bluuebunny/crossref_metadata_2025 huggingface dataset:
Influence of Cyclical Patterns on Innovation and Transformation Processes in the Economy
Authors: Shcherbakov G. A.
Published: March 2020

Purpose: the main purpose of this article is to present and develop a cyclic approach in the theory of innovation. This section of economic theory is based on the understanding of the innovation process as a dynamic system that develops (depending on the type of innovation) within the medium or long-term cycle. The cyclic approach has an insufficiently studied subject of research. In theoretical and practical aspects, this approach is very poorly developed, despite its prospects for this method. The application of the cyclic approach in the practical sphere will increase the effectiveness of activities planning in the field of the state innovation policy, as well as increase the efficiency of the state resources using.

Methods: a set of methods of theoretical research is used, including: logical, system and abstract methods, as well as specific scientific (special) research methods. Based on the study of a wide range of scientific literature, as well as statistical and factual information on innovative issues, models (modeling method) were drawn up, which were graphically fixed in the figures illustrating the main provisions of the article.

Results: this article develops the cyclic approach to the innovations study, proposed in the works of foreign and domestic scientists. The article describes and presents a scientific method of innovative processes management, called "triad of innovative and transformative activity". The article also contains a brief overview of the cyclic method development in the works of domestic and foreign researchers, giving a general idea of the elaboration degree of the scientific question.

Conclusions and Relevance: the analysis of the main theories and concepts in the field of innovation, gives reason to argue that scientific views on the implementation of the innovation process contain a serious omission. It consists in the fact that it does not take into account the influence of cyclical conditions of various medium-term cycle phases or long-term cycle stages. In practice, this leads to asynchronous processes that prevent the effective innovation activities.
Tax Relations from a Position of Business Safe Development and Protection of State Interests
Authors: Vyakina I. V.
Published: March 2020

Purpose: the article analyzes the tax policy of the Russian Federation and judicial practice of the cases related to tax legislation from the standpoint of business safe development and protection of state interests; contains measures that allow the formation of adequate tax relations between the state and business aimed at the development of the national economy.

Methods: tax relations consider in two aspects: from the position of state interests, on the one hand, and subjective perception of business, on the other. In the research process, economic and statistical methods for processing analytical data, graphical and tabular methods for visualizing research results used, as well as methods for complex, system, comparative and structural-functional analysis and traditional general scientific methods: analysis, synthesis, induction, deduction, comparisons, generalizations, analogies, etc.

Results: the author has performed an analysis of the structure and dynamics of tax revenues to the budget system of the Russian Federation and the results of the consideration of tax legislation application in terms of meeting the claims of various parties and the amounts recovered from lawsuits of tax authorities and taxpayers. The features of the regulatory framework to protect the interests of the state and business in the field of tax relations have considered. The key threats and opportunities for development at different levels of the functioning of tax relations have identified and specific measures aimed at improving the mechanism of tax relations between the state and business have proposed.

Conclusions and Relevance: analysis of judicial practice shows an increase in the fiscal focus of the results of the consideration by the Arbitration courts of the cases related to tax legislation. The formation of a set of specific organizational and legal measures in the field of taxation aimed at improving business protection is necessary for protection of the state interests and the safe development of the national economy. They are the organization of effective interaction of business with regulatory authorities; reduction of taxation of investments in fixed assets; development of mechanisms for protecting the rights of investors.
Digital Technologies in the System of Technological Development and Knowledge Management in a Problem Region (on the example of the North Caucasus Federal district)
Authors: Batov G. H. , Khutova L. A. , Shogenov T. M.
Published: March 2020

Purpose:the purpose of the study is to analyze the state of technological development and technological structures of the region, identify the features of knowledge management and develop a model for using new knowledge using digital technologies.

Methods:the research is based on the use of the methodology of the system approach, the use of methods of economic and statistical analysis, scientific abstraction, analogies and scientific generalizations. During the development of the proposed topic, classical and modern works of domestic and foreign scientists, statistical and empirical material collected in the course of field research were used. In the part concerning the technological development of the region, aspects of the theory of technological structure are used in the interpretation of domestic and foreign researchers. The experience of determining the integral indicator of the state of technological structure in the region's subjects was used.

Results:the study showed that in the economy of the studied district there is a high lack of demand and immunity of scientific results from the real sector, as well as significant demand constraints, which in turn are associated with the fact that the conditions for competition are insufficiently developed here. The district subjects have not developed strategies for switching to a new format of development using innovation and digital technologies.

