bluuebunny/crossref_metadata_2025 huggingface dataset:
Exercise Tolerance Test Using Duke Treadmill
Authors: Arif Muhammad Maaz , Arif Butt Muhammad Zarrar , Arif Butt Muhammad Afan
Published: June 2021

Background:

Ischemic heart diseases (IHDs) are one of the most prevalent diseases worldwide. Several tests are undertaken for diagnosing IHDs including electrocardiography (ECG), echocardiography, troponin test, and angiography. Exercise tolerance test (ETT) is an ideal noninvasive test for diagnosing IHDs. ETT is quite useful for risk estimation in patients diagnosed with coronary artery diseases or undergoing vascular surgery. The Duke treadmill score has a great prognostic value for ETT.

Aims:

The study aimed to compare the data between positive, negative, and inconclusive cases undergoing ETT with several variables that are related to cardiac scores, pathologies, and risk factors.

Materials and Methods:

It was a cross-sectional study that included 61 patients undergoing the test. The study was conducted at the cardiology ward, Fatima Memorial Hospital, Lahore, Pakistan.

Results:

The demographic characteristics showed majority of the patients to be male with 44 (72.13%) as opposed to female with 17 (27.87%) cases. The average age of all the cases was 43.48 ± 8.65. Most of the patients undergoing the test had atypical angina with 55 (88.71%), followed by typical angina with 3 (7.14%) and no angina with 3 (7.14%) cases. Cases showed the past history of positive family reports with 20 (32.79%), followed by a history of smoking with 11 (18.03%), diabetes with 9 (14.75%), catheterization with 7 (11.48%), coronary artery bypass grafting with 5 (8.2%), and myocardial infarction with 5 (8.2%) cases.

Conclusion:

Duke treadmill scores of the three groups revealed that most of the cases (81.97%) fall in the intermediate-risk group (between 4 and − 10 scores) and the standard Bruce protocol showed that majority of the cases only passed Stage II (37.7%) and Stage III (37.7%) of the treadmill. Few studies have been conducted on ETT that shows a detailed analysis of this test with different associated factors. Studies like these will help in conducting greater work of this nature, analyzing important content.
Clinical Profile of ST-Elevation Myocardial Infarction Thrombolysed with Tenecteplase in Coronavirus Disease 2019 Pandemic
Authors: Jena Kamal Kant , Manohar G , Elamaran C , Rudrappa A
Published: June 2021

Background:

Coronavirus disease-2019 (COVID-19) pandemic has affected millions worldwide. The various complications of COVID-19 have been discussed in the recent studies. We would like to discuss about one such cardiovascular complication, ST elevation myocardial infarction (STEMI) in COVID-19, and its characteristics in this article.

Methodology:

An observational study was done from April 1, 2020, to July 15, 2020, selecting all STEMI patients admitted to a tertiary care center in Chennai and treated with tenecteplase were grouped in to COVID-19 positive and negative. Their presenting features and complications and outcome were studied.

Results:

A total of 300 patients were admitted with STEMI during the study period, of which 11.66% were COVID-19 positive. Atherosclerotic cardiovascular risk factors were much lower in COVID-19-positive STEMI patients when compared to non-COVID STEMI patients. Mean oxygen saturation at time of presentation in COVID-19 positive and negative patients was 85.1% and 97.5%, respectively (P < 0.001). COVID-19 group had significantly higher noncardiac complications than non-COVID patients (P < 0.001). The average duration of hospital stay in COVID-19 STEMI was 13.6 days, whereas in non-COVID group was 6.8 days (P < 0.001). Higher mortality was found in the COVID-19 positive group (14.28%) when compared to non-COVID STEMI (7.9%; P < 0.001).

Conclusion:

COVID-19 itself is a systemic inflammatory disease, which could increase the risk of coronary plaque rupture. Thrombosis has also been described as a mechanism underlying certain cases causing presentation of STEMI, because of endothelial dysfunction and hypercoagulable state.
Cold Injuries in the Glacial Regions of India
Authors: Ranjan Priya , Pawar Aditya , Naik Anant Kumar , Bhardwaj Saurabh , Sharma Pawan
Published: June 2021

Background:

Personnel deployed at an altitude ranging from 9000 ft to 23,000 ft are exposed to sub-zero temperatures up to −40°C. These conditions lead to the development of various cold injuries which presents in varying grades and severity. Aim: The aim of this study is to study the epidemiological trends and assess risk factors/conditions those are contributing to the development of cold weather injuries (CWI) at extreme cold climate in high altitude areas.

Methodology:

This is a retrospective, observational study on cold injury cases evacuated from the northern glaciers of India. The data were collected and tabulated in MS-Excel sheets, and analysis was done using percentage, mean, median, linear regression, and P value calculation. SPSS statistical analysis software version 23 was employed for generating the results. P < 0.05 was considered for statistically significant.

Results:

The annual incidence of cold injuries calculated for troops deployed at high altitude (>9000 feet) with extreme cold climate is 6.4/1000/year. The average duration of exposure for the development of CWI was found to be 4.85 h with a standard deviation = 2.88 h. Statistically significant association was found between the median temperatures and number of cold injury cases evacuated monthly with a strong negative coefficient of correlation (Pearson's) value r = −0.8214, and P = 0.001063. No correlation was found between the severity of frostbites and duration of exposure as the coefficient of correlation r (Pearson's) was weakly positive with a value of 0.19 and statistically not significant with P = 0.127.

