bluuebunny/crossref_metadata_2025 huggingface dataset:
Upgrading seismically isolated bridges with space-flange energy-dissipation devices
Authors: Misini Misin , Ristic Jelena , Guri Zijadin , Ristic Danilo , Pllana Nebi
Published: July 2019

Non-linear three-dimensional analytical models of bridges with laminated-rubber seismic bearing devices upgraded with multi-directional space-flange energy-dissipation (SF-ED) devices were experimentally validated under multi-directional seismic action by shaking table tests of large-scale prototypes. The experimentally verified hysteretic models were used to model the upgraded seismic isolation (USI) system. The seismic protection benefits of the USI were demonstrated through a comparative analysis of bridge prototypes with both standard and upgraded systems. It was confirmed that the SF-ED devices provided a qualitative contribution under very strong earthquakes in all directions. The variation of the structural characteristics of the devices illustrates the technological options for qualitative seismic upgrading of various types of isolated bridges with complex plane geometries under multi-directional seismic actions.
Liposoame characterization protocol v1
Authors: Ahmed Fahmy Sherif , Shoeib Tamer
Published: July 2019

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Preparing 10 L of M9 buffer for nematode culture v2
Authors: Institute media kitchen Gurdon
Published: July 2019

Prepare 10 litres of M9 solution for collecting and washing C. elegans.
Venous thrombosis in children, adolescents and young adults with acute lymphoblastic leukemia receiving chemotherapy in the Republic of Belarus
Authors: Dmitriev V. V. , Migal N. V. , Bydanov O. I. , Lipay N. V. , Dmitriev E. V.
Published: July 2019

Objective: to clarify the conditions for the occurrence of thrombosis and assess the effect of anticoagulant therapy on the survival and outcome of thrombosis in children, adolescents and young adults with acute lymphoblastic leukemia (ALL) receiving program chemotherapy.

Materials and methods. The study included 592 patients with ALL received program chemotherapy from 2008 to 2017 in the Belarusian Research Center for Pediatric Oncology, Hematology and Immunology (Minsk, Belarus). Of them, in 42 patients various localization venous thrombosis was detected at different therapy phase.

Results.The cumulative detection rate of thrombosis was 7.5 ± 1.1 %. The use of pegelated asparaginase (PEG-asp) at a dose of 1000 IU/m2 in induction therapy increased the relative risk of thrombosis in the first 5 weeks of treatment by 3 times (relative risk 3.4; 95 % confidence  interval 0.98–11.9), compared to patients not receiving PEG-asp. The cumulative detection rate of thrombosis in patients with the post-induction L-asparaginase (L-asp) 25,000 IU/m2 regimen was 14.7 ± 2.6 %, which was higher (p = 0.0536) than when using L-asp in other dosing regimens. In addition to ALL as the main disease, taking chemotherapy drugs, other risk factors for thrombosis (thrombophilia, the presence of antiphospholipid antibodies, a decrease of natural anticoagulants activity) in various combinations were in half (23 of 42) patients with venous thrombosis. Therapeutic dose of low molecular weight heparins (LMWH) 150–200 IU/kg received 30 patients. Reduced for the period of thrombocytopenia from 100 to 35 × 109/L for up to 4 weeks, a daily dose of LMWH was received by 12 patients. The dose of LMWH was reduced in proportion to the blood platelets count. After the recovery of the platelet count of more than 100 × 109/L, patients continued treatment of LMWH in a daily dose of 150–200 anti-Xa IU/kg. Reducing of LMWH dose during thrombocytopenia period did not affect the outcome of thrombosis (χ2 = 0.494; p = 0.78). Among 42 patients with thrombosis, 38 completed maintenance therapy, eventfree survival was 83.0 ± 8.0%, which did not differ (p = 0.654) from that (81.0 ± 2.0 %) in patients without thrombosis. 

Conclusion. The presence of venous thrombosis with the use of LMWH as antithrombotic therapy did not lead to a decrease in the event-free survival of ALL patients, compared with those without thrombosis. Reducing the therapeutic dose of LMWH did not affect the outcome of thrombosis in the analyzed groups.
Performance by early bilinguals of the combined test with the tasks of stroop, poffenberger, sperry in the foreign and native languages
Authors: Kutsenko T. , Nasiedkin D.
Published: July 2019

The disclosure of neurophysiological foundations of both native and foreign languages is an actual problem of modern science, since their understanding can have not only theoretical but also practical, including social significance. The Stroop effect, which allows to estimate the level of voluntary attention, is also widely used in the study of language functions. By the task of Poffenberger, it is possible to evaluate the interhemispheric transfer of information. The study used a combined test with the tasks of the Stroop, Poffenberger, Sperry with native (Russian or Ukrainian) and foreign (English) languages. Students studying English were the subjects surveyed, but the vast majority of them never lived in the English-speaking environment. Stimuli (the word "Green" or "Red" written in relevant or irrelevant color) were exposed on the right or left from the center of the screen. In the case of congruence the word and its semantic meaning should press one button by the ipsilateral hand ("yes"), while in the case of mismatch – the other button by the contralateral one ("no"). In previous studies, we found that the answer "yes" is faster than answers "no" for both right and left hands. Comparison of latent period of reactions of similar responses of both hands showed that answer "yes" is faster for the right hand and answer "no" – for the left one, so that the difference in latent period between "yes" and "no" for the left hand is shorter than for the right one. This points out to easily transfer of information from the left hemisphere to the right one than in the opposite direction. Current study found out that in case of performing the test in the native language, in comparison with the foreign one, latent periods of reactions were in the average 60-70 ms longer with the same number of errors, which can be hypothetically explained by fewer associations of words of the foreign language and simpler neural networks for their processing. When performing the test in native language, the number of errors for both hands is the same, whereas when performing the test in English the left hand carries fewer errors than the right one. Probably this indicates that the center of error control in the case of passing a test in a foreign language is situated in the right hemisphere.
RELATIONS IN THE SYSTEM OF MODAL MEANINGS OF THE COGNITIVE-SEMANTIC FIELD OF NECESSITY
Authors: Okhrimenko Valeria
Published: July 2019