Conclusions and Relevance:it is necessary to change the existing practices and policies, each region needs to develop its own mechanism and approach to the digital economy and technology transfer, depending on its characteristics. The proposed model of knowledge management based on the use of digital technologies and artificial intelligence can become one of the tools for realizing the potential that the district has. Using new technologies and technological developments, it will be able to fit into the new technological order and ensure economic growth.
Obstructed labour at Usmanu Danfodiyo university teaching hospital Sokoto: a five-year review
Authors: Yakubu Ahmed , Sagir Tukur Dabo , Panti Abubakar A. , A. Garba Jamila , Mani Isah Usman , Funtua Anas Rabiu , Chappa Aliyu Muhammed , Markus Mbakwe
Published: March 2020

Background: Obstructed labour is an obstetric emergency and one of the major causes of maternal and perinatal morbidity and mortality in the developing countries, Nigeria inclusive. The aim of this study was to determine the prevalence, causes and feto-maternal outcome of cases of obstructed labour managed at Usmanu Danfodiyo University Teaching Hospital Sokoto from 1st January, 2014 to 31st December, 2018.Methods: This was a retrospective review of all cases of obstructed labour managed at Usmanu Danfodiyo University Teaching Hospital Sokoto over 5 years. List of cases managed during the study period was obtained and case notes were retrieved. Relevant information such as age, booking status, parity, educational status, address, causes, mode of delivery and both maternal and foetal outcomes were obtained from the case notes. Data analysis was done using statistical package for social sciences version 22 (SPSS Inc, Chicago, IL, USA).Results: A total two hundred and seventy-six cases of obstructed labour were managed out of the 15,452 total deliveries during the study period. This gives an obstructed labour prevalence of 1.79%. The major cause of obstructed labour identified in this study was Cephalopelvic disproportion (74.6%) and majority of the patients were delivered by emergency lower segment caesarean section (70.6%). Up to 32.3% of the patients had no maternal complications and also 42.3% of them had live birth with no fetal complication. However, 20.2% of these patients had ruptured uterus and 37.9% of them had still birth, while 19.8% had live birth complicated by birth asphyxia.Conclusions: This study has found that obstructed labour resulted in adverse maternal and perinatal outcome. Hence, there is need to prevent obstructed labour in order to avert this consequence.
Prevalence of anemia among school going adolescent girls in rural area of Pune, Maharashtra, India
Authors: Bodat Suman , Bodat Rakesh , V. V. G. Prasanth Vinjamuri , Rathore Anita Raj
Published: March 2020

Background: Anemia is like the tip of an iceberg, as majority of anemic subjects are asymptomatic. Low iron diet for longer period perpetuates an inter-generational cycle of anemia, anemic women giving birth to anemic children. This situation is more acute in rural area due to their dietary habits, illiterate parents, socio-economic status, misconception about food, religions belief, menstruation and physical activity.Methods: This descriptive cross-sectional study was conducted in rural field practice area of Rural Heath Training Centre (RHTC) under department of community medicine, Bharati Vidyapeeth Medical college Pune, Maharashtra, India. There are 11 villages under RHTC Lavale: Out of them one village viz. Pirangut village was randomly selected. (by using random sampling method). This study was conducted in 2013. Total 740 senior secondary school girls studying in class 6th to 12th (10-19 age group) were included. Hb level was measured by Sahli′s hemoglobinometer. Chi square was used to test for association between qualitative variables, and p-value less than 0.05 was considered significant.Results: The Hb level of girls reveal that majority 648 (87.6%) of them were anemic. It was found that 305 (47.06%) and 340 (52.48%) were suffering from mild and moderate anemia while 3 (0.46%) had severe anemia. The significant association was found with BMI for age.Conclusions: Active measures to decrease the prevalence of anemia through educating these girls and their mothers, school diet supplementation, providing low cost diet.
Uterovaginal prolapse: the sociodemographic profile and reproductive health service uptake in a low resource setting, Calabar, Nigeria
Authors: Obinna Njoku Charles , N. Njoku A. , E. Efiok E. , M. Eyong E.
Published: March 2020

Background: Uterovaginal prolapse is a common gynaecological condition in low resource countries because of high prevalence of grand multiparity, low skilled attendant at delivery and low contraceptive usage. Objective of this study was to determine the prevalence, sociodemographic profiles, utilization of reproductive health services and delay in seeking medical care of patient with uterovaginal prolapse in Calabar, Nigeria.Methods: This was a retrospective study of women who presented with uterovaginal prolapse at University of Calabar Teaching Hospital, Calabar, Nigeria between 1st May 2009 and 1st June 2019. Patients case records were retrieved and analyzed. Statistical analysis was done using SPSS version 22.Results: The prevalence of genital prolapse was 0.3%. The mean age and parity were 60.19±8.71 years and 6.31±2.80, respectively. The mean duration of symptoms before presentation was 3.19±2.16 years. Genital prolapse was commonest among age group 60-79 years (52.8%), parity 5-9 (66.7%), post-menopausal (97.2%), primary education (55.6%) and farmers (47.2%). Grade 3 uterovaginal prolapse was the commonest grade (58.3%). Most patients (86.1%) had symptoms of genital prolapse for less than 5 years before seeking medical treatment. The majority of patients had no antenatal care during their pregnancies (80.6%), no skilled attendant at deliveries (86.1%) and no contraceptive use during their reproductive years (77.8%). Participants with lower parity (1-4) (p=0.03), higher educational level (p˂0.001) and teachers/civil servants (p=0.043) presented earlier (less than 1 year) to the hospital.Conclusions: There is poor utilization of reproductive health services among women who develop uterovaginal prolapse in study environment. Women with higher social status sought for help earlier. Increasing awareness of this condition and providing antenatal care, skilled birth attendants and contraceptive services will reduce the burden of this condition.
A prospective observational study to determine the utility of placental laterality for prediction of preeclampsia in pregnancy
Authors: Rana Anshul , Thakur Rama , Rao Rohini
Published: March 2020

Background: Preeclampsia is a multisystem disorder of unknown aetiology and recently its link with placental laterality has been explored. The objective of this study was to find the association of placental laterality with maternal and fetal outcomes in pregnancy. Study also determined the predictive ability of placenta laterality for the development of hypertension in pregnancy.Methods: A prospective observational cohort study was conducted on 200 pregnant women. Routine investigations and doppler analysis were done. Placenta position was categorized into central and lateral. Maternal and fetal outcomes were recorded. The data was entered in MS excel spreadsheet and analysis was done using statistical package for social sciences (SPSS) version 21.0. A p value of < 0.05 was considered statistically significant.Results: Study found no significant association of placental laterality with hypertension in pregnancy. Various fetal complications, birth weight, Apgar scores and NICU admission were comparable among women with central or lateral placenta (p > 0.05). Even the maternal outcomes like mode of delivery, onset of labor, indication of labor induction and caesarean deliveries were comparable among women with central or lateral placenta (p > 0.05). On applying univariate logistic regression analysis, previous history of hypertension in pregnancy was a significant risk factor for development of preeclampsia with odds ratio of 168.43 (p < 0.05).Conclusions: It can be concluded that the maternal and fetal outcomes are independent of the placenta laterality. The doppler characteristics and placenta laterality did not show any increased risk for hypertension in pregnancy. However future studies are recommended with large sample size including more women with diagnosed hypertension in the pregnancy so that a better association can be derived with placenta laterality and doppler characteristics.
Partial hydatidiform mole evolving into metastatic trophoblastic tumor: case report
Authors: Elmouri I. , Tanouti S. , Taheri H. , Saadi H. , Mimouni A.
Published: March 2020

Partial hydatidiform mole can evolve into a metastatic trophoblastic tumor. A 36-year-old, multiparous woman, pregnant with a 22-week embryonic hydatidiform mole, having spontaneously expelled. Histopathological examination showed a non-invasive partial mole. During biological monitoring, a trophoblastic tumor was diagnosed with pulmonary metastasis on CT-scan and myometrial invasion by MRI. Authors opted for a monochemotherapy with a good evolution. The potential risk of malignant transformation of the partial hydatidiform mole requires an adequate therapeutic strategy with strict monitoring.
Epidemiology of sepsis and its various characteristics in a tertiary care adult-multidisciplinary ICU in South India: a retrospective study
Authors: Tharappel Jalal Hussain Khan , Thomas Teju P. , George Alfy Ann , Mohammed Hamadan
Published: March 2020

Background: The incidence of sepsis is increasing, especially in elderly populations with more comorbidities. It is now estimated that sepsis is a leading cause of mortality and critical illness worldwide. The Epidemiological data regarding sepsis, septic shock and organ involvement is mainly from western literature. Data from India, especially south India, are less when compared to western data. In this background authors conducted a retrospective study in tertiary care hospital in south India. Objectives of the study was epidemiology of sepsis and its various characteristics in a tertiary care adult-Multi disciplinary ICU in South India.Methods: This study was a retrospective observational study, conducted during the time period of June 2016 and May 2017. The study population was patients above 18 yrs admitted in MDICU with sepsis. The study was conducted in a tertiary care adult -Multidisciplinary ICU in South India. Various characteristics like age group, comorbidities, organ involvement, septic shock, sofa score, need for ventilatory support, RRT support and outcome data was collected.Results: In this study, 497 patients who satisfied the Surviving Sepsis Campaign guidelines were included. The majority of the patients (59.8%) were male; the majority was above 60 yr (range 18 to 92 yr). 76.3% Patients had comorbid disease. Hypertension was the most common co-morbid (62%) followed by diabetes mellitus (51.3%). Chronic Kidney Disease was found in 132 patients (26.6%) and Coronary artery disease in 121 patients (24.3%). 186 patients (46.5%) had single organ involvement 140(35%) patients had 2 organ involvement. 74(18.5%) patients had more than 2 organ involvement. Septic shock was found in 155 patients (31.2%). Renal involvement was the most common organ involvement found in 279 patients(59.9%). Most common source for sepsis was the respiratory system found in 230 patients (46.3%), followed by urinary tract infection in 117 patients (23.5%). The study shows a significant association between SOFA score and mortality (p-value 0.001) 52% of mortality happened in group of patients with SOFA score more than 15 and mortality was 28 % in group with a SOFA score of 10-15.Conclusions: In this retrospective study of sepsis, authors found that the most common source of sepsis was pneumonia (46.3%) followed by urinary tract infection (23.5%). Majority of the patients had one organ involvement (46.5%). Among the organ involvement, Acute Kidney injury was the most common organ involvement (56.1%) followed by septic shock (31.2%) and respiratory support (29.6%). Mortality in this study was higher with higher SOFA score.
Correlation between acute ischemic stroke onset with Alberta stroke program early CT score
Authors: Nasution Iskandar , Surbakti Khairul Putra , Lubis Netty Delvrita , Ekayana Etiya
Published: March 2020

