bluuebunny/crossref_metadata_2025 huggingface dataset:
Surgical management of choledocholithiasis: a single institutional experience
Authors: Annareddy Dinakar Reddy , Thota Anuroop
Published: January 2022

Background: Choledocholithiasis is the 2nd most common complication of gallbladder stone disease and its incidence increases with age. There are different modalities of treatment ranging from endoscopic techniques to open and minimally invasive surgery. However, the single best modality has remained a point of major speculation. This study was undertaken to evaluate various modalities of surgical treatments undertaken at our institute.Methods: A retrospective analysis of all the patients who underwent surgery for common bile duct stones during the study period was done. The parameters analyzed were epidemiological data, clinical parameters, surgical details and any complications.Results: A total of 50 patients were included in the study with a M:F ratio of 1:1. The most common presenting complaint was pain abdomen and the majority, were post ERCP failure cases. The common cause for failure was multiple or impacted stones. Majority of the patients underwent an open surgery and a drainage procedure in the form of choledochoduodenostomy was added. Laparoscopic exploration showed advantage in form of shorter hospital stay, early return to activity. There were no instances of retained or missed stones and the complications were limited to wound complications.Conclusions: In the era of advanced endoscopy, surgery still holds an eminent place in the management of choledocholithiasis. With growing expertise, the complication and clearance rates are better than endoscopy. Laparoscopic exploration can be the single best treatment for patients with both cholelithiasis and choledocholithiasis.
Enteric perforation with peritonitis
Authors: Meghwal Sohan Lal , Maida M. L. , Kharadi Arjun Lal , Pargi Mayur Kumar
Published: January 2022

Background: Typhoid fever, also known as enteric fever, is a systemic infection by Salmonella typhi or by the related but less virulent Salmonella paratyphi. Patient with perforation present with sign and symptoms of peritonitis complains of pain abdomen along with distension abdomen, obstipation and vomiting. Enteric perforation in managed surgically. Aims and objective: To study various epidemiological factors in relation with enteric perforation with peritonitis and to compare the outcomes of various procedures of enteric perforation with peritonitis.Methods: The present study was performed on 50 patients of enteric perforation with peritonitis admitted in various surgical wards of RNT medical college hospital, Udaipur. Those patients who underwent conservative treatment or drainage under local anesthesia were not included in this study.Results: Enteric perforation was more common in young males, maximum cases were in 3rd decade followed by 2nd and 4th. Male:female ratio was 1:77:1. Most common symptoms were acute pain abdomen and fever. Constipation (60%) abdominal distension (40%) and vomiting (52%) were other predominate complains. Simple repair of perforation was done in 25 patients. Repair was done in double layer (inner layer) by continuous vicryl and outer by interrupted silk. Mortality was 14%, almost equal irrespective to procedure chosen for management of enteric perforation peritonitis.Conclusions: To deal with enteric perforation(s) operative procedure has to be decided to greater caution taking into consideration patient’s general condition, gut condition, number and site of perforation and contamination of peritoneal cavity.
Intravesical prostatic protrusion and prostate volume in patients with acute urine retention
Authors: Galeti Ershad Hussain , Rasool Mustaq , Bharali Mriganka Deuri
Published: January 2022

Background: To study the prevalence of significant Intravesical Prostatic Protrusion (IPP) in patients presenting with acute urinary retention (AUR) due to Benign prostatic hyperplasia (BPH) and to study the correlation between intravesical prostatic protrusion and prostatic volume.Methods: We assessed 68 men between the ages 45 to 85 who presented with acute urinary retention. Initial assessment included detailed clinical history, International Prostate Symptom Score (IPSS) and Quality of Life assessments and a transabdominal ultrasonogram to measure Prostate Volume (PV) and Intravesical Prostatic Protrusion (IPP). The degree of IPP was determined by the distance from the tip of the protrusion to the circumference of the bladder at the base of the prostate gland. Patients with IPP >10 mm were taken have significant IPP and those ≤10 mm was taken to be insignificant. Statistical analysis included descriptive analysis and Pearson’s correlation coefficient.Results: Of the 68 patients in our study with resented with AUR, 29 patients (42.9%) had significant IPP. Mean IPP was 9.81mm with a standard deviation of 5.41 mm. All patients with significant IPP had a severe IPPS grade. IPP had a statistically significant correlation with prostatic volume.Conclusions: The IPP as assessed by transabdominal ultrasound can be used to direct appropriate patients to more aggressive treatment strategies like surgery.
Clinicopathological study and management of salivary gland neoplasms in a tertiary care hospital
Authors: Bommareddy Ratta Reddy , Gogineni Raghuveer Chakravarthy , Adusumalli Ramya Sai , Mallavarapu David , Dunga Swetha
Published: January 2022