The article focuses on correlation in the system of modal meanings of cognitivesemantic modal field of necessity in Italian. The system of modal meanings of modal field of necessity is organized in according to the principle of continuality and gradualism: 1) privative necessity; 2) negative willing; 3) necessity contaminated by emotiveness; 4) necessity contaminated by willing; 5) dispositive necessity (necessity contaminated by disposition); 6) deontic necessity; 7) deontic necessity of totality quantor. These modal meanings reflect a different proportion of subjective and objective factors, of synthesis and analysis during modal evaluation that influence on the opposition of the modal field “indefiniteness vs definiteness” according to increasing of a degree of definiteness. Taking down of indefiniteness realizes as a result of contamination of dominant willing modus by other ones: perceptive, emotional, epistemic, axiological. A proportion of subjective factors is maximum for the modal meanings of necessity contaminated by emotiveness and necessity contaminated by willing. A proportion of objective factors is maximum for the modal meaning of deontic necessity of totality quantor: emotions, willing, system of evaluation of specific subject lose importance being subordinated to the common axiological values.
FUNCTIONALLY SEMANTIC FEATURES OF GREEK CONSTANT EXPRESSIONS WITH A PRETEXT ΕΚ (ΕΞ) AND THEIR TRANSLATION
Authors: Romanenko Olga
Published: July 2019

In the article is explored the specific of translation of constant expressions with the ancient Greek pretext εκ(εξ), and also is examined his semantic denotation. The individual approach is used for the ancient Greek prepositional constructions which were not translated into the Ukrainian language with the purpose of observance and preservation of their original specifications.
Review of the monograph by M.B. Kirchanov “Crying for never-ending world”: colonialism, nationalism and transculturalism (problems of postcolonial analysis). -Voronezh, 2011
Authors: Shturba E. V.
Published: July 2019

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EPISTEMOLOGÍA E IDENTIDAD CIENTIFÍCA
Authors: Choque Álvarez Rosa Teresa
Published: July 2019

El propósito de la presente investigación radica en la revisión  documental respecto a la  epistemología e identidad científica, a partir de cuyo proceso se generó una labor de razonamiento reflexivo, crítico, e interactivo; que llevo tomar posición en el marco del estudio de las diferentes teorías  sobre epistemología de la investigación científica y su relación directa  dentro de la  experiencia disciplinaria y profesional de las ciencias sociales, de este modo se toma mayor ahínco en el paradigma socio crítico en relación del resto de paradigmas existentes,  ello en razón  de poder defender la labor investigativa en el campo de la educación superior. Llegando a la conclusión de que es fundamental  que los aspectos subjetivos de la investigación social puedan  tener un mayor grado de validez a  partir de los sustentos cualicuantitativos, que permitan a su vez abarcar un proceso dialógico en razón de la dinamicidad de la conducta social cambiante.
Ecosofía y gerencia androcratica desde el sujeto – grupo para el desarrollo de los nuevos imaginarios de la humanidad
Authors: Rojas Chadid José Enrique
Published: July 2019

En este artículo se sugiere que con una visión ecosófica, en los tres registros, desde los espacios controversiales, relaciones entre los humanos, entre sujeto y objeto, y entre sujeto y el conocimiento utilizando la gerencia Androcrática se puede conducir sujetos – grupo que faciliten la materialización de imaginarios como insertar microprocesos vitales en macroprocesos de sostenibilidad de la vida colectiva, que conduzcan a mejor calidad de vida general. Para ello la visión ecosófica y la gerencia Androcrática son del orden del imaginario en el que se visualiza que si nos gobernamos como especie y no como países (Mojica), se puede alcanzar aquel imaginario.
ENSEÑAR A INVESTIGAR: Desafío para la Universidad del Siglo XXI|
Authors: Vidal Moruno Mario
Published: July 2019

En la sociedad de la gestión del conocimiento, enseñar a investigar e investigar para enseñar se constituye en una actividad clave para la producción científica como contribución al desarrollo humano, social, científico, tecnológico y ambiental de la sociedad del siglo XXI. Estos dos tipos de procesos constituyen dos prácticas distintas, la de producir conocimiento nuevo y la de enseñar a producirlo. El desarrollo de este estudio permite delineando algunos elementos para construir los espacios más adecuados para el desarrollo de los procesos de la gestión del conocimiento, juntamente a los procesos de desarrollo de las competencias investigativas. En esa intención, el objetivo de la presente investigación es contribuir al análisis y comprensión de los procesos de enseñar a investigar en el contexto de la “formación de investigadores” a partir del desarrollo de competencias investigativas en los estudiantes y docentes para generar procesos de gestión del conocimiento. En la sociedad de la gestión del conocimiento, enseñar a investigar e investigar para enseñar se constituye en una actividad clave para la producción científica como contribución al desarrollo humano, social, científico, tecnológico y ambiental, hacia la formación de investigadores en la Universidad del siglo XXI.
Negritud y género: la representación de la mujer negra en la literatura argentina decimonónica
Authors: Mbaye Djibril
Published: July 2019