Background: Alberta Stroke Program Early CT Score (ASPECTS) is a valid method for assessing early ischemic changes in the middle cerebral artery from a CT scan of patient with acute ischemic stroke. One of the factors that influence ASPECTS is stroke onset time, where a very subtle level of hypodensity in early onset can provide poor reliability on ASPECTS assessments. Aim of the study was to determine the relationship between the onset of acute ischemic stroke and ASPECTS.Methods: This study used a cross-sectional design with Chi-Square method in patients with acute ischemic stroke and anterior circulation stroke treated in The Stroke Corner and Integrated Ward of Haji Adam Malik General Hospital during the months of February - May 2019. All patients were evaluated for ASPECTS and stroke onset at admission. Stroke onset was divided into 3 parts: Under 24 hours, 24 - <48 hours and 48-72 hours. ASPECTS value was assessed by 2 observers. Authors categorized the ASPECT value into 2 groups: Low (≤7) and High (˃7).Results: Among 36 patients with Acute Ischemic Stroke, mean age was 55.7±13.9 years old, which male and female shares equal number by 18 persons (50%). Mean ASPECTS score was 7.2±2.0. This research found 5 patients (13.9%) with less than 24 hours onset and low ASPECTS score, 3 patients (8.3%) with 24 - <48 hours onset and low ASPECTS score, 7 patients (19.4%) with 24 - <48 hours onset and high ASPECTS score, 8 patients (22.2%) with 48-72 hours onset and low ASPECTS score, and 2 patients (5.6%) with 48-72 hours of onset and high ASPECTS score. Valuation of ASPECTS from both observers was considered as excellent (statistic K value = 0.9).Conclusions: ASPECTS has a significant relationship with stroke onset (p=0.029) and the initial ischemic change will be seen more clearly with increasing stroke onset time.
Prevalence of depression and anxiety in type 2 diabetes mellitus patients in tertiary care hospital
Authors: Kamat Ashok M. , Raddi Sudha A.
Published: March 2020

Background: The prevalence of depression and anxiety in diabetes is considerably higher than normal population and found to have a negative impact on diabetes. Objective of the study was to assess the prevalence of depression and anxiety and to identify their associated risk factors among people with type 2 diabetes mellitus.Methods: Descriptive study was done in Endocrine and medicine outpatient Department of Vijaya Hospital in Belagavi, South India. Total 384 patients with type 2 diabetes mellitus were interviewed for depression and anxiety by administering the Hospital Anxiety and Depression Scale (HADS).Results: Of the total 384 patients surveyed, depression and anxiety were found in 32.56%. (95%CI 27.8-37.2%) and 37.76% (95% CI 33.1-42.9%) respectively. In Multiple Logistic regression analysis age, unmarried, religion, duration of type II diabetes and type of treatment were significantly associated with depression symptoms, Anxiety symptoms were associated with age, Qualification, Occupation, Religion, Duration and type of treatment.Conclusions: This study found a high prevalence of depression and anxiety in patients with Type 2 DM. Therefore, the care of individuals with type 2 Diabetes Mellitus (DM) should include the screening and possible treatment of depression and anxiety in order to achieve and sustain treatment goals.
Effect of dexamethasone with granisetron or ondansetron for prevention of post-operative nausea vomiting in patients undergoing laparoscopic gynaecological surgery
Authors: Sharma Shailendra Kumar , Singh Shalendra , Paul Debashish , Ameta Nihar , Taank Priya , Singh Tina
Published: March 2020

Background: Post-operative nausea and vomiting (PONV) is generally self-limiting, associated with high level of patient dissatisfaction and may delay hospital discharge. The anaesthetist is usually blamed, despite evidence that PONV results from a variety of factors and variety of antiemetic drug available in market. With this issue we aim to compare the effectiveness of dexamethasone with granisetron or ondansetron in patients undergoing laparoscopic gynaecological surgery.Methods: 120 patients were registered in this prospective, randomized double blind study. Group I (n=60) received ondansetron 4 mg intravenously (IV)+dexamethasone 8mg I/V or II (n=60) received granisetron 1 mg IV+dexamethasone 8 mg I/V prior to anaesthesia. Post-operative data of PONV was recorded at pre-defined intervals.Results: The majority of the patients were of the age group 20-25 years (55.83%). The mean score of Group I subjects was 0.30±0.72 and that of Group II was 0.20±0.57 (p=0.43).  There are 3.33% of patients in group-I having vomiting episodes, and 1.67% of patients in group-II having vomiting episodes, none of the patients developed 2nd episodes of vomiting in either group. Thus it appears that dexamethasone in combination with ondansetron and granisetron is effective in decreasing the number of episodes of PONV. The occurrence of sickness episodes within 24 hours of surgery revealed no significant different in both groups. Haemodynamic variables showed no significant difference recorded in postoperative care unit between the study groups. The most common complaint was headache 16.67% in both groups.  Conclusions: Dexamethasone 8 mg with either granisetron 1 mg or ondansetron 4 mg showed no significant difference in antiemetic efficacy with minimal side effects and excellent patient satisfaction.
Students perceptions about the pedagogic strategies for teaching-learning anatomy at university Eduardo Mondlane in Mozambique
Authors: Rodrigues Maria Alexandra Fernandes
Published: March 2020

Background: From the need to develop a new curriculum for the medical course, changing the traditional model used for teaching Gross Anatomy it was sought to incorporate active teaching methodologies which can allow students to be more involved in the process of knowledge construction. The way in which Gross Anatomy is delivered in most Faculties of Medicine has been seen as a big challenge to the teachers and the students too as a consequence of permanent changes that are required in order to be in line with the technological development. This study aimed to explore the student's perceptions about the effectiveness of the strategies and resources, used in teaching-learning Gross Anatomy in the medical course at EMU.Methods: Data were collected using a questionnaire administrated to those medical students who attended (1st and 2nd year) Gross Anatomy subjects, in November 2018. Descriptive statistics and data content analysis were performed. The sample comprised 171 students.Results: A convergence of strategies preferred by the students involved in the study was seen. It was recognized that Gross Anatomy curriculum was designed based on the limitations of the use of cadaver dissection, with the emphasis on applied anatomy and learning in small groups using other resources, including computer assisted learning based on the 3-D Slicer software.Conclusions: It appears that the students' desire is that the teaching-learning strategies used in Anatomy classrooms at UEM might contribute to their better training for the professional challenges when graduated. They perceived that with the strategies used for teaching Anatomy, they are being very well prepared to get in an entrepreneurial, transformative profile and are able to learn more complex contents in order to provide a qualified health care to people in the performance of their future functions as doctors.
Evaluation of the response rate of chemo-radiation and brachytherapy in patients with locally advanced carcinoma cervix in a tertiary care center
Authors: Semwal Sukanya , Sethi Jaskaran S. , Gairola Munish , Simson David K. , Kumar Rajendra , Goyal Ankit , Vashistha Apoorv , Kumar Ankit , Goel Palak
Published: March 2020

Background: Incidence and mortality estimates are used to measure the burden of cancer in a population and survival estimates are ideal for evaluating the outcome of cancer control activities. Survival studies evaluate the quality and quantity of life of a group of patients after diagnosing the disease. The patient survival after the diagnosis of cervical cancer is indirectly influenced by socio-economic factors. The present study was carried out with an aim to evaluate the success rate of chemo-radiation followed by brachytherapy to the patients of locally advanced carcinoma (Ca.) cervix in a tertiary care center.Methods: All cases were staged according to the International Federation of Gynaecologists and Oncologists (FIGO) staging system. To illustrate the observed survival of cancer patients Kaplan-Meier curve was plotted. All the patients, except one, completed chemo-radiation and were retrospectively analyzed for the presence of local residual disease, local recurrence, distant metastases, radiation reactions, disease-free survival, and overall survival.Results: There were 22 patients of Carcinoma cervix reported in the radiation oncology department in the year 2018 and 2019. The overall treatment time ranged from 30 days to 178 days, with a median of 63 days. All the patients had a complete response after the treatment. The median follow-up time for all the patients was 15 months. Three patients had a metastatic recurrence and one patient developed distant metastases as well as local recurrence. Overall survival rate was 100% while the disease-free survival rate was 81.82%.Conclusions: The response to chemo-radiation in the treatment of locally advanced Carcinoma cervix is comparable to historic data and is well tolerated.
Awareness and importance of human body donation for the purpose of teaching and research
Authors: Fulwaria Mukesh , Bilodi Arun Kumar S. , Solanki Sohel , Gurjar Anoop Singh , Soni N. D. , Choudhary Dinesh
Published: March 2020

Background: Human body is studied by dissection method on unclaimed or donated human cadavers. Anatomy is of paramount importance taught for the first year M.B.B.S students all over Indian Medical Colleges since decades.Methods: Medical Institution was started in month of September 2019 with 100 intakes on merit basis. Aim was to teach the human anatomy to 1st MBBS students by dissecting the cadavers for which an Awareness programme was conducted by department of anatomy regarding to Body donation. Study was done going through and studying the donated forms with full consent in duly signed consent forms. Their age, physical conditions and mental status were taken into considerations as the yard sticks.Results: Since college has started in September 2019, there was poor response and awareness about body donation. So far fifteen live donors including 12 males and 3 females have filled their forms in perfect normal status and with NO compulsion from anybody. Five dead bodies (Cadavers) received in the Department of Anatomy of Government Medical College, Barmer for the propose of dissection to teach the 1st year MBBS students. Awareness of donation of the body is in progress.Conclusions: In the present study, authors concluded that only few people gave response in favour of awareness programme of body donation showing the lack of awareness towards the body donation. So, the study has shown the requirement of more awareness programmes about body donation among the population. It will help to clarifying any myths or/and superstition so that the general public should aware and show interest towards the body donation.
Trends in the profile of non hodgkins lymphoma in North and South India: a study from two tertiary care hospitals in India
Authors: Sud Rahul , Kumar Kishore , Dubey A. P. , Bhagat Sagar
Published: March 2020

Background: A number of environmental and chemical factors have been thought to been implicated in the occurrence of Non-Hodgkin’s Lymphomas (NHLs).To fill the knowledge gap in various aspect of the disease, this study was undertaken at this tertiary care centre in Delhi and Bangalore.Methods: This was a prospective observational study conducted in two defenses medical centre in India among patients of Non Hodgkins Lymphoma, registered at Command hospital Airforce Bangalore and Army Hospital (Research and Referral), New Delhi, between March 2016 and March 2019.Results: The disease showed a bimodal onset in both centres with 26 (26%) and 24 (24%) cases occurring in the age group of 31-40 years and 24 (24%) and 25 (25%) cases occurring in the age group of >60 years at CHAF (B) and AH (RR) respectively. B cell Lymphoma was the most common type of NHL seen in 85% and 89% patients, whereas T-cell lymphomas constituted 13% and 11% at CHAF (B) and AH (RR).  32(32%) patients presented with an Ann Arbor Stage 1 or 2 disease whereas 68(68%) patients were with Stage 3 or 4 disease at both the centers. IPI score was ≥3 in 45 % and 43% patients.Conclusions: NHL in India is a homogeneous and uniform disease. But there was increased detection of hepatosplenomegaly and associated hepatitis B/C in the southern part of India. Also, the occurrence of Cutaneous T cell lymphoma was only seen in the south India centre. The early stage NHLs has better survival and increase chance of complete response.
Removal of locked intramedullary nails with the aid of bolts
Authors: Echem Richard C. , Eyimina Phillip D.
Published: March 2020

Background: Removal of an intramedullary nail would require the extraction system of the inserted nail to be available. Sometimes the system is not available, and an alternative system would have to be utilised. Aim of the study was to document the removal of interlocked nails using bolts in the absence of appropriate fitting extraction system.Methods: A prospective study of consecutive patients seen by the authors between September 2016 and September 2018 in private clinics in Port Harcourt where the authors were invited to remove intramedullary nails. Bolts fitted to the proximal tips of the nails were utilized. With the aid of plier applied to the bolts and mallet, the nails were extracted. The patients’ socio-demographic and information relevant to the injury were obtained. Data was analysed using SPSS version 23.Results: Fifteen patients were seen. Ages ranged from 29 to 72 years, consisting of 10 males and five females. The tibia was affected in six and the femur in nine. There were five united tibial fractures and one non-united tibial fracture, six united femoral fractures and three non-united femoral fractures. Indication for removal was mostly patients’ request. Duration of surgery ranged from 1 to 4 hours. All the nails were extracted. Complications included broken nail, heterotopic calcification, bony overgrowth/ ingrowth/ongrowth around the nail and interlocking screws. There was no mortality.Conclusions: In the absence of conventional intramedullary nail extraction system, appropriate size bolts can be applied to the threaded proximal tip of nails and used for nail extraction.
An assessment of the learning styles of first year medical and dental students of North Bengal Medical College, Darjeeling, West Bengal, India
Authors: Panja Sumana , Lahiri Pratibha Rao , Lahiri Aditi
Published: March 2020

Background: Learning is the act of acquiring, modifying and reinforcing existing knowledge, behavior, skills and values. This phenomenon of learning is dominated by an individual’s learning style. Learning style is a popular concept in psychology and education, and it refers to how a person learns best. This study aims to identify the Learning Styles of the first year MBBS and BDS students at NBMC by administering the questionnaire of the VARK model.Methods: This cross-sectional study was performed in the Department of Physiology at North Bengal Medical College, West Bengal after. The VARK questionnaire 7.8 version was administered to 180 first year MBBS and BDS students from the 2017-2018 batch who had volunteered for the study. The Questionnaire consisted of 16 questions, along with a scoring chart. Students were allowed to choose more than one option. If in majority of the questions they opted for a single sensory modality they were considered as unimodal learners and if they chose multiple options, they were recognized as multimodal learners.Results: The study showed 57% of the students to be multimodal learners and 43% to be unimodal learners. Read/Write was the most preferred (31.22%) sensory modality followed by kinesthetic mode (29.57%).Conclusions: As majority of our students are multimodal learners teachers should incorporate active teaching and learning strategies to cater to all types of learners. Also, as the most preferred method is Read/Write which includes googling and the use of internet to browse for information, we must try and incorporate e-learning into our curriculum.
Estimation of various associated factors in multiparous females undergoing primary caesarean sections at a tertiary care health centre in rural Western Maharashtra, India
Authors: Nene Deepti Kiran , Baheti Tushar Chandrakant , Bangal Vidyadhar B.
Published: March 2020

Background: Caesarean section is one of the commonly performed operation in women due to safety reason and modern techniques. Primary caesarean section in the multipara means first caesarean section done in the patients who had previously delivered vaginally once or more. Aims and objectives of this study were to know association of various parameters like Age, Parity, Haemoglobin, Blood Pressure, Baby weight, Perinatal and Maternal Mortality with primary caesarean section among multipara.Methods: This was a prospective study of primary caesarean section in multipara women admitted at tertiary care hospital in western rural Maharashtra during the period of 6 months from January 2018 to June 2018. Multipara with pregnancy of >28 weeks gestation (gravida 2 and above), each of whom has had a previous vaginal delivery of >20 weeks gestation were included. Women with previous abortions and previous section were excluded.Results: Total 1705 sections were performed during the same period out of total 4648 deliveries. Out of these sections 194 sections were performed in multipara for the first time. Maximum numbers of patients (58%) were in the age group of 15-24 years and Parity 2 (68%). Almost 70% women among multipara have Hb <11 Mgm/dl. Most of the patients (84.53%) have normal Blood pressure readings. Most of the babies’ i.e.70 (36.08%) have birth weight in the range of 2.5-3 kg. Out of 194 deliveries, there were only 3 neonatal deaths (1.54%) and 1 maternal death (0.51%).Conclusions: Proper antenatal and intrapartum care and early referral can reduce the maternal and perinatal morbidity and mortality in multipara.
Study on incidence of silent cerebral ischemia among diabetic nephropathy patients admitted in tertiary care hospital
Authors: Diggikar P. M. , Satpathy P. K. , Mishra Shubham , Dandi Kranthi
Published: March 2020

