bluuebunny/crossref_metadata_2025 huggingface dataset:
Eighteen-Year-Old Nulliparous Woman with Massive Mucinous Cystadenoma in Pregnancy: Case Report
Authors: Amo-Antwi K. , Agambire R. , Konney O.T. , Appiah-Kubi A. , Ankobea-Kokroe F. , Tawiah A. , Nti K.M. , Ulzen-Appiah K. , Opoku K.B.
Published: July 2023

Background: Ovarian mucinous cystadenoma is rare in adolescents. We report the diagnosis and management of a massive ovarian mucinous cystadenoma in a pregnant adolescent. Case Presentation: An 18-year-old G1PO was referred by a midwife to the Komfo Anokye Teaching Hospital on account of excessive abdominal distension at 25 weeks’ gestation and an ultrasound scan finding of a large non-septate cystic adnexal mass. She, however,reported to the hospital 6 weeks later with a complaint of worsening abdominal distension and discomfort. A transabdominal ultrasound scan revealed single intrauterine gestation and a large non-septate cystic adnexal lesion measuring more than 19 cm in its widest plane. She had a conservative in-patients management followed by emergency caesarean delivery, exploratory laparotomy and unilateral salpingo-ophorectomy at 33 weeks 1 day. The outcome of the delivery was a 1.8 kg female infant with Apgar score of 4 and 6 at 1 and 5 minutes respectively. A 6.8 kg cystic ovarian mass measuring about 40 cm at its widest diameter was removed.Conclusion: Although pregnancy-associated adnexal masses are not uncommon, significant socio-economic challenges may render the diagnosis and treatment of extremely large pelvic masses in pregnant adolescents difficult. The decision to optimize maternal and fetal outcomes is essential in managing rare conditions in marginalized obstetric populations.
Delays in Breast Cancer Treatment Schedules During the Covid-19 Pandemic and Patient Experience with Saftey Protocols: A Tertiary Hospital Experience in Ghana
Authors: Nsaful J. , Dedey F. , Ayirebi-Acquah E. , Nartey E. , Clegg-Lamptey J.N.
Published: July 2023

Objective: As at 30th September 2020 in Ghana 46,626 confirmed cases of COVID-19 with 301 related deaths had been reported. All over the world and in Ghana, elective surgeries including cancer surgeries were delayed. Korle Bu Teaching Hospital had to adjust byperforming fewer elective surgeries. The hospital also put into place COVID-19 safety protocols to protect both patients and staff. These included temperature checks, handwashing, limited number of visitors and health education at the Out-patient Departments. This study set out to evaluate how the pandemic affected access to breast cancer treatment, particularly surgery and the patients’ experience with the COVID-19 safety protocols.Methodology: This was a cross-sectional study conducted on all patients who had surgery for breast cancer during the COVID-19 pandemic, from April to September 2020. The areas assessed were OPD, chemotherapy and surgery appointments. Categoricalvariables were reported as percentages and continuous variables as mean (± SD) or median (with IQR). Descriptive analysis used to represent delays in OPD, Chemotherapy and Surgery appointments.Results: A total of 103 breast cancer surgeries were identified. Seventy-seven (74.8%) of these consented to participate in the study. This study documented 10.4% delays in OPD attendance, 24.5% delays in chemotherapy sessions and 61.0% postponement ofsurgeries with a mean waiting time to surgery of 6.4 weeks [SD 3.8]. The enforcement of the COVID-19 safety protocols and the practice of physical distancing made the majority (72.7%) feel safe.Conclusion: Healthcare capacity and planning should support the national agenda to fight the pandemic without undue delays in cancer care.
Causes Of Ascites And Its Correlation With Serum-Ascites Albumin Gradient In Patients Admitted At Medical Wards In A Tertiary Hospital In Ghana.
Authors: Duah Amoako , Agyei-Nkansah A , Duah F , Asafu-Adjaye F , Nartey YA
Published: July 2023

Objective: Ascites can be classified depending on whether it results from portal hypertension (PH) or non-portal hypertension (NPH) causes. This classification is relevant because the modes of evaluation and management are different for these two groups. Serum-ascites albumin gradient (SAAG) has been proposed in many studies to categorise ascites better than ascetic fluid total protein. This has not been determined in Ghanaian patients with ascites. The aim of this study was to determine the aetiology of ascites and to assess the performance of SAAG in the classification of portal versus non-portal hypertension ascites among patients admitted to a tertiary hospital in Ghana.

Methodology: A cross-sectional study was conducted at the Korle-Bu Teaching hospital, where 140 patients with ascites were recruited within the study period. Data on socio-demography, clinical features, and results of relevant laboratory investigations and imaging studies were collected using pretested questionnaires

Results: The mean age of patients was 44.7±13.2 years. Chronic liver disease (CLD) was the major cause of ascites in this study representing 73.57%. SAAG had a sensitivity of 91.59%, positive predictive value of 95.15% and diagnostic accuracy of 90.0% in classifying ascites as due to a PH or NPH.

Conclusion: CLD was the major cause of ascites in Ghanaian patients. SAAG has satisfactory diagnostic accuracy in differentiating ascites related to PH from NPH causes. This could be used as a first line investigation in the aetiological diagnosis of ascites for initiation of prompt treatment.
Appendiceal Base Ligation With The Hand-Made Polydioxanone (Pds) Extracorporeal Knot
Authors: Afuwape Oludolapo O , Ayandipo Omobolaji , Ulasi Batholomew
Published: July 2023

Objective: This study describes our experience with a low cost handmade polydioxanone (PDS) extracorporeal knot to reduce the cost of laparoscopic appendectomy in a surgical practice.

Methodology: This retrospective study was conducted from January 2018 to December 2019 in a general surgical unit of the University College Hospital Ibadan. The files of 20 patients with complete data for whom extracorporeal hand-made PDS’0’ knots were used for appendiceal stump closure during laparoscopic appendectomy were retrieved.

Results: The mean age was 28.4 ± 13.2 years. There were nine male and eleven female patients. All the operations were performed by the same surgical team. The mesoappendix was coagulated with bipolar cautery and cut with scissors. The appendix base was double ligated with two extracorporeal knots and divided. The mean duration of surgery was 59.2 ± 31.2minutes. The median length of hospital stay was 2days. The mean duration of follow up was 2.80 ± 0.50 months. One patient developed superficial port site infection.

Conclusion: The handmade extracorporeal knot used in this retrospective study for securing appendicular stump was found to be safe and cheaper than pre-tied extracorporeal loop. This will reduce dependency upon preformed endoloops making the procedure cheaper. There was no incidence of failed application of the handmade extracorporeal knot.
Dysmenorrhea Among University of Ghana Medical and Dental Students: Prevalence and Management Options
Authors: Hasford KE , Amponsah Seth Kwabena , Yawson AE
Published: July 2023

Objective: Dysmenorrhea or menstrual pain is a common gynaecological disorder that affects the quality of life of most women in their reproductive years. Many women resort to the use of drugs and other remedies in an attempt to relieve this menstrual pain. The aims of the current study were to determine the prevalence of dysmenorrhea among female students of the University of Ghana Medical and Dental School, and also to identify common management strategies among these students.
Methodology: This was a cross-sectional study conducted in 2020, using an online questionnaire among 170 female students in the University of Ghana Medical and Dental School. Data was coded, stored and analyzed using SPSS version 23.
Results: Prevalence of dysmenorrhea among respondents was 91%; with significant correlation between dysmenorrhea and family history, duration of bleed, onset of pain and duration of pain. Data showed that 89% of students with dysmenorrhea engaged in selfmedication. The commonest drug used by respondents with dysmenorrhea was paracetamol. A large number of the respondents who had dysmenorrhea had mood disturbances and majority also reported that dysmenorrhea affected their day-to-day (academic)activities.
Conclusion: Dysmenorrhea was found to be highly prevalent among female medical and dental students, with self-medication being the most common management strategy. Among the various drugs used in management, paracetamol was found to be commonest.
Acute Complications of Leiomyoma During Pregnancy: Report of Three (3) Cases that Required Antepartum Myomectomy
Authors: Gumanga Solomon Kwabena , Srofenyoh EK , Chawey VT , Tagoe-Reinhold C , Osei-Sarpong WN , Lartey NK
Published: July 2023

Introduction: Some women with uterine leiomyoma can experience life threatening complications during pregnancy. These leiomyomas are usually large and their associated symptoms were either neglected before the onset of the pregnancy or surgical treatment may have been rejected earlier by the patient.
Case Presentation: Three cases of antepartum myomectomy are reported in this paper. They had severe abdominal pains not responding to medical treatment with gross abdominal distention. Additionally, they had severe life-threatening symptoms including right hypochondria pain and shallow breath in case no.2 and intestinal obstruction in case no.3, an acute surgical complication which could not be resolved by conservative management. All three patients had successful antepartum myomectomy using a new flap techinique not previously described in the literature on reported cases of myomectomy during pregnancy. All the patients recovered successfully from the operation and their pregnancies continued to delivery of their babies at term by caesarean section. Cases no.1 and 2 presented in this report were managed in health facilities in Tamale, Northern Region in 2019. Case no.3 was managed in Accra at the Greater Accra Regional Hospital in 2022.
Conclusion: Pregnant women may present with life threatening complications of leiomyomas, antepartum myomectomy can be considered and successfully performed to improve quality of life or prevent maternal mortality. The procedure for the myomectomy in such situation may not be routine but a special approach is required to avoid fatal complications for both mother and foetus.
Factors Contributing to Neonatal Admissions and Outcomes at Effia Nkwanta Regional Hospital January to December 2015
Authors: Dodor Emmanuel Atsu , Ntodi Paul Kwaw , Bagina Joyce , Ofori-Gyasi Samuel , Tinkorang Emmanuel Kojo Tinkorang , Antweam Dominic , Nagai Richard Afedi Nagai , Ansah Evelyn , Ofosu Anthony
Published: July 2023