Este trabajo se propone analizar la representación que se hace de la mujer negra en los escritos fundacionales de la literatura argentina del siglo XIX. Considerada como un sujeto subalterno y doblemente discriminado por su color y por su feminidad, la mujer negra viene retratada desde el ámbito político y social. José Mármol, Esteban Echeverría y José Hernández nos describen en Amalia, El Matadero y Martín Fierro a una figura femenina delatora y animalizada. Así, en este artículo, presentaremos primero el panorama sociohistórico y político de la condición negra y femenina en Argentina y analizaremos después, por obra, la imagen y protagonismo de la mujer negra.
Identification of professionalism behaviour blueprint assessment medical students with Eastern and Islamic culture in the profession program
Authors: Triastuti N. Juni , Herawati Erna , Oktasari Nur Aida , Rhaisya Ade Oktavia
Published: July 2019

Background: Medical institutions have a role and responsibility in training medical students to have the knowledge and skills needed to become a reliable doctor in terms of mastering knowledge, skills in the field of medicine. One thing that is often overlooked by medical institutions is forgetting aspects of professional behaviour. Professional behaviour is indispensable in creating a new generation of doctors who have professionalism and character. For medical institutions as a starting point in professional behaviour, it is very important to be able to formulate indicators of professional behaviour for medical students. Previous research is limited to the assessment of professional behaviour that is still generally conveyed and does not relate aspects of eastern and Islamic culture. The purpose of this study is to create a blueprint assessment of professional behaviour in the profession program of medical students.Methods: This research using a qualitative approach. Data collection was conducted with semi structured interviews and conducted at the Faculty of Medicine, University of Muhammadiyah Surakarta, Pabelan, Kartasura, Central Java, Indonesia. Data analysis is done by general inductive approach.Results: This study formulated three major themes that influenced professionalism in professional students including professionalism in terms of cognitive/knowledge, skills/behavior, and attitude. Based on the results using semi structured interview, 18 items of instruments were formulated related to professionalism assessment in professional students including three cognitive assessments, seven assessment items about professionalism in terms of skills, and eight items of evaluation on professionalism in terms of attitude.Conclusions: Professionalism in Islamic and eastern culture of medical students includes cognitive abilities, skill abilities and attitudes. The instrument for evaluating the medical professionalism of Islamic and eastern culture was determined for 18 assessment items.
Factors related to the pre-eclampsia case in Oesapa Health Center, Indonesia
Authors: Acihayati Justina Purwarini , Moeda Serly Sandra
Published: July 2019

Background: Pre-eclampsia is a special condition during pregnancy where hypertension and proteinuria occur after 20 weeks of gestation in mothers who have had normal blood pressure. The number of pregnant women with pre-eclampsia in the Oesapa Health Center since 2014-2015 has increased. The purpose of the study was to determine the factors associated with the incidence of pre-eclampsia in the Oesapa Health Center.Methods: This study was an analytic observational study with a case control research design through a retrospective approach. Bivariate data analysis with Chi Square Test and multivariate analysis with Logistic Regression.Results: Bivariate test results obtained data that there are 3 variables that have a relationship with the incidence of pre-eclampsia in pregnant women, namely age (p value 0.000, p <α), gravida status (p value 0.001) and Record of hypertension in the family (p value 0.000). Two variables did not have a relationship between the incidence of pre-eclampsia in pregnant women, namely education (p value 0.488, p> α) and respondent's work (p value 0.899). In the multivariate analysis, the factor that most influence the incidence of pre-eclampsia is age (p value 0.000).Conclusions: Health workers need to improve antenatal care, so that they can take maximum preventive action against all risky pregnant women.
Factors predicting the occurrence of syringomyelia in patients with Chiari I malformations
Authors: Peettakkandy Vijayan , Rajagopalawarrier Bijukrishnan , Kuniyil Sreenath , Thankaraj Jithin Veliyath
Published: July 2019

Background: Chiari I malformations are defined as the downward herniation of cerebellar tonsils more than 5 mm through the foramen magnum. Syringomyelia is a common association of Chiari I malformation.Methods: This purpose of this study was to determine the various factors predicting the occurrence of syringomyelia in patients with Chiari I malformations. This retrospective study was conducted in Government medical college, Thrissur, Kerala, India. 27 patients admitted with diagnosis of symptomatic Chiari I malformations during the period of January 2015 to January 2019 were selected for the study.Results: The mean age was 22.8 years and syringomyelia was more common in patients older than 10 years (p value0.005). Females were 17(63%) and males were 10(37%) but there no difference in occurrence of syringomyelia among both sexes(p value is 0.16). Syringomyelia was present in 17(63%) cases. Association between various factors and syringomyelia measured by calculating P value which was 0.005 for age >10 years, 0.16 for sex, 0.093 for duration of symptoms >12 months, 0.05 for tonsillar descend >10mm and 0.097 for hypertension. The p value for the association of duration of symptoms >12months and extend of tonsillar descend is 0.001 Mean duration of symptoms (onset of first symptom to the time of presentation) was 16.3 months and syringomyelia was more common in patients with duration of symptoms more than 12 months but this difference was statistically not significant (p value 0.093). Mean tonsillar descend from the level of foramen magnum was 11.3 mms and syringomyelia was more common in patients with tonsillar herniation more than 10mm (p value 0.05). There is a statistically significant relationship between duration of symptoms more than 12 months and tonsillar descend more than 10mm(p value 0.001).There is no significant association between hypertension and occurrence of syringomyelia in patients with Chiari I malformation.Conclusions: Incidence of Chiari I Malformations is more among adults and it is slightly higher in females. Syringomyelia is a common association of Chiari I Malformations. The occurrence of syringomyelia in patients with Chiari I Malformations associated with increasing age of patients and extend of tonsillar herniation. There is no statistically significant association between syringomyelia and duration of symptoms or hypertension.
Role of hippocampal volumetry in drug resistant epilepsy
Authors: Sachdev Namrita , Gupta Shivani , Singh Yashvant
Published: July 2019

Background: Hippocampus is a brain structure located deep in the temporal lobe. The structure is crucial for learning and memory and is a natural inhibitor of seizure activity in brain. In drug resistant epilepsy (DRE), there is shrinkage of the hippocampus leading to poor seizure control.Methods: Patients meeting the diagnostic criteria for drug resistant epilepsy between the age group of 10-60 years were enrolled in the study. Epileptic non drug resistant controls and normal healthy individuals were taken from same cohort. Selected patients underwent MRI Brain and their hippocampal volumes were estimated manually. Coronal oblique sections, perpendicular to the long axis of hippocampus were taken and hippocampal volume (HV) were calculated using region of interest approach with manual delineation . Results: There was increment in detecting hippocampal atrophy from 30% to 46.6% in DRE patients when manual hippocampal atrophy was used in addition to visual assessment. The mean right and left hippocampal volumes in drug resistant epilepsy cases were found to be 2.17+0.57 cc and 1.52+0.54 cc respectively. Left HV was found to be statistically significantly smaller than right side (p value < 0.05). DRE patients had smaller mean bilateral HV than healthy controls, the difference being 33%. The left HV loss was almost double the right HV loss among DRE cases. The hippocampal volumes were reduced in DRE patients compared to epileptic non-resistant patients; however the difference was found to be less than that of normal healthy controls.Conclusion: Manual hippocampal volumetry detected more patients with hippocampal atrophy in our study compared to visual assessment. Manual hippocampal volumetry should be routinely done in patients with Drug resistant epilepsy.
A retrospective, observational, single center study of gonadotropin-releasing hormone agonist protocols at the Reproductive Center of Farah Hospital in Jordan
Authors: Kilani Zaid , Shaban Mohammad
Published: July 2019

Background: Data on infertility and in vitro fertilization (IVF) are incomplete and uncertain in Jordan and worldwide because of difficulties in evaluating infertility in the general population. This study aimed at comparing the effectiveness of the gonadotropin-releasing hormone agonists (GnRH-a) long and short protocols as part of IVF or intracytoplasmic sperm injection.Methods: This observational, retrospective, comparative, longitudinal study was conducted in a reproductive center in Jordan. It reviewed data charts from women who took GnRH-a for IVF, from 2010 to 2013. These were categorized in Group A (long-term GnRH-a: single 3.75 mg-monthly injection) or Group B (short-term GnRH-a: multiple daily 0.1 mg injections). The primary endpoint was the rate of ongoing clinical pregnancy (number of pregnancies/number of women) and live birth rate in fresh cycle/protocols.Results: Out of 1,946 eligible women, 471 underwent the long-term treatment of GnRH-a administration and 1,523 the short-term treatment. The women’s mean age was 29.61±3.80 years old. Out of the 471 women in Group A, 216 (45.9%) women had ongoing clinical pregnancy, of whom 69 (31.9%) had live births. In the short-protocol group, 485 (31.8%) women had ongoing clinical pregnancy, of whom 133 (27.4%) had live births.Conclusions: GnRH-a long protocol is more effective than the short protocol regardless of the agonist formulation used in subfertile women/men who underwent IVF/ intracytoplasmic sperm injection.
Multi detector computed tomography evaluation in chronic obstructive pulmonary disease and correlation with severity of disease
Authors: Kumar Ajay , Rohira Ankita , Vijay Ashish , Sharma Abhay
Published: July 2019

Background: Multi Detector computed tomography (MDCT) may effectively characterize and quantify the extent of emphysema and the air trapping related to the small airway’s disease. Here we highlight the computed-tomography findings of Chronic Obstructive Pulmonary Disease (COPD) and correlation with the Spirometrics values.Methods: The study group included the total of 100 adult patients of either sex with a clinical suspicion of COPD and those who undergone MDCT of thorax. Lung function of the patients with the COPD stages mild to very severe was evaluated by both the MDCT and Spirometrics Pulmonary Function Tests (PFTs). The scanning was done at maximum end inspiration and maximum end expiration.Results: There was a preponderance of male patients with highly significant correlation between values of mean lung density and low attenuation values (p<0.000I). MDCT correlated well with those obtained from spirometric Pulmonary Function Tests in the patients with COPD and that the correlation at expiration was superior to that at inspiration.Conclusions: The study concludes that Multi-detector computed tomography is the invaluable tool in defining and quantifying COPD and the characterization of emphysematous changes.
Early education and clinical exposure on hand hygiene: a key for better compliance
Authors: Thakuria Bhaskar , Pandey Anita , Chaturvedi Priyanka
Published: July 2019

Background: India is underperforming when it comes to compliance to hand hygiene. Early education on followed by regular hand hygiene audits can bring positive changes in infection control practices.Methods: Group I included the 3rd Semester MBBS students who had early education and training on hand hygiene and Group II included the post graduate residents who were exposed to Hand Hygiene later in their carrier were followed up for compliance of WHO Hand Hygiene moments for four months. Compliance among students and residents were observed and compared.Results: Compliance rate was more (40.4%) among medical students as compared to residents (17%). The After moments had a better compliance than Before moments among both students and residents. The difference in the compliance rate was statistically significant.Conclusions: Early clinical exposure of the students to any problem, is the key for better compliance thus explaining the better compliance rate among medical students. Better HH practice can bring down prevalence of Healthcare associated infection by multidrug resistant organism which is a major concern today.
Pattern and management of penetrating and nonpenetrating thoracic injuries
Authors: Pal Naresh , Mishra Vineet , Jain Udit , . Poonam
Published: July 2019

Background: Chest trauma constitutes a major public health problem which  includes the injuries to chest wall, pleura, tracheobronchial tree, lungs, diaphragm, oesophagus, heart and great vessels. It consist of more than ten percent of all traumas and twenty five percent of death due to trauma occurs because of chest injury. Chest trauma is increasing in frequency in urban hospitals. Penetrating and nonpenetrating thoracic injuries the most serious injuries leading to significant morbidity and mortality.Methods: This study was prospective observational study of 220 patients of thoracic trauma both penetrating and non-penetrating. These patients admitted in general surgical units from August 2017 to May 2018  of Pandit Bhagwat Dayal  Sharma,  PGIMS  Rohtak Haryana India. The study was pertaining to both penetrating  and non-penetrating chest trauma.Results: Out of 220 chest injury patients who were studied during the said period, Males were 203 and females 17 by a ratio of 12:1 and age ranged from lowest 18 years to 85 years of age. Majority of the patients (90.45%) sustained blunt injuries. RTA was the common mechanism of blunt injury affecting (50.45%) of patients. Multiple Rib fractures was the commonest type of chest injury (21.36%) followed by head injury (17.27%). Head injury was the commonest associated injury seen in our patients. Conclusions: Chest trauma resulting from road traffic accident remains a major mechanism of chest injury. The  measures to decrease the trauma are, educating people about traffic rules and regulations and strictly implementing them is necessary to reduce incidence of chest injuries.
Oral versus intramuscular midazolam for paediatric preanaesthetic medication
Authors: Vyawahare Kiran R. , Pahuja Heena D. , Pande Sushma T.
Published: July 2019

Background: The need for effective preanesthetic medication in children is obvious and midazolam has proven to be one reliable choice. The aim of the present study was to compare the efficacy, acceptability and reliability of the oral and intramuscular routes of administration of midazolam towards paediatric preanesthetic medication at various doses.Methods: Hundred eligible patients in the age group of 1 to 10 years undergoing ambulatory or routine planned, minor or major surgery during study period were allocated to one of the four groups of 25 participants each, formed on the basis of premedication they received. Haemodynamic parameters, level of sedation and anxiety and induction score were noted before premedication and after each 15 minutes interval for next 45 minutes in all the four groups. Postoperative assessment included sleep level, anterograde amnesia, picture recall and occurrence of complications.Results: The sedative and anxiolytic effects were observed to be maximum at 45 minutes after premedication in all the four groups and better sedation, anxiolysis and quality of induction were achieved with higher doses for both oral as well as intramuscular routes. Postoperatively, the sleep level did not increase with higher dose and 64% patients were awake with 0.75 mg/kg oral midazolam. The sleep level was more with higher dose with the Intramuscular route, with 60% patients feeling drowsy with 0.1mg/kg dose. 0.75 mg/kg dose showed better anterograde amnesia (64%) than 0.5 mg/kg (28%), while it was present in 64% participants premedicated with 0.8 mg/kg intramuscular does and 72% in 0.1 mg/kg intramuscular dose.Conclusions: Intramuscular midazolam at 0.1 mg/kg dose seems to be the ideal dose and route for paediatric preanesthetic medication, with oral midazolam at 0.75 mg/kg to be considered an effective and acceptable alternative.
Mycobacterium tuberculosis infection and diabetes mellitus-mycobacterium tuberculosis dual burden in subjects attending infectious diseases hospital Calabar, Nigeria
Authors: Eworo Raymond E. , Okhormhe Zibril A. , Ntamu Ntamu A. , Esiere Kaiso-Umo S.
Published: July 2019

