bluuebunny/crossref_metadata_2025 huggingface dataset:
PAKISTANI M.PHIL. STUDENTS’ EXPERIENCES AND CHALLENGES IN USING THE ENGLISH ARTICLE SYSTEM
Authors: ,Muhammad Zeeshan Muhammad Irfan, Faria Saeed Khan
Published: July 2023

The English article system poses difficulties for English language learners, particularly those whose mother tongues or L1 do not possess the article system as in the English language. This mixed-method study aimed to measure if Pakistani M.Phil. students used the English article system correctly. Moreover, this study also explored the participants’ perspectives about the factors which caused problems for them in using the English articles correctly. To achieve these objectives, the present research adapted Miller’s (2005) instrument. Through the purposively sampling technique, data was gathered from 108 MPhil students from one of the universities in Balochistan, Pakistan. Overall, the quantitative analysis suggests that the use of correct English articles was a problem for most of the participants. The qualitative data analysis also corresponds with the results of the quantitative data as the participants acknowledged that the English article system caused difficulties for them. From participants’ perspectives, such difficulties stem from several factors including lack of reading, absence of articles in participants’ L1, government schooling background, teachers’ lack of English language proficiency, grammar-based teaching method, and learners’ least knowledgeability about the grammatical aspects of the English article system. Based on the findings of this study, pedagogical recommendations are proposed.
HUBUNGAN PERILAKU HIDUP BERSIH DAN SEHAT (PHBS) DENGAN KEJADIAN DIARE PADA PENGANGKUT SAMPAH DI LINGKUNGAN TPST PIYUNGAN BANTUL YOGYAKARTA
Authors: Nanda Sagita  , Dian Nur Adkhana Sari
Published: July 2023

Menerapkan Perilaku Hidup Bersih dan Sehat merupakan langkah ampuh untuk menangkal penyakit. Perilaku hidup bersih dan sehat harus diterapkan oleh semua orang termasuk pekerja pengumpul sampah karena pekerjapengangkut sampah selalu kontak dengan sampah. Kontak langsung dengan sampah dapat mengakibatkan kerentanan terhadap beberapa penyakit bawaan dari sampah seperti penyakit kulit dan diare. Tujuan Penelitian ini bertujuan untuk mengetahui hubungan perilaku hidup bersih dan sehat (PHBS) dengan kejadian diare pada pengangkut sampah di lingkungan TPST Piyungan Bantul Yogyakarta. Metode penelitian yang digunakan adalah non-eksperimental dengan pendekatan Cross Sectional. Teknik pengambilan sampel dengan metode total sampling. Populasi penelitian sebanyak 80 pengangkut sampah di TPST Piyungan Bantul Yogyakarta. Uji yang digunakan adalah uji Chi Square. Hasil penelitian nilai perilaku hidup bersih dan sehat (PHBS) dalam kategori baik sebanyak 69 responden (86,2%), diare mayoritas yang tidak megalami diare sebanyak 68 responden (85,0%), Nilai signifikan antara perilaku hidup bersih dan sehat (PHBS) dengan kejadian diare didapatkan 0,000 <0,05. Kesimpulan penelitianadanya hubungan perilaku hidup bersih dan sehat (PHBS) dengan kejadian diare pada pengangkut sampah dilingkungan TPST Piyungan Bantul Yogyakarta.
STANDARDISASI MUTU SIMPLISIA DAN EKSTRAK ETANOL BUNGA TELANG (Clitoria ternatea L.)
Authors: Rizki Nisfi Ramdhini
Published: July 2023

Tanaman obat merupakan jenis tanaman yang berkhasiat dapat meningkatkan sistem imun dan menyembuhkan berbagai jenis penyakit. Salah satu jenis tanaman yang dapat dijadikan obat tradisional adalah bunga telang (Clitoria ternatea L). Bunga telang sebagai bahan baku obat tradisional harus terstandar. Tujuan penelitian ini adalah untuk menentukan parameter spesifik dan non-spesifik simplisia dan ekstrak bunga telang. Berdasarkan pengamatan organoleptis menunjukkan bahwa simplisia bunga telang memiliki karakteristik bentuk kering, rasa manis, warna biru dan aroma khas sedangkan ekstrak bunga telang memiliki karakteristik bentuk kental, warna cokelat tua, tidak berasa dan aroma khas. Pengamatan mikroskopik ditemukan fragmen pengenal yaitu jaringan epidermis dan serbuk sari. Pemeriksaan pengotor asing simplisia bunga telang sebesar 1,2%. Pengujian skrining fitokimia menunjukkan terdapat senyawa flavonoid, saponin, tanin, steroid, triterpenoid, terpenoid dan alkaloid. Kadar senyawa terlarut dalam air pada ekstrak sebesar 8,5%, sedangkan kadar senyawa terlarut dalam etanol sebesar 1,1 %. Susut pengeringan yang diperoleh dari simplisia dan ekstrak bunga telang sebesar 0,8%. Bobot jenis yang diperoleh terhadap ekstrak bunga telang sebesar 1,38 g/ml. Hasil standardisasi simplisia dan ekstrak bunga telang dapat dinyatakan telah memenuhi syarat umum yang ditetapkan.
Application of Material Criminal Law Against Embezzlement in Lubuk Pakam District Court Decision Number 2697/PID.B/2021/PN LBP
Authors: Syahputra Kurnia Rezeki , . Kusbianto , Sitompul Ariman
Published: July 2023

The result of this study is the application of the material criminal law against embezzlement in the office is very important to consider the application of a firm and consistent criminal law, valid and convincing evidence, proportionate sanctions, and strict supervision of employees. The application of this law maintains public safety and prevents criminal acts from harming the public interest. Darkening is divided into ordinary and with weighting. The application of criminal law against embezzlement with weights requires elements such as the unlawful taking of objects belonging to another person in a more severe way. The aggravating elements of embezzlement are "employment relationship" and" ex officio". Article 374 of the Criminal Code does not provide for embezzlement from office, but in certain functions.

