bluuebunny/crossref_metadata_2025 huggingface dataset:
Adaptive Neuro-Fuzzy Inference System for Waste Prediction
Authors: Haviluddin Haviluddin , Pakpahan Herman Santoso , Puspitasari Novianti , Putra Gubtha Mahendra , Hasnida Rima Yustika , Alfred Rayner
Published: May 2023

The volume of landfills that are increasingly piled up and not handled properly will have a negative impact, such as a decrease in public health. Therefore, predicting the volume of landfills with a high degree of accuracy is needed as a reference for government agencies and the community in making future policies. This study aims to analyze the accuracy of the Adaptive Neuro-Fuzzy Inference System (ANFIS) method. The prediction results' accuracy level is measured by the value of the Mean Absolute Percentage Error (MAPE). The final results of this study were obtained from the best MAPE test results. The best predictive results for the ANFIS method were obtained by MAPE of 3.36% with a data ratio of 6:1 in the North Samarinda District. The study results show that the ANFIS algorithm can be used as an alternative forecasting method.
An Accurate Real-Time Method for Face Mask Detection using CNN and SVM
Authors: Hechmi Shili
Published: May 2023

Infectious respiratory diseases, including COVID-19, pose a significant challenge to humanity and a potential threat to life due to their severity and rapid spread. Using a surgical mask is among the most significant safety precautions that can help keep this sort of pandemic from spreading, and manual monitoring of large crowds in public places for face masks is problematic. In this research, we suggest a real-time approach for face mask detection. First, we use a multi-scale deep neural network to extract features. As a result, the attributes are better suited for training the detection system. We employ SVM post-processing in the classification stage to make the face mask detection method more robust. According to the experimental findings, our strategy considerably decreased the percentage of false positives and undetected cases.
Traffic Density Prediction using IoT-based Double Exponential Smoothing
Authors: Asmara Rosa Andrie , Noprianto Noprianto , Ilmy Muhammad Ainur , Arai Kohei
Published: May 2023

The number of vehicles and currents that tend to increase causes traffic density. A system is proposed to calculate the number of vehicles and predict real-time traffic density. This research uses Haar Cascade to detect the number of cars and motorcycles and the Double Exponential Smoothing (DES) for forecasting the number of vehicles on the road. MAPE describes forecasting accuracy as a base for selecting the best smoothing constant (Alpha). The best test results from June 13 to 20, 2020, are cars on June 14, 2020 (alpha 0.5, MAPE 0%) and Motorcylecycles on June 18, 2020 (alpha 0.5, MAPE 0.1134% ). The most significant MAPE results of the car were on June 15, 2020, with alpha 0.5 and MAPE 2.1073%. The 3 minutes haar cascade detects 72.58% of cars and 81.90% of motorcycles.
Associated Patterns in Open-Ended Concept Maps within E-Learning
Authors: Prasetya Didik Dwi , Hirashima Tsukasa
Published: May 2023

A concept map is a diagram that visualizes the structure of individual cognitive knowledge. An approach to creating a concept map structure that allows users to contribute concepts and linkages that express their understanding freely is known as an "open-ended concept map." It has been demonstrated that an open-ended concept map accurately depicts student knowledge structures and reveals student differences. However, manually analyzing an open-ended map is difficult, time-consuming, and includes many propositions, especially in a big classroom. Educational data mining could be used to further process and analyze a collection of concept maps. However, many works attempted to employ data mining in order to produce concept maps structure from text documents rather than examining the knowledge representation. This study aimed to identify hidden students' knowledge representation combination patterns using association rules analysis. The dataset used in this study consisted of 27 open-concept maps created by university students. This study found interesting patterns that reveal students' knowledge in understanding the material given by the teacher.
A Variable Speed Synchronous Motor Approach for Smart Irrigation using Doubly Fed Induction Motor
Authors: Hassan Emad , S. Oshaba Ahmed , M. Osheba Dina S. , A. Shanab Mervet
Published: May 2023

Introduction— Doubly Fed Induction Motor (DFIM) is a popular machine used in variable speed drives, and its ruggedness, reliability and simplicity of speed control make it a suitable candidate for use in smart irrigation systems.
Objective— This paper studies and evaluates the performance of DFIM at different operating conditions and shows that it can be viewed as a variable speed synchronous motor.
Methodology— A mathematical model has been developed to optimize the performance of the DFIM in smart irrigation systems, taking into account the specific conditions of the application. In addition, an experimental setup was built and tested to enhance the theoretical results, which showed good correlation between the theoretical and experimental results.
Results— The research results reveal that DFIM can be used to control the flow rate of water in irrigation systems, by adjusting the speed of the motor to match the desired flow rate.
Conclusions— The results of this research demonstrate the potential of using the DFIM in smart irrigation systems to improve the performance and efficiency of irrigation and to provide better control and lower costs.
Factores agroclimáticos y de manejo que afectan la producción de leche en el municipio Catatumbo, estado Zulia, Venezuela
Authors: González Hebandreyna , Finol Hernández Lionardy José , Soto Bracho Anibal Angel , Soto Villasmil Liliana
Published: May 2023

Introducción— La producción de leche es un rasgo básico en la eficiencia de los sistemas de producción y la mejor manera de evaluar el comportamiento productivo del rebaño; esta producción tiene estrecha relación con diversos factores, entre los que destacan la raza, la alimentación, las condiciones ambientales, las instalaciones, el número de partos y, en general, el sistema de producción.
Objetivo— Describir los factores agroclimáticos y de manejo que afectan la producción de leche en una finca ganadera doble propósito.
Metodología— El estudio se desarrolló desde el paradigma positivista con enfoque cuantitativo, siendo una investigación descriptiva con diseño de campo no experimental y longitudinal. Se tomaron en cuenta registros de la producción de leche y factores agroclimáticos a través del programa ganadero y la estación meteorológica, respectivamente, disponible en la finca, y se consideró una encuesta estructurada con 57 preguntas cerradas para observar los factores de manejo llevados a cabo.
Resultados— Los registros más altos en temperatura (38°C - 39°C) corresponden en aquellos donde la producción de leche es menor (entre 13.181 l y 16.926 l). Simultáneamente, los valores de precipitación más altos, es donde la producción de leche disminuyó de una manera importante. En la unidad de producción no se le proporcionan a los animales suplementos, solo realizan pastoreo rotativo, realizando un corte después de este. El movimiento de rebaño lo hacen en todas las fases del ciclo productivo del animal; de acuerdo al peso del mismo. Asimismo, casi siempre existe rotación del personal, y las razones serían conductas inapropiadas y otras ofertas de trabajo hacia los subalternos. Por otra parte, la producción de leche mensual y el promedio de producción por lactancia se ubicó entre 64.29 l/mes y 173 l/mes; y 73.79 l/días de lactancia y 209, 86 l/días de lactancia, respectivamente. La tasa de mortalidad en becerro estuvo entre 0% y 2.88%; y en adultos de 0% a 1.29%. En cuanto al peso de crías nacidas y de becerros destetados, los promedios se ubicaron entre 26.27 kg y 35.97 kg; y 162 kg a 182 kg, equitativamente; mientras que los litros de leche por hectárea estuvieron entre 35.15 l/ha y de 90.88 l/ha.
Conclusiones— De los factores agroclimáticos evaluados, la temperatura es uno de los que mayor incide en la producción de leche; en cuanto al manejo, la suplementación en la alimentación así como también fertilizar los pastos y aumentar los días de descanso se consideran prácticas necesarias de inclusión en el manejo de la finca. También se sugiere tomar en cuenta dentro de su plan de manejo, prácticas para mitigar el estrés calórico generado en los animales y así reducir en su mínima expresión el efecto de este en la producción de leche.
El crimen desde la concepción de la antigua Roma, un juicio justo y una pena pública
Authors: Vargas Castillo María Monserrat
Published: May 2023

El presente artículo original representa una reminiscencia histórica, puesto que en muchas de las ocasiones se apertura la practicidad hacia la época actual. El diseño empleado es de análisis temático histórico de enfoque cualitativo tipo básico descriptivo. Hablar de crimen, en nuestros días, lamentablemente es uno de los temas más comunes y de principal atención para las políticas públicas; sin embargo, el quehacer frente a esta problemática también fue de especial atención en la antigua Roma. Reconocido el impacto que los romanos tuvieron al ser la base de diferentes ordenamientos jurídicos, su efecto no solo se limitaría al derecho civil o mercantil, sino que ellos tendrían una aportación trascendente en el derecho penal, denominado “derecho penal romano”.

La historia nos invita a considerar que hablar de crimen y hacer un análisis jurídico sobre la criminalidad abarca aspectos concretos como la evolución del delito y la humanización de la pena, de tal forma que en su momento marcó el devenir del ius punendi.
Plain Politics: Assessing Old Order Amish Voter Participation in the 2004, 2016, and 2020 Presidential Elections
Authors: Kopko Kyle C.
Published: May 2023

No abstract available.
Buy That Stamp! Letter Writing and Amish Research: A Personal Reflection on a Research Technique
Authors: Johnson-Weiner Karen M.
Published: May 2023

Letter writing is one method researchers can use to build on their in-person fieldwork experience. Through letters, a researcher can approach the Amish in a way that equalizes the exchange, allowing the correspondent the time and space to consider their responses. Moreover, while a visit from a non-Amish researcher interrupts daily activity, reading and writing letters remains a daily activity in the Amish world, especially among Amish women. Researchers may find that correspondence opens new areas of inquiry as Amish writers make connections to topics and subjects the researcher had not considered. By revealing deeper aspects of daily life, correspondence can force researchers to rethink their stereotypes and assumptions. Finally, the author reflects on some of the challenges of correspondence as a research method.
Eitzen, Fooling with the Amish: Amish Mafia, Entertaining Fakery, and the Evolution of Reality TV
Authors: Trollinger Susan
Published: May 2023

No abstract available.
Report on Survey of Researchers Who Study the Amish and Related Groups
Authors: Rohrbaugh Rachel Grove
Published: May 2023

No abstract available.
Tacit Tribes and Soft Allegiances in American Life
Authors: Bowman Carl Desportes
Published: May 2023

No abstract available.
Editors' Introduction
Authors: Donnermeyer Joseph F. , Nolt Steven M.
Published: May 2023

No abstract available.
Purwarupa Radio Beacon sebagai Bagian dari Sistem Intelligent Speed Assistance untuk Manajemen Lalu Lintas
Authors: Saputra Randy Erfa , Virgono Agus
Published: May 2023