Conclusion:

This study highlights the magnitude of problem, high risk zones, and predisposing activities. Statistical association has been drawn between altitude, temperature and duration of exposure with burden of cold injury. This study provides an insight with respect to associations and risk factors for the development of CWI, in Indian perspective and may be beneficial for better planning and preventive measures to reduce burden of CWI.
In vivo comparison of postoperative pain using two different techniques for local anesthesia in single-sitting root canal treatment
Authors: Bhagwat Sumita A. , Mehta Anchal , Padhye Leena V.
Published: June 2021

Aim:

This in vivo split-mouth randomized control trial was carried out to study and compare the incidence of postoperative pain associated with single-sitting endodontic treatment using inferior alveolar nerve block and intraligamentary injection as primary anesthetic technique.

Methods:

A total of 30 patients with bilateral symptomatic irreversible pulpitis in mandibular molars were selected to be included in the study. In each subject, molar in one quadrant was randomly assigned to Group 1 (intraligamentary injection), and the molar in the opposite quadrant was assigned to Group 2 (inferior alveolar nerve block). The root canal procedures for the patients were carried out in single sittings under rubber dam using hand ProtaperTM system, 2.5% sodium hypochlorite as irrigant alternating with normal saline and obturation by the lateral condensation technique. A questionnaire employing Visual Analog Scale (VAS) for pain assessment was given to the patient and instructions on how to fill the form were given. VAS scores for every tooth treated in every patient were recorded before beginning treatment and after completion of treatment for each tooth. The patients were recalled after 2 days, and the scores were analyzed. The results were tabulated and statistically analyzed for incidence and degree of pain.

Results:

Group 1 and Group 2 showed a steady reduction in postoperative pain from 4 h to 48 h as seen in the mean VAS scores. Comparison between the two groups at each time interval showed a difference which was statistically insignificant (P > 0.05).

Conclusion:

There is no difference in the incidence of postoperative pain when either inferior alveolar nerve block or intraligamentary injection is employed as the primary technique for achieving anesthesia during single-sitting root canal treatment.
Portfolios in medical education: A tool for learning and assessment of medical students
Authors: Shrivastava Saurabh , Shrivastava Prateek
Published: June 2021

The period of medical training is a long one and it is quite crucial for a medical student to document their learning, substantiate the same with evidence, and record personal reflections to make it a long-term learning. Portfolios have been identified as a tool for learning as it envisages the value of student-centered learning, gives importance to what a learner can accomplish, and can be used as a tool for both learning and assessment. As the primary objective of the portfolio is a reflection on learning, it plays a significant role to ensure professional growth and development. In conclusion, advocating the use of a portfolio among medical students is the foundation stone for lifelong learning and ensures continuous professional development. It is the need of the hour that all the medical colleges should implement the maintenance of the portfolio within their settings based on a framework that clearly defines the purpose for the same and its periodical assessment.
The Prevalence and Distribution of the Variants of Pectoralis Minor in Cadaveric Studies
Authors: Asghar Adil , Naaz Shagufta , Naya Sunita
Published: June 2021

Introduction:

Pectoralis minor (PMi) is used as a vascularized and innervated free-muscle graft in the reconstructive surgical procedure. The present review aims to provide insights to the surgeons regarding the variants of PMi in terms of costal attachment, insertion, nerve supply and arterial supply.

Methodology:

Three major databases (PubMed, EMBASE, and Google Scholar) were thoroughly searched along with the full text of journals.

Results:

Seven studies (n = 1787) were analysed for the evaluation of costal attachment. PMi arise from 3rd to 5th rib in 33% (95% confidence interval [CI], 30–37%), but the most common variants II-5 ribs was observed in 36%, which was higher than normal. Eighteen studies (n = 2424) reported details of insertion. The variant insertion of PMi was observed in 21% (15–28; 95% CI). Seven studies reported nerve supply. Both medial pectoral nerve (MPN) and lateral pectoral nerve (LPN) innervates PMi in 93% and MPN absent in 7%. Only two studies reported arterial supply. The PMi was vascularized by single dominant artery in 77% (68–85; 95% CI) or two arteries in 19% (13–29; 95% CI) or three arteries 2% (2–8; 95% CI) or even four arteries in 1% (0–7; 95% CI).

Conclusion:

PMi has a constant costal attachment to the 3rd and 4th ribs. Origin of PMi from 5th rib is reported with a pooled prevalence of 73.3% and from 2nd rib is reported in 61.5%. PMi inserts to the superomedial boundary of the coracoid process in 79% only.
Recurrent Tolosa–Hunt syndrome
Authors: Thu Phyo-Wai , Chen Yu-Ming , Liu Weng-Ming
Published: June 2021

The Tolosa–Hunt syndrome (THS) is caused by granulomatous inflammation in the cavernous sinus, superior orbital fissure, or orbit characterized by painful ophthalmoplegia. Here, we report a case of recurrent THS in a 48-year-old female, who initially showed a poor response to low-dose steroids. Each episode involved different cranial nerves and painful ophthalmoplegia. Neuroimaging showed enhancement in the right cavernous sinus. The patient was treated with glucocorticoid pulse therapy and azathioprine. THS was previously considered to be responsive to glucocorticoids. This report demonstrates a case of THS with poor response to steroids and unique presentation of frequent recurrence with different cranial nerve involvement.
The use of preoperative neutrophil–lymphocyte ratio and lymphocyte–monocyte ratio in predicting survival and groin node involvement of patients with squamous cell carcinoma of penis
Authors: Jindal Tarun , Pawar Pravin , Agarwal Sanjit , Jain Prateek , Meena Monika , Sarwal Ankush , Dhanalakshmi M.
Published: June 2021

Introduction:

The association between inflammation and malignancies is being recognized. In this study, we assessed the use of preoperative neutrophil–lymphocyte ratio (NLR) and lymphocyte–monocyte ratio (LMR) in predicting cancer-specific survival (CSS) and inguinal node involvement in patients with carcinoma penis.

