bluuebunny/crossref_metadata_2025 huggingface dataset:
Sphere of Concepts that Represents Impact-Generating Issues in Terms of Consciental War as a Component of Russia’s Hybrid Aggression against Ukraine
Authors: Vashchenko Nataliia
Published: June 2018

Despite the fact that the hybrid war in the east of Ukraine has been going on for more than three years, the support of the aggressor by Ukrainian citizens not only in the Donbas and Crimea, but in other regions of Ukraine remains significant. This means that in today’s hybrid aggression of Russia against Ukraine, the consciental war continues playing a leading role aimed at maintaining and contagion of pro-Russian sentiments among the Ukrainian citizens.

This research proposes the sphere of concepts that represents impact-generating issues in terms of consciental war as a component of Russia’s hybrid aggression against Ukraine. To achieve this objective, namely to create this sphere of concepts, we applied the following research methods and implemented the following tasks: using the empiric method and the method of scientific generalization we determined the purpose and tasks of Russia’s consciental war against Ukraine and its risks and consequences for Ukraine; we outlined how through archetypes as transmitters of national identity in terms of a consciental war the distinction of clear separation between “friend-enemy”, destruction of spiritual values and the ability of a person to free self-identification and, as a result, a confrontation between citizens who represent the Ukrainian and the Soviet identities take place. Using the logical methods of induction, deduction and generalization we defined the concepts of impact-generating issues on the basis of Anti-Maidan neologisms, which, having archetypal nature, evoke Enemy Image, form an image of identity alien to Ukraine and pander to conflicts in public consciousness. We proved that the chosen concepts belong to unreal (mythical) sphere and correspond to the key myth of Russian propaganda – “Russia won a victory over fascism” and therefore they have the most powerful potential impacting on subconscious in terms of a consciental war.

Given that division over the basic political issues still remains in the society, the sphere of concepts that provides insight into impact-generating issues as the main result of this study is in special focus, as it provides an opportunity to understand a mechanism of mind control through archetypes in terms of the contemporary consciental war of Russia against Ukraine, and also to understand the nature of challenges which Ukraine is facing to and as a result – to cope with these challenges and to be able to sweep in this hybrid war.
Methodology-Related Problems in Scientific Research
Authors: Romakh Oksana
Published: June 2018

On the basis of quantitative and qualitative analysis of twenty two dissertations for PhD degree, we studied the methodology-related problems in scientific research.

Our study included the following analyses of the empirical sources: estimating the quality of the methodology description in the introduction of dissertations; analysing the correlation between proposed methodology and tasks of the dissertations; estimating the relevance of methodology with the objectives; studying the correlation between the methods indicated in the introduction and the methods actually applied in the main text of dissertations; analysing the relevance of the research procedure; estimating the reliability of the research results.

For better indication of the whole situation the outputs of our study were presented in a table. Conclusions were made on the correspondence of the analysed dissertations with the scientific criteria of objectivity, validity, rationality, systematic and methodological relevance.

Based on our research, we indicated the following methodology-related problems in scientific research: insufficient description of the relevance of chosen methodology; in some cases the total lack of section with description of the applied methodology; the lