: Among Group A , Recovery at 6 weeks was occurred in 9 (36%) patients while in Group B Recovery at 6 weeks was occurred in 17(68 %) patients.(p value 0.046). There was statistically significant lower mean CRP level was found in group B as compared to Group A (p value 0.003). Although, lower mean Vit D3 level was found in group B as compared to Group A but this difference was not found to be statistically significant. (p value 0.218). Although, lower mean CRP and higher mean Vit D3 level was found in recovered patients in group A as compared to who were not recovered but this difference was not found to be statistically significant(p value 0.198 and 0.324 respectively). Similarly,higher mean CRP and Vit D3 level was found in recovered patients in group B as compared to who were not recovered but this difference was not found to be statistically significant.( p value 0.804 andp value 0.418). Similarly ,in recovered patients there was no statistical significant difference in mean CRP and Vit D3 level(P value 0.9536 and 0.2486 respectively) in both groups, although the mean CRP and Vit D3 level were higher in Group A as compared to group B. But in non recovered patients, the mean CRP level was statistically higher in Group A as compared to group B(P value0.0029) while there was no statistical significant difference in Vit D3 level in both groups.(p value-0.8919). Conclusion: Study concluded that there was no statistical significant difference in mean Vitamin D3 and CRP levels in both groups as well as there was no significant association between Vitamin D3 and CRP levels and recovery status of patients in both groups.
Neonatal Umbilical Myiasis
Authors: Sharma Manish , Sharma Uma , Sharma Bipan
Published: July 2022

Myiasis is the infestation of skin or wound by larvae, maggots of variety of flies. It is usually found in neglected and immuno-compromised adults residing in tropical and sub-tropical areas. A rare case of maggot infestation of umbilicus in a neonate is being reported here. In times of Covid 19 epidemic and lockdown at its peak this case was successfully managed at District hospital set up in rural area of Una of Himachal Pradesh with bare minimal resources available.
Evolution of Different Surgeries of Cholecystectomy: A Historical Review
Authors: Chaudhary A , Singh R
Published: July 2022

First cholecystectomy was performed by Carl Langenbuch in June 1882. . Langenbuch’s open cholecystectomy remained the gold standard for symptomatic cholelithiasis for over a century and even still being performed in many areas. In view of the emerging trend towards minimal invasive surgery, the evolution of laparoscopic surgery started in 1982 and the first laparoscopic surgery was appendectomy in 1982. As a bridge between traditional laparoscopic surgery and natural orifice transluminal endoscopic surgery, the recent focus has been on the development of single incision laparoscopic surgery (SILS) to further minimize the invasiveness of laparoscopic surgery by reducing the number of incisions.
Epidemiology and Trends in the Treatment of Cholelithiasis in 21st Centure: A Critical Review
Authors: Chaudhary A , Singh R
Published: July 2022

Cholelithiasis is 10-15% prevalent in India and approximately 1-2% of asymptomatic patients will develop symptoms and require cholecystectomy each year. There has also been a remarkable shift in the trend of gall stone disease from middle aged, fertile, fat, females to young asthenic females in their twenties. Open cholecystectomy was the standard treatment for symptomatic gallstones for more than 100 years. Today, laparoscopic surgery is preferred because it involves less postoperative pain, a rapid recovery period, a greater degree of comfort and a better cosmetic appearance from smaller incisions. Today, laparoscopic surgery is preferred because it involves less postoperative pain, a rapid recovery period, a greater degree of comfort and a better cosmetic appearance from smaller incisions.
Assessment of Correlation between Transcerebellar Diameter and Gestation age in IUGR pregnancies
Authors: Patial Neha , Jhobta Anupam , Kapila Sumala
Published: July 2022