Keywords: Criminal, Law, Application.
‘Yellow’ Environment and Women as Allegorical Despoliation: A feminist Ecocritical Reading of Kaine Agary’s Yellow Yellow
Authors: Ufuoma Davies
Published: July 2023

Environmental degradation and preservation have become a topical issue in academic and non- academic discourse. African literary critics, especially Niger Delta writers have responded to the discourse by deploying their works towards exposing environmental damages in the region, and to seek intervention for the Niger Delta people. This study examines the dual aesthetics of environmental despoliation and sexual exploitation, and demonstrates the women’s responses to such anomalies. The representative novel of Kaine Agary’s Yellow Yellow is explored to discuss women’s experiences in the region, when the environment is degraded. The author utilizes the ecofeminist framework to elucidate the nexus between environmental exploitation and sexist oppression, and recommends ways to promote an egalitarian society for women, and respect for the natural environment.

Keywords: Niger Delta, sexism, ecofeminism, environment
Determination of Optimal Protein Amount in Macedonian White Brined Cheese
Authors: Borche Makarijoski
Published: July 2023

White brined cheese is a popular dairy product that is enjoyed by people all over the world. One of the key nutrients found in white cheese is protein, which plays a crucial role in maintaining the health and function of the human body. This protein is an essential nutrient that is required by the body for a range of functions, including building and repairing tissues, supporting immune function, and regulating hormone production. In this research paper the optimal protein amounts for Macedonian white brined cheese was determined. White brined cheese is Macedonian traditional product with specific taste and quality parameters. Four variants of Macedonian white brined cheese were analysed for their protein amount during ripening period of 60 days. The protein amount of white brined cheese comes primarily from casein, which is a slow-digesting protein found in milk. Casein is considered a high-quality protein, as it contains all the essential amino acids required by the body to build and repair tissues. According to the data obtained from the laboratory analyses, it was determined that the optimal range for protein amount in Macedonian white brine cheese was between 12.91±0.01% to 13.18±0.01%. Also it was determined that the protein level in analysed cheese samples were statistically significant at level p<0.05;

Keywords: white brined cheese, protein, casein, optimal amount;
The “Art of Case Taking” by Pierre Schmidt, a Book Review
Authors: Sriharitha Ambala
Published: July 2023

In Homoeopathy, the “Case taking” is one of the cardinal aspects to deal with. “A WELL TAKEN CASE IS HALF CURED”. Homoeopaths puts lot of efforts in case taking, for understanding “patient as an individual person”, to reach the similimum. Many stalwarts have given instructions regarding Homoeopathic case taking, as it is challenging to every physician. This article contains review of the book “THE ART OF CASE TAKING BY PIERRE SCHMIDT”, which deals with such directives to physicians regarding case taking.

Keywords: Case Taking, Homoeopathy, Organon, Pierre Schmidt.
Purging Gout with Homoeopathic Approach
Authors: Aarathi Reddy Tummala
Published: July 2023

Gout is an inflammatory and painful condition associated with arthritis. This is due to accumulation of uric acid crystals in and around the joint. Due to the uric acid accumulation severe pain, swelling, tenderness, redness is noted at the site of joint. Homoeopathy plays vital role in treating Cases of Gouty arthritis based on symptom similarity. Not only the severity comes down with Homoeopathy but also the frequency and gradually even the serum uric acid levels come down.

Keywords: Gout, Uric acid, Homoeopathy, Arthritis
PENGEMBANGAN BAHAN AJAR TEMATIK ORGAN GERAK HEWAN BERBASIS NILAI-NILAI KEISLAMAN KELAS V DI MI AL-AWWAL PALEMBANG
Authors: Pujiarti Eni
Published: July 2023

This research is an R&D (Research and Development) which aims to: 1) produce a thematic teaching material product for animal organs based on valid Islamic class V values, 2) produce a thematic teaching material for animal organs for animal organ based on class V Islamic values the practical one. The development procedure of this study adopted the ADDIE model. The stages are: 1) analysis, 2) design, 3) development, 4) implementation, 5) evaluation, but only carried out until the implementation stage (implementation). This study involved three experts, namely linguists, design experts, and material experts. Subjects one-on-one trials and small-scale trials are students of Va MI Al-Awwal Palembang class. Data collection instruments used observation, interviews, student questionnaire respondents, and validation sheets. The results of this study indicate that: 1) the thematic teaching materials of animal motion organs based on Islamic values ??of class V are declared valid with details of language validation obtaining an average score of 4.2 with very valid criteria, the results of design validation obtain an average score of 3, 4 with valid criteria and the results of material validation obtained an average score of 3.5 with valid criteria, 2.) students' responses to the thematic teaching materials of animal motion organs based on Islamic values ??of class V from the results of the one-on-one trial results obtained an average of an average score of 4.2 with very practical criteria and small-scale trials obtaining an average of 8.2 with very practical criteria.
RELEVANSI PERUBAHAN KURIKULUM 2013 TERHADAP KURIKULUM MERDEKA BELAJAR DI ERA DIGITAL
Authors: Waton Muhammad Nasrul
Published: July 2023