Objectives: To investigate factors contributing to neonatal admission outcomes at Effia Nkwanta Regional Hospital (ENRH)Method: All neonatal admissions to the Neonatal & Intensive Care Unit (NICU) of the hospital that were entered into the DHIMS2 database were extracted and complemented with additional information from patients’ folder review. The data from the two sourceswere merged and analysed using SPSS version 21. Univariate and multivariate regression analysis was performed to identify factors associated with admission outcomes, taking statistical significance as p < 0.05. ARC-GIS version 10.1 was used to describe the geospatial distribution of health facilities referring to ENRH.Setting: Neonatal & Intensive Care Unit of ENRH Participants: All neonates admitted to NICU between January and December 2015.Intervention: NoneResults: Nine Hundred and Ninety-Three out of the 1150 neonatal admissions were entered into DHIMS2. Fifty-two percent were males, 57.3% were delivered through Caesarean Section, 72% were admitted within 2 days of birth, and 56.8% had normal birth weight. Fifty- Eight percent of the neonates were delivered at the ENRH, whilst 39.9% were referred from health facilities located within Sekondi-Takoradi Metropolis. At 1 minute, only 14% of the neonates had normal Apgar score (8-10), and this improved to 50% at 5 minutes. The main causes of neonatal admission were birth asphyxia 21.0%, followed by prematurity 17.5%, neonatal jaundice 17.1% and neonatal sepsis 14.5%. The death rate was 18% with more than 80% of the deaths occurring during the early neonatal period. More than 80% of deaths were due to four admission diagnoses: birth asphyxia, prematurity, neonatal jaundice, neonatal sepsis. Factors associated with adverse admission outcome are: low birth weight, delivery by Caesarean Section and low Apgar score at 5 minutes.Conclusions: The institution of appropriate interventions to reduce or manage the four major causes of adverse neonatal admission outcomes will significantly reduce neonatal mortality in the hospital.
Trends In Cervical Pap Smear Cytology In A Tertiary Hospital: Implications For Cervical Cancer Screening In Low-Income Countries
Authors: Umemmuo M.U. , Oguntebi E.
Published: July 2023

Background: Screening rate for cervical cancer in Nigeria is low and not much is known about the changing trend in the premalignant stages of the disease.Objective: To evaluate the trend of epithelial cell abnormality in the Pap smear in the past 10 years.Methods: A 10-year review of cervical smear cytology (2008 -2017) at a tertiary institution in Nigeria using clinical and histopathological records. There were 5850 cervical smear cytology during the period.Results: A total of 5212 (89.1%) were analyzed. The modal age ranged from 35 to 44years. Majority 4481 (85.9%) of the smears were negative (Negative intraepithelial lesion or malignancy). Smear unsatisfactory for interpretation accounted for 398(7.6%). The prevalence of abnormal Pap smear was 6.5% (CI 5.8% - 7.1%). ASCUS -3.5%, LSIL – 2.2%, HSIL – 0.4%, malignancy – 0.3% and ASC-H –o.1%. The mean age of women with malignant smear was 51.2 ± 10.0years; compared to 42.4± 10.7 and 46.4± 13.4years for LSIL and HSIL respectively. There was moderate increase in LSIL in 2012 and 2013 with a decline in 2014. However, the rate of LSIL, in the last 4years, increased from 3.5% to 17.9% (p<0.0001). HSIL increased from 15.8% in 2013 to 21.1% in 2015 but had a sharp decline afterwards. Malignant cytology rate fluctuated over the years without a specific pattern.Conclusion: Given the increasing rate of LSIL in this setting and late commencement of cervical screening among our women, there is an urgent need to increase the awareness of the benefits of early detection of cervical cancer using Pap smear.
Near Miss: A Case Of Ruptured Rudimentary Horn Pregnancy Managed At A Tertiary Centre In Ghana
Authors: Anane-Fenin B.A.O. , Ken-Amoah S. , Agbeno E.K.
Published: July 2023

Objective: To increase awareness on the potentially lifethreatening consequence of rudimentary horn pregnancies, and to reiterate the need for elaborate obstetrics and gynaecologic ultrasound scans to enable early diagnosis. This is the second reported case of thiscondition in Ghana, and the first in our hospital in its 20 years of existence.Case Report and Interventions: A 26-year old with two previous uneventful pregnancies and vaginal deliveries presented at 33 weeks with a classical clinical picture of haemoperitoneum secondary to a spontaneous uterine rupture and a class IV haemorrhagic shock. Her antenatal records were nil of significance for risk factors for spontaneous preterm uterine rupture. She was resuscitated and had a successful laparotomy which revealed a unicornuate uterus with a ruptured noncommunicating rudimentary horn pregnancy. Sherecovered remarkably post-operatively. Though she delayed in reporting her symptoms, the prompt management with adherence to referral protocols was life-saving.Conclusion: The diagnosis of rudimentary horns can be quite challenging, but the consequences of a missed diagnosis can be life-threatening. Clinicians and sonographers need to consciously look for such anomalies in their routine gynaecologic and obstetricultrasound scans. There must also be a high index of suspicion for a ruptured rudimentary horn in a spontaneous pre-term rupture of an unscarred uterus.
A Case Report On Excoriation Disorder and Type 1 Hypersensitivity; A District Health Facility-Based Study
Authors: Asare B.A.
Published: July 2023

Excoriation disorder (ED) or psychogenic excoriation is a "repetitive and compulsive picking of skin which results in tissue damage" characterized by an obsessive-compulsive spectrum mental disorder with a repeated urge or impulse to pick at one's own skin to theextent of causing psychological or physical damage. Prevalence of this condition is unavailable in developing countries of the world. It is classified as "L98.1 Excoriation (skin-picking) Disorder" in ICD-10 and referred in some literature as "dermatillomania". ED is characterized by, but not invariably, the compulsive urge to pick, squeeze or scratch skin surfaces experienced by patients. Commonly picked parts of the body include the face (most picked), arms, legs, back, gums, neck, shoulders, scalp, abdomen, chest, the knuckles (via mouth leading to temporary disfiguration of distal and proximal joints of the middle and little fingers) and other extremities e.g. the fingernails, cuticles, and toe nails;5 skin picking may be accompanied by anxiety with depression following picking.  It is often triggered by factors that include feeling or examining irregularities on the skin, feeling anxious etc. Complications include infections, tissue damage and sepsis. Rarely, severe cases cause lifethreatening injuries. Risk of self-harm is increased by feelings of intense helplessness, guilt, shame and embarrassment.8 Studies further describe significant associations between ED and suicidal ideation, suicidal attempts and psychiatric hospitalizations.
Otoacoustic Emission Hearing Screening of Newborns In Korle-Bu Teaching Hospital, Ghana
Authors: Abdulai E.R. , Baidoo K.K. , Jangu A.A. , Searyoh K. , Ahonon Y.
Published: July 2023

Objectives: The aim of the study was to determine outcomes of new-born hearing screening and identify possible causes of hearing loss in NICU Admissions.Method: The research is a cross sectional study of new born screening conducted on all consenting consecutive new- born who are healthy and seen at the post-delivery ward, and NICU outpatient department of KBTH. Associations or differences in variables were examined using chi-squared test. P-value ≤0.05 was considered statistically significant.Results: A total of 483 babies were screened during the period. The incidence of hearing loss in the new-born was 7.2%. More than half of the new-born were 4 weeks or less weeks (n=254, 52.6%) and the rest were greater than 4 weeks (n=229, 47.4%). The mean age (±SD) of the new-born are 3.94 (±2.09) and 3.80 (±2.16) weeks in the admitted and not admitted group respectively. It was revealed that 27% of the babies were admitted at Neonatal Intensive Care Unit (NICU) because of prematurity and Macrosomia (from diabetic mothers) respectively. Among the babies that were admitted, 7 failed the OAE and 101 passed. In the not admitted group, 28 failed OAE test and the rest passed (n=347). This study revealed that, there was no statistically significant association of hearing loss between babies admitted to NICU and Non-NICU babies (p= 0.728).Conclusions: The incidence of hearing loss among the new-born was 7.2% and the main reason for NICU admission are prematurity, big baby, Birth asphyxia, neonatal jaundice, neonatal sepsis, small baby and vacuum delivery. There is no statistically significantassociation between these different group babies with hearing loss.
Multidisciplinary Teamwork In The Management Of Advanced Abdominal Pregnancy- A Case Report
Authors: Adjetey V. , Apau A.A.D. , Ashong J.
Published: July 2023

Introduction: Abdominal pregnancies are rare; often being misdiagnosed or completely missed till surgery is done. This presents a challenge in the diagnosis and management of the condition, especially in a resourceconstrained setting. A high index of suspicion istherefore required for prompt diagnosis. The objective in this report is to increase the awareness of the need for early diagnosis of abdominal pregnancy and the need for multidisciplinary planning and care for optimum management.Case Report and Interventions: A 34-year-old gravida 4 parity 2+1, presented at 41 weeks with a two-month history of abdominal pain. Thorough examination and ultrasound revealed an advanced abdominal pregnancy. At laparotomy an abdominal pregnancy with placenta attached to the omentum was noted. A live male infant was delivered with a birthweight of 3.4 kg with an APGAR score of 4 and 6 at 1 and 5 minutes respectively. The baby had a respiratory arrest a few hours after the delivery. Attempted resuscitation in the SCBU unit was unsuccessful. Mother was discharged three days later with no post-op complications.Conclusion: The occurrence of abdominal pregnancy seems to be a gradually increasing phenomenon. It is therefore imperative for clinicians to have a high index of suspicion to reduce maternal as well as perinatal morbidity and mortality associated with the condition.
Caesarean Scar Pregnancy: A Maternal Near- Miss In The Sandema District Hospital, Ghana
Authors: Titigah A.B. , Charadan A.M.S. , Gumanga S.K. , Mumuni K. , Akanbasiam N.A.
Published: July 2023

Introduction: An ectopic pregnancy located in a caesarean scar could have more catastrophic sequelae due to abnormal placentation and early invasion of the myometrium. It has a high possibility of Placenta previa and antenatal uterine rupture as the pregnancyprogresses with gestational age. It is very high risk for severe maternal morbidity and associated high maternal mortality.The case: We presented a case reporting a few weeks after missing her period to the Sandema District Hospital with bleeding per vaginum and a positive urine pregnancy test. The initial diagnosis was a threatened miscarriage with a differential of possiblecervicoisthmic pregnancy after ultrasound scan was done. She was managed conservatively as a case of threatened miscarriage to be reviewed weekly but she defaulted to review and presented four months later with hemodynamic instability after she collapsed at home at 18 weeks gestation. Laparotomy with wedge resection and reconstruction of the previous caesarean section scar was done on account of ruptured uterus and placenta percreta at 18 weeks.Conclusion: In patients with previous caesarean scar, caesarean ectopic pregnancy should also be suspected when managing them for threatened abortions even in primary care facilities of low income countries.
The First African Doctors-West Africa Medical Service of the British Army
Authors: Editor-In-Chief
Published: July 2023

The First African Doctors-West Africa Medical Service of the British Army
Implementation of Medical Rehabilitation and Social Rehabilitation for Addicts and Victims of Narcotics Abuse
Authors: Delmiati Susi , Irsal Irsal
Published: July 2023

The implementation of medical rehabilitation and social rehabilitation for addicts and victims of drug abuse by the National Narcotics Agency of Payakumbuh City is for drug addicts who are undergoing judicial proceedings can be placed in medical rehabilitation institutions and / or social rehabilitation. For addicts, both those caught and those through the IPWL program, before rehabilitation is carried out, they will first go through an assessment carried out by an integrated assessment team.  In addition to medical treatment and/or rehabilitation, healing of drug addicts can be organized by government agencies or the community through religious and traditional approaches. The obstacle faced by the Payakumbuh City National Narcotics Agency in the implementation of medical rehabilitation and social rehabilitation of addicts and victims of drug abuse is that the recommendation letter of the integrated assessment team consisting of the medical team and the legal team is only a recommendation. Rehabilitation places in each area have not been fulfilled (none). Weak coordination between law enforcement, health services and social services. Optimization of the implementation of medical rehabilitation and social rehabilitation for addicts and victims of drug abuse at the National Narcotics Agency Payakumbuh City is carried out with counseling, supervision and monitoring, carried out so that victims of narcotics abuse do not return to using narcotics under any conditions by checking periodically for 4 months after completing rehabilitation at BNNK Payakumbuh. Optimization is measured from the results of the rehabilitation and the number of people who participate in rehabilitation Rehabilitation participants then no one repeats. This shows that the implementation of rehabilitation has been optimal.
Disparity In Criminal Convictions Against Perpetrators of The Crime of Circulating Alcoholic Beverages Without a Distribution Permit
Authors: Simarmata Anthony , Faniyah Iyah
Published: July 2023

Alcoholic Beverages Supervision and Control are set out in Regulation of President Number 74 of 2013 on Alcoholic Beverages Supervision and Control. For the region in this case Padang City, it is be regulated under Regional Regulation of Padang City Number 8 of 2012 on Alcoholic Beverages Supervision, Control, and Restriction. Based on such Regional Regulation whereas any distribution of alcoholic beverages should have a permit. In this study, 2 decisions were used, the offenders distributed alcoholic beverages without any circulation permit. The case has been decided under the Decisions Number 125/Pid.Sus/2020/PN.Pdg and 245/Pid.Sus/2020/PN.Pdg respectively. There is a decision disparity under the judges’ decisions. Research problems of this study included first, How is the Criminal Decision Disparity for Criminal Offenders of Alcoholic Beverages Distribution Without Circulation Permit under Decisions Number 125/Pid.Sus/2020/PN.Pdg and Number 245/Pid.Sus/2020/PN.Pdg? Second, How the judges consider to render decisions against criminal offenders of alcoholic beverages circulation without circulation permit under the Decisions Number 125/Pid.Sus/2020/PN.Pdg and Number d245/Pid.Sus/2020/PN.Pdg? This is a descriptive analytical study. This study used a normative juridical approach by conducting a legal analysis based on evidence (in-concreto). This study used secondary data. All secondary data comprise primary, secondary, and tertiary legal materials collected from documentary study, then compiled and qualitatively analyzed, and presented in qualitative descriptive form. According to the study results, discussion, and analysis, this is concluded that first, Criminal Disparity in Decisions Number 125/Pid.Sus/2020/PN.Pdg and Number 245/Pid.Sus/2020/PN.Pdg is reflected from its similarity in article indictment rendered to the defendants within those two decisions and there is a criminal imprisonment difference rendered against  each defendant. Second, the Judges’ consideration in rendering decisions against the criminal offenders of alcoholic beverages distribution without circulation permit under the Decisions Number 125/Pid.Sus/2020/PN.Pdg and Number 245/Pid.Sus/2020/ PN.Pdg includes juridical considerations, namely in connection with article components indicted, witnesses’ information, the defendants’ evidence information, and experts’ information, as well as non-juridical considerations, namely related to the history and condition of the defendants.
25 YEARS OF THE ZONE SYSTEM IN THE USA
Authors:   R. STAHL, McIntyre J.M.
Published: July 2023

n the area of explosion protection, the publication of Article 505 in the 1996 National Electrical Code (NEC®) was seen as a giant step toward global harmonization. It allowed for the implementation of the Zone system for explosive gas atmospheres (gases, flammable liquid-produced vapors, and combustible liquid-produced vapors) in the United States to co-exist with the traditional North American Class/Division system.
Topical Antibiotic Optimization of Wijayakusuma Plant (Epiphyllum oxypetalum) as Mosquito Repellent Therapy Oil
Authors: Agus Darwanto Agus Darwanto , Rindi Kis Rindiana Subroto , Novita Novita Dian Susilowati
Published: July 2023

Wijayakusuma plants contain various active compounds that are beneficial to health, such as alkaloids, triterpenoids, and saponins. This research aims to optimize topical antibiotic products from Wijayakusuma plant that were synergized with Sambung Nyawa, Sambang Darah, Bratawali, Sambilata, and Tobacco leaves into a therapeutic oil for a mosquito repellent. The topical antibiotics were made by maceration method by soaking wijayakusuma, sambung nyawa, sambilata, bratawali, sambang getih, and tobacco leaves using VCO then tested by viscosity test, antibacterial test, phytochemical screening, antioxidant test, and efficacy test. Data were analyzed with descriptive statistics. The results showed that viscosity measurement with Oswald 20oC showed 22.56 cP. Antioxidant analysis used the % DPPH inhibition method with a sample of 50,000 ppm was 51.6%. Antibacterial activity against Bacillus subtilis (grampositive) was 18.8 mm (strong), and against Escherichia coli (gram-negative) was 10.4 mm (strong). The equivalent flavonoids as topical antibiotics contained 15.51 mg QE/ml, phenolics 8.11 mg GAE/ml, and tannins 11.30 mg TAE/ml. Mosquitoes stumbled and flew away when exposed to this topical antibiotic. This topical antibiotic has good antioxidant content for body care, antibacterial and aromatherapy that repels mosquitoes, and is suitable for external massage oil treatment.
Rancang Bangun Sistem Informasi Approval Dismentling NTE Telkom Akses dengan Metode RAD (Rapid Application Development)
Authors: Simanungkalit Aditya Pratama , Putri Nadya Andhika , Tasril Virdyra
Published: July 2023