Background: The rising global DM epidemic is driving the problem of TB control. This research determined glycemic control in TB only infected and DM-TB comorbidity and the consequence of the double burden on treatment outcome.Methods: fifty M. TB infected subjects and fifty control subjects were enrolled into the study, all the participants gave consents. FPG and HbA1c were determined by Colorimetry. Data were analyzed using SPSS version 20.0 statistical package, differences between groups and variation among groups were determined by Student’s t-test and ANOVA respectively while the association between variables by Pearson’s correlation. Differences were considered statistically significant at p<0.05.Results: The mean FPG and HbA1c levels of TB subjects were significantly (P<0.05) higher than those of the control. The mean BMI of the TB infected subjects was significantly lower (p=0.001) than that of the controls. The mean age, FPG and HbA1c of TB subjects at the beginning phase of treatment were significantly lower (p<0.05) than those of subjects at the continuation phase of treatment. The mean age, FPG and HbA1c of subjects with DM-M.TB coexistence were significantly (p<0.05) higher than those of the M.TB only infected subjects. BMI of the DM-M.TB comorbidity subjects was lower than that of the M.TB only infected subjects (p=0.109). A significant positive correlation was obtained between HbA1C and FPG in M.tb infected subjects. (r=0.910, p=0.001). A negative correlation obtained between HbA1C and BMI in M.tb infected subjects. (r=0.267, p=0.061).Conclusion: Infection with mycobacterium tuberculosis poses a risk to DM and vice versa, which may adversely affect treatment outcome and control of both diseases. Firm efforts to control DM may likely have a significant valuable effect on TB treatment outcome.
Extrahepatic undifferentiated embryonal sarcoma, cytology as an accurate method for early diagnosis: an extremely rare case report in an Indian child
Authors: Rastogi Nupur , Tanwar R. K. , Saxena B.
Published: July 2019

Undifferentiated embryonal sarcoma has been described in the liver, a rare malignant mesenchymal neoplasm, that occurs primarily in children and teenagers. Approximately 260 cases have been reported arising in the liver since 1978 when this disease was first described. Its pathogenesis is still obscure. Authors presented a case of extrahepatic undifferentiated embryonal sarcoma in a 9-year-old female presenting with upper abdominal dull pain. Ultrasound and CT Scan showed normal liver architecture, with liver pushed upwards due to compression by tumor arising in the retroperitoneum. To the best of our knowledge, this is first case of extrahepatic undifferentiated embryonal sarcoma diagnosed on cytomorphology and confirmed by histopathology and immunohistochemistry markers.
Action research arm test as a tool for assessment of motor recovery in patients with stroke: a critical review
Authors: Dandekar Sukanya Parag , Ganvir Suvarna
Published: July 2019

Action research arm test has been used widely clinically for the assessment of upper extremity function post stroke and in various other conditions. Measurement of recovery after stroke is becoming increasingly important with the advent of new treatment options under investigation in stroke rehabilitation research. The Action Research Arm Test scale was developed as the first quantitative evaluative instrument for measuring motor stroke recovery, based on a upper extremity test by Lyle. It is a well-designed, feasible and efficient clinical examination method that has been tested widely in the stroke population. Excellent interrater and intrarater reliability and construct validity have been demonstrated. Limitations of the motor domain include a ceiling effect. Further study should test performance of this scale in specific subgroups of stroke patients and better define its criterion validity, sensitivity to change, and minimal clinically important difference. Based on the available evidence, the Action Research Arm Test is recommended highly as a clinical and research tool for evaluating changes in motor impairment following stroke.
Knowledge and attitude towards basics of communication skills amongst resident doctors
Authors: Chavan Kalidas D. , Giri Purushottam A. , Mumbre Sachin S. , Bangal Rajendra S.
Published: July 2019

Background: The pillar of doctor patient relationship is the bond of mutual trust. This pillar is strengthened by effective communication between doctor and patient/relatives. It has been widely accepted that a doctor needs to have very good communication skills in addition to clinical knowledge and skills required for effective healthcare. Every doctor duly needs to demonstrate humanity, healthy behaviour, as well as sensible communication with patients which can build the sustainable ‘trust’ in the treatment offered by that doctor. However, the current curriculum of medical courses is enormously focused on providing competent medical knowledge but lacking the focus on inculcating communication skills.Methods: A cross sectional study was carried out amongst 377 resident doctors of first to third year, from randomly selected medical colleges of Maharashtra having postgraduate courses in clinical subjects and affiliated to Maharashtra University of Health Sciences, Nashik, Maharashtra, India during the period of February 2017 to January 2019. Data was entered in MS Excel sheet and analyzed using percentages and proportions wherever appropriate.Results: Highest study respondents were from General Medicine with 13% of total and having 17.4% males and 8% females among respective genders followed by General surgery and Pediatrics residents with 12.5% each specialty.Conclusions: The study has shown that there was varied knowledge about the communication skills among the resident doctors. The residents have shown fair attitudes and behaviours towards mindfulness and basic communication skills.
Evaluation of different methods of laparoscopic treatment of common bile duct stones
Authors: Elghamry Elghamry E. , Elsheikh Mohamed M. , Mohamed Hamdy A.
Published: July 2019