Abstract: Background: Diabetes accelerates the atherosclerotic process in blood vessels, leading to micro- and macro vascular complications, stroke being one of these. Carotid artery atherosclerosis in patients with Diabetic nephropathy is found to be associated with Silent cerebral infarction (SCI). Present study was carried to found any relationship between carotid intima media thickness and silent cerebral infarction in patients with type 2 diabetic nephropathy.Methods: The study was done in 50 DN patients admitted in medicine ward of tertiary care hospital. Subjects were evaluated based on detailed clinical data like symptoms, signs, and associated illnesses, general and systemic examination. Subjects were diagnosed with silent cerebral infarct based on MRI Findings. Each subject had undergone MRI to find out incidence of SCI.Results: Maximum (54%) was in age group of 61-70yrs and very few (6%) were below age of 50yrs. M: F was 1.6:1. Around 44% had duration of diabetes in 1-5yrs of duration and very few (6%) had diabetes >15yrs. On USG scan of carotid vessels it was found that 86% had increased carotid intimal media thickness either or side of vessel. On MRI brain there was incidence of silent cerebral ischemia among 30% study subjects.Conclusion: Both CIMT and SBI showed rise in incidence with corresponds to increase in age, duration of diabetes and urine albumin level among study subjects.
Comparative evaluation of caudal tramadol and fentanyl when mixed with bupivacaine in paediatric age group
Authors: Tewari Abhinav , Singh Ajit Kumar
Published: March 2020

Background: A caudal block is commonly performed block for postoperative analgesia pediatric surgeries. Duration can be enhanced by addition drugs like fentanyl, tramadol, clonidine midazolam etc to local anesthetics helps in decreasing the requirement of postoperative analgesics. This study was conducted to assess the analgesic efficacy of tramadol or fentanyl when mixed with bupivacaine in pediatric patients for surgeries below the umbilicus.Methods: Fifty children of ASA I and ASA status, between 2 to 12 years of age, of both sexes underwent elective surgeries below umbilicus were selected and randomly divided into groups of 25 each. One Group, T (n = 25) received 0.75 ml/kg of 0.25% bupivacaine with tramadol 1mg/ kg and other Group F (n = 25) received 0.75 ml/kg of 0.25% bupivacaine with Inj fentanyl 1μg/kg. Assessment of analgesia and any side effects after caudal injection to the first administration of analgesia were recorded for both the groups in next 24 hours following objective pain scores. Duration of analgesia and requirement of additional rescue analgesics was noted.Results: The Mean duration of analgesia recorded longer in Group T (18.26±6.1 hours) as compared to Group F (10.0+/- 2.68 hrs.) and no significant haemodynamic changes or adverse effect noted between 2 groups.Conclusions: Addition of tramadol, 1mg/kg to bupivacaine 0.25% for caudal anesthesia in children undergoing surgeries below umbilicus, enhances and prolongs postoperative analgesia compared to caudal fentanyl 1μg/kg and bupivacaine 0.25% alone.
Effect of prenap coffee on daytime sleepiness in university students
Authors: Upadhyay Dishant B. , Agrawal Siddharth B. , Verma Anita , Mahajan Neeraj , Shah Nilima
Published: March 2020

Background: Daytime sleepiness impairs academic performance in college students. Napping is a counter to daytime sleepiness, but often causes sleep inertia on waking up. Caffeine absorption from beverages peaks 30 minutes after their ingestion presenting a window of opportunity to have a short nap such that the time of waking up is in synchrony with onset of action of caffeine; thereby abolishing post-nap inertia and achieving synergistic mitigation of fatigue.Objective of this study to assess effect of nap, coffee, ‘coffee and nap’ and ‘wakeful break without coffee’ on daytime sleepiness using Psychomotor Vigilance Tests (PVTs) and Karolinska Sleepiness Scale (KSS) score.Methods: After Institutional Review Board clearance, 10 subjects (aged 19-21 years) were selected using their Epworth Sleepiness Scale score (ESS >5) and called to the study site 8 times on different days to be exposed to these four conditions twice - only coffee (standardized), only nap (30min), coffee immediately followed by 30min nap, wakeful break (30min) without coffee or nap. Pre and post scores were recorded for electronic PVT (Reaction Time and Motor Responsiveness) and KSS for each attempt.Results: Test outcome was associated with intervention used (p=0.00001). ‘Nap only’ group was associated with deterioration in outcomes (p=0.00001), accounting for highest percentage (41%) of all deteriorated test outcomes. ‘Coffee only’ group was associated with improvement in test scores (p=0.00001), responsible for highest share (38.8%) of all improved test outcomes. ‘Nap only’ and ‘Coffee-nap’ group showed improvement in 11.67% and 21.67% of outcomes respectively. Conclusions: Pre-nap coffee is a proactive counter-measure to post nap sleep inertia.
Outcomes of multi drug resistant tuberculosis under programmatic conditions: the experience
Authors: Yellapu Gayatri Devi , Koyyana Preethi , Nammi Vasundhara , Dondapati Priyanka Dharshini , Boppe Priyanka
Published: March 2020