Methods:

Sixty-nine patients operated for squamous cell carcinoma penis with inguinal node dissection between 2012 and 2020 were identified. We recorded the type of surgery (partial/total penectomy), T stage, grade, lymphovascular invasion (LVI), perineural invasion (PNI), pathological status of inguinal nodes and nodal stage (pN1–3), extranodal extension (ENE), and CSS. The hemogram performed within 2 weeks of surgery was used for calculating NLR and LMR.

Results:

Partial penectomy was the most common surgery (65.22%) and pT2 was the most common stage (53.62%). Grade 2 was seen in 66.67%, LVI in 34.78%, PNI in 37.68%, 52.17% had inguinal node involvement with pN3 being the most common (36.23%), and 36.23% had ENE. Kaplan–Meier analysis revealed that NLR of >3 and the LMR ≤3 indicated an inferior CSS (P = 0.05 and 0.04, respectively). T stage, inguinal node involvement, LVI, pN stage, and ENE were also associated with inferior CSS (P < 0.05). On multivariate analysis, T stage was significantly associated with CSS (P = 0.02). The NLR >3 and LMR ≤3 were also significantly associated with the presence of pathological inguinal node involvement (P = 0.001 and 0.026).

Conclusion:

NLR and LMR may help in predicting CSS and inguinal node involvement in patients of carcinoma penis.
Pediatric urology surgical practice in the time of COVID-19
Authors: Raheem Ali Abdel , Banihani Omaya , Abasher Abdelazim , Alotay Abdulhakim , Alyami Fahad A. , Alsaad Tamer A. , Alqarni Naif , Alsowayan Ossamah , Jamalalali Yasser A. , Alhuwaiti Mohammad , Al-Madi Maha , Rubeea Subbhy Abo , Aljallad Hossam , Elhelaly Ahmed , Alroumaih Abdullah , Almutairi Faisal , Alhams Abdulwahab E. , Alayad Abdullrhman , Alshammari Ahmad
Published: June 2021

Purpose:

Our study aimed to evaluate the effect of COVID-19 on pediatric urology practice in the Kingdom of Saudi Arabia (KSA).

Methods:

Data of 10 tertiary hospitals in KSA were retrospectively analyzed. Data of outpatient department (OPD) visits and pediatric urology surgical procedures from January 1, 2019, to April 30, 2019, and from January 1, 2020, to April 30, 2020, were extracted. The primary outcome was to compare OPD visits and pediatric urology workload in the first third of 2020 versus 2019, where there was no curfew. The secondary outcome was to compare the same variables during the full curfew time, i.e., April 2020 versus April 2019.

Results:

The number of OPD visits was lower in the first third of 2020 (7390 vs. 10,379 in 2019 P < 0.001). OPD visits in April 2020 were 78.6% lower than in April 2019, and teleclinics represented 850 (94.3%). Elective procedures in the first third of 2020 were 688, with a reduction rate of 34.3% compared to the same period of 2019 (P < 0.001). In April 2020, there were 18 elective surgeries, with a 91.4% decrease than in April 2019. Ureteric reimplantation, hypospadias, cryptorchidism, and circumcision stopped, while pyeloplasty (n = 14) and urolithiasis (n = 4) procedures had declined by 50% and 76.5%, respectively. Most of the procedures (71.8%) were day surgery. Emergency procedures were similar in the first third of 2020 (65 vs. 64 in 2019, P = 0.994) and declined in April 2020 by 6.7% versus April 2019. During the full curfew, the most common emergency intervention were cases with obstructive uropathy (42.8%), followed by torsion testis (28.6%), posterior urethral valve (14.3%), and urological trauma (14.3%).

Conclusions:

In KSA, the number of elective pediatric surgical procedures were reduced by >90%, while the number of emergency pediatric surgical procdures were similar during COVID-19 pandemic compared with non-COVID-19 time. Ureteric reimplantation, hypospadias repair, cryptorchidism, and circumcision procedures were postponed. Pyeloplasty and urolithiasis-related procedures were performed to prevent irreversible disease progression or organ damage. There was an increase in rate of teleclinic and day surgery to reduce the risk of COVID-19 infection.
Empirical therapy for male factor infertility
Authors: Al Khayal Abdullah M. , Balaraj Faisal K. , Alferayan Turki A. , Al Sait Mutaz A. , Abumelha Saad M. , Alrabeeah Khalid A.
Published: June 2021

Background:

Empirical therapy is sometimes used by urologists who desire to improve the outcomes for infertility patients. However, the literature on empirical therapies is scarce. Therefore, we aimed to assess the clinical practice of urologists regarding the use of empirical therapy in the treatment of infertility patients.

Methodology:

An online survey using Google Forms was used to collect data during the Saudi Urological Association Annual Meeting, February 2019. Additional data were gathered electronically in March and April 2019 and sent to respondents. The study was closed in May 2019. No incentives were provided to the respondents.

Results:

A total of 96 (80%) urologists participated in the survey, of whom 69.8% were consultants, and 20.8% were andrology-trained urologists. Empirical therapy was used by 86.5% of urologists for patients with idiopathic oligoasthenoteratozoospermia. The most commonly used empirical therapies were zinc, L-canitine, clomiphene citrate, and L-arginine. The main factors that influenced the selection of empirical therapy were follicle-stimulating hormone, total testosterone, and luteinizing hormone levels.

Conclusion:

Empirical therapy was used by more than three-quarters of the participants for idiopathic male infertility. There were no clear guidelines for the ideal therapy to be considered for individual patients while treating empirically. Our concern is that urologists use a wide variety of medications without significant data to support these medications.
Safe transition from open to pure laparoscopic donor nephrectomy
Authors: Saifee Yusuf , Chamania C. S. , Bhatia Sushil , Salgia Pradeep , Kriplani Jai , Sepaha Achal
Published: June 2021

Introduction:

Laparoscopic living donor nephrectomy (LLDN) offers many advantages compared to open living donor nephrectomy. However, the perceived difficulty in learning LLDN has slowed its wider implementation. Herein, we describe the evolution of LLDN at a single center, emphasizing the approach and technical modifications and its impact on outcome.

Methods:

The series included a 2½-year period and three different surgeons. We started with two-stage plan for establishing LLDN at the institute (introduction and consolidation). Data of laparoscopic donor nephrectomy performed at the institution were prospectively evaluated regarding donor and recipient outcome.

Results:

From December 2016 to April 2019, 221 donors underwent LLDN. Three donors required conversion to open surgery. The mean operation time was 96.4 (62–158) min and the mean warm ischemia time was 186 (149–423) s. The complications were observed in 11.6% of donors from LLDN group and all complications were Class I and Class II only (Clavien–Dindo classification). No Class III and Class IV complications occurred. In the present study, there was some learning curve effect observed only in operative time (OT) with longer OT in initial cases. However, the overall operative complications were minimal, showing that this learning curve had no deleterious effects on donor safety.

Conclusion:

The present study demonstrates that with proper planning, team approach, and a few technical modifications, the transition from open to LLDN could be safe and effective.
Quality of life is improved by endoscopic surgery and fluticasone in nasal polyposis with asthma
Authors: Olsson P. , Ehnhage A. , Nordin S. , Stjarne P. , NAF2S2 Study Group
Published: June 2021

Background: The aim was to investigate the health impact of nasal polyposis with asthma and to study effects of endoscopic sinus surgery (ESS), and addition of fluticasone propionate nasal drops (FPND), on health related quality of life (HRQoL). Methods: Prospective study of 68 patients with nasal polyposis and asthma. Effects were measured with Study 36-Item Short Form (SF-36). A randomized, double-blind, placebo-controlled 14-weeks phase measuring additive effects of FPND 400 µg twice daily (b.i.d.) was included. Results: HRQoL was significantly decreased in both Physical Component Summary, PCS, (45 vs 48, p=0.049) and Mental Component Summary, MCS, (43 vs 51, p<0.001) vs reference population. ESS significantly improved PCS, (p=0.027) and MCS (p=0.021) after five weeks. We found significant additional benefit of FPND on three domains (RP, p=0.002; VT, p=0.007; SF, p=0.002). The increase in HRQoL with FPND reached reference population levels in all domains, as well as in both PCS (50, p=0.003) and MCS (52, p=0.002), five weeks after ESS. Conclusions: FPND 400 µg b.i.d. can be added to ESS in order to improve, and to reach population levels of, HRQoL already five weeks post-ESS. Physicians should evaluate HRQoL and consider ESS with nasal steroids early in their treatment of these patients.
Comparison of two different odorants in an olfactory detection threshold test of the Sniffin’ Sticks
Authors: Zernecke R. , Vollmer B. , Albrecht J. , Kleemann A.M. , Haegler K. , Linn J. , Fesl G. , Bruckmann H. , Wiesmann M.
Published: June 2021

The olfactory test battery Sniffin’ Sticks is a test of nasal chemosensory function that is based on pen-like devices for odour presentation. It consists of three olfactory subtests: threshold, discrimination, and identification. The detection threshold can be measured using two different odorants--n-butanol or PEA (phenylethyl alcohol). Both tasks are commonly applied in published studies, but little is known about the formal comparison of values obtained using them. Unlike the Sniffin’ Sticks with n-butanol as odorant, there is poor validation for the threshold subtest with the odorant PEA. The purpose of this study was to compare these two different odorants. Both odorants were applied to 100 normosmic, healthy subjects (50 females). The experiment was divided into two sessions performed on two different days. After each threshold test the discrimination and identification subtests were conducted. We obtained significant differences in detection thresholds of PEA and n-butanol. The mean score of PEA threshold and PEA TDI (sum of threshold, discrimination, identification) was significantly higher compared to n-butanol. No significant correlation between individual PEA and n-butanol thresholds was observed. The differences between both odorants indicate that a formal validation of the Sniffin’ Sticks with PEA as odorant for probing olfactory thresholds may be required.
Therapeutic Index (TIX) for intranasal corticosteroids in the treatment of allergic rhinitis
Authors: Schafer T. , Schnoor M. , Wagenmann M. , Klimek L. , Bachert C.
Published: June 2021

Background: Intranasal corticosteroids (INS) are the first line treatment for allergic rhinitis (AR). To guide clinical decision-making, we created a therapeutic index (TIX) for INS reflecting efficacy and safety. Methods: A Medline search (1966 to June 2009) was carried out to identify all placebo-controlled randomized trials, and observational reports for safety issues, with Dexamethasone, Budesonide (BUD), Fluticasone propionate (FP), Fluticasone furoate (FF), Flunisolide, Mometasone furoate (MF), Triamcinolone (TRIAM), and Beclomethasone dipropionate (BDP) as treatment for AR. Data on three efficacy (nasal symptoms, ocular symptoms, global assessment) and three safety outcomes (epistaxis, growth, systemic ocular effects) were extracted. Meta analyses were performed for each INS and outcome and results were categorised into scores by quartiles. Scores of the three efficacy and safety outcomes were summed up to create summation scores for efficacy (ES) and side effects (AES), respectively with a maximum of 9 points. The TIX was then defined as the ratio of ES and AES. Results: Data of 84 studies were extracted. Based on availability of data, a TIX was calculated for 6 substances. BUD showed the highest efficacy score followed by MF and TRIAM. The lowest scores for side effects were achieved by MF and TRIAM followed by FP. These findings resulted in TIX scores of 7 and 5 for MF and TRIAM, respectively, indicating a high efficacy and low potential of adverse events. Medium scores were reached by BUD and FP and lower scores by BDP and FF. Conclusion: Although safety and efficacy is proven for all available INS by multiple studies, the systematic aggregation and analysis of data allows for a differentiated summary on clinically important features.
The menthol and cold sensation receptor TRPM8 in normal human nasal mucosa and rhinitis
Authors: Keh S.M. , Facer P. , Yehia A. , Sandhu G. , Saleh H.A. , Anand P.
Published: June 2021

Background: Menthol and cold sensation trigger symptoms and reflex responses in the upper airway, but the underlying molecular mechanisms are unknown. We have therefore studied nerve fibres expressing the menthol and cold receptor TRPM8 in normal human mucosa, and in rhinitis. TRPM8 nerve fibres were compared with those expressing other TRP receptors including TRPV1 (capsaicin and heat receptor), and TRPA1 (mechano-cold receptor). Methods: Immunohistology and image-analysis were used to study TRP receptors in biopsies of nasal turbinate from control subjects, patients with allergic rhinitis, and non-allergic rhinitis. Results: TRPM8-immunoreactive nerve fibres were observed in the sub-epithelium, and were profuse around blood vessels in deeper regions, where they were markedly greater in number than TRPV1+ fibers. Image analysis of TRPM8 in sub-epithelial and vascular regions showed no significant differences between control and the rhinitis patient groups. TRPA1-immunoreactivity was weak and seen rarely in nerve fibres. Conclusion: We show that TRPM8 nerve fibres are abundant in nasal mucosa particularly around blood vessels, and may mediate neurovascular reflexes. TRPM8 antagonists deserve consideration for therapeutic trial in rhinitis.
Audit of CT scanning of paranasal sinuses in patients referred with facial pain
Authors: Amir Ida , Yeo Justin C.L. , Ram Bhaskar
Published: June 2021

Background: Computed tomography (CT) scans are performed by some clinicians in the belief that they are a useful primary investigation in patients with facial pain. Objective: To assess the appropriateness and outcome of sinuses CT scans in patients with facial pain based on the European Position Paper on Chronic Rhinosinusitis and Nasal Polyps (EPOS) 2007 guideline and International Headache Society (IHS) criteria for diagnosing and investigating rhinosinusitis. Methodology: The first cycle of audit was performed on 50 patients with facial pain who underwent CT scanning. The findings on nasal endoscopy, Lund-Mackay scores (LMS) of the scans and management of these patients were analysed. Following implementation of the IHS and EPOS criteria, 50 consecutive patients were re-audited. Results: In the first cycle, 16% of patients had positive nasal endoscopic findings. Thirty patients had LMS of 0 and only 9 showed significant changes (LMS ≥ 8) on their scans. In the second cycle, only 10 patients underwent CT imaging as per EPOS guideline and 4 of them showed significant changes. The remaining 80% of patients in this cycle were diagnosed and treated for non-sino- genic causes. Conclusion: Applying the IHS and EPOS criteria has reduced the number of inappropriate CT scans requests and allowed consideration of non-sinogenic aetiologies.
Bleeding control in endoscopic sinus surgery: a systematic review of the literature
Authors: Rodriguez Valiente A. , Roldan Fidalgo A. , Laguna Ortega D.
Published: June 2021

In the literature various methods are described to reduce bleeding in endoscopic sinus surgery. Scientific evidence and results were gathered and analysed to determine the effectiveness of the various methods used. A total of 20 articles fulfilled the inclusion criteria. Two retrospective articles studied the differences between local and general anaesthesia. Three articles analysed the use of local methods to control bleeding. The majority of the articles analysed the use of different systemic drugs to control intraoperative bleeding. Certain procedures, such as the reverse Trendelenburg position, the use of high doses of epinephrine, the infiltration of phenylephrine and lidocaine into the pterygopalatine fossa, the preoperative use of prednisone, and the control of the heart rate (with dexmedetomidine or remifentanil), appear to reduce the intraoperative blood loss and/or improve the visualisation of the surgical field. However, the evidence supporting these conclusions is poor. The benefits of other procedures, such as the preoperative use of β-blockers, antihypertensive agents, and surgical pledgets with oxymetazoline, phenylephrine, or cocaine, for bleeding control are not evidenced in the literature. In addition, the literature does not present any evidence on the benefits of local anaesthesia compared with general anaesthesia or the use of propofol compared to inhaled analgesics in terms of intraoperative bleeding or complication rates.
Treatment with a topical glucocorticoid, budesonide, reduced the variability of rhinomanometric nasal airway resistance
Authors: Thulesius H.L. , Cervin A. , Jessen M.
Published: June 2021