The curriculum is a very important part of the educational process, because the curriculum is the main substance in the material being taught. The Minister of Education and Culture of the Republic of Indonesia emphasized the need for changes and developments in the 2013 curriculum Besides that, the 2013 curriculum also develops information and communication technology literacy, as well as strengthening character education in character building and spiritual values. All education standards in Indonesia are formulated into the Indonesian Partnership for 21st Century Skill Standards. The author takes a study where the curriculum was made when the times were so fast with the use of technology, namely the 2013 curriculum or better known as K13 with the independent learning curriculum. The rapid changes in the Indonesian education curriculum where the 2013 curriculum has begun to be seen and can be felt has born a new system, a new curriculum that is echoed as the Independent Curriculum which has started in the 2022/2023 school year. This research uses a systematic review approach because the writing of this article is based on several references in the form of books and articles as well as scientific publications online. The 2013 curriculum is a competency and character-based curriculum that aims to increase educational attainment and is expected to produce productive, creative, innovative and effective young people. independent learning focuses on the freedom to learn independently and creatively. It is very appropriate that now a different curriculum is needed from the previous curriculum in dealing with the digital era.
A marginalização da educação de jovens e adultos e a precarização do processo de ensino e aprendizagem.
Authors:   , Maria Souza Santos Ana
Published: July 2023

A Educação de Jovens e Adultos nasceu da necessidade de interagir as experiencias de vida dos educandos com a sistematização dos conteúdos programáticos, preparando-os para atuar no mundo como cidadãos críticos, e, sobretudo livres. Partindo desse contexto, o presente estudo revela que as mediações pedagógicas desenvolvidas para esta modalidade de ensino, não tem levado em consideração, os conhecimentos e as experiencias dos sujeitos. A ausência de programas e metodologias oriundas de uma racionalidade transformadora vem sendo percebida nitidamente no ensino de Educação de Jovens e Adultos no município de Zabelê-PB, através do elevado numero de alunos evadidos e do numero de matriculas que vem diminuindo gradativamente. O trabalho estruturou-se no estudo de caso e na pesquisa participativa, na qual, o investigador realiza em comunhão com o grupo envolvido uma autoreflexão. Não obstante, aplicou-se um questionário aos professores para compreender como se constituem as praticas educativas e outro com os alunos para diagnosticar possíveis respostas em relação ao desinteresse dos alunos no processo de aprendizagem. Posteriormente, realizaram-se oficinas abordando temáticas que envolvessem elementos de suas vivencias e experiencias, ou seja, das interações sociais estabelecidas entre os sujeitos com a comunidade e com o ambiente. Concluídas as atividades, buscou-se analisar a percepção dos alunos sobre educação e a sua relação com o trabalho. Com base nos dados coletados, notou-se que as principais problemáticas estão atreladas a uma educação precarizada e descontextualizadas com a realidade local.
Economia solidária como ferramenta no ensino de linguagens e códigos do programa Projovem Campo - Saberes da Terra no município de Sumé - PB.
Authors:   , Lêla Araújo Tanielba
Published: July 2023

O programa ProJovem Campo-Saberes da Terra visa oferecer qualificação profissional e escolarização a jovens agricultores familiares de 18 a 29 anos que não concluíram o ensino fundamental, ampliando o acesso à educação desta parcela da população historicamente excluída do processo educacional. A área do conhecimento de Linguagens e Códigos procura contribuir para ampliar a compreensão das práticas sociais, funcionando como um elo entre as áreas do conhecimento e os Eixos Temáticos trabalhados no Projovem. Sendo assim, o presente trabalho tem por objetivo discorrer a respeito dos planejamentos feitos por professores da área de Linguagens e Códigos do Programa no município de Sumé-PB, tendo em vista a inserção do tema Economia Solidária como ferramenta para o ensino da supracitada área. Com isso, pretende-se verificar se os conteúdos referentes à Educação. Para tanto, foi utilizada a pesquisa qualitativa-interpretativa, tendo envolvido duas docentes do Programa Projovem Campo-Saberes da Terra, do município de Sumé-PB, tendo como objeto de análise seus planos de aulas (Módulos I e II), buscando-se verificar como os conteúdos acima referidos são introduzidos nos seus planos, bem como o impacto que causam na formação da consciência crítica dos discentes voltada para o trabalho no contexto da Economia Solidária. Observou-se que as docentes inserem a Economia Solidária no cotidiano de suas aulas, colaborando para desenvolver nos educandos um interesse pelo cooperativismo, visto que tentam aproximar os conteúdos das disciplinas às necessidades dos alunos.
Dificuldades encontradas no processo de leitura e escrita dos aluno da educação de jovens e adultos em uma escola municipal da cidade de Sumé-PB.
Authors:   , Simone Ramos Feitosa Kátia
Published: July 2023

O presente discute o tema da proficiência na habilidade de leitura e escrita entre os discentes do PROEJA da Escola Municipal de Educação Infantil e Fundamental Rodolfo Santa Cruz, localizada no município de Sumé. Dentro desse contexto, este estudo apresenta como objetivo geral analisar quais são as dificuldades que os alunos do PROEJA, das turmas de 3ª e 4ª série sentem com relação à aprendizagem de leitura e escrita. Lançamos como pergunta norteadora deste estudo a seguinte indagação: Como a professora da turma analisada utiliza métodos eficazes para aprimorar a aprendizagem de leitura e escrita com esses alunos?, Metodologicamente, o presente estudo se configura como um estudo de caso, bibliográfico, descritivo, qualitativo e com características predominantes de estudo de caso. Como resultado pode ser salientado que há um esforço admirável por parte da educadora em planejar atividades relacionadas com as experiências dos educandos, levando em consideração os conhecimentos prévios deles, daí partindo para a apreensão de outros conhecimentos. Há também uma considerável participação dos educandos nesse processo, e essa motivação colabora positivamente no ensino e na aprendizagem. Sendo assim, ficou claro também que faltam maiores incentivos e apoio da coordenação desse programa, no sentido de orientar o educador, colaborar com materiais didáticos, pois a educadora por ter pouca experiência docente, ainda necessita de um olhar técnico e pedagógico.
Concepções de estudantes que concluíram o ensino fundamental sobre a importância da estatística para compreensão do mundo atual.
Authors:   , do Nascimento Araújo Fabiana
Published: July 2023