Background: Accurate assessment of the gestational age is very critical in the management of IUGR cases and their associated complications. Present study was done with the objective to evaluate the Correlation between Transcerebellar Diameter and Gestation age in IUGR pregnancies. Material and Methods: This Prospective Cross-sectional study was conducted on antenatal women of gestational age 15-40 weeks with IUGR pregnancies cases attending the antenatal clinic and admitted in the Department of Obstetrics and gynecology, and sent to Department of Radiology KNSH MandC and IGMC Shimla for Antenatal USG Scan. In every patient TCD was measured. Data was analysed by appropriate statistical test using EPI INFO Version 7.2 software. Correlation coefficients were then used to compare TCD with Gestational age in IUGR pregnancies. Results: In this study 120 cases were studied out of which 20 were pregnancies with IUGR. Age distribution of IUGR pregnancies was 20 to 27years with mean age of 22.6±2.14 years. Maximum number of patients 13(65%) was between 21-25 years followed by 16-20 years 4(20%). Youngest patient was 20 years old and the eldest was 27 years. Maximum number of patients 8(40%) was between 30-36 weeks and 36-42 weeks of gestation and least number of patients 1 (5%) were between 24- 30weeks. In third trimester of pregnancy it was observed that TCD shows strongest correlation with gestational age and shows a statistically significant correlation (P is less than 0.001).It was noted that there is a correlation between gestational age and TCD in second trimester of IUGR pregnancies however the correlation was statistically insignificant(P>0.05). Conclusion: TCD is better predictor of gestational age in IUGR pregnancies as it remains nearly unaffected and correlates more closely with gestational age both in second and third trimester of pregnancy.
Health and Wellness Centre Mentoring By Medical College in a Hilly District of Himachal Pradesh
Authors: Sharma Sumit , Verma Rohit , Sharma Ankita
Published: July 2022

Background: Government of India has launched an ambitious programme – Ayushman Bharat for achieving Universal Health Coverage (UHC). Ayushman Bharat has two pillars, one being PradhanMantri Jan ArogyaYojna (PM-JAY) and the other Ayushman Bharat – Health and Wellness Centres (ABHWC). PM-JAY aims to provide financial protection for secondary and tertiary care and PM-HWC aims to achieve delivery of Universal Comprehensive Primary Health Care. Methodology: Mentoring hub was established at PSM department of IGMC Shimla. A pair of HWC-PHC and HWC-HSC was selected so that selected Subcentre falls under selected PHC. A team consisting of 1 Consultant, 1 SR, 1 JR from PSM was formed. The team conducted at least 1 visit every month and the team would cover 1 pair of HWCs in 1 visit. The MO PHC-HWC accompanied the team while visiting HWC HSC under that PHC.NHM provided list of 10 HWCs every year to be mentored by each of the MC in consultation with Distt. Reports were submitted to NHM for planning of strengthening of capacities of various primary health care teams across the state as and when required. Results: The team visited the 5 HWC HSCs and 5 HWC PHCs for consecutive 5 months. They interviewed the CHOs, ANMs, MPWs and Medical Officers on the basis of checklist. For evaluation of skills the hands-on was also conducted. The gaps were identified as High, Medium and Low. Corrective measures were identified and responsibility was fixed for the gap closure. The report was submitted to National Health Mission, H.P.
Study of the Different Etiologies of Intestinal Obstruction and the Factors Affecting the Type of Administration
Authors: Al- Rubayee Tareq Jawad kadem , Yakoop Kaisser Salah , Zghair Luai Farhan
Published: July 2022

30 patients were collected from Al-Yarmouk Teaching Hospital, and the research aimed to Study of the different etiologies of intestinal obstruction and the factors That affecting type of administration And based on data analysis by a specialist in the statistical analysis program SPSS 22, we find that the mean value and SD to the patients’ ages were 35.7±5.87 and the number of women participating in this study was 45% and men were 55%. As for intestinal obstruction, we find that the most of them were with 11 patients without adhesion, and the least was in the proportion of one patient—the Intussusception. As for Surgical procedures, most of them were for the removal of foreign bodies. We conclude from this study that the indications for surgical treatment of intestinal obstruction should be reasonably understood, and the optimal timing of surgery should be understood. To achieve maximum benefits for patients.
A Randomized Control Study to Compare the Clipless Laparoscopic Cholecystectomy (CLLC) and Conventional Laparoscopic Cholecystectomy (CLC)
Authors: Attri Anshu , Sharma Parul , Chandel U K , Devkaran Bhavash , Kaundal Ashok , Syal Kartik
Published: July 2022