Background: Tuberculosis is the most common cause of death from an infectious disease worldwide after HIV/AIDS. Drug resistant tuberculosis continues to be a public health crisis. India stands, one among 27 “high burden” MDR countries and has over 2 million new TB cases every year and TB kill’s nearly 1000 people every day. The WHO 2018 Global Tuberculosis Report estimated that, worldwide, approximately 3.5 percent of all new TB cases and 18 percent of previously treated cases are caused by MDR or rifampicin-mono resistant strains.Methods: Presumptive drug resistance TB cases were subjected for CBNAAT or LPA to detect resistance patterns. About 231 cases of MDR/RR TB cases after pre-treatment evaluation started on CAT- IV regimen and both interim and final outcomes were analyzed.Results: Out of 231cases 172(74.4%) were males and 59(25.6%) were females with age between 13-75yrs. Total of 194 cases culture conversion occurred out of which 28 cases the cultures were reverted back to positives. Final Outcomes were, cured in 84 (36.3%) cases, treatment completed in 42 (18.18%) cases, defaulters in 31 (13.4%) cases, turned to be XDR in 10 (4.32%) cases, treatment failure in 10 (4.32%) cases, 50 (21.6%) cases died, 3(1.29%) cases were transferred out.Conclusions: Approximately 2/3rd of MDR/RR TB cases are retreatment sputum positive cases. Successful outcome observed in 54.54% of cases only. High rates of deaths and defaulters alarm the necessity of more effective implementation and surveillance of the programme.
Study of impact of transcendental meditation on reaction time and cardiovascular parameters in young healthy volunteers
Authors: Azmi Unaiza , Iyer Neeta , Azmi Tanzeem
Published: March 2020

Background: Transcendental meditation technique is purported to help treat high blood pressure, chronic pain, insomnia, and many other physical ailments. The present study was conducted to evaluate the impact of transcendental meditation on reaction time and cardiovascular parameters in young healthy volunteers.Methods: In this single centre, randomized, controlled study, 120 1st year M.B.B.S and OTPT students were recruited and put into two groups [control (60), experiment (60)]. Simple Auditory Reaction Time (ART) and Visual Reaction Time (VRT), along with Heart Rate (HR) and Blood Pressure (BP), of all subjects were recorded and compared. The experimental group participated in 16 weeks of TM programme and performed TM twice in a day, for 20 minutes, sitting comfortably with eyes closed and chanting OM. Control group were only made to sit with eyes closed during the same time. Keeping all the variables constant, all the parameters were measured again after 16 weeks.Results: There was significant reduction in all parameters (ART, VRT, HR, systolic BP and diastolic BP) in experimental group after 16 weeks of TM as compared to control group. ART was significantly shorter than VRT in both experimental and control groups and this difference was maintained after the intervention also.Conclusions: Transcendental meditation is an effective technique for reducing cardiovascular risk and can be prescribed to pre-hypertensive and hypertensive patients for stress reduction, along with medications for better results.
Approach for reporting serous effusion fluid in pleural, peritoneal and pericardial cavity and immunohistochemistry
Authors: A. Zahida O. , Upadhyaya Krishnaraj , Niaz Mohammad , Khandige Shreesha
Published: March 2020

Background: The aim of this study is to make a detailed cytological study of effusion fluids and compare with cell block study of the representative cases and IHC studies were done.Methods: Prospective study of 216 cases effusion fluids from in and around hospitals, Mangalore. This study conducted over a period of 18 months from October-2014 to April-2016. This study scrutinized and approved by Institutional Ethics Committee. The samples were processed by conventional cytology using Papanicolaou-stain and Cell Block (CB) method using 10% Alcohol-formalin fixative and stained with H and E. The cellularity, architectural patterns, morphological details were studied both smears. Ancillary immunohistochemical staining with calretinin and EMA are done.Results: A total of 216 cases of effusion fluids with cell block study were included, age range of 13 years to 93 years. Pleural fluid comprised of 55.09%, peritoneal fluid of 43.51% and pericardial fluid of 1.38%. 71% were clinically diagnosed as non-neoplastic and 29% were neoplastic condition. In CS study, 84.5% cases were benign/reactive effusion and 8.5% were positive for malignancy. In CB study, 84.5% were benign/reactive effusion and 10.2% were positive for malignancy. In comparison authors found an increase in diagnostic efficacy by 18%. IHC EMA for adenocarcinoma cells has sensitivity of 100% and calretinin for reactive mesothelial cells has specificity of 100%.Conclusions: Authors concluded that cell block technique when used as an adjuvant to routine smear examination in effusion fluids has increased the diagnostic yield and better preservation of architectural pattern. IHC is helpful in differentiating between reactive mesothelial and adenocarcinoma cells.