A estatística na contemporaneidade vem se tornando cada vez mais importante para compreender o mundo que nós rodeia. Assim, o trabalho objetivou identificar as concepções de jovens que concluíram o Ensino fundamental, acerca da importância do letramento estatístico para a compreensão das questões da atualidade. A pesquisa foi desenvolvida na Escola cidadã integral professor José Gonçalves de Queiroz, com alguns estudantes do 1º ano do Ensino Médio. A coleta de dados foi realizada mediante a aplicação de um questionário semiestruturado, com 24 estudantes no qual os mesmos responderam 14 perguntas. Na metodologia foi usada a pesquisa qualitativa, cuja preocupação incide mais no processo do que no produto, com atenção especial voltada para o ponto de vista dos participantes. Foi constatado na pesquisa que os estudantes da possuem algumas concepções acerca da estatística para a compreensão das questões atuais do mundo atual, creio que eles fazem o uso no seu dia a dia muitas vezes nem sabem que estão fazendo uso dos dados estatísticos. Foi possível perceber que os estudantes possuem criticidade perante as informações estatísticas, cotidianamente veiculadas pelos os meios de comunicações, pois para eles as informações repassadas por esses meios não são confiáveis, sendo muitas dessas distorcidas e até mesmo não verdadeiras.
О вопросе языковой политики РА, осуществляемой в отношении национальных меньшинств
Authors: Ангелуш Лусине М.
Published: July 2023

Языковая политика - это комплекс мероприятий, которые направлены на сохранение языков, функциональное распределение, создание языковых норм. Языковая политика, ее принципы и их осуществление имеют прямое влияние на развитие языков и культур.В Армении проживают одиннадцать национальных меньшинств и около пятидесяти этнических групп, для которых важна проблема сохранения национальной культуры и языка. Целью данной статьи является представление языковых прав и проблем с их применением, механизмов урегулирования и мероприятий, которые направлены на сохранение языков национальных меньшинств Армении.
Լեզվական քաղաքականությունը միջոցառումների համալիր է, որն ուղղված է լեզուների պահպանմանը, գործառութային բաշխմանը կամ փոփոխմանը, լեզվական նորմերի ստեղծմանը։ Լեզվական քաղաքականությունը, դրա սկզբունքները և դրանց իրականացումն ուղղակի ազդեցություն ունեն լեզուների և մշակույթների զարգացման վրա։ Ներկայումս ՀՀ-ում բնակվում են տասնմեկ ազգային փոքրամասնություններ և շուրջ հինգ տասնյակին հասնող փոքրաթիվ էթնիկ խմբեր, որոնց համար կարևոր նշանակություն ունեն ազգային մշակույթի և լեզվի պահպանման խնդիրները: Հոդվածի նպատակն է ներկայացնել ՀՀ տարածքում ապրող ազգային փոքրամասնությունների լեզվական իրավունքները և դրանց կիրառման խնդիրները, կարգավորման մեխանիզմներն ու լեզվի պահպանմանն ուղղված միջոցառումներ։
Language policy is a set of measures aimed at preserving languages, functional distribution, and the creation of language norms. Language policy, its principles and their implementation have a direct impact on the development of languages and cultures. Eleven national minorities and about fifty ethnic groups live in Armenia, for which the problem of preserving the national culture and language is important. The purpose of this article is to present linguistic rights and problems of their application, settlement mechanisms and activities aimed at preserving the languages of the national minorities in Armenia.
Over Head: Notes on the River
Authors: Magee Paul , Collis Paul , Crawford Jen
Published: July 2023

This is the first chapter of A Book That Opens, a volume containing story-based knowledge about river management by Barkindji people in outback New South Wales, Australia. Passing on vital understandings of how better to live in such environs, the book is also intended to provide a different sort of reading experience, and indeed time, by generating a form of writing that brings orality to the fore. Specifically, the book’s 13 chapters are each improvised on the spot, taped, and then transcribed. But nothing is really made up on the spot. The rivers of story and pre-given phrasing from which everyday speech arises, in European and indigenous cultures alike, contour this chapter, a university seminar dialogue serving as prelude to our conversations some months later in Bourke and Brewarrina. What is more, those rivers bring us to speak of reading, the kind of reading one does when open to Country.
Evaluation of Therapeutic Use of Antifibrinolytics in Cats
Authors: Wahldén Lotta , Stanzani Giacomo , Cutler Simone , Barfield Dominic , Manson Katrina C. , Wilson Helen E. , Thomas Emily K.
Published: July 2023

Limited data are available regarding the use of the antifibrinolytic drugs tranexamic acid (TXA) and epsilon aminocaproic acid (EACA) in cats. This study aimed to evaluate the indications for the use of TXA and EACA in cats and to describe dosing regimens used, occurrence of adverse events, and patient outcomes. This was a retrospective multicenter study. Medical databases were searched for feline patients billed for TXA or EACA between 2015 and 2021. Thirty-five cats met the inclusion criteria; 86% received TXA and 14% received EACA. The most common indication was nontraumatic hemorrhage (54%), followed by traumatic hemorrhage (17%) and elective surgery (11%). The median dose was 10 mg/kg for TXA and 50 mg/kg for EACA. Overall, 52% of cats survived to discharge. Potential adverse events were noted in 7/35 (20%) patients. Of these, 29% survived to discharge. No standardized dosing regimen was identified; rather, dose, dosing interval, and duration of administration varied markedly between patients. Administration was potentially associated with severe adverse events, although the retrospective design makes it difficult to establish a causal association with antifibrinolytic use. This study provides a base for future prospective studies by giving an insight into the use of antifibrinolytic drugs in cats.
Subtotal Pericardiectomy and Epicardiectomy for Treatment of Septic Pericarditis and Constrictive Epicarditis in a Dog
Authors: Mastorakis Andrea Nichole , Filliquist Barbro
Published: July 2023