Background: Previous rhinomanometry studies have shown significant long-term variability of the nasal airway resistance and questioned the clinical validity of rhinomanometry. Research question: Could treatment with a topical glucocorticoid, budesonide, influence the long-term variability of active anterior rhinomanometry? Methods: Eight healthy volunteers participated in an unblinded controlled trial without, and later with, nasal budesonide once a day for 5 months. Their nasal airway resistance was measured every two weeks with active anterior rhinomanometry before and after decongestion with xylometazoline hydrochloride. In addition, subjective nasal obstruction was evaluated on a Visual Analogue Scale before each measurement. The participants had a year earlier been investigated with rhinomanometry every two weeks during 5 months but without budesonide treatment. We compared the variability of nasal airway resistance during the two periods with and without treatment with topical budesonide. Results: Budesonide significantly reduced mean nasal airway resistance and the standard deviation of the mean after decongestion for 6 of 8 participants. The mean reduction of the nasal airway resistance was 40% for the decongested nasal cavity compared to the period without treatment with nasal budesonide. Subjective nasal obstruction assessed by Visual Analogue Scale was reduced in 3 of the 8 participants. Conclusion: The variability of nasal airway resistance was significantly reduced by treatment with topical budesonide for 6 out of 8 healthy volunteers participating in an unblinded repeated 5 month trial where the participants served as their own controls.
Feasibility of balloon sinuplasty in patients with chronic rhinosinusitis: the Graz experience
Authors: Tomazic P.V. , Stammberger H. , Braun H. , Habermann W. , Schmid C. , Hammer G.P. , Koele W.
Published: June 2021

Background: Balloon sinuplasty (BSP) is a catheter-based technique to dilate sinus ostia and drainage pathways to create ventilation and drainage. The aim of this study was to evaluate the feasibility of BSP in routine treatment of patients suffering from chronic rhinosinusitis (CRS). Methodology: Patients with CRS refractory to medical therapy who had been scheduled for endoscopic sinus surgery between 2009 and 2011 were included in this study. Results: Forty-five consecutive patients were included in this study, in whom 112 sinuses were approached by BSP. Of the 112 sinuses, 68 (60%) were planned as a "Balloon-Only" procedure and 44 (40%) were planned as a "Hybrid" procedure. Of the 68 sinuses in the "Balloon-Only" group, in 44 sinuses BSP failed, equating to a failure rate of 65%. Forty-four sinuses were planned for "Hybrid" procedures. In 29 of these sinuses BSP failed, giving a failure rate of 66%. Conclusion: According to literature, BSP can be a useful adjunct technique to standard FESS. In our experience, however, a failure rate of 65% for "Balloon-Only" and of 66% for "Hybrid" procedures occurred, which was regarded as unacceptable by the study group. Therefore, the study initially scheduled for 200 consecutive patients, was abandoned.
Efficacy of fexofenadine in isolated rat tracheas
Authors: Lai W.S. , Lin Y.Y. , Chu Y.H. , Wang C.H. , Wang H.W.
Published: June 2021

Objectives: Histamine is an important chemical mediator in both nasal and bronchial inflammation in patients with allergic rhinitis and asthma. The effect of histamine receptor-1 antagonists on nasal mucosa in vivo is well known, however, the effect on tracheal smooth muscle has rarely been explored. The purpose of this study was to determine the effects of fexofenadine on isolated tracheal smooth muscle in vitro. Methods: Six tracheal strips were used for each experiment, and one untreated strip served as a control. We examined the effectiveness of fexofenadine on isolated rat tracheal smooth muscle by testing the effect on: 1) tracheal smooth muscle resting tension; 2) contraction caused by 10E-6 M methacholine as a parasympathetic mimetic; and 3) electrically induced tracheal smooth muscle contractions. Results: The results indicated that addition of methacholine caused the trachea to contract in a dose-dependent manner. The addition of fexofenadine at a dose of 10E-4 M elicited a significant relaxation response compared to 10E-6 M methacholine-induced contraction. There were no detectable changes in the peak tension of electrical field stimulation-induced contractions in the fexofenadine group. Conclusion: High concentrations of fexofenadine had an anti-cholinergic effect. In addition to diminishing histamine-mediated allergic symptoms, fexofenadine may have a potentially therapeutic implication in alleviating asthma-related symptoms due to reducing methacholine-induced contractions of tracheal smooth muscle though these aspects were not studied.
SDFS: A Standardization Technique for Nonparametric Analysis
Authors: Vatsa Avimanyou K.
Published: June 2021

Due to availability of computational tools for data acquisition, it is very easy to collect many dimensions from an object. Nevertheless, data acquisition from an object in an experiment may have a low number of dimensions. The analysis of low dimensional data has break-through role. But raw and sparse nature of dataset imposes new challenges and requirements for data analysis due to their special and unique characteristics. In the process of overall characterization of low-dimensional data, the data pre-processing plays crucial role. One of the first processes is normalization and standardization process. Therefore, in this paper, I would like to propose novel standardization technique called SDFS (Standardization for Distribution Free Statistics) for nonparametric data analysis. This technique is robust for small sample size with missing values of data points, which commonly exist in real time experiments lead to sparse low-dimensional data.  The comprehensive experimental evaluation shows that SDFS standardization is significantly outperforms on existing standardization methods.
El Absurdo en la obra de Albert Camus
Authors: Flores Moisés
Published: June 2021