Kecelakaan lalu lintas mayoritas disebabkan karena pengemudi melebihi batas kecepatan aman.  Penggunaan rambu batas kecepatan hanya akan membantu jika pengemudi patuh pada rambu yang terpasang. Untuk mengatasi permasalahan tersebut, perancangan sebuah alat yang dapat memaksa pengemudi untuk patuh pada aturan batas kecepatan dapat menjadi sebuah solusi. Alat yang dimaksud terdiri atas tiga subsistem, yaitu pemancar dan penerima radio, pengolah informasi dan pengambil keputusan, serta kendali pembatas kecepatan kendaraan. Penelitian ini difokuskan pada perancangan purwarupa pemancar dan penerima radio menggunakan Arduino dan radio RS-232 pada frekuensi 433 MHz. Hasil penelitian menunjukkan purwarupa radio dapat diimplementasikan dengan daya jangkau radio antara 7 meter sampai dengan 10 meter untuk kondisi ada halangan, dan 10 meter sampai 15 meter untuk kondisi tanpa halangan. Handoff dapat berjalan dengan baik selama berada dalam jangkauan pemancar yaitu antara 10 meter sampai dengan 12 meter, dengan jarak antar dua pemancar yaitu 20 meter sampai 25 meter.
Kinerja Pembubutan Basah pada Baja Dikeraskan Berdasarkan Permukaan Akhir Menggunakan Parameter Pemotongan yang Berbeda
Authors: Ndaruhadi Paulus Yustinus Maria Wibowo , Budi Wardoyo Toto Triantoro , Saefudin Deny Bayu , Fiqri Muhamad Zulfian
Published: May 2023

Baja yang dikeraskan banyak digunakan untuk produk dengan persyaratan tinggi, termasuk akurasi dimensi dan permukaan akhir. Proses gerinda silindris yang dinilai kurang ramah lingkungan karena penggunaan cairan pemotongan yang banyak. Proses pembubutan baja yang dikeraskan dapat sebagai substitusi proses gerinda. Tujuan studi adalah untuk mengetahui kinerja pembubutan basah dari baja yang dikeraskan berdasarkan respon permukaan akhir dan keausan pahat menggunakan parameter pemotongan yang berbeda. Beberapa percobaan pembubutan basah dilakukan pada baja AISI-O1 yang dikeraskan (± 58 HRC). Hasil penelitian menunjukkan bahwa gerak makan minimum pada semua kecepatan potong mampu menghasilkan kekasaran permukaan yang menurut ISO dikategorikan sebagai N6 dan identik dengan produk proses gerinda. Kombinasi parameter pemotongan minimum menghasilkan permukaan akhir terbaik (Ra 0,625 – 0,802 mm). Keausan tepi meningkat seiring dengan peningkatan gerak makan yang berada pada kisaran 0,037 – 0,109 mm.
A Prospective Study of Thermal Comfort in Users in Technical Institution TVET: Workshop Facilities Space
Authors: Mat Alias Noorazimah , Kassim Umar
Published: May 2023

Thermal comfort is a part of indoor environmental quality that should be considered to ensure the occupants' well-being. Unconducive buildings not only bring occupants discomfort but also tend to affect health, disrupt the process of teaching and learning, and reduce work productivity. Thus, this study determines the thermal condition of existing workshop buildings used in Technical and Vocational Education and Training (TVET) implementation. Evaluations of comfort are based on occupant surveys and environmental measurements. A total of 257 people completed a questionnaire distributed at three technical institutions in Kedah, Malaysia. According to the findings, the average thermal sensation vote is 1.85, which leads to 66.5% of respondents feeling discomfort. Meanwhile, the adaptive model analysis showed that the workshop environmental conditions were out of the comfort zone and did not comply with the ASHRAE 55 standard. Hence, the thermal discomfort factors from the occupants' perspective were identified and widely discussed. As a result, the research findings will benefit parties involved in new building construction or existing building renovations to improve indoor air quality.
Fabrication and Characterization of PVC-Based Nanofiber Membranes for Water Filtration Application
Authors: Sosiati Harini , Ramadhan Fachri , Rahman M. Budi Nur
Published: May 2023

Polyvinyl chloride (PVC) dissolved in N-dimethylacetamide (DMAC) and filled with polyvinyl pyrrolidone (PVP) has been studied for water treatment applications due to the material being hydrophobic, rigid, and biodegradable. However, it does not have antibacterial properties. The chitosan nanoparticles (CSNPs) as a natural antibacterial polymer are added into PEO/PVC blend to fabricate nanofiber membranes for well water filtration. We investigate the effects of adding PEO and CSNPs to PVC on the morphology, tensile properties, water contact angle, and water filtration efficiency of the nanofiber membranes. The PEO-PVC polymer solutions are dissolved in DMAC by varying concentrations of 0, 1, 2, 3, and 4% PEO (w/w), then fabricated to be the nanofiber membranes by the electrospinning technique. The PEO/PVC membrane’s contact angle decreases with the PEO concentration and by adding 1% CSNPs. This trend aligns with the average nanofiber diameter but is opposite to the tensile strength. The 1% CSNPs/4% PEO/PVC membrane has shown 78% and 92% efficiency in filtering Coliform and Colitinja bacteria in the well water, respectively.
Dasbor Akademik: Pendukung Data Akademik Universitas dan Pemantauan Studi Mahasiswa
Authors: Prasetyo Eko , Sari Nur Iqra , Kurnianti Aprilia
Published: May 2023