A 1 yr old, 1.7 kg, spayed female Chihuahua was presented for respiratory distress and an enlarged cardiac silhouette as seen on thoracic radiographs. Echocardiogram revealed pericardial effusion and cardiac tamponade. Computed tomography revealed marked pleural and pericardial effusion, thickening of the pericardium caudally, and a mass along the mediastinum. Pericardial fluid obtained via pericardiocentesis showed suppurative inflammation with mixed anaerobic bacteria isolated on culture. Subtotal pericardiectomy and partial lung lobectomy was performed to treat septic pericarditis. Postoperative echocardiogram showed increased right-sided pressures consistent with constrictive epicarditis, and 10 days after surgery, the dog was re-presented for right-sided heart failure. An epicardectomy was performed. A definitive source of infection was not identified, although a penetrating foreign body (e.g., grass awn) was suspected. The dog recovered and 10 yr follow up revealed no evidence of constrictive pathology on echocardiogram. This case report demonstrates the successful treatment of septic pericarditis and constrictive epicarditis via subtotal pericardiectomy and epicardiectomy.
Botulism in the southeast region of Brazil: an epidemiological analysis from 2007 to 2021
Authors: Benvenuto Brendo Bezerra , Carvalho Pedro Henrick Guimarães , Guimarães Matheus Procópio , Dias Tereza Cristina Batista , Lucena Renner Cassio Nunes de , Silva Tiago Lameque de Sousa e , Martins Maria Eduarda Medeiros , Almeida Fabricia dos Santos , Beserra Eric Cymon do Vale , Dantas Iury Hélder Santos
Published: July 2023

Introduction: Botulism is a rare, serious neurological disease caused by a toxin produced by Clostridium botulinum. Although rare, it has a high lethality rate, reaching up to 15%. The Southeast region of Brazil is the most populous and may have more cases. Epidemiological analysis is essential to understand its occurrence, identify risk groups, and adopt preventive measures. Objectives: To perform an epidemiological analysis of botulism in the Southeast of Brazil between 2007 and 2021, in order to evaluate its incidence, geographic and temporal distribution. Methods: Data on botulism cases in the Southeast region of Brazil were obtained from the Brazilian Ministry of Health’s Notifiable Diseases Information System (SINAN). The study included confirmed cases between 2007 and 2021 and analyzed the number of cases per year, gender, age range, and mode of transmission. Results: 41 cases of botulism were reported, with an average of 2.73 cases per year. The year 2009 presented the highest number of cases (n = 6), followed by 2007 and 2008 (n = 5 in each year). The majority of cases occurred in males (n = 29, 70.7%) and the most affected age group was 30 to 59 years old (n = 21, 51.2%). The most frequent mode of transmission was foodborne (n = 39, 95.1%). No significant correlations were found between the number of cases and gender, age range, or mode of transmission. Conclusion: Botulism in Southeast Brazil has the highest incidence in the country, with a variable temporal and geographic distribution. Foodborne transmission is the most common and predominantly affects young adult males. Health professionals must be vigilant for early diagnosis and treatment, and prevention measures must be intensified, particularly for proper food handling and storage.
Quality of life assessment in individuals with recurrent remitting multiple sclerosis at a referral center
Authors: Sousa Beatriz Silva de Jesus , Bevenuto Brendo Bezerra , Silva Tiago Lameque de Sousa e , Dias Tereza Cristina Batista , Martins Maria Eduarda Medeiros , Araujo Ana Luiza Bezerra de , Guimarães Matheus Procópio , Melo Neto Fernando de Paiva , Oliveira Bianca Etelvina Santos de
Published: July 2023

Introduction: Multiple sclerosis (MS) is a demyelinating and autoimmune disease that affects the central nervous system (CNS). It is the most common CNS disabling disease in young adults, predominantly in the 20-40 age group. Patients with MS have a compromised quality of life. The Short Form Health Survey 36 (SF-36) is the most widely used questionnaire to assess quality of life in patients with MS. Objectives: To analyze the quality of life of patients diagnosed with relapsingremitting multiple sclerosis (RRMS), in a Reference Center for Multiple Sclerosis in Paraíba. Methods: This is a cross-sectional field work of quantitative approach, of descriptive and exploratory nature. The SF-36 questionnaire was applied in April 2021, at the Reference Center for Multiple Sclerosis. At the study site, 390 patients with Multiple Sclerosis were registered. For the research to present a confidence level of 90% and an expected error of 10%, a sample of 58 patients was determined. The statistical data were made by IBM SPSS statistics. The study was approved by the Research Ethics Committee of Joao Pessoa University Center. Results: The data found in the sample are compatible with what is described in literature, reaffirming the predominance of MS for the female gender of 77%. As for the analysis of the patients’ quality of life, the domains with the most impairment were limitation by emotional aspects, followed by vitality and limitation by physical aspects. The use of Betainterferone 1a was associated with a better quality of life in six of the eight domains studied. Conclusion: Patients with RRMS have a decreased perception of Quality of Life. Other factors that affect the quality of life of these patients are gender and the use of betainterferone 1a.
Assessment of the stess score as a prognostic tool in a Latin American hospital: a retrospective cohort study
Authors: Rodrigues Bruno Cassis Antunes , Cukiert Cristine Mella , Assunção Darah Fontes da Silva , Cabral Fábio Barreto , Gagliardi Rubens José
Published: July 2023