Background: Present study was undertaken to compare the
advantages of Clipless Laparoscopic Cholecystectomy (CLLC) over conventional
laparoscopic cholecystectomy (CLC). Material and methods: This prospective
randomized study was conducted in the Department of Surgery IGMC, Shimla
over a period of 1 year starting from 1st july 2019 to 30th june 2020. In this study
100 consecutive patients of symptomatic cholelithiasis confirmed by USG
reporting were participated and randomized into 2 groups of 50 each. Group 1
patients underwent CLC and Group 2 patients underwent CLLC. Outcomes were
measured in terms of operative time, intra operative stone spillage, intra operative
blood loss, amount of CO2 used , post operative pain , conversion into open
cholecystectomy and post operative complications. Results: In the present study
among 100 patients, 19 were males and 81 were females. Among them, 5 males
and 45 females underwent CLC using electrocautery while 14 males and 36
females underwent CLLC. Mean age of males were 47.60 ± 3.36 years and
females were 45.20 ± 15.82 years in CLC group and mean age of males were
53.07 ± 18.96 and females were 44.44 ± 15.41 in CLLC group. Present study
showed that there was significant less Operative Time, Less Mean CO2 used, less
Approx. Blood Loss, less Average pain score at 6 and 24 hours, less Average
Length of hospital stay, less Intra Op. Stone spillage and less Use of Drain in
CLLC as compared to CLC but there was no significant difference in Conversion
to Open Cholecystectomy and Post op. Complications in both groups.
Conclusion: Study concluded that CLLC had significant advantage over CLC in
terms of operative time ,intra operative stone spillage , intra operative blood loss ,
amount of CO2 used , post operative pain and Use of Drain
Neutrophil-Lymphosit Rasio as a Pedictor Outcome of Elective Pediatric Surgery for Clean and Clean Contaminated Operation: Single Centre Study
Authors: Sintaningtyas Linda Jana , . Suwardi , Budhi Ida Bagus
Published: July 2022

Background: Neutrofil-Limfosit Ratio (NLR) is a simple indicator for study inflammatory status easily in patient. An increasing value of neutrophils and decreasing value of lymphocytes is a physiological response in the immune system to systemic inflammation. Methods: This study was an analytical observational quantitative study using a prospective cohort approach, involving 51 patients pediatric surgery from age ≥1 months until ≤18 years who had done elective operation clean and clean contaminated criteria and after 6 hours operation, the subject had differential counted blood examination. Then we checked the outcome after first, third and seventh day after surgery, whether the condition improved (without complication) or worsen conditions (with complication). Results: From the total 51 patients, there was a significant result for gender in variable post operation in this research (OR=3.968; 95%CI=1.160- 13.579;p =0,028), whether female patient were more risky 3,968 times to become worsen condition (with complication) than male patient. 34 patients with RNL is less than 5 consists of 25 patients (73.5%) got improved condition (without complication), whether 17 patients who got worsen condition (with complication) with RNL >5 consist of 12 patients (70,6%). Sensitivity rate was 0,735, and specificity rate was 0,706 and prevalence ratio was 1,716. From this research we got RNL>5 (OR=6.667; 95%CI=1.832-24.264; p=0,004) were more risky 6.667 times to become worsen (with complication) than RNL is less than 5. From chi square result we got p value=0,003 (p is less than 0,05) that’s mean there was a significant relationship between RNL and outcome of pediatric surgery patients age ≥1 months until ≤18 years who had done elective operation. Normal value of NLR would give better outcome. Conclusions: There was a significant relationship between RNL and outcome operation in pediatric surgery age ≥1 month- ≤18 years that was done elective operation with clean and clean contaminated surgery criteria, whether normal value of NLR would give improved outcome (without complication).
Evaluation of Clinical and Laboratory Findings of Acute Meningitis in Children Below 10 Years.
Authors: Hameed Samer Mouaid Abdul , Hasson Nadia Sattay , Ahmad Sarah Shakir
Published: July 2022