Background: Salivary gland neoplasms are rare and constitute 3 to 4% of head and neck neoplasms. Majority of them are benign and a small percentage of them constitute malignant tumors. A careful clinical examination and judicious investigations help us to plan for an optimal surgical management. The aim of the study was to study clinico-epidemiological pattern, histological subtypes, management & postoperative complications of salivary gland neoplasms.Methods: This retrospective study was conducted on 52 patients admitted into the surgical wards of DR. PSIMS and RF during the period between November 2017 and October 2020. All the patients were followed up until one year (October 2021) after surgery.Results: Data of 52 cases of salivary gland neoplasms were recorded, of which 20 were male and 32 were female, and the median age group was 41 to 50 years. Majority of the patients (47) presented with swelling in the parotid region of 1 to 2 years duration. 44 patients were diagnosed with pleomorphic adenoma of the parotid gland and 43 of them underwent superficial parotidectomy.Conclusions: The parotid gland is the most commonly involved gland with the majority of the cases being pleomorphic adenoma. Superficial parotidectomy was the most common surgery done with a minimal complication rate.
Epidemiology and management of ventral hernia in a tertiary health care centre- a prospective observational study
Authors: Gaur Sourabh , Sharma Dharamanjai K.
Published: January 2022

Background: Ventral hernias are a common problem confronting surgeons. Data about standards of their surgical management have failed to keep pace with rapid advances in surgical techniques, and materials. Older techniques have often been discarded simply because of availability of newer ones without due consideration to availability, feasibility, training, local conditions and constraints. Therefore, a balanced, practical and pragmatic opinion regarding surgical management at individual, institutional and regional levels is needed. We studied clinical aspects and best treatment modalities of ventral hernias in our set-up.Methods: This is a prospective observational study of various types of ventral hernias, surgically managed at a tertiary care hospital between January 2018 and September 2019.Results: Mean age of presentation among 71 patients (27 males, 44 females) was 48.11±5.71 years. Incisional hernias (30.98%) were the commonest type. Painless swelling (49.29%) was the most common clinical presentation. Obesity (40.84%) and multiparity (30.98%) were the most common associated risk factors. Incisional hernias are probably better managed by open approach.Conclusions: Ventral hernias are more prevalent in the elderly and females. Incisional, umbilical, epigastric hernias are the more common types. Laparoscopy is being preferred over open procedure due to some advantages that it offers, but incisional hernias can often be better managed by open approach depending upon local set up. In addition, laparoscopic approach is not universally applicable and also has certain drawbacks.
Evaluation of preoperative predictive factors that determine difficult laparoscopic interval appendectomy
Authors: Dogra Varun , Mushtaq Umer , Gilkar Ishfaq Ahmed , Peer Javid Ahmad
Published: January 2022

Background: Appendicitis is one of the most widely recognised causes of acute abdominal pain. A wide range of treatment from medical management using antibiotics to a minimal invasive surgery can be done for appendicitis. The usual classical open approach of appendectomy is time tested treatment. However laparoscopic appendectomy is being increasingly preferred these days over classical open approach in majority of patients suffering from appendicitis. This study was undertaken to evaluate preoperative data that can serve as predictors of difficult laparoscopic appendectomy and help in planning of surgery.Methods: This was a prospective observational study that was done at department of surgery, government medical college, Srinagar for a period of three years. A total of 50 consecutive patients who underwent laparoscopic interval appendectomy were enrolled in this study. Various preoperative factors such as age, gender, body mass index, history of recurrent episodes, history of previous surgery, ultrasonographic findings and a few investigation results were studied to find their association with the difficulty in performing laparoscopic appendectomy and results were tabulated and analysed.Results: This study found a significant relation between body mass index, history of previous surgery, history of multiple episodes, C reactive proteins and difficulty in doing a laparoscopic interval appendectomy. However, we didn’t find any significant relationship between age, gender, ultrasonographic findings, serum bilirubin, transaminase levels, WBC counts and difficult laparoscopic interval appendectomy.Conclusions: Knowledge of these positive factors for difficult laparoscopic appendectomy could help surgeons during pre-operative assessment and take necessary precautions during laparoscopic appendectomy.
Urinary amylase levels in the diagnosis of acute pancreatitis: a prospective case control study
Authors: Judal Hiren , Ganatra Vasant , Choudhary Prema Ram
Published: January 2022

Background: Serum amylase has a short biological half-life and returns to normal levels within short time. Thus it’s quite conflicting in the diagnosis of acute pancreatitis, particularly in patients with mild acute pancreatitis. Therefore, present study investigates the urinary amylase levels in the diagnosis of acute pancreatitis.Methods: The present prospective study was conducted on 100 patients, 50 with acute pancreatitis and 50 normal subjects in the departments of General Surgery and our surgical hospital. All patients were examined by clinically, biochemical and radiological investigations and diagnosed acute pancreatitis. Serum amylase levels, serum lipase levels and urinary amylase levels were estimated in both groups: cases and controls. The sensitivity and specificity of serum amylase, serum lipase and urinary amylase levels were established after comparing their values in cases and controls.Results: The preponderance of the patients was aged between 21 and 50 years. Increase the serum amylase, lipase and urinary amylase mean values of patients with acute pancreatitis were observed statistically significant (p<0.001). Serum amylase had the highest sensitivity (100%) and serum lipase had the highest specificity (96.53%). The sensitivity and specificity of urinary amylase was found to be 97.25% and 91.47% respectively. On ROC curve analysis, the area under the curve for serum amylase, serum lipase and urinary amylase was found to be 0.845, 0.945 and 0.934.Conclusions: We conclude that urinary amylase is a convenient and a more sensitive test for diagnosis of acute pancreatitis.
A prospective study on the correlation between clinical outcome and residual prostatic adenoma weight ratio after transurethral resection of the prostate for benign prostatic hyperplasia
Authors: Rana Y. P. S. , Swami Yogesh K.
Published: January 2022