Introduction: Status epilepticus (SE) is a neurological emergency, with variable mortality according to several factors, such as etiology, age and type of seizure. It is currently unclear whether the aggressive therapeutic approach promotes better outcomes for all patients. In this context, the clinical score “Status Epilepticus Severity Score” (STESS), which considers four factors: age, history of seizures, type of seizure and impaired level of consciousness, is a tool with the potential to identify patients with a better prognosis and prevent aggressive treatments that can cause complications and worsen the outcome. Objectives: Evaluate the use of the STESS score to predict the risk of in-hospital death in patients with status epilepticus (SE) at Santa Casa de Misericórdia de São Paulo. Methods: Forty-six patients with SE evaluated at Santa Casa de Misericórdia de São Paulo, from March to December 2022, were included. Variables associated with mortality in previous studies were evaluated, such as age, etiology and type of crisis and, mainly the STESS score. Results: Forty six patients, intra-hospital mortality was 28.3%, higher than that shown in previous studies. The STESS score showed a statistically significant relationship (P < 0.05) with the cutoffs ≤ 1, ≤ 2 and ≤ 3, but with a better sensitivity and specificity ratio with the cutoff ≤ 2, according to the receiver operating characteristic curve, justifying the use of this as the best predictor of in-hospital mortality, with a negative predictive value of 95% for death. Conclusion: STESS is a useful tool to predict intra-hospital mortality, regardless of other risk factors, with potential to guide treatment and avoid aggressive therapy and its inherent risks in patients with a good prognosis.
NfL levels significantly decrease in response to treatment with patisiran or vutrisiran in hATTR amyloidosis with polyneuropathy
Authors: Aldinc Emre , Ticau Simina , Sayegh Raphael , Polydefkis Michael , Nienhuis Hans , Karam Chafic , Ajroud-Driss Senda , Sekijima Yoshiki , Waddington-Cruz Marcia , Barnes Jennifer , Nioi Paul
Published: July 2023

Introduction: Neurofilament light chain (NfL) is a potential biomarker of disease progression and treatment response in patients with hereditary transthyretin-mediated (hATTR) amyloidosis with polyneuropathy (PN). Objectives: To analyze NfL levels in patients from the APOLLO and HELIOS-A studies to further assess its potential utility in hATTR amyloidosis. Methods: NfL plasma levels were measured at different time points in healthy controls and in a subset of patients from APOLLO or HELIOS-A. Results: NfL levels at baseline were slightly higher in APOLLO (69.4 pg/mL) than in HELIOS-A (58.2 pg/mL). In the APOLLO placebo arm, NfL increased from baseline at 4 months (+19.0 pg/mL, P < 0.001) and 18 months (+36.3 pg/ mL, P < 0.001). In the APOLLO patisiran arm, NfL decreased from baseline at 4 months (-20 pg/mL, P < 0.001) and 18 months (-23.2 pg/mL, P < 0.001). Similarly in HELIOS-A, in both patisiran and vutrisiran groups, NfL decreased from baseline at four months (-9.7 pg/mL and -11.0 pg/mL, respectively; P < 0.01). Conclusion: NfL may serve as a biomarker of treatment response as early as 4 months following initiation of patisiran or vutrisiran. The observed decreases in NfL from baseline are maintained through 18 months of treatment, in contrast to increased levels in untreated patients, making it potentially useful for monitoring disease progression and treatment response over time in hATTR amyloidosis with PN.
An uncommon neurological manifestation of acute myeloid leukemia: longitudinally extensive transverse myelitis
Authors: Stella Isabela de Almeida , Moreira Vanessa de Freitas , Coelho Arthur da Veiga Kalil , Alves Amanda de Freitas , Canzian Kássia Braga , Toloi Marcella Canato , Almeida Sephora Sabrina Candido de
Published: July 2023

Case presentation: A 68-year-old male patient presented with progressive difficulty walking over the course of two months, associated with sphincter dysfunction and weight loss of 25 kg. On examination, the patient presented fluctuation in the level of consciousness, bilateral papilla edema and asymmetric tetraparesis with crural predominance. During investigation, the magnetic resonance imaging showed areas of hypersignal in T2/FLAIR with foci of contrast uptake in the region of cerebellar peduncles and hemispheres, bulb and spinal cord of C1-C8, associated with diffuse meningeal enhancement. Cerebral spine fluid (CSF) showed 20 cells with 56% of monocytes; 61 red blood cells; 419 protein and 5 glucose. After extensive negative investigation, CSF immunophenotyping showed 92% of anomalous monocytes, associated with bone marrow study without evidence of atypical cells, the diagnosis of primary acute monocytic leukemia (AML) of the central nervous system (CNS) was made. Discussion: CNS infiltration in lymphoproliferative diseases may be present at the time of diagnosis or develop over the course of the disease, but there are few reports in the literature of CNS involvement preceding peripheral blood and bone marrow involvement. The clinical presentation can be very varied, and may even manifest as longitudinally extensive transverse myelopathy. CSF examination usually shows pleocytosis and hyperproteinorrhachia associated with hypoglycorrhachia, being a differential diagnosis of neuroinfectious diseases, and the diagnosis is usually made with the result of immunophenotyping that shows anomalous myeloid lineage. Conclusion: Primary CNS AML is a rare condition, however it should be considered as a differential diagnosis of myelopathy. This disease is diagnosed through the evaluation of CSF immunophenotyping. Therefore, one should consider performing this test in cases of myelopathy as described above.
Body fat percentage and Alzheimer’s disease biomarkers in people with mild cognitive impairment
Authors: Ribeiro Isadora Cristina , Souza Thiago Mattos Frota de , Oliveira José Igor Vasconcelos de , Uchida Marco Carlos , Rizzi Liara , Balthazar Marcio Luiz Figueredo
Published: July 2023