Desde la perspectiva filosófica el objetivo de la investigación fue analizar el absurdo en el pensamiento de Albert Camus. Para ello se empleó el análisis hermenéutico de algunos textos de éste y de otros autores relacionados con el concepto del absurdo. En Camus el absurdo es un procedimiento: se trata de un reto intelectual, que intenta buscar desde la razón, respuestas a un estado del alma. No se trata necesariamente de un absurdo real, sino metódico, que nace de la confrontación entre el hombre y el mundo, es por ello, que el absurdo no es un fin, sino el comienzo de un proceso de diálogo o reflexión individual o intersubjetivo. Sobre este punto, el autor explica que el tener conciencia de nuestra situación absurda es solo el punto de partida. Al menos existencialmente se concluye que, cuando el hombre toma conciencia del absurdo de su vida ¿Ha de seguir arrastrando su existencia en este mundo o poner fin a su vida mediante el suicidio? Camus juzga que todo intento de escapar del absurdo seria evadir el problema. En consecuencia, el hombre debe vivir conforme a su condición absurda, llegando a ser de esa manera un hombre en el absurdo.
Positioning control of square arrangements of solar panels by solar tracing using fuzzy logic
Authors: Mejía Diego Armando , Chávez Ivaldo Torres , Mejía Abelardo
Published: June 2021

In this project a fuzzy control system is developed to follow the sun with its respective dynamics.  The positioning of the panel must take into account changes in the weather, the disturbances that may occur, the area in which the tracker is located and so on.  To do this, the maximum capture point positioning control system is studied using fuzzy logic.  Prior to design and implementation, corresponding design criteria were established in instrumentation, mechanical structure, control, communication, and processing for prototype development.  By means of the above, the photovoltaic array positioning system is designed, to then carry out the efficient implementation thanks to the calculations and adjustments made.  After having the physical structure, we start to develop the positioning control of quadruple arrangements of solar panels with two degrees of freedom per maximum point of capture of solar radiation using fuzzy control, taking into account that the radiation sensors give a reference point. for the setpoint in the control loop and after this, control signals are sent to the selected actuators.  Finally, the control system is validated for the positioning of the tracker with the fuzzy control loop implemented; In addition, the system is compared with the strategy implemented before a static system in order to analyze its efficiency. 

In order for the solar tracking system to show greater efficiency compared to the static system, radiation sensors are implemented that compensate for the influence of climatic disturbances that any solar panel tends to suffer.
Aspectos Da Relação Brasil– Argentina, Próximos, Ou Distantes?
Authors: Almeida Fernando Roberto de Freitas , Gomes Victor Leandro Chaves
Published: June 2021

O presente trabalho visa à análise das relações entre Brasil e Argentina, nos últimos anos do século XX e início do presente século. Há pouco mais de três décadas, estão comprometidos num processo de integração que havia sido projetado de forma abrangente, mas reduzido a uma forma mais pragmática, quando ambos aprofundaram suas orientações liberais. Embora o desequilíbrio entre ambos nunca fosse tão grande, dado o desempenho acumulado da economia brasileira, fatores de coesão prevaleceram sobre os de afastamento, significando que forças profundas de ambos tinham sido mobilizadas de modo favorável ao entendimento. Para a análise deste processo, foi aplicado o método da Economia Política Internacional, identificando e analisando os agentes políticos, econômicos e sociais envolvidos, com uma abordagem teórica baseada no Estruturalismo e nas Teorias Críticas das Relações Internacionais.
Impacto de la comunicación educativa a través de la tecnología de la información y comunicación en el contexto universitario ecuatoriano
Authors: Cedeño María Eugenia Intriago , Vélez Maritza Elizabeth Vélez , Zambrano Nexar Lenin Zambrano , Sardi Gustavo Adolfo Santana
Published: June 2021

El presente artículo pretende abordar el impacto de la comunicación educativa que por efecto se le asocian a las nuevas tecnologías  de información y comunicación donde para ello se hace referencia de una forma general  a las teorías de la comunicación, teorías que nos pueden aportar claves interesantes en el estudio de los procesos de interacción didácticos, considerados éstos como procesos comunicacionales. Las Tecnologías de la Información y la Comunicación  (TIC)  siguen  ocupando  un  lugar destacado  entre  las  temáticas  de  la  formación que se ofertan y se demandan entre el colectivo docente, es importante destacar que en el Ecuador el impacto de las TIC en la educación superior también es un tema de estudio y por lo mismo se busca brindar información a través de un estudio bibliográfico con una técnica documental  para explicar todas aquellas inquietudes o aportaciones de las partes involucradas como son los docentes y alumnos.
Innovative Irrigation Using Humidity and Soil Moisture for Efficient Usage of Water in Agriculture Field Compared to Drip Irrigation
Authors: Jahnavi P. , Kalyanasundaram Dr.P.
Published: June 2021