Kecerdasan bisnis diperlukan oleh manajemen puncak untuk mendukung berbagai keputusan. Data pendidikan, seperti data penerimaan, akademik, dan alumni pada institusi akademik akan semakin bertambah dari waktu ke waktu. Sehingga, proses pengumpulan, komputasi, analisis, dan visualisasi data yang sangat besar menjadi tantangan bagi manajemen puncak. Institusi akan membutuhkan pengumpulan data untuk melengkapi formulir akreditasi dengan dukungan pengaturan pengakses laporan. Data yang dikumpulkan dari berbagai aplikasi ini dapat memunculkan masalah baru, di antaranya data yang tidak lengkap dan tidak standar. Tujuan makalah ini adalah mengembangkan dasbor akademik yang berisi informasi untuk mendukung pengambilan keputusan dan menyajikan informasi penting yang berguna dalam memantau kinerja mahasiswa. Metode pengembangan dasbor akademik menggunakan Business Intelligence Roadmap yang meliputi Justification, Planning, Business Analysis, Design, Construction, dan Deployment. Pada pengembangan ini juga dibangun data warehouse yang mengintegrasikan data akademik dari berbagai sumber serta menggunakan penyimpanan data yang dinormalisasi (NDS) dan arsitektur penyimpanan data dimensional (DDS). Arsitektur menyediakan data master akademik yang disimpan di NDS. Kemudian dasbor dikembangkan menggunakan Microsoft Power BI. Hasil pengembangan memperlihatkan bahwa dasbor mampu untuk menampilkan data penting universitas dan mendukung pembuatan laporan untuk akreditasi. Selain itu juga digunakan untuk memantau kinerja mahasiswa dengan menggunakan IPK rata-rata sebagai acuan.
Differential antibody response to COVID-19 disease and COVID-19 vaccines
Authors: Senol Feray Ferda , Bahceci Ilkay , Mercantepe Filiz , Ibik Yunus Emre , Suay Timurkaan Esra , Toraman Zulal Asci , Aytac Ozlem , Oner Pinar , Senol Arzu
Published: May 2023

Background: In our study, antibody positivity was evaluated by two methods in vaccinated and unvaccinated people according to their demographic characteristics and history of COVID-19.
Methods: In this study, venous blood samples were taken from patients who were requested to have COVID-19 antibodies from our hospital's outpatient clinics between February 2022 and March 2022.
Results: There was no statistically significant difference when IgG antibody positivity was compared according to the age ranges in chemiluminescence and immunochromatographic methods. When patients were evaluated according to antibody titers, it was found that 81% of the seronegative patients were unvaccinated and had not had Covid-19, and it was found that this group was statistically significant compared to other groups.
Conclusions: It has been concluded that it will be of great importance for every country, even every region, to have a test and vaccine policy for diagnosis and follow-up in the fight against COVID-19.
Knowledge, comprehension, attitude to and practice of the five levels of prevention in child healthcare in a Nigerian teaching hospital
Authors: West Timipah P. , Tabansi Petronilla N. , Yarhere Iroro , Nkanginieme Kanu E. O.
Published: May 2023

Background: Preventive Paediatrics involves all activities geared towards protecting, promoting and maintaining the health and wellbeing of children. The aim of this study to determine the knowledge, attitude and practice of the five levels of prevention by child-care doctors at the University of Port Harcourt Teaching Hospital.
Methods: This was a descriptive cross-sectional survey using a self-administered questionnaire. Information on socio-demographics, knowledge, comprehension and attitude of the respondents towards the five levels of prevention and its utilization by the doctors at the University of Port Harcourt Teaching Hospital was sought. Data were analyzed using descriptive statistics.
Results: 295 doctors participated. 26 (8.8%) doctors had good knowledge of the five levels of prevention. As the doctors’ age increased, they were less likely to be knowledgeable about the levels of prevention (OR=0.955; 95% CI: 0.917-0.995; p-value=0.029). Doctors in Pediatrics were four times more likely to be knowledgeable about the levels of prevention than the others (OR=3.637; 95% CI: 1.496-8.844; p-value= 0.004). 287 (97.3%) doctors had good attitude towards preventive activities while practice was by 222 (75.3%). There were no significant differences across gender, age, department, designation and years of practice. Doctors with good knowledge significantly practiced more levels of prevention compared to those with poor knowledge (p=0.049, 0.024, 0.001 and 0.010 respectively).  
Conclusions: Majority of the doctors have poor knowledge of the five levels of prevention, despite having a good attitude and practice which suggests a knowledge-practice gap. Interventions to improve doctors’ knowledge are recommended.
Correlation between caries and hemoglobin level among primary school children suffering from iron deficiency anemia
Authors: Hassan Soliman Hossam Mohamed
Published: May 2023

Background: Iron deficiency anemia (IDA) is a severe health problem that affects over two billion people worldwide. Data has shown that IDA is intrinsically related to dental caries. However, few studies have been performed on their relationship. Our study aimed to assess the correlation between a caries index score and hemoglobin (Hb) level in primary school students in the age group 6-12 years.
Methods: A cross-sectional study was done. A sample of forty patients; suffering from IDA; was selected from three pediatric outpatient clinics by simple random technique and interviewed with a final questionnaire.
Results: Our findings concluded that there was a significant moderate negative correlation between caries index score and Hb level (r=-0.475, p=0.0019). There was a statistically significant Hb level mean difference between the high and low caries index groups. There was also a significant moderate negative correlation between caries index score and age, and height. Parameters predicting caries index score were identified as Hb level and frequency of sugar intake.
Conclusions: In conclusion, patients of three pediatric outpatient clinics have a significant moderate negative correlation between caries index score and Hb level and need implementation of proper dental screening and preventive programs.
Study of vitamin D level in patients with different etiologies of chronic liver disease and its correlation with Child Pugh class in a tertiary care centre in North India
Authors: Verma Ajit Kumar , Gautam Shri Krishna , Giri Richa , Singh Reena , Gupta Vishal
Published: May 2023