Introduction: Patients with mild cognitive impairment (MCI) have an unnatural cognitive loss of aging and have an increased chance of developing Alzheimer’s Disease (AD). Another factor that also increases this risk is the chronic inflammation caused by obesity, described by a body fat percentage (BF%) above healthy values. Objectives: This study aimed to investigate whether BF% in older adults with MCI correlates with AD biomarkers, such as total TAU protein and beta-amyloid. Methods: Twenty-one older adults with MCI were evaluated, 11 men and 10 women with a mean age of 66.3 (standard deviation, SD: ±5.88) years. The participants were submitted to the collection of 10 ml of cerebrospinal fluid (CSF) via lumbar puncture and evaluated regarding the dosages of CSF total TAU protein and beta-amyloid protein using immunoenzymatic ELISA kits: INNOTEST® ß-AMYLOID (1-42), INNOTESTR h TAU Ag (Innogenetics, Gent, Belgium). They were also evaluated for BF% on a bioimpedance scale (Tanita® BC-108). Kendall’s tau correlation coefficient was applied for statistical analysis using the IBM SPSS Statistics 22 Software. Results: Both men and women had an average BF% that classified them with higher BF (men: 27% (SD: ±4.23) and women: 36.7% (SD: ±4.84). We found a weak positive correlation (τ = 0.360*) between BF% and Total TAU protein concentration and between BF% and beta-amyloid protein concentration (τ = 0.341*). Conclusion: Our results provide an insight into the possible influence of BF% on concentrations of biomarkers related to neurodegeneration in elderly people at increased risk of developing AD. The higher the BF%, the higher the protein concentration that reflects neuroinflammation. Studies with more individuals with MCI and with different degrees of obesity are suggested to contribute to the investigation of the relationship between AD biomarkers and BF%.
A case study on dysarthria present in coexisting autoimmune diseases
Authors: Dias Alice Estevo , Sciarini Bruna Helena , Telles Juliana Aparecida Rhein , Ariana Ibis , Monteiro Carlos , Silva Talita Dias da
Published: July 2023

Introduction: Autoimmune diseases are characterized by immune dysfunction, autoantibody production and chronic inflammation. The aim is to describe dysarthria in a case that combines autoimmune diseases. Case report: This study reports the case of a 43-year-old woman with complaints of speech difficulties and a diagnosis of dysarthria due to Multiple Sclerosis, Sjögren’s Syndrome, Raynaud’s Phenomenon, Systemic Lupus Erythematosus and Hashimoto’s Thyroiditis. Assessments were performed using the GRBASI scale, Praat software and Voice Related Quality of Life Protocol for six years consecutive. During the period, the patient sought speech therapy support annually and reported symptoms of low and hoarse voice, slurred speech and tiredness when speaking. Negative impact on quality of life was self-reported in the presence of speech difficulties, with mean scores in the VRQOL domains: total = 75, physical = 71, and socioemotional = 82. The most frequent signs were a breathy and asthenic hoarse voice with marked instability, and reduced intensity (56 decibels), slowed speech, and imprecise articulation, characterizing mixed dysarthria. The signs and symptoms did not always occur simultaneously with the expressions of the diseases and had intermittent, heterogeneous manifestations of varying severity. Conclusion: This study shows that dysarthria affects verbal communication, family, social and professional interaction and compromises quality of life. Considering the complexity of these chronic diseases, periodic specialized speech therapy monitoring is recommended for analysis of speech subsystems, guidelines and personalized approaches.
Longitudinal extensive myelopathy (LEM): a case with investigation pitfalls
Authors: Coradine Tácio Luis Cavalcante , Guida Lucas de Oliveira Cantaruti , Yankelevich Daniel Natalio Gauss , Moreira Heloisa Lopes Cohim , Gubeissi Mariana Campos , Oliveira Enedina Maria Lobato de , Pedroso José Luiz , Barsottini Orlando Graziani Povoas
Published: July 2023

Introduction: Systemic lupus erythematosus (SLE) can affect the central nervous system, with different presentations. The aim is to describe a case of LEM and its pitfalls investigation. Literature review in the PubMed and LILACS electronic library databases. Case: A 45-year-old man presented with a history of low back pain, radiating to the lower limbs, evolving with weakness in legs and hands, episodes of falling and tingling in lower limbs. After a week, he was restricted to bed, with urinary and fecal retention. His neurological examination shown weakness in hands 4/5 and in lower limbs 0/5. Bilateral lower limbs reflexes were absent and there was hypoesthesia under the level of T12. Initial investigation showed VDRL 1/8 and positive HIV serology. Spinal cord magnetic resonance imaging revealed LEM, with central predominance. Due to his probable immunocompromised status, ganciclovir and crystalline penicillin were started empirically. Cerebrospinal fluid study revealed lymphomonocytic pleocytosis (120 cells), protein (96 mg/dl), lactate (34 mg/dL), glucose (48 mg/dL), negative VDRL and PCR for CMV, VZV, HSV and EBV. A confirmatory HIV test was negative and the complementary investigation showed FAN 1/160, undetectable complement and positive anticardiolipin, CVT and bilateral PTE, in addition to subnephrotic proteinuria. At this point, we made a diagnosis of SLE and Antiphospholipid syndrome myelopathy. Immunosuppression was started with a reduction of the myelitis and further negative VDRL. Discussion: Lupus myelopathy is characterized by inflammation and damage to the spinal cord, which can lead to a variety of symptoms. Treatment for lupus myelopathy typically involves immunosuppressants, and biologic agents. Conclusion: Lupus myelopathy is a serious complication that requires prompt diagnosis and treatment.
A467T variant of the polg gene: description of two clinical cases
Authors: Silva Ana Marina Dutra Ferreira da , Brockhausen Igor Dias , Tolentino Alessandra Lima Nogueira , Moura Ana Laura , Carvalho Alzira Alves de Siqueira
Published: July 2023