Aim: The storage of clean water assets around the world has produced a requirement for their ideal use. Innovative irrigation is the advance method which can overcome the drawbacks of traditional drip irrigation. Materials: In this proposed system two soils, sandy soil with average moisture content 60% and clay soil with average moisture content 76% are taken; A total of 20 samples are taken from 2 groups. The sample size was estimated to be 5 in each group using Gpower with the input soil samples with alpha error of 0.95, threshold value of 0.05, confidence level of 95%, pretest G- power is 80%. Significance of this proposed system is 0.05. Result: Comparing the two soils, the soil which can maintain a low percentage of moisture content appears to be suitable for the irrigation. Minimum percentage of moisture can be achieved by using the smart irrigation system which appear to be better than the traditional drip irrigation. The moisture content in sandy soil is 83% and the clay soil is 63%. Since moisture content is inversely proportional to water content. Conclusion: Clay soil appears to be better than sandy soil, traditional issues in drip irrigation is overcomed by innovative irrigation system.
Condition Index, Meat Yield and Biochemical Composition of Mediterranean Mussel (Mytilus Galloprovincialis Lamarck, 1819) from Canakkale Strait, Turkey
Authors: Yildiz Harun , Vural Pervin , Acarli Sefa
Published: June 2021

The present study was performed in Çanakkale Strait from September 2012 to August 2013. Biochemical composition (protein, total lipid, moisture, and ash), condition index, and meat yield of Mediterranean mussel, Mytilus galloprovincialis in the net systems hung out the open sea cage units monthly. The mean condition index and meat yield of M. galloprovincialis were found 8.12±0.48 and 16.07±0.70%, respectively. A positive correlation was found between condition index and protein, carbohydrate, and meat yield whereas a negative correlation was seen between condition index and weight, length, lipid, moisture, and ash. In terms of seasons, condition index and protein values were high in autumn, lipid values in summer, and carbohydrate values in spring.
Determining of the Most Optimal Parameters of Monopolar High Frequency Diathermocoagulation in Endodontic Practice
Authors: Yuryevna Daurova Fatima , Islanbekovna Tomaeva Diana , Magomedovna Gasanova Zarema , Taymurazovna Butaeva Natalia , Vasilevna Podkopaeva Svetlana , Alexandrovna Taptun Yulia , Tomaeva Diana I.
Published: June 2021

The main criterion for successful endodontic treatment is thorough cleaning of the root canal from microorganisms. Modern technologies are being developed to decontaminate the root canal system due to local temperature increase. High-frequency monopolar diathermocoagulation refers to one of these technologies. Aim. To determine the optimal parameters of monopolar high-frequency diathermocoagulation providing a distinct antibacterial effect and which are safe for the surrounding tissues in endodontic dental treatment. Materials and methods. Root canals of single-root removed teeth from the group of upper and lower jaw incisors (12 samples). The DC-35 MS device (2640 kHz, 1. 5 kOhm) was used to study various modes of high-frequency monopolar diathermocoagulation. 6 exposure modes were studied. To determine the heating degree of the tooth root surface, thermometry using a compact infrared radiation converter of the Seek Thermal imager was used, and a remote infrared thermometer Testo 830-T1 was used for temperature monitoring. After determining of the diathermocoagulation modes that are not able to cause significant heating of the surrounding tooth tissues, the antibacterial effect of diathermocoagulation in these modes was studied. To do this, we used clinical strains of optionally anaerobic bacteria obtained from the teeth root canals in pulpitis: Streptococcus sanguis, Streptococcus mutans, Enterococcus faecalis, Escherichia coli and yeast-like fungi Candida albicans. Results. When performing diathermocoagulation of the root canal contents, the third, fourth and sixth modes of the device settings with the power given to the tissue within three seconds of energy in the range of 3.06 W to 5.4 W are safe for the tissues surrounding the tooth root. When treating root canals in the third and sixth modes, the power of diathermocoagulation is 5.4 W and 4.1 W. A multiple, significant decrease in microbial contamination of root canals by all kinds of pathogenic optional anaerobic microflora obtained from the teeth root canals in pulpitis was found.
Spatial-Temporal Analysis of Air Pollutant Concentrations in Relation to Land Use and School Environment
Authors: Julit Healice , Khalid Nafisah , Rasam Abdul Rauf Abdul , Razali Mohamad Hezri , Halim Maisarah Abdul
Published: June 2021

Excessive exposure schoolchildren to air pollution can lead to long-lasting health problems, allergies and respiratory disease. It is well known that the major factors contributing to increase of air pollution are motor vehicles and industries. Thus, it is important to analyze the spatial temporal air pollutant concentrations and its relation with school location as the location of schools and its surrounding can increase their exposure. In this study, six schools in Johor were selected and the land use surrounding the schools were updated using ArcGIS. The Inverse Distance Weighting (IDW) interpolation technique was used to identify which schools’ area in Johor has a higher range of air pollutant concentration. There are four air pollution parameters obtained from the Department of Environment (DOE) which are PM2.5, CO, O3 and SO2. Hourly air pollutant concentration reading was obtained from the DOE in order to analyze air pollutant concentration during school period. The results obtained from the IDW technique showed that Sekolah Menengah Pasir Gudang (2) located in Pasir Gudang, Malaysia has reached a very unhealthy and hazardous level as compared to other schools in Johor. On the other hand, Sekolah Menengah Kebangsaan Tanjung Pengelih, Pengerang, Malaysia showed good to unhealthy range as compared to other schools in Johor. The spatial autocorrelation tool was used to analyze the relationship between the air pollution concentration and the school’s location in Johor. The results showed that the Moran’s Indices is positive showing a strong relationship that is clustering. It can be stated that there is a relationship between air pollutant concentrations with the school locations.