Background: Transurethral resection of the prostate (TURP) has been the most common surgical method for relieving symptoms of benign prostatic hyperplasia (BPH). However, there is no consent regarding the amount of tissue resected during TURP and it’s persuading on ruling of symptoms. Therefore the aim of the present study was to assess the correlation between clinical outcome and residual prostatic adenoma weight ratio after transurethral resection of the prostate for benign prostatic hyperplasia.Methods: A total of 70 patients presenting with obstructive/irritative lower urinary tract symptoms were evaluated for pre and post TURP values of prostatic weight, international prostate symptoms score (IPSS), postvoid residual volume (PVR), maximum flow rate (Q-max) and total prostate volume (TPV). Residual prostatic weight ratio (RPWR) was recorded in each case using transrectal ultrasound.Results: The effectiveness of TURP was 71.42%. On appraisal of the patients for IPSS, PVR, Q-max and TPV; the difference between pre-operative and post-operative values of these parameters was found to be statistically significant p<0.001. RPWR was found to be significantly lower (p<0.001) in patients who received valuable treatment. A strong linear correlation was found between total prostate and transition zone volumes in all groups.Conclusions: Values of IPSS, PVR, Q-max, TPV and operative parameters such as RPWR and residual prostatic weight are important parameters for the prediction of treatment outcome.
Pilonidal sinus and use of Limberg flap: a three years’ experience from two tertiary care centres of Northern India
Authors: Dogra Varun , Mushtaq Umer , Gilkar Ishfaq Ahmed , Peer Javid Ahmad
Published: January 2022

Background: Pilonidal sinus is a common chronic inflammatory anorectal condition that arises usually in the natal cleft of the sacrococcygeal region. This disease leads to deterioration not only in professional life of young adults but in their personal life as well. The Limberg flap reconstruction is a frequently used procedure in pilonidal sinus. This aim of this study was to observe the usefulness of Limberg flap technique in treatment of pilonidal sinus in our setup.Methods: This study enrolled a total of 50 patients who underwent Limberg flap surgery for sacrococcygeal pilonidal sinus over a period of 6 years in two different tertiary care hospitals of northern India. Various factors were studied in this study which included age group, gender, operative time, length of hospital stay, post-operative complications, recurrence and time required for return to normal work and activities. All the data was tabulated and analysed.Results: In this study we found that the maximum number of patients were young males in their third decade of life who presented with complaints of discharging sinus, pain and infection. The Limberg flap technique was used in these patients which showed a good outcome as far as complication rates and recurrence rates were concerned. Also return to work in these patients was quite early when compared with other methods in literature.Conclusions: In this study, we can conclude that this procedure is relatively easy to perform with a shorter learning curve, fewer complication rates, faster healing and is associated with a shorter hospital stay.
Surgical management of fracture odontoid type II by anterior screw fixation: an institutional experience
Authors: Modha Prakash
Published: January 2022

Fractures of the odontoid process (the dens) of the axis account for 10-20% of acute cervical spine fractures. Recent advances in intra-operative imaging including neuron avigation and O-arm can now increase accuracy and lower morbidity of odontoid screw placement. The present study was done in the department of surgery, in the medical college and associated hospital. During study period, total of 22 patients with type II fracture of odontoid were included in the study. All operations were done with the same technique of Cloward anterior approach using cannulated single lag screw. In the majority of patients, the follow up has been for 2 years and in 3 cases the follow up has been for one year. At the time of presentation, the major complains of the patient included in the study was of pain in neck area.  The 14 patients were discharged to home on third postoperative day with Philadelphia neck collar, 6 patients with weakness stayed in hospital one week on physiotherapy and 2 patients were in ICU for three days post-operative due to associated lung contusion. Follow up CT after 1.5 and 3 months show well alignment with good fusion with no signs of mal union or pseudo arthrosis and patients were followed up for six months. Anterior screw fixation is a good technique to practice. It achieves good outcome and good fusion in young generation with horizontal fracture line.
A rare presentation of ruptured amoebic liver abscess with caecal perforation - a case series
Authors: Kopperundevi V. , G. Vimala , Vyshnavi Y. Sai , R. Kannan
Published: January 2022

A rare complication of simultaneous rupture of liver abscess with caecal perforation occurs mainly in malnourished patients and carries a high mortality rate. In invasive amoebiasis, the trophozoites penetrate the intestinal mucosal layer causing amoebic colitis which is carried along the portal circulation to produce liver abscess that is more prone to rupture in cases of immunocompromised status. Here we report 4 cases of ruptured liver abscess associated with caecal gangrene which were operated at our institute. All 4 patients were male who were chronic alcoholics and presented with ruptured amoebic liver abscess and simultaneous perforation of caecum that was identified on exploratory laparotomy. The different approaches to surgical management of these patients is discussed, wherein early identification and timely intervention remain as mainstay of treatment in all cases.
Multimodal management of Fournier’s gangrene with subsequent wound closure techniques
Authors: V. Vijayalakshmi , Girieasen M. Sabari , S. Deepika , R. Kannan , Kumar M. S. Kalyan
Published: January 2022