Background: Skeletal manifestation in liver diseases represents the minimally scrutinized part of the disease spectrum. Vitamin D has a central role in developing hepatic deficiency of osteodystrophy in patients with chronic liver disease. This study aimed to investigate vitamin D levels and their and their relationship with disease advancement in these patients according to child Pugh-score. Aims and Objectives were study of vitamin D level in patients with different aetiology of chronic liver disease and its correlation with child Pugh score.
Methods: This was a cross sectional study conducted over 200 patients after applying inclusion and exclusion criteria in patients with different etiology of chronic liver disease.
Results: In our study total (N=200), 152 patients of alcoholic liver disease 41 patients having deficient vitamin D, 79 having insufficient vitamin D level and 32 patients having normal vitamin D level. Patients of chronic liver disease also have negative correlation on vitamin D level with Child Pugh score. In our study it was found that patients having higher Child Pugh score there is more chance of having vitamin D deficiency and insufficiency than the patient’s low Child Pugh score.
Conclusions: The prevalence of vitamin d deficiency in patients with CLD was found to be having a significant correlation with increasing CTP score with p value <0.001.
Modified Rockall score: a predictor for outcome in patients presenting with upper gastrointestinal bleed
Authors: Khan Farhan , Gupta Ajesh Chandra , Giri Richa , Kumar Vinay
Published: May 2023

Background: Upper gastrointestinal bleeding (UGIB) is a life-threatening emergency with an overall mortality rate of around 10%. Complete Rockall score is designed to identify patients who are at greater risk of adverse outcome. The aim of this study was to assess the Rockall score as a predictor of adverse outcome in elderly population presenting with UGIB.
Methods: Cross-sectional observational study to be carried out in indoor patients presenting with upper GI bleed and to study the correlation between Rockall score and outcome of patients at GSVM Medical College, Kanpur during 2020-2022.
Results: Patients were grouped according to Rockall score with number of patients having score less than 3-13, 3-6-63, more than 6-18. Out of 120 cases, 56 (46.66%) had re-bleeding during hospital stay has an average score of 5.05 and rest 64 (53.33%) did not had re-bleeding and has a score of 4.11. Number of cases requiring having average score <3 has 8.1, score 3-6 has 8.38 and >6 has 9.67 has average hospital of stay (days). Number of cases requiring intensive care were 27 (22.5%) has 5.19 average Rockall score. Out of 120 studied cases, 101 (84.16%) were discharged has 4.29 and 19 (15.83%) were expired has 5.95 average Rockall score.
Conclusions: Acute UGIB is a medical emergency and Rockall score is ideal to stratify elderly patients to anticipate outcome and prognosis.
Prevalence and spectrum of rheumatological diseases in a newly formed Peripheral Medical College in Northern India
Authors: Malik Altaf Ahmed , Kelam Mohd Arif , Sharma Susheel Kumar
Published: May 2023

Background: Rheumatic disorders are chronic inflammatory and non-inflammatory disorders of the musculoskeletal system and connective tissue causing a significant socioeconomic burden resulting in immense morbidity owing to poor quality of life, loss of function and productivity.
Methods: In this prospective study, consecutive patients attending Medicine Outpatient Department at GMC Doda, between august 2019 and July 2022, were studied for various rheumatological diseases.  Rheumatological diagnoses of 3560 consecutive newly detected and returning patients were recorded for three year.
Results: During the study period, a total of 27546 patients visited the Medicine OPD, 3560 of which were diagnosed with various rheumatic diseases, yielding a prevalence of 12.9%. The mean age of the patients in the study was 42.33±13.18 years ranging from a minimum age of 18 to a maximum age of 96 years. Females were notably predominant in all diseases at 64%. Non inflammatory rheumatological disorders osteoarthritis and soft tissue rheumatism were most predominant in this study.
Conclusions: Osteoarthritis and soft tissue rheumatism were the most predominant rheumatic disorders in our study. Rheumatic diseases constitute a major disease burden in almost all of the age groups, especially in young patients (30-50 years) within our setup.
Evaluation of Mycobacterium tuberculosis by conventional methods, GeneXpert and line probe assay in cases of extrapulmonary tuberculosis
Authors: Murhar Renuka , Gajbhiye Sunita , Zodpey Sunanda Shrikhande , Lichade Shailesh
Published: May 2023

Background: Diagnosis of EPTB is often delayed due to its paucibacillary nature. Diagnostic modalities like conventional methods and molecular methods like GeneXpert are employed for Mycobacteria detection and their results are compared. Line Probe Assay is used for determination of resistance in first line and in second line anti-tubercular drugs.
Methods: In this study 302 extrapulmonary samples from suspected cases of all age groups were included. Samples were first homogenised and decontaminated and then subjected to various diagnostic modalities like microscopy, culture and GeneXpert for Mycobacteria detection. Culture and smear positive isolates were subjected to LPA for determination of drug resistance in first and second-line anti-tubercular drugs.
Results: Out of the 302 extrapulmonary samples, maximum samples were of lymph nodes (19.86%) followed by pus (17.88%). Male to female ratio was 1:3. GeneXpert detected 45.04% positive cases and 5.96% were rifampicin resistant. Positive samples detected by microscopy and culture were 21.19% and 24.17% respectively. When compared to culture, microscopy showed a sensitivity of 86.30% and specificity of 99.56%. GeneXpert reported 100% sensitivity and 72.48% specificity. LPA reported 9.45% isoniazid resistant cases, 4.05% rifampicin resistant cases and 5.40% both isoniazid and rifampicin resistant cases (MDR-TB). Out of the MDR-TB cases, 25% cases were resistant to fluoroquinolones indicating pre-XDR TB.
Conclusions: For Mycobacterium tuberculosis detection in extrapulmonary samples, multiple modalities should be employed so that the bacilli in these samples is not missed and the turn-around time is lowered which is a key to TB control strategy.
A randomized comparison between intravenous iron sucrose and oral iron in treatment of iron deficiency anemia in pregnancy at a rural health training centre of a teaching medical institution
Authors: Chavhan Swati S. , Bansode-Gokhe Seema S.
Published: May 2023

Background: Iron deficiency is a leading cause of anemia in pregnancy. The standard treatment in majority of the institutions is oral iron, with blood transfusion reserved for severe or emergency cases. However, it is unreliable in the treatment of severe anemia. The aim of this study was to compare the efficacy and safety of intravenous iron sucrose and oral iron administration for the treatment of iron deficiency anaemia in pregnancy.
Methods: Hundred women with gestational age between 30 and 34 weeks with established iron deficiency anaemia with hemoglobin between 6-8g/dL were randomized to receive either oral ferrous sulphate 200 mg thrice daily or required dose of intravenous iron sucrose 200 mg in 200 ml NS on alternate days. Hemoglobin was measured at recruitment and on 2nd week, 4th week and at 37 weeks. Adverse drug reactions were also noted in both the groups. Results were analyzed by student’s t-test and Chi-square test.
Results: Haemoglobin values varied significantly with time between the two groups at second week, 4th week and at term (p<0.005). When compared to iron sucrose group, the oral iron group had significant gastro-intestinal adverse effects.
Conclusions: Intravenous iron sucrose treated iron deficiency anaemia of pregnancy faster, and more effectively than oral iron therapy, with no serious adverse drug reactions.
Diagnostic utility of skin prick test in fungal asthma
Authors: Raut Prasanna P. , Menon Sarala , A. Joshi Ameeta
Published: May 2023

Background: Allergic bronchopulmonary mycosis (ABPM) is a clinical syndrome associated with immune sensitivity to various fungi. Aspergillus spp. predominates in colonizing the airways of asthmatics. Early and accurate identification of fungus in such cases can prevent worsening of asthma. Also, can help in retarding the progression of ABPM. Objectives of this study were to evaluate different fungal allergens associated with clinically diagnosed Asthma patients by Skin Prick testing (SPT), to study total IgE in asthmatic patients by serological testing and to characterize the fungal isolate associated with SPT+ cases by conventional mycological culture.
Methods: A prospective study of known asthma cases was done. Their sensitivity to fungal allergens was tested by SPT. The total IgE levels were measured by ELISA. Sputum collected from SPT+ cases were subjected for fungal identification.
Results: Out of 175 patients, 25 (14.2%) showed positive reaction against fungal antigens in which fungal growth was seen in 21 (84%) sputum specimens.  Aspergillus fumigatus was isolated from 16 (76%) specimens followed by Candida albicans in 3 (14%) and Penicillium spp in 2 (9.5%) cases. Out of 25 SPT+ asthmatics, 21 patients with fungal growth had total IgE levels >600 IU/ml and 4 patients with negative culture had IgE levels 400-500 IU/ml.
Conclusions: A significant prevalence of fungal asthma is seen among asthmatics. Thus, it is essential to screen asthma patients for fungal allergy. SPT seems to be a good screening test. SPT is easy to perform, less time consuming and inexpensive however needs to be performed under pulmonologist’s supervision.
Bioabsorbable screws versus metallic interference screw fixation in anterior cruciate ligament reconstruction using hamstring autograft: comparative analysis of functional outcome
Authors: Hiremath Vivekanand D. , Tegginamath Akshay , Patwegar Abdul Qadeer , Kumar C. Satish
Published: May 2023

Background: This prospective comparative study aimed to evaluate the functional outcomes of bioabsorbable screws versus titanium interference screws for anterior cruciate ligament (ACL) reconstruction using hamstring autograft.
Methods: The study included 30 patients who underwent ACL reconstruction with a quadrupled hamstring graft; 15 were fixed with titanium interference screws and 15 with bioabsorbable screws. The patients were followed up for six months post-surgery. The functional outcomes were evaluated using the Lysholm score. The data were analyzed using SPSS version 22.0.
Results: There was no significant difference in the functional outcomes between the two groups at the six-month follow-up.
Conclusions: Our study shows that there was no difference in functional outcome whether bioabsorbable or titanium interference screw was used. The success of ACL reconstruction depends on the correct technique used for the surgery, precise placement of graft and rehabilitation methods than on type of graft fixation device used, neither titanium nor bioabsorbable screws.
Study of insulin resistance as an inflammatory marker for ischemic stroke severity among non-diabetics
Authors: Nawaz Mohammed M. , Sundaramurthy Harsha , S. C. Nemichandra , Paneyala Shasthara
Published: May 2023