Background: Meningitis is an inflammation of fluid and protective membranes of the brain and spinal cord, it can be difficult to diagnose clinically particularly in young infants who do not seem to reliably display the classic features of the disease. Objective: To describe different cl inical and laboratory findings of acute meningitis among children aged below 10 years. Patients and Methods: A descriptive study comprised One hundred eight patients aged below 10 years had admitted to the emergency department of Child's Central Teaching Hospital diagnosed as meningitis during six months' period from 1 st of February 2017 to 31 st of July 2017. They were subdivided into two groups according to age: infants less than 1 year and children between 1-10 years. Results: The mean age was 2.67±2.4 years. There were 41 patients below 1 year and 67 patients from 1-10 years. Males were significantly more than females in both age groups with male: female ratio of 1.7:1. Sixty-one patients (57%) used antibiotics before doing lumber puncture ( LP), while fortyseven patients (43%) did not use any antibiotics. According to the etiology of meningitis is subdivided into two groups viral and bacterial meningitis, Thirty-eight patients (36%) had viral meningitis, 70(64%) patients had bacterial meningitis, 54 patients of them (50%) were partially treated with antibiotics, and 16 patients (14%) without antibiotic use. Fever was the most common symptom present in viral and bacterial meningitis in a 92% and 99% order. Vomiting and convulsions follow fever in the order of occurrence. Photophobia and headache found only in patients above 1 year. While poor feeding and lethargy were found in both age groups, but was significant in cases below 1 year. Bulging fontanel and irritability were the most common signs in infants with acute meningitis, where neck stiffness, kernig’s sign, and irritability were the most common signs above 1 year aged. CSF glucose was low in 69% of bacterial meningitis, 94% of partially treated bacterial meningitis, and 11% of viral meningitis. CSF protein was high in 88% of bacterial meningitis, 83% of partially treated bacterial meningitis and 8% of viral meningitis. These differences were significant. Leukocytosis was found in 48% of viral meningitis, 71% of partially treated bacterial meningitis, and 75% of bacterial meningitis, these differences were significant. Serum C-RP was positive in 26% of patients with viral meningitis, 37% of patients with partially treated bacterial meningitis, and 94% of patients with bacterial meningitis. Differences were significant. Conclusion: Fever, vomiting, and convulsions were the most common symptoms of meningitis in both age groups. No single clinical feature is diagnostic, and the most accurate is the combination of clinical features to raise suspicion of meningitis. Leukocytosis was found most prominent with bacterial more than viral meningitis.
Helpful Parameters in Early Detection of Neonatal Sepsis
Authors: Hussein Adnan Ali , Shareef Azhar M , Allah Ammar M.Ata
Published: July 2022

The indications of neonatal sepsis are vague. A high file of doubt with or without labratory confirmations of disease is the key for early conclusion. The diagnosis of neonatal infection is challenged because traditional markers of infection often mislead instead of diagnosis. The point of this review to assess the worth of gastric suction gram stain as an early marker for determination of neonatal sepsis in correlation with C-receptive protein and absolute white platelet counts The example collected during the period from April 2010 to October 2010" the example were taken from children conceded to the pediatrics-neonatal wards at Tikrit Teaching Hospital who were clinically analyzed as sepsis. The review incorporates 50 cases every one was surveyed clinically by pre-arranged poll including history" clinical evaluation and research center boundaries incorporates gastric suction" C-responsive protein (CRP) and all out WBC count were finished all cases. This study uncovered that" the quantity of likely sepsis was higher in guys 30 (60%) than in females 20 (40%). Among every clinical indication" helpless taking care of had the most elevated extent 39 (78%).Only 18 (36%) youngsters were ordinary birth weight" while 32 (64%) were low and extremely low birth weight. Investigation of maternal gamble factors uncovered that the most successive variable was maternal disease 30 (60%) . Comparable to positive consequences of examinations the cases with positive gram stain more than cases with positive CRP and unusual WBC count. The results of gastric aspirate showed that 19 (38%) of samples were positive. The results of identification showed that the most bacterial infection were gram positive 14 (74%)" while gram negatiive 5 (26%). Results of WBC count showed that 17 (34%) cases had high or low WBC count" while the rest was in the category of normal range. The results of CRP were 15 (30%) positive" at which the differences were statistically significant among positive and negative gram stain cases. Accordingly" we conclude that gram stain provides early identification of the gram-negative or gram-positive status of the organism for preliminary identification more than other traditional tests (CRP and WBC count) that could be used in diagnosis of early neonatal sepsis.
Pathogenicity of the variant m.12158A>G in ND5 in MELAS Remains Unsupported
Authors: Finsterer Josef , Matovu Daniel
Published: July 2022