Fournier’s gangrene (FG) is a fulminant and lethal condition usually occurring in the immunocompromised, first described in 1883 by the French dermatologist Jean Alfred Fournier. It is a form of necrotizing fasciitis of the perineal, genitourinary and perianal regions mostly in males with a mortality of nearly 20-50%. It is a surgical emergency and requires early diagnosis aided by scores such as laboratory risk indicator for necrotising fasciitis (LRINEC) and FG severity index (FGSI), extensive debridement combined with supportive procedures to manage associated complications and broad-spectrum antibiotics. Management of FG thus required a multimodal approach and emphasis on reconstruction after recovery in patients who survive was crucial to improving the quality of life in these patients. Here we were presenting 7 cases of FG successfully managed at our institution, grouped under the four methods by which wound closure was achieved: fecal diversion and split skin grafting of scrotum, urinary diversion and penoscrotal split skin grafting, delayed primary closure (with and without orchidectomy) and wound healing by secondary intention.
Thirty-three-year-old textiloma found during exploratory laparotomy: a case report
Authors: Velázquez José Miguel Huerta , Gómez Carlos Octavio García
Published: January 2022

The problem caused by a retained surgical sponge is known as a textiloma. Surgical gauze pads can be easily retained due to their ubiquitous use, their relatively small size, and when soaked in blood, making them difficult to distinguish from surrounding tissues. In most cases, the diagnosis of a textiloma is usually given in the following days of a surgical intervention, but there are few cases reported in the literature where a textiloma persists for a variable number of years. A 63-year-old female with a surgical history of a caesarean section 33 year ago complaining of an abdominal palpable mass and chronic abdominal pain. CT scan findings suggested the diagnosis of textiloma, the exploratory laparotomy revealed an encapsulated mass which was completely excised, and intraoperative study confirmed the diagnosis of textiloma. Textilomas occur infrequently and can be a source of great concern to the surgeon and the patient. Foreign bodies within body cavities and organs can present with several nonspecific clinical features that can make diagnosis difficult. An aseptic fibrotic reaction causes that the textilomas can remain asymptomatic for many years, with very few cases of 30 or more years old textilomas reported in the literature. Surgical removal remains as the treatment of choice. Textiloma can be a life-threatening problem that is an avoidable complication. Textilomas should be part of the differential diagnosis of abdominal tumors even after a 30-year surgical history.
Acute calculous cholecystitis complicated by a large anterior abdominal wall abscess
Authors: Bordo Zanis , Berzina Arta , Zeiza Kaspars
Published: January 2022

We present a 74-year-old male patient with a rare case of acute calculous cholecystitis that was complicated by formation of a large anterior abdominal wall abscess due to neglection. The primary management consisted of antibiotic therapy and two consequent procedures of abscess drainage. Cholecystectomy was postponed due to the massive volume of the abscess which posed a great risk for complications if the patient were to be operated on at that point, therefore an elective open cholecystectomy was performed 3 months later. This case is a good example for the management of such a rare and interesting complication.
A rare case of colonic lipoma causing colo-colonic intussusecption
Authors: Nair Akhil S. , Hemachandran Sneha , P. Santosh
Published: January 2022

Gastrointestinal tract (GIT) lipomas are rare, benign mesenchymal neoplasm affecting all segments of the GIT and colon is affected most frequently. Reported incidence of colonic lipomas varies from 0.2% to 4.4%. Adult intussusception represents 1% of all bowel obstructions and 5% of all bowel intussuceptions. Gastrointestinal lipomas are rare benign tumors and intussusception due to a gastrointestinal lipoma constitute an infrequent clinical entity. Although intussusception is a common disease in children, intussusception caused by colonic lipoma in adults is a rare condition, and is usually caused by a large pedunculated lipoma. The majority are asymptomatic but may cause abdominal pain, obstruction or bleeding. The treatment for symptomatic or large lipomas is surgical excision. We would like to report a unique case of an elderly lady with colonic lipoma causing colo-colonic intussusception. After thorough investigations, exploratory laparotomy with colo-colonic anastomosis was done.
Case report on post COVID-19 penile gangrene
Authors: Sharma Devashish , Mishra Shirish , Chaurasia Dilip
Published: January 2022

SARS-CoV-2, a β-coronavirus, is a highly contagious respiratory pathogen that causes a disease. Penile Gangrene may be a rare manifestation in the post COVID-19 infection period in a non-vasculopathic patient. There may be an association with component of coagulopathy seen in COVID-19 patients. This case report describes a case with gangrene of penis in a young boy with concurrent COVID-19 infection. Clinical evaluation, investigation diagnostic workup and management of the patient was done in a routine basis. It was found that acute onset pain and blackening of his penis which developed after COVID-19 related symptoms in absence of any other identifiable cause. Unfortunately, the patient lost the involved body part and sustained a permanent disability. Early identification of such a morbid and disabling condition can help in preventing further spread of infection and may also prevent loss of organ or body part.
Diffuse hemangiolymphangioma of small bowel-rare cause of obscure gastrointestinal bleeding
Authors: Rengasamy Sudhagar , Devakumar Murugesan Satish , Amudhan Anbalagan , Kamalakannan R. , Thangasamy Selvaraj , Sathyanesan Jeswanth
Published: January 2022