Background: Insulin resistance (IR) is emerging as an important modifiable risk factor causing acute ischemic stroke. The purpose of the study was to evaluate insulin resistance among patients of acute ischemic stroke, in non-diabetic patients, and to correlate insulin resistance with the severity of acute ischemic stroke, and to observe its association with traditional risk factors.
Methods: It was a prospective study conducted at JSS Medical College, Mysore, India from September 2021 to December 2022. Patients who presented with the history of stroke, who were non-diabetics and aged >18 years were included with informed consent. Ischemic stroke was diagnosed with clinical findings and by neuroimaging. Stroke severity was assessed by NIHSS score. Homeostasis model assessment (HOMA) was used to estimate insulin resistance and the levels were studied in relation to the stroke severity.
Results: A total of 127 non-diabetic ischemic stroke patients were enrolled in the study. Hyperinsulinemia, i.e. serum insulin >9 μU/mL, was observed in 44 (34.64%) patients. IR with HOMA-IR ≥2.5 was noted in 39 (30.7%) patients. NIHSS score in severity (group III) was strongly associated with serum insulin >9 μU/mL (62.1%) (P = 0.001) and HOMA-IR ≥2.5 (62.1%) (P<0.0001).
Conclusions: Screening for insulin resistance in nondiabetic patients with ischemic stroke may identify those who are at higher risk for poor outcomes, allowing for early intervention and closer monitoring. Also, interventions to reduce insulin resistance, such as lifestyle modifications or medications, may be beneficial in improving stroke outcomes.
Improvement in maternal child bonding and lactation establishment with antenatal counseling
Authors: Meshram Pallavi S. , Kania Prema , Giri Avinash B.
Published: May 2023

Background: Breastfeeding (BF) is best food source for infants to improve child health, maternal health and mother-infant bonding. We aimed to assess the effect of antenatal education in increasing the frequency and duration of breast feeding and helpful in increasing the intimacy of mother and child and further improve the maternal and fetal outcomes.
Methods: It is a prospective, randomized and interventional study held at tertiary care hospital for 18 months on 200 pregnant females. The counselled group (n=100) received one session of antenatal breastfeeding education, while the non-counselled group received routine antenatal obstetric care with no special intervention applied.
Results: It was observed that the mean age and education of the mothers in the counselled as well as non-counselled group was statistically similar. The mean ANC visits, early initiation of BF, mean BSES and exclusive BF, were significantly higher in the counselled group as compared to non-counselled group. Complications are more in non-counselled group mothers.
Conclusions: This study results demonstrate that a meaningful breastfeeding support and clinical health education can improve exclusive BF and BF self-efficacy with lowers the risk of complications.
Role of renal doppler ultrasonography in evaluating renal haemodynamics in diabetic patients and its correlation with laboratory parameters (serum HbA1C and serum creatinine)
Authors: Sharma Kritika , Thakur Madhurjya Kumar , Mahela Sangita , Konwar Ranjumoni , Varma Dixit , Ullah Ibrahim Khalil , Baishya Nirupam Konwar
Published: May 2023

Background: Due to high prevalence of Diabetes Mellitus in India, Diabetic nephropathy is on the rise. Diabetic Nephropathy is the leading cause of End stage renal disease and the major factor responsible for renal transplantation. Grey scale ultrasound can detect morphologic renal parenchymal changes late in the disease but the functional haemodynamic changes can be detected early on, by the means of doppler indices such as Resistive Index (RI) and Pulsatility Index (PI). Hence, application of renal doppler can aid in the diagnosis of early nephropathic changes to allow early medical intervention, therefore improving disease prognosis.
Methods: Renal doppler ultrasonography was performed in 64 diabetic individuals, in the main renal artery and at the interlobar arteries of both kidneys in the upper pole, interpolar region, and lower pole. RI and PI were obtained for each artery and averaged. The correlation between the Mean RI and Mean PI, each with HbA1c and serum creatinine was checked for every patient using relevant statistical tests.
Results: Mean RI and PI in study participants were above the normal range. RI and PI both showed a statistically significant positive correlation with serum creatinine, HbA1c as well as the age of the patient and duration of diabetes mellitus (p<0.001).  
Conclusions: Evaluation of renal doppler indices while correlating them with laboratory parameters can help slow disease progression. The patient can be provided with medical intervention at the early stage on detection of altered renal indices, hence reducing morbidity and mortality and significantly improving disease prognosis and outcome.
Effects of preoperative dexmedetomidine on the occurrence of postoperative delirium in adult cardiac surgery patients
Authors: Mishra Sharad Chandrika , Chowdhury Sudip
Published: May 2023

Background: Postoperative delirium (POD) is a serious complication in elderly patients undergoing cardiac surgery. This study was aimed at investigating the effect of perioperative administration of dexmedetomidine for general anesthesia maintenance on occurrence and duration of POD in elderly patients after cardiac surgery.
Methods: This randomized control trial was done in central India after the institution's ethical committee gave their approval. One hundred and sixty-four patients were enrolled after cardiac surgery. Each patient gave their written consent after being fully informed. Patients over 60 years’ old who were going to have heart surgery were included in the study.
Results: The difference in POD incidence between the dexmedetomidine and propofol groups was not statistically significant (p=0.0758). When compared to patients receiving propofol, patients receiving dexmedetomidine had a median delirium onset time that was delayed (second day vs. first day) and a shorter median delirium duration (2 days versus 3 days). Additionally, the patients receiving dexmedetomidine showed a lower VAS score and less use of opiate analgesics. Regarding other postoperative results, no difference was seen.
Conclusions: Dexmedetomidine administration during cardiac surgery decreased the incidence, postponed the onset, and shorten the duration of POD in elderly patients.
Drug utilization study of patients with dermatophytosis attending dermatology outpatient department in tertiary care teaching hospital in Central India
Authors: Badar Vandana A. , Gaikwad Parul , Pradhan Kalyani , Chavan Rachana
Published: May 2023