This study aims to develop a web-based Information System for Approval Dismentling NTE using the RAD (Rapid Application Development) method at PT Telkom Akses. The system design process is carried out using DFD (Data Flow Diagram) to determine the necessary design steps. The system development involves programming languages such as PHP, HTML, JavaScript, and CSS, along with a SQL database for data storage. The RAD method is utilized in the design phase, which consists of three main steps: planning, design, and implementation. The research findings indicate that the web-based Information System for Approval Dismentling NTE has no significant impact on the performance of asset monitoring at PT Telkom Akses. Despite PT Telkom Akses having its own Approval system application, there are still several shortcomings, including an unattractive interface. This study contributes to the development of a web-based Information System for Approval Dismentling NTE using the RAD method. The implementation of this system is expected to enhance the efficiency and effectiveness of the NTE dismentling approval process at PT.Telkom Akses. Improvements that can be made to the system include refining the interface to make it more appealing and addressing other existing deficiencies.
Implementasi Model Pembelajaran Inquiry Training Berbasis Modul Digital Dalam Mempengaruhi Hasil Belajar Siswa
Authors: Indra Muhammad , Bahri Syaiful
Published: July 2023

The research method used in this study is a quantitative method with a quasi-experimental design, and the sampling technique employed is Stratified Random Sampling. The research sample consists of students from class X TKRO-1 as the experimental group and class X TKRO-2 as the control group, with 32 students in each group. The experimental group received treatment in the form of inquiry training-based learning using digital modules, while the control group underwent conventional learning. The research instrument used in this study was a multiple-choice test consisting of 20 items with 5 answer choices. The results of the study showed that the average score of the experimental group was 81.09, while the average score of the control group was 70.63. Significance testing with a significance level of α 0.05 (5%) indicated that the obtained t-test value was significant (2-tailed), which was 0.00, with the students' learning outcomes being less than 0.05. Therefore, Ha was accepted, indicating a significant difference in mathematical ability between students who applied the inquiry training learning model and those who applied the conventional learning model
Climate Change and Environmental Security in Bangladesh
Authors: Ahmed Toufik , Islam Mafiqul
Published: July 2023

Climate change is a major non-traditional Security (NTS) issue that poses a massive threat to global environmental security. Climate change is still occurring, manifested in rising temperatures, increased river, and coastal flooding and erosion, rising sea levels, increasing salinity, and more frequent, severe weather events. It is evident that men and women are affected differently by the environmental consequences of climate change. Women become more vulnerable to climate change impacts and environmental disasters. The paper aims to show the interrelationship of climate change, environmental security, and gender in Bangladesh. Moreover, the paper examines the impacts of climate change in environmental security from the gender perspective exploring the condition of women during disasters and their vulnerabilities under climate change scenarios in Bangladesh. Secondary data have been used and analyzed to identify the overall condition of women during hazardous situations in Bangladesh. Available data reveal that a number of climate-induced hazards are already affecting many women especially in the coastal zone, low-lying areas, and northwest part of the country. The paper finds that climate change has disproportionate impacts on women in Bangladesh affecting their food security, water security, health security, economic livelihood as well as internal migration. Finally, the paper provides policy recommendations dealing with the gender-differentiated climate change vulnerabilities experienced by Bangladesh.
CONTAMINANT IDENTIFICATION IN WATER BY MICROBIAL BIOSENSORS –
Authors: Zaheer Mushal , Sumia Urainab
Published: July 2023

The various micro-organisms are used to identify contaminated water. By the help of biosensors,

drinking water pollution can be estimated. Rising environmental pollution is badly affecting water.

Drinking contaminated water causes serious diseases in human beings as well as in animals.

Microorganism in contaminated water can spread serious diseases. Biosensors are genetically

modified to identify the occurrence of heavy metals, chemicals and toxins in contaminated water.

Different microbes are used as biosensors such as Escherichia coli, Algae, Fungi and Clostridium

etc. All these biosensors help to detect water pollution by different ways. For example, algae can

detect water contamination by fluorescence during photosynthesis. Most rural areas are being

affected by contaminated water. Most of the people living in rural areas are being affected by the

polluted water as clean water is not available in these areas. People living in rural areas use water

that looks clear but contains micro-pathogens that can cause dangerous diseases. Biosensors are

important for identifying contamination, Due biosensor, can easily deduct pollution. Water is very

important for the survival. Drinking contaminated water can cause serious illness. Therefore, clean

water is very important.