Background: Common bile duct (CBD) stones are the second most common complication of gall bladder stones. The best management of patients with CBD stones remains controversial. The aim of this study was to evaluate the methods of laparoscopic CBD exploration (LCBDE).Methods: This prospective study was conducted on 30 patients with CBD stones through 2 years. CBD stricture was excluded. Authors used transcystic and transcholedochotomy approaches for LCBDE either with or without choledoschope. Primary repair of the choledochotomy incision was done. Results: The mean age was 48.90±11.84 years. Biliary colic was the presentation in 63.3% of patients. The transcystic approach for CBD exploration was used in 16 cases without conversion, 11 cases were completed without choledochoscope, while 5 cases with choledochoscopic guided extraction. Choledochotomy approach had been used in 13 cases, 6 cases were completed with choledochoscope and 7 cases without it, two cases of them failed. One case failed from the beginning and was converted to open exploration. 5 ERCP previously inserted stents were removed. The mean operative time was 162.33±74.67 min. Bile leakage occurred in 2 cases following the choledochotomy approach. The mean hospital stay was 3.37±1.38 days.Conclusion: LCBDE is a feasible, effective and safe approach to bile duct stones. Depending on proper training and gaining experience.
Anticoagulation alone versus combined catheter-directed thrombolysis and anticoagulation in treatment of acute ilio-femoral deep venous thrombosis
Authors: Elaggory Mostafa A. , Eldesouky Mahmoud S. , Zeid Nehad A.
Published: July 2019

Background: It was found that 50% of patients with iliofemoral deep venous thrombosis (DVT) treated by anticoagulant alone and compression stocking developed post thrombotic syndrome (PTS). Accelerated removal of thrombus by thrombolytic agents may increase venous patency and prevent PTS. The objective of the study was to assess short-term efficacy of additional catheter directed thrombolysis (CDT) compared with standard anticoagulant therapy alone.Methods: Prospective, randomized, controlled study on 50 patients (18–75 years) with acute iliofemoral DVT and symptoms <21 days were randomized to receive additional CDT or standard anticoagulant therapy alone. After 6 months, vein patency and insufficiency (reflux) was assessed using duplex ultrasound by an investigator blinded to previous treatments.Results: Fifty patients were allocated additional CDT (n=25) or ACs alone (n=25). After CDT, grade III (complete) lysis was achieved in 17 (68%) and grade II (50%–90%) lysis in 5 patients (20%). One patient suffered major bleeding and two had clinically relevant bleeding related to the CDT procedure. After 6 months, iliofemoral patency was found in 17 (68%) in the CDT group vs. 8 (32%) controls, corresponding to an absolute risk reduction 36% (95% CI, p=0.002). Femoral venous insufficiency was found to be higher among the ACs group 11 patients (44%) vs. 7 patients (28%) in the CDT group.Conclusions: After 6 months, additional CDT increased iliofemoral patency from 32% to 68% and decreased venous insufficiency from 44% to 28%.
A sub-specialised emergency general surgery on call can improve theatre utilisation
Authors: Musbahi Aya , Abdulhannan Peshang , Rao Milind , Gopinath Bussa
Published: July 2019

Background: Theatre efficiency and delivery of a safe emergency general surgery service are important topics in the current climate of limited funding and resources. No studies have examined the impact of restructuring a general surgery emergency on call system on theatre utilisation and efficiency.Methods: Data was collected for twelve months prior and twelve months after the introduction of a sub-specialised on call system on operating minutes, out of hours operating and which procedures were done after 10 PM using a prospectively maintained database. Theatre utilisation was calculated and compared using a paired T test.Results: In 2012, between 8 AM and 5 PM, 993 emergency procedures were done in 2012 compared 1300 in 2015 corresponding to 34585 and 90311 minutes of operating respectively and 17.5% and 45.8% of total theatre time available (p<0.05). 160 procedures in 2012 were performed after 10 PM and 106 in 2015 corresponding to 16457 and 9341 minutes respectively (p<0.0001).Conclusions: A sub-specialised emergency general surgery on call system can improve theatre utilisation.
Impact of additional abdominal approach to transanal one stage endorectal pull-through in treatment of Hirschsprung’s disease
Authors: Huu Thien Ho , Xuan Thanh Cao , Thanh Xuan Nguyen , Huu Son Nguyen
Published: July 2019

Background: The transanal one-stage endorectal pull-through (TOSEPT) procedure sometimes requires assistance by an abdominal approach to complete the operation. This study aims to rectify this by evaluating the impact of an assisted abdominal approach in the outcomes of the TOSEPT in children with HD.Methods: A retrospective study was conducted at surgical paediatric department of Hue central hospital. All consecutive medical records of patients operated on for HD in our department between June 2010 and June 2018 were retrieved and analysed.Results: 66/446 (14.79%) patients with HD who required TOSEPT with an additional abdominal approach to complete the operation for inclusion in this retrospective study. Length of the resected colon: 13.30±3.45 cm (open group) and 19.70±4.50 cm (laparoscopic group). Average operative time: 156±12 minutes (open group) and 170±14 minutes (laparoscopic group). No deaths or intra-operative complications were recorded in this study. No postoperative complication occured in the laparoscopic group. Grade II complication based on Dindo-Clavien classification occurred in 14 (21.21%) of the open group and one (1.51%) grade III complication. The length of hospital stay was shorter in the laparoscopic group at 5±1.5 days compared to 7±2.5 days for the open group. All of the complications were grade I or II, mainly enterocolitis at 3-month follow-up.Conclusions: Additional abdominal approach impacts on post-operative results of TOSEPT procedure for HD but not on outcome of disease. Laparoscopic surgery as the additional abdominal approach should be used to reduce the complications.
Management of syndactyly: a clinical study
Authors: Nangineedi Nagaprasad , Harish Gangavaram Praveen , Rafi Mohammed
Published: July 2019