Hemangiolymphangioma (HL) is a rare benign tumor, commonly present in pediatric age group that involves the head and neck. Small bowel HL has been reported as solitary or segmental involvement. Here we report a case of diffuse small bowel HL, presented as chronic anemia, fatigability and obscure gastrointestinal (GI) bleeding. A 42-year male presented with 15 years history of bleeding per rectum, anemia, and fatigability, received multiple blood transfusions. The exact cause could not be identified. His complete hemogram parameters were low requiring further imaging studies. Imaging and intraoperative enteroscopy showed multiple nodular lesions in mesentry as well as in the mucosa of the entire small bowel. Bleeding points were noted in a proximal jejunal lesion which was resected. Histopathological study confirmed as benign HL. HL are rare tumors of gastrointestinal tract. To the best of our knowledge diffuse HL of the small bowel have not been reported in the medical literature. With this case scenario, one should consider these tumors in the differential diagnosis of obscure lower GI bleed and chronic anemia, as well as explore definitive management options for these benign symptomatic tumors.
A laparoscopic resection of mucocele appendix in COVID time:a case report
Authors: Tanwar Himanshu , Chawla Subhash , Biswas Prakash , Sharma Shivam
Published: January 2022

We present a case of 62 year old female presented with complaints of pain right lower abdomen. Contrast enhanced computed tomography (CECT) abdomen showed appendicular lesion likely mucocele appendix. Diagnostic laparoscopy and proceed was planned. Intraoperatively there was no pathological condition found at the base of appendix and there were no lymph nodes enlarged so laparoscopic appendectomy was done carefully and specimen was retrieved in endo bag. Appendiceal mucocele is a rare disease and has a clinical picture that may resemble acute appendicitis. Mucocele of the appendix can also mimic an adnexal mass due to its nonspecific symptoms and prove to be a diagnostic challenge. A correct diagnosis before surgery is very important for the selection of surgical technique. Ultrasonography (USG) and CECT abdomen, should be used extensively for this purpose. Laparoscopic surgery provides the advantage of good exposure with more rapid recovery and a better cosmetic outcome provided that there should be no intraperitoneal spillage.
Role of Ayurveda in the management of Vatashthila W. S. R. to benign prostatic hyperplasia: a review study
Authors: Gujjarwar Shriniwas , . Shalu
Published: January 2022

In Ayurvedic texts vatashthila [i.e.; benign prostatic hyperplasia (BPH)] is a one of major urinary disorder described in mutraghata (i.e.; decreased urine flow due to obstructionin urinary passage). It is a very major common problem in geriatric age group in males (usually in 60-70 years of age). Histo-pathologically the prevalence of BPH is age dependent, initiate usually after 40 years of age. More than 50% of men in their 60s and upto 90% of men in their 70s and 80s have some symptoms of BPH. In contemporary science conservative and surgical treatment are given to the patients suffering with BPH. The symptoms of vatashthila have been described in mutraghata resembles to the benign prostatic hyperplasia in modern science. The aim of the study is to focus on various studies done on vatashthila (i.e.; BPH) between 2016-2021. The various studies have been done on efficacy of Kanchnar guggulu, Trikantakadi guggulu, Veertarnadi gana kshaya, Varun bark decoction (Kwath), Ushiradi taila as Uttarbasti and Dhanyak gokshur ghrita yavkshar as Uttarbasti in the management of Vatashthila (BPH). These studies may be very beneficial to improve the tonicity of urinary bladder and to reduce the size of the prostate.
Estudio de la aplicación del método de costos ABC en las mypes del Ecuador
Authors:   Facultad de Ingeniería Económica, Universidad Nacional del Altiplano - Puno Perú., Escobar-Mamani Fortunato
Published: January 2022

The Micro and Small Enterprises need to implement a cost accounting management system as a basic element that allows the determination of costs of production of goods and services, for decision making and establishing the sales price that allows Compete in the market with your competition. In this context, the objective of the research is to determine the importance of the application of the cost-based method of activities (ABC) in the accounting of costs in the Micro and Small Enterprise of the Republic of Ecuador. For this purpose, a documentary review of the research carried out on accounting and costing in the MyPES was used as methodology. It is causal. The study considers a population of 972,846 and a sample of 22,919 micro enterprises. The results show that the use of cost accounting is related to management accounting; Occurs in manufacturing companies with a higher degree than in commercial and service companies, and it is likely that the ABC method has been applied in the calculation of costs by SMEs.
Control Systems Cyber Security Reference Architecture (RA) for Critical Infrastructure: Healthcare and Hospital Vertical Example
Authors: Scalco Aleksandra , Flanigan David , Simske Steven
Published: February 2022