Keywords: Microbial Biosensors; Water Pollution
Budget Impact Analysis for Proton Beam Therapy in adult population in Poland
Authors: RUDŹ RADOSŁAW , MOĆKO PAWEŁ , SIWIEC JACEK , PEŁECH PATRYCJA
Published: July 2023

Objective: The use of proton beam therapy (PBT) increases in the treatment of some cancers, especially in the critical organs. Contrary to traditional radiotherapy, protons limit the radiation of healthy tissues. Due to high cost of treatment and limited options, decisions to treat adults with PBT must be based on relative value compared to the current standard of care. The purpose of this publication is to assess the budgetary impact of using PBT in 8 selected oncology indications in Poland. Methods: The budget impact analysis (BIA) was carried out in a 3-year time horizon. The ‘new’ scenario presents the estimated costs of PBT in adult population while the ‘existing’ scenario includes only other forms of radiotherapy – IMRT and stereotactic radiotherapy. Cost data reflect the estimated costs incurred by the public payer (NHF) in providing health benefits. Sources of data were: epidemiological data, opinions of clinical experts, scientific evidence and NHF data. Results: Total incremental cost of the base case with PBT was about €34.6 million (€10.4 million, €11.5 million. and €12.7 million in each year of analysis). In comparison to ‘existing’ scenario cost increased approximately 2.75 times (total costs from €19.8 million to €54.4 million, cost per patient from €5,543 to €15,265). Sensitivity analysis revealed that total incremental costs in the minimum scenario were over 20% lower than in base case, while the cost in maximum scenario was similar to base case. Conclusion: The expected costs of PBT in adult cancer patients in Poland significantly exceed the costs of treatment with IMRT and stereotactic radiotherapy. Keywords: proton beam therapy, PBT, budget impact analysis, BIA, economic analysis, pharmacoeconomic analysis
Quantum Game—Research on “PQ” Problem
Authors: Wei LI  , Xiaoken Yang  , Yong-Chang Huang  ,   Institute of Theoretical Physics, Beijing University of Technology, Beijing 100022, P. R. China
Published: July 2023

This paper reviews the coin flipping problem of PQ in a classical two-player game, and shows that when one player adopts quantum strategy, he can beat his classical opponent and gain higher returns. By means of quantitative means, the whole PQ problem is put in a more general and fair condition, and it is generalized and studied again from many aspects and angles. Finally, we get some more essential and important conclusions, and through some examples to explain the conclusions and its practical significances. At the same time, this paper gives the definitions of imperfect fair games and perfect fair games, revises the quantum coin flipping game to make the game fair, and studies a multi-round version of quantum coin flipping. Some basic conclusions of fair quantum game are obtained, and the meaning of perfectly fair game is explained in practice.
How nearby nutrients shape tumor growth
Authors: Kalaany Nada
Published: July 2023

Studying the nutrient composition immediately surrounding pancreatic cancer cells provides new insights into their metabolic properties and how they can evade the immune system to promote disease progression.
Dossier Rondônia
Authors: Bins Bruno , Favero Marcos
Published: July 2023

Con el 80% de su área original deforestada, ocupando el segundo lugar en el ranking de conflictos agrarios del país, Rondônia, estado considerado un gran “laboratorio territorial”, se encuentra al borde de una catarsis. Realidad que moviliza esta investigación: una (re)interpretación de este territorio metamórfico, que tiene como punto de partida la investigación de Hervé Théry, “Rondônia: Mutações de um Território Federal na Amazônia Brasileira”, que analiza la producción y uso del territorio de Rondônia en la década de 1970. Itinerario marcado, en nuestros días, por la emergencia de protociudades, al parecer el dispositivo espacio-temporal más reciente y nebuloso, configurando el frente más avanzado de lo que se caracteriza, según Bertha Becker en “Geopolítica da Amazônia”, como una selva urbanizada.
Prospective Study Evaluating the Association between Time since Scorpion Bite and Spinal Anaesthesia Outcomes
Authors: Gautam Archana , Tripathi Manoj , Gupta Vandana , Gautam Sandeep , Rai Sujeet , Malviya Deepak
Published: July 2023

Introduction: The drug mainly used in Spinal Anaesthesia (SA) is Local Anaesthetic (LA) agents. It acts via sodium channel by reversibly inhibiting the nerve transmission. Scorpion venom causes mutation in receptors of sodium channel that leads to LA resistance which results in failed SA. Although, there are few studies and many case reports, which shows direct association of scorpion bite with failed SA, but association of duration since, scorpion bite on outcome of spinal anaesthesia is still not known. Aim: To evaluate the association between time since scorpion bite and multiple bites, an outcome of SA on patients posted for elective lower abdominal and lower limb orthopaedic surgeries. Materials and Methods: This monocentric, prospective, single blind observational study was conducted in the Department of Anaesthesia at Rajarshi Dashrath Autonomous State Medical College (RDASMC), Ayodhya, Uttar Pradesh, India. The duration of the study was two years, from December 2019 to December 2021. A total of 33 patients of either gender or age, between 18-70 years were taken and divided them into three groups of 11 each. Groups were divided on the basis of history of duration since scorpion bite/sting. Group A included patients with history of scorpion bite being less than eight months, group B from eight-14 months and group C more than 14 months. SA was provided with 15 mg 0.5% hyperbaric bupivacaine. The pin prick method and Bromage scale were used to detect the onst of sensory (T1), onset of motor (T2), peak of sensory (T3) and peak of motor block (T4). General Anaesthesia (GA) was given if the SA was found inadequate or failed. The mean±Standard Deviation (SD), Student’s t-test and Chi-square test were used for statistical analysis of data. Results: The mean age of the study participants of group A was 49.27 years, group B was 50.27 years and group C was 52.18 years. Demographically, all the three groups were comparable. The authors have found that, block failed completely in group A. There was statistically significant increase of T1, T2, T3 and T4 in group B than group C (p<0.05). Statistically significant difference were not found between single scorpion bite and multiple scorpion bite in group B and group C in terms of SA characteristics T1, T2, T3 and T4 (p>0.05). Conclusion: The present study concludes that, the duration of scorpion bite is a significant factor on the effect of SA in terms of sensory and motor block, but number of stings does not determine the sensory and motor characteristics of SA. The SA should not be given if, the history of scorpion bite is recent (less than eight months).
Knowledge and Attitudes of Parents Regarding Digit Sucking Habit in Children in Pune: A Questionnaire-based Cross-Sectional Study
Authors: Khan Haniya Ali , Mathur Aditi , Nair Sneha M , Shetty Samiksha
Published: July 2023