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Evaluation of Functional Outcome and Complications after Open Reduction and Internal Fixation of Acetabulum Fractures
Authors: Kumar Ravi , Sharma Divyansh , Bhushan Bahrat , Lal Mukand , Kashyap Sandeep
Published: July 2022

Background: The present study was done to evaluate the functional outcome and complications after open reduction and internal fixation of acetabulum fractures. Material and methods: The present study was done in 44 patients of fracture acetabulum managed by open reduction internal fixation in the Department of Orthopaedic surgery, Indira Gandhi Medical College, Shimla. Results: There were 16 prospective (36.4%) and 28 retrospective (63.6%) cases. The mean age was 45.07 years with maximum number of 39 (88%) patients in the age group of 21- 60 years. Majority (77.3%) of the patients was males and 22.8 % were females. Modified Merle d’Aubigne and postel (MDA) score was excellent in 77%patients, good in 13%, fair in 10%. Matta’s radiological score at final follow up was excellent in 54.55%, good in 36.36%, fair in 4.55% and poor in 4.54% patients. The average Modified Harris Hip score was 94 at final follow up in 44 patients. Patients with anterior column fracture had HHS of 96 at final follow up; posterior wall fracture patients had average HHS of 92 at final follow up. Two patients had complications. One patient had femoral head fracture along with fracture of posterior wall developed AVN and also had subsequently Secondary OA with post-operative subluxation of femoral head. Thus three complications were seen in this patient. Another patient with fracture dislocation with fracture of posterior wall developed AVN and subsequently secondary OA 5 year after surgery. No patient developed sciatic nerve injury post operatively. None of patients developed postoperative sciatic nerve palsy. No patient died during treatment or follow up. Conclusion: Open reduction and internal fixation as a gold standard for acetabulum fractures which is indicated with excellent to good results in majority of the patients as assessed by Modified Merle d’Aubigne score, Modified Harris hip score and Matta Radiological score with minimal complications at final follow up.
Risk of Malignancy in Solid Breast Masses Considered Probably Benign or Low Suspicion
Authors: Mohammed Ali Sally Sarmad , Fareed Sahar Basim Ahmed , Abdulhakeem Wasan M. Saeed
Published: July 2022

Background: To determine whether solid breast masses with benign sonographic features have less than 2% incidence of malignancy, allowing management by follow up instead of biopsy. Patients and Methods: Sonography reports of solid breast masses from February 2021 to the end of February 2022 in Al-Yarmouk teaching hospital, prospectively classified as probably benign (BIRAD III) or low suspicion (BIRAD IVa) were reviewed .The BIRADS categories were correlated with outcome data and tissue diagnosis. Results: The study population included 136 lesions in 100 patients (mean age 36.78 years, range 11-79 years). A total of 63 lesions were prospectively classified as BIRAD III and 73 lesions as BIRAD IVa. A total of 133 lesions were proved as benign lesions and only 3 lesions were malignant. All 3 malignancies seen in women older than 50 years. Conclusions: The incidence of malignancy in solid breast lesions classified as BIRAD III was 1.5 % and in BIRAD IVa was 2.7 %. Palpability alone does not considered as features to rise up the BIRAD grade of any breast lesions.
Ripasa versus Alvarado as a Scoring System in Diagnosis of Acute Appendicitis in Al-Yarmouk Teaching Hospital
Authors: Rajab Khalid Kareem , Ammash Abu Bakr Ghalib , Muhsin Abdulhadi Majed
Published: July 2022