A reference architecture (RA) provides a common frame of reference with a common vocabulary, reusable designs, and principles that may be applied to future architectures. It can promote re‐use of best practices, improve interoperability, and improve awareness of a system under development of the same mindset. The next version of the Department of Defense (DoD) Chief Information Officer (CIO) Cyber Security Reference Architecture (CSRA) will include an appendix for control systems. It provides a frame of reference for cybersecurity implementations based on generalizations of common principles that can provide a starting point for an organization's architecture effort, inform decision‐making, suggest governance, and help define future policy decisions for control systems. The appendix is based on the outcome of the MOSIACS Joint Capability Technology Demonstration (JCTD), which provides the initial cyber defensive capability framework for integrations of Commercial‐Off‐The‐Shelf (COTS) and Government‐Off‐The‐Shelf (GOTS) components to form a control system cyber defensive solution. The MOSAICS capability was successfully demonstrated in the energy sector critical infrastructure vertical on a power system in August 2021. Its applicability embodied delivery methods for technologies in other essential infrastructure sectors, repeatable playbooks for automated Courses of Action (COA), best practices, and templates for cyber security requirements for control systems. The advantages of the RA are to enable better decision‐making and policy‐making support about cybersecurity for control systems. This paper demonstrates the RA used in the Healthcare and Public Health sector's critical infrastructure vertical to evaluate concepts such as Zero Trust (ZT) and Defense‐in‐Depth (DiD) architecture principles related to policymaking.
The Effect of Superheated Water Extraction Conditions on Properties of Quinoa-Barley Malt Extract
Authors: Sabah Samireh , Sharifan Anoshe , Akhonzadeh Basti Afshin , Jannat Behrooz , TajAbadi Ebrahimi Maryam
Published: February 2022

Background: Superheated water extraction (SWE), is a novel method, used to extract proteins or other bioactive component from agriculture products. Methods: In this study, the extract from quinoa-barley malt (in a proportion of 30:70) was treated by SWE method. The effect of extraction time (15, 30, and 45 min) on physicochemical and functional properties of the extract was determined at 120 ºC. Results: The result showed that by increasing the extraction time the amount of protein increased. The maximum protein (%) was obtained in 45 min of SWE. The results revealed that increasing the extraction time had a significant effect on the turbidity and pH. In addition, increasing the extraction time had a positive effect on the functional properties. The highest protein isolate (PI) solubility was at 120 °C. Conclusions: Although SWE method appears to be a useful extraction method for producing valuable materials from cereal and pseudocereal, this method has only been used at pre-commercial scale and more investigation is required to study the quantity, quality, and stability of the extracted valuable materials to scale it up for industrial means.
Perceived Barriers to Weight Loss: A Qualitative Study of the Lived Experiences of Women with Obesity in Shiraz
Authors: Borazjani Mohadese , Amini Maryam , Faghih Shiva
Published: February 2022

Background: Obesity is a public health issue, leading to many medical and socially unacceptable complications. To combat obesity, going on a diet is a routine prescription by dieticians. Although men and women with obesity are equally advised to lose their body weight, almost in all societies women are more adhered to their prescribed diets. However, some of weight reducing diets seems neither effective nor long lasting.  This study aimed to assess perceived barriers to weight-loss programs among women with obesity in Shiraz. Methods: This qualitative study was conducted in 2017 in Shiraz. To fulfill the objectives of the study, eight semi-structured focus group discussions (FGDs) and seven in-depth interviews with key informants were performed. The eligible participants for FGDs were women with obesity who were not satisfied with their diet and were selected through a public call in Shiraz. Results: A total of 1429 initial codes were obtained from FGDs, and after categorizing, four main barriers were resulted. Dietary, socio-cultural, supportive- psychological, and economic issues were identified as the main perceived barriers to weight-loss programs. Conclusion: The study findings provided comprehensive information about the probable causes of diet prescriptions failure, which can assist dietitians to improve the efficacy of their weight management advice in clinics.
The Association between People’s Chronotype and Hormones Related to Appetite
Authors: Rabiei Samira , Haghgoo Mazyar , Borumandnia Nasrin , Nasrollahzadeh Javad , Hejazi Ehsan , Sadeghzadeh Hakimeh
Published: February 2022

Background: Recently, it has been suggested that people’s chronotype is involved in regulating food intake and obesity. This study aimed to investigate the association between chronotypes with hormones related to appetite in adults in Tehran. Methods: This cross-sectional study was conducted on 353 men and women aged 18-60 years using convenience sampling in Tehran municipality community centers. Information on morningness-eveningness choronotype and physical activity (PA) level were collected by validated questionnaires. The data for anthropometric measurements and 3-day food recalls were also collected. ELISA method was used to assess Neuropeptide Y (NPY) and leptin serum level.  Results: The prevalence of eveningness, intermediate, and morningness chronotypes was 11%, 47.6%, and 41.4%, respectively. The participants with eveningness type were significantly younger (P = 0.001). The percentage of men with eveningness type was significantly higher than women (P = 0.001). The mean values of height, weight, body mass index (BMI), waist circumference, total calorie intake, protein, carbohydrate, fat, and calorie intake from each of the main meals and snacks, were not different among three chronotypes. Leptin and NPY did not show any significant association with chronotypes. Conclusion: Individual’s chronotype was not associated with NPY and leptin serum level. Further studies on a population with more varied work shifts are suggested.
Specific Questionnaire in Assessing Occupational Burnout among Nurses
Authors: Kolagari Shohreh , Yazdi Khadijeh , Sabzi Zahra , Vakili Mohammd Ali
Published: January 2022

Introduction: Job burnout among nurses is a global concern caused by frequent and round-the-clock encounters with stressful situations. This study aimed to specify the status of using a specific questionnaire in assessing the occupational burnout among the nurses.
Methods: This was a cross-sectional descriptive-analytical study conducted on 637 Iranian nurses in 2019. The cluster sampling method was used to collect data. The data collection tool was a specific nursing burnout questionnaire. The frequency, mean, and standard deviation were assessed using SPSS- 16, and after proving abnormality with inferential tests such as Mann-Whitney and Kruskal-wallis tests, data were analyzed.
Results: Most of the nurses participating in this study (85.4%) were female. The mean age and work experience of participants were 33.29±7.07 and 8.14±7.46 years, respectively. The mean score of job burnout among the participants was 123.60±18.20. The highest mean was related to the consequences (40.74±10.01) and organizational antecedents (32.76±4.38), whereas the lowest mean was related to the individual’s toughness (21.08±2.74). Regarding demographic variables, marital and employment status, the number of children, and working shifts had a significant relationship with job burnout (p<0.05).
Conclusions: The results of this study indicated that the mean of burnout among nurses was moderate, and most of the subscales related to burnout were seen under the subscales of consequences and organizational antecedents. Therefore, it is essential that nursing managers identify the causes of burnout and consider plans and workshops to reduce and eliminate the causes of burnout, and maintain the safety and physical and mental health of nurses.
A Qualitative Meta-analysis of Perceptual-motor Problems in Visually Impaired People
Authors: Rashidipour Shams al Muluk , Meshkati Zohreh , Badami Roshsareh , Fallah Mohammed Hussain
Published: January 2022

Introduction: Perceptual motor activities improve motor skills and learning. These skills play an effective role in receiving, interpreting and responding to the sensory stimuli. This study aimed to identify perceptual-motor problems in visually impaired people.
Methods: This qualitative research was conducted using a research synthesis method. Therefore, the analysis unit consisted of all the related scientific studies. With regard to the systematic research in internal and external databases based on the inclusion criteria, 1052 scientific studies were identified, and finally, according to the exclusion criteria, 71 studies were selected for the final analysis. To collect the required data, a researcher-made worksheet was used, and to ensure of the coding, two examiners were asked to reencode the findings. For data analysis, Roberts’ six-step research synthesis model with open and axial coding methods was used.
Results: The results from this study led to the identification of 41 categories, which was eventually narrowed down to 14 codes of alternative concepts. The most common perceptual -motor problems of the blind were navigation, coordination of motor function, and balance disorders.
Conclusion: Success in implementing educational programs and its effectiveness on the blind requires providing solutions in line with their most important problems in order of priority. Providing appropriate infrastructure, proper preparation regarding knowledge, skill and attitude among students and professors, as well as appropriate designing of educational programs for the blind prioritizing their navigation, motor coordination, and balance problems are suggested.
Evaluation of Ecological Factors Regarding the Use of Disposable Containers among Khomeini Shahr Residents:A Qualitive Study
Authors: Taghi Ghanein Mohammad , Zamani Fereshteh , Ebrahimi Abdolmajid , Rahmati Maryam , Ehrampoush Mohammad Hassan , Mir Hosseini Abolghasem
Published: January 2022

Introduction: Excessive consumption of disposable containers, and specifically the plastic ones, has adverse effects on ecosystem and the community's health. To identify ecological factors (individual, interpersonal and social) related to these containers, this study aimed to specify the most important factors according to the participants.
Methods: This was a qualitative content analysis  conducted through interviews with participants in different age and gender groups in Khomeini Shahr, Esfahan, in 2021, and continued until data saturation with 37 participants was reached. Data analysis was performed by qualitative content analysis method, based on the steps suggested by Elo in MAXQDA20 software.
Results: The results demonstrated that the factors affecting the use of disposable containers were divided into two main categories of individual factors including four subcategories: preferences and priorities, personal beliefs, information and knowledge, fear and negative emotions. The interpersonal and social factors included nine subcategories: force of using, conflict between economic advantages and health, features and efficiency, putting foodstuff in disposable containers, hygiene elements related to health, factors related to families, social norms, the effect of advertisements, and increasing places using disposable containers.
Conclusion: The results of this study indicated that comfort of use, being light and unbreakabl, ease of transportation, welfare and observing hygiene issues increased the use of containers, but paying attention to the health issues and effective educational sessions on the proper consumption of these disposable containers, can decrease the use of these containers.
Causes and Consequences of Male Infertility
Authors: Hashemikhah Zeinab , Afshani SeyedAlireza
Published: January 2022