Introduction: Digit sucking is a most common oral fixation observed in children, which involves placement of thumb or fingers into the mouth. Knowledge of the risk factors for the presence of this habit helps to provide a better understanding of the phenomena and is of great significance to the establishment of preventive measures, which can avoid the damage caused by the persistence of these habits. Aim: To evaluate the knowledge and attitude of parents of children aged between 3-6 years regarding digit sucking habit. Materials and Methods: A cross-sectional study was carried out in the Department of Paediatric and Preventive Dentistry, belonging to urban and semiurban area of Pune, Maharashtra, India from December 2020 to May 2021. A total of 310 parents of children, aged between 3-6 years were included. A closeended questionnaire was administered to parents to assess their knowledge and attitude regarding digit sucking habit in children. Completely filled questionnaires were considered for result synthesis. The data obtained was tabulated and descriptive data were statistically analysed using software International Business Machines (IBM) Statistical Package for the Social Sciences (SPSS) version 21.0. Results: Although 229 (73.9%) of parents agreed that for achieving good oral health prevention of digit sucking habit is essential, but 197 (63.5%) parents were unaware of the predisposing factors for digit sucking habit. A total of 195 (62.9%) parents did not agree that inadequate parental attention may lead to thumb sucking habit. A total of 197 (63.5%) parents agreed that prolonged digit sucking can cause misaligned teeth but majority of the parents 205 (66.1%) and 166 (53.5%) disagreed on its effects on facial growth and speech respectively. A total of 219 (70.6%) parents did not receive any scientific information or counselling from healthcare worker regarding sucking habit. A total of 299 (96.5%) of parents agreed that guidance from healthcare workers is needed regarding oral habits in children. Conclusion: Present study concluded that the attitude towards learning about digit sucking habit was good the knowledge of the study participants was poor.
Risk Stratification of COVID-19 Patients based on Proposed Simple Clinical Parameters Score: A Retrospective Observational Study
Authors: Rai Niket , Chandel Satish , Shetty Manu Kumar , Rai Geeta Katheit , Khanna Shreshth , Jain Kunal
Published: July 2023

Introduction: India has impacted severely by multiple waves of Coronavirus Disease-2019 (COVID-19) and still struggling with limitation of resources to cater such a huge population. Available triage methods to treat COVID-19 are either too complex to use or time-consuming. A triage score, that should be independent of any laboratory investigations and exclusively based on clinical parameters was required, so that the healthcare provider at the first contact can segregate patients on the basis of intensity of care required to save, as many lives as, possible. Simple Clinical Parameters (SCIP) score may be a useful tool for fast triage of patients at the point of care and can help to screen patients, who will benefit from early hospitalisation, from those, who can be managed as outpatients. Aim: To validate the usefulness of SCIP score in triage of COVID-19. Materials and Methods: This single-centre, retrospective, observational study was conducted at a Tertiary Care Hospital. The duration of the study was six months, from Nov 2021 to May 2022. A total of 945 patients were involved in the present study. SCIP score was formulated using basic clinical parameters like Pulse Rate (PR), Respiratory Rate (RR), and arterial oxygen saturation at room air (SpO2 ). The risk score ranges from 1 to 10. The lower the score, more severe the disease and hence, more intense care is warranted. All the parameters required for calculating the SCIP score are continuous variables, expressed in mean±Standard Deviation (SD) and categorical data of patients in specific levels of care are represented as proportions. Data was collected and analysed using Microsoft Excel 2007 and the Python statistics module. Results: The mean age of the study participants was 49.7±16.5 years. A total 945 patients were included in the study, out of which 552 (58.4%) were males and 393 (41.6%) were females. In more than half patients, the LOC predicted by the proposed SCIP score, matched the actual Level of Care (LOC) received. The mean scores were within the proposed score ranges. SCIP score was 97% sensitive in detecting the patients, who can be managed at Outpatient Department (OPD) and 99% specific in detecting those, who did not require intensive treatment at Intensive Care Unit (ICU). SCIP score showed the need for ICU with 92% accuracy and the patients, who can be treated at OPD, without requiring hospitalisation with 90% accuracy. Conclusion: SCIP scoring system based on routine clinical parameters, is helpful in early detection of severity of the disease and in making a fast decision to predict the LOC required. A score based on clinical parameters ensures the availability of a fast and simple triage method to ensure optimal utilisation of available resources and help healthcare provider to make quick decisions.