Introduction: Variations in the POLG gene are the most common causes of mitochondrial disease of autosomal inheritance, and may be present in about 2% of the population. Case report: Case 1. CMAM, male, 48-year-old, complaining of bilateral eyelid ptosis with onset in adolescence. Since the age of six, he has been diagnosed with epilepsy. After five years of follow-up, he developed sensory ataxia. After 10 years he began to present dysarthria, dysphagia, tremor and pyramidal syndrome. Case 2. ASB, female, 42 years old, at 20 years old presented generalized clonic tonic crisis during the second and third trimesters of pregnancy; at 35 years of age she complained of tingling in plants and legs; at 37 years she noticed bilateral eyelid ptosis and at 39 years she noticed the presence of slurred speech and fatigue on small efforts. He has 3 siblings with similar symptoms and great difficulty walking. No history of consanguinity. Propedeutics: Normal serum lactate and CPK dosage; muscle biopsy showed variation in the caliber of muscle fibers, with the presence of “ragged red fibers” in Gomori’s Trichrome stain. Cranial magnetic resonance imaging: mild cerebellar atrophy in patient 1 and normal in patient 2. Electroneuromyography reveled absence of sensory action potentials in all nerves studied in both cases. New generation sequencing myopathy panel revealed pathogenic variant in homozygosis in the POLG c.1399G>A gene (p.Ala467Thr). Results: The patients received the diagnosis of mitochondrial disease, presenting complex clinical phenotype. Conclusion: DNA polymerase gamma is the enzyme responsible for replicating and maintaining mitochondrial DNA, encoded by nuclear DNA. The c.1399G>A variant in exon7 causes a replacement of an alanine with threonine (A467T), and is one of the causes of ataxia, such as spinocerebellar ataxia with epilepsy; autosomal recessive mitochondrial ataxia, sensory neuropathy, dysarthria and ophthalmoparesis and myoclonic epilepsy, myopathy and sensory ataxia. However, most of the time, they present a continuum between the phenotypes described.
Impact of acute hepatic porphyria attack frequency on patient-reported outcomes: results from the Porphyria Worldwide Patient Experience Research (POWER) study
Authors: Azevedo Fernanda , Dickey Amy , Wheeden Kristen , Burrell Sue , Falchetto Rocco , Barman-Aksözen Jasmin , Bulkley Alison , Meninger Stephen , Lombardelli Stephen , Nance Danielle
Published: July 2023

Introduction: Acute hepatic porphyria (AHP), a group of rare genetic diseases, is characterized by neurovisceral attacks. Objective: This study evaluated its impact in patients with sporadic or recurrent attacks. Methods: Adult patients having >1 attack within the past two years or receiving prophylactic treatment were recruited from the United States, Italy, Spain, Australia, Mexico, and Brazil for an online survey. Patients taking givosiran were excluded. Differences between patients with sporadic attacks (annualized attack rate [AAR], <6 within past two years) and recurrent attacks (AAR, ≥6) were evaluated. Attacks included those leading to hospitalization, emergency room, outpatient doctor, or self-management. Outcomes were assessed with Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire (PHQ-8) and burden of chronic symptoms. Results: Of the 92 patients who completed the survey, 60% reported sporadic attacks and 40% recurrent attacks. Most patients were female (sporadic 92.7%; recurrent 86.5%), and the most frequent diagnosis was acute intermittent porphyria (sporadic 83.6%; recurrent 59.4%). Most patients in the sporadic (52.7%) and recurrent (67.6%) groups reported a PHQ-8 score indicating moderate to severe depression; 43.6% in the sporadic and 56.8% of recurrent groups reported a GAD-7 score indicating moderate to severe anxiety. Pain was one of the most burdensome chronic symptoms in the sporadic (50.9%) and recurrent (59.5%) groups. Most patients reported muscle weakness as a top three symptom that limited their daily activities (sporadic 83.3%; recurrent 90.6%). Conclusion: While disease burden appeared greater for AHP patients experiencing recurrent attacks, both sporadic and recurrent group patients experienced a substantial impact on physical, mental, and emotional quality of life.
Collision-free process technology for arrayed multipoint devices in coffee machines
Authors: YU Jiao , LI Chenghai , CHEN Chaoxue , SHAO Lifeng , XU Bifeng
Published: July 2023

Coffee machines have become very popular in recent years, but their lack of functionality still requires a great deal of manual maintenance, which inevitably has many hidden dangers. Coffee machines with radio frequency identification systems (RFID) are more effective in reducing losses due to manual labor, and increasing efficiency. However, collision problems in RFID systems can seriously affect the performance of the system. In this paper, we propose a specific solution to such problems by proposing a collision-free process technology for arrayed multipoint devices. And this technique is successfully applied in a coffee machine. Through design experiments, after 10,000 repeated tests, no collision error occurred. The problem of collisions in coffee machines with RFID mechanisms has been successfully solved.