Background: Appendicitis is one of the most frequent diagnoses for emergency department visits resulting in hospitalization. A number of scoring systems have been developed to try to identify people who are likely to have appendicitis and are eligible for surgery. Aim of study: is to compare the accuracy of RIPASA to Alvarado score in the diagnosis of acute appendicitis. Methods: A prospective comparative study that was conducted at Al-Yarmouk Teaching Hospital / Baghdad during the period of one year from 1st of Feb. 2019 till 1st of Feb. 2020. It included 200 patients attended the outpatient clinic or the emergency department in Al-Yarmouk Teaching Hospital complaining from lower abdominal and/or right iliac fossa pain suggestive of acute appendicitis. Scoring was done to diagnose appendicitis by two scoring systems (Alvarado and RIPASA) using the data for each patient. The individual scores were then compared to the final diagnosis made by the clinician and to the recommendations of each scoring system. Results: In this study, most of the patients (172 patients, 86%) underwent appendectomy. We noticed that 44.8% of the operated cases were diagnosed as catarrhal appendicitis. Incidences of rebound tenderness, leukocytosis, migratory pain, ROVSING sign, and right iliac fossa guarding were significantly higher in patients diagnosed with appendicitis than those in patients diagnosed as normal appendix. Means of ALVARADO and RIPASA scores were significantly increased with severity to reach the highest level in patients diagnosed with severe appendicitis than other findings. ALVARADO score was 69.7% sensitive, 87.5% specific, and 74% accurate. RIPASA score was 94.1% sensitive, 62.5% specific, and 86.5% accurate. Conclusion: RIPASA score is more accurate and more sensitive than Alvarado score, in spite of the lower specificity, so that it can be effectively conducted for the better evaluation of acute appendicitis. RIPASA score is simple, non-invasive, and cost effective way to be used in resource limited conditions.
A Single-Center Review of Clinical Profile, Prognostic Factors, and Outcomes of Emphysematous Pyelonephritis ─ A Retrospective Study
Authors: Ali Nawaz . , Singh A k. Kaku , Somarendra Khumukcham .
Published: July 2022

Background: Emphysematous pyelonephritis (EPN) is an uncommon life-threatening condition characterized by the production of gases within the renal parenchyma and perirenal space. We aimed to study the clinical features, radiological classification, prognostic factors of EPN, and outcome among the various radiological classes of EPN. Methods: All the patients who were admitted to the urology ward of our Institute were included and the study period was for the last 5 years. It was a retrospective study and the collection of file records were done from the medical record section department of our Institute. Results: Overall 20 cases were diagnosed to have emphysematous pyelonephritis. There were 12 females and 8 males and the majority of the patients were from (40-50) age groups. Eighteen cases had type 2 diabetes mellitus and two patients had upper ureteric calculus. 16 cases had unilateral involvement, 3 had bilateral involvement and one patient had solitary kidney with EPN. 12 cases were classified as having class 1 or 2 diseases and eight cases had class 3 and 4 diseases. The most common clinical presentations were flank pain (95%) and fever (85%). The most common organism cultured was Escherichia Coli (E. coli) (70%). Most of the cases were managed by percutaneous nephrostomy drainage (PCN) of the collecting system with medical management. Shock at admission (p=0.009), serum creatinine >5.0 mg/dl (p= 0.031) and DIC (p= 0.045) were independent poor prognostic factors. Conclusions: Early control of blood sugar with vigorous hydration and appropriate intravenous extended-spectrum antibiotic should be the initial treatment of choice. Early percutaneous nephrostomy should be tried even in advanced stages. Shock, DIC and Serum creatinine >5mg/dl on admission are independent predictors of poor outcome