Background: Dermatophytosis is a common fungal infection in India, with prevalence ranging from 36.6% to 78.4%. Treatment options include topical and systemic antifungal agents such as amphotericin B, clotrimazole, miconazole, luliconazole, itraconazole, and terbinafine. With the availability of newer antifungal drugs, a drug utilization study is necessary to understand prescription patterns and promote rational use.
Methods: This is a retrospective observational study conducted among the patients attending outpatient department of dermatology of Indira Gandhi Government Medical College and Mayo Hospital. Prescription of patients with diagnosis of tinea were collected using efficient digital database. These prescriptions were then analysed depending on their demographic profile, treatment and then results were evaluated with the help of MS Excel and results presented as percentage and proportion.
Results: Total 3701 patients had tinea with 1658 females and 2043 males with majority of patients from 16 to 30 years of age. 81% medicine were prescribed using brand names with prescription containing maximum antifungal drugs followed by antihistaminic drugs. Most common drug prescribed was terbinafine (29%), followed by luliconazole (27.46%) and itraconazole (17%). Most commonly topical antifungal agents were prescribed as cream (35.80%) followed by as lotion (26.26%).
Conclusions: Drug utilisation pattern study like this is very important for studying the varying prescription pattern in treatment of dermatophytosis and to make a first step towards uniform and rational drug prescription.
Case series on herbal medication induced acute kidney injury in central India
Authors: Vinay Kumar A. V.  , Rathore Vinay , Vijayalakshmi Shanbhag
Published: May 2023

Around 60 to 70 percent of the people from India reside in rural areas and usually opt for herbal medicine for illness from local traditional medicine practitioners before seeking allopathic advice. Kidneys play a central role in excretion of the metabolites of these substances or the substances themselves. Renal injury happens in the form of acute tubular necrosis, interstitial nephritis, rhabdomyolysis, nephrolithiasis, urothelial cancers and rarely renal cortical necrosis and progressive interstitial fibrosis. Physicians and patients may ignore the potential nephrotoxicity caused by certain herbal medicines, assuming them to be harmless. Adverse event reporting is usually done on a voluntary basis, and toxicity has been reported through case reports and series. It is important for clinicians to factor in the use of herbal medicines when treating patients with unexplained acute kidney injury or progressive chronic kidney disease.  We hereby present a case series of renal injury mediated by herbal medications with different mechanism of injury to kidney. This article is first of its type reported from central India.
Difficult airway management in an ankylosing spondylitis case using video laryngoscope: a case report
Authors: Limalvin Nicholas Prathama , Kurniawan Fajar
Published: May 2023

I
Ankylosing spondylitis (AS) known as autoimmune disease with chronic inflammation within vertebral bone, characterized with bamboo spine. AS with cervical and temporomandibular joint involvement can lead to difficult airway. In this report, we present an AS patient with severe ARDS (acute respiratory distress syndrome) due to COVID-19 who was successfully intubated using video laryngoscope. A-37 years old male, came to emergency room in agitated condition, history of AS with cervical spine and temporomandibular joint involvement, history of pulmonary tuberculosis in 2008, and haven’t been vaccinated (COVID-19). This patient was diagnosed with severe ARDS due to COVID-19 with GCS 3-1-3, respiratory rate 36 times per minute, maximum peripheral saturation only 90% with Jackson Rees and pCO2 103 mmHg. These conditions are indication for endotracheal intubation. With the aid of video laryngoscope, endotracheal intubation was successfully performed. Improvements of peripheral saturation and blood gas analysis were obtained after intubation. This patient was included in the criteria for intubation due to respiratory rate over 30 times per minute and pCO2 more than 100 mmHg. Based on difficult airway predictor (MOANS, LEMON, RODS and SHORT), this patient was categorized as hard to ventilate and hard to intubate so it is necessary to prepare supraglottic airway device if intubation fails or surgical cricothyrotomy if intubation and supraglottic device fail. In difficult airway conditions, endotracheal intubation is ideally performed without muscle relaxants or awake intubation. The use of video laryngoscope is a recommended procedure in difficult airway management as in AS patient or in head and neck trauma cases. The availability of video laryngoscope in every hospital will maximize airway management in emergency room in Indonesia.
Single puncture percutaneous nephrolithotomy for large staghorn calculus: experience at a tertiary care center
Authors: Dayapule Sreedhar , Qazi Ifrah Ahmad , Tappa Mustaq Rasool  , Jain Udit , Dinesh Ravi
Published: May 2023

Percutaneous nephrolithotomy (PCNL) is recommended procedure for stones greater than 2 cm This procedure is being used commonly by all urologists worldwide. With increasing using of imaging studies, the incidence of large staghorn calculus has been consistently decreasing because most of the stones are being detected while they are still small. In this case report we are presenting a case of a large staghorn calculus of size 6.7×5.2 cm which was completely cleared by PCNL with a need for relook procedure.