Introduction: Infertility has various and innumerable causes, which pointing them out one by one is difficult and out of the scope of this paper. Infertility causes are different between males and females, and each case requires a separate and thorough research. The present study aimed to identify the male infertility causes.
Methods: This study was conducted using a qualitative method, which analyzed the infertile males' accounts regarding their problem. For this purpose, couples suffering from infertility were interviewed 13 times .In all these cases, men were responsible for infertility, but both men and women experienced the issues related to infertility. Interviews were analyzed using Glaser approach.
Results: Various causes regarding male infertility were discussed, the most important of which was infertility as a consequence of previous diseases. Furthermore, in addition to the cultural view of women as the ones responsible for infertility, infertile males unconsciously, affected the fertility of their female partners, where ,in time they also became infertile.
Conclusions: In general, all the points discussed, were classified into five categories including: “genetic infertility,” “physiological infertility,” “gender stereotypes of infertility,” “reproduction of male infertility,” and “genesis of infertility,” from which the core concept of “the challenges of infertility”  was derived.
The Effect of Educational Intervention on Self-efficacy Related to the Oral and Dental Hygiene of Pregnant Mothers
Authors: Roozbeh Behzad , Pourmovahed Zahra , Zare Chahooky Samaneh , Shabani Khalilabad Elham , Jabinian Fatemeh
Published: January 2022

Introduction: Paying attention to oral health of the vulnerable groups, including pregnant women, is of particular importance. Because self-efficacy is a predictor of behaviors related to oral and dental health, this study was conducted to determine the effect of educational intervention on the self-efficacy related to the oral and hygiene among pregnant mothers.
Methods: This was a quasi-experimental study performed on 100 pregnant women who referred to Yazd Karami General Health Center in 2020. Samples were objective-oriented and randomly divided into case and control groups (50 people in each group). The demographic questionnaire and Oral Hygiene Self-efficacy Questionnaire (OHSQ) were used. It included 19 items related to self-efficacy ,such as: brushing, flossing and visiting the dentist (with a score range of 0-76).The intervention was done during one month in four 60-minute training sessions. One month later, data from both groups were collected again. Data were analyzed using SPSS Version 21 software and paired t-test, independent t-test and Chi-square.
Results: There was a significant increase in the mean of self-efficacy regarding flossing in the case group before (11.26 ±5.66) and after the intervention (14.06 ± 5.79) (P = 0.03). The difference in self-efficacy of flossing between the case and control groups (11.64 ±6.83) after the intervention was significant, as well. (P = 0.04). The total self-efficacy in the case group increased significantly before (41.00 ± 9.18) and after the intervention (46.34 ± 10.10) (P = 0.04), and between the case and control groups (41.32 ± 13.45) after the intervention, too, became significant (P = 0.04).
Conclusion: Educational intervention can increase the self-efficacy related to oral and dental hygiene among pregnant mothers, especially with regard to the use of dental floss, and can be effective in maintaining their oral and dental health during pregnancy.
Editorial
Authors: Grimaldo Muchotrigo Mirian
Published: January 2022

La universidad es un espacio experiencial que complementa la educación básica y brinda a los estudiantes la posibilidad de ampliar su capacidad reflexiva, de tal manera que las personas puedan asumir la responsabilidad de su participación cotidiana en la creación de la nación (Maturana, 1997). Esta definición enfatiza la importancia del rol formador de la universidad y de cómo esta se inserta en la cotidianidad de nuestras vidas; elementos tan necesarios cuando nos encontramos en medio de una pandemia que demanda conductas socialmente responsables, no solo en el aspecto individual sino colectivo, como país.
KUMRÎ’NİN KENZÜ’L-MESÂİB’İNDE KERBELÂ’NIN ÖN ŞEHİDİ MÜSLİM B. AKÎL
Authors: KARATAŞ Muzaffer
Published: January 2022

Kerbelâ hâdisesi, Hz. Muhammed’in (sav) benim dünyadaki reyhanım dediği biricik torunu Hz. Hüseyin ve beraberindeki yetmiş iki kişinin şehit edildiği İslâm tarihinin en vahim hâdiselerinden biridir. Kerbelâ hâdisesi yaşanmadan hemen önce Yezîd ve askerleri Hz. Hüseyin ve Ehl-i Beyt’e yakın olan kişileri şehit etmeye başlamışlardır. Bu trajedinin ön şehitlerinden biri Müslim b. Akîl’dir. Kerbelâ hâdisesi yüzyıllar içerisinde Arap, Fars ve Türk edebiyatında çokça işlenmiştir. Hatta Hz. Hüseyin’in şehâdetini konu edinen eserler zamanla edebî bir tür haline dönüşmüş ve ‘‘Maktel’’ ya da ‘‘Maktel-i Hüseyn’’ adını almıştır. Kerbelâ hâdisesini konu edinen eserlerden biri de doktora çalışması olarak incelediğimiz ve 19. yüzyılda yazılmış olan Mirzâ Muhammed Nakî (Kumrî)’nin Kenzü’l- Mesâib adlı eseridir. Eserde Hz. Hüseyin ile birlikte ailesi de sıkça şiirlerde işlenmiştir. Söz konusu eserde dikkat çeken şahsiyetlerden biri Hz. Hüseyin’in elçi olarak Kûfe’ye gönderdiği ve Kûfe’de şehit edilen amcaoğlu Müslim b. Akîl’dir. Çalışma, Kenzü’l-Mesâib’de Kerbelâ’dan hemen önce şehit edilen Müslim b. Akîl’in şehâdetini anlatmaktadır.