Background: Syndactyly is a congenital anomaly, basic principles of surgical release of syndactyly have been well established, each patient requires a thorough assessment of the soft-tissue and bony components in the syndactylized region. Reconstruction must be planned carefully when more than two digits are involved or when the syndactyly is a component of a systemic congenital syndrome. The aim of the treatment strategies for syndactyly is to separate the fused digits, create a functional hand, and produce an aesthetically acceptable web.Methods: The prospective clinical study is conducted in the Department of Plastic & Reconstructive surgery, between October 2016 to October 2018. Twenty six patients with congenital syndactyly and post burn syndactyly of fingers were included in this study.Results: There were no intra operative complications and no cases had any neurovascular compromise. Integrity of Dorsal and volar flaps, quality of scars, aesthetical aspects of fingers are reasonably good in almost all the cases that are operated in this study. Overall 97% of patients treated achieved good function and superior results following single surgery.Conclusions: Primary syndactyly is more common than secondary syndactyly. In this study the primary goal is separation of fused digits/toes and covering the web space with dorsal flap, and covering the separated digits/ toes with a graft and create a functional hand and produce an aesthetically web with fewest complications and fewest surgical corrections.
Correlation of clinical, cytological, sonological diagnosis with histopathological diagnosis in cases of clinically diagnosed solitary thyroid nodule
Authors: Sachin Idoor D. , Omprakash Muruganathan , Amarendra Pasham
Published: July 2019

Background: Thyroid disorders are highly prevalent in India. Clinical examination although very accurate, is inadequate in some areas. Ultrasound is most sensitive method for detection, while FNAC is most accurate method for evaluation of thyroid nodules. Both are used along with clinical examination but have drawbacks and final answer to this problem is elusive. Hence this study was planned to evaluate the usefulness of clinical examination, FNAC and USG in managing thyroid nodule.Methods: Hundred patients with clinically solitary thyroid nodule were included. USG and FNAC of thyroid were conducted. They were operated and specimen was sent for histopathological examination (HPE). Histopathology reports were correlated with USG and FNAC.Results: The commonest age group with thyroid pathology was 31-40 years. Majority of patients were females. All patients presented with swelling in anterior neck. Majority of patients presented between 6 months to 3 years. Consistency of nodule was firm in 88 patients and hard in 12. On USG, 70 cases were benign, 25 malignant and 5 suspicious while, on FNAC, 61 had benign lesions, 29 suspicious and 10 malignant. Commonest surgery was hemithyroidectomy. Most common lesion was benign follicular adenoma by HPE.Conclusions: Majority of patients were females aged 31-40 years with swelling in anterior neck. Duration of swelling prior to presentation was 6 months to 3 years. Incidence of malignancy in solitary nodule of thyroid was 18%. On FNAC majority of the lesions were benign. The sensitivity and specificity of FNAC was 74.3% and 100% while for USG was 73% and 85.3% respectively.
Laparoscopic choledochal cyst excision and Roux-en-Y hepaticojejunostomy in children: a single-institution prospective cohort study
Authors: Xuan Nguyen Thanh , Thien Ho Huu , Thanh Phan Hai , Vu Pham Anh , Son Nguyen Huu , Thanh Dang Nhu , Vinh Nguyen Du , Hiep Pham Nhu
Published: July 2019

Background: Laparoscopic cyst excision and Roux-en-Y hepaticojejunostomy is gaining popularity as a treatment for choledochal cyst in children. The aim of this study is to determine the feasible and safe of the laparoscopic excision with Roux-en-Y hepaticojejunostomy, and evaluate the short-term outcomes after treatment for children with choledochal cyst.Methods: A prospectively of 51 consecutive pediatric patients undergoing laparoscopic choledochal cyst excision and Roux-en-Y hepaticojejunostomy performed by one surgeon cysts at Hue Central Hospital from June 2012 to December 2017 was studied.Results: The mean operative time was 214.7±67.95 minutes (range, 100~360 minutes), including the time for intraoperative cholangiography. There were two children requiring blood transfusion. Time to first flatus was 40.35±28.55 hours in average. The mean time to drain removal was 2.89±1.02 days. Mean postoperative hospital stay was 9.31±3.43 days. 6 out of 51 cases having early complications, including 2 cases of pancreatitis and 4 cases of bile leakage. Most of cases (90.5%) were classified as good after 10 days to 3 months of follow-up.Conclusions: Laparoscopic choledochal cyst excision and Roux-en-Y hepaticojejunostomy was feasible and safe in children. The short-term outcomes were good in most cases.
A simple scoring system to determine axillary lymph node metastasis in carcinoma breast
Authors: Masthi Greeshma K. , Krishnappa Rohit , S. Rajagopalan
Published: July 2019

Background: The aim of this study is to develop a scoring system wherein axillary lymph node metastasis in carcinoma breast can be predicted preoperatively using simple variables.Methods: A prospective study carried out from December 2017-November 2018 at Rajarajeswari Medical College and Hospital. All clinically node negative cases were included. Data from clinical examination, histopathology report and immunohistochemistry (obtained from trucut biopsy preoperatively) is correlated with presence or absence of lymph node metastasis obtained after modified radical mastectomy. And a scoring system is proposed according to the results obtained. Results: Out of 36 cases studied, 12 cases had score <10, 11 cases had score 11-13, 13 cases had score >14, indicating that more than 50% of cases were over treated with axillary lymph node dissection.Conclusions: Lymph node metastasis in carcinoma breast can be predicted clinically using a scoring system. Further a recommendation for or against axillary node dissection can be made according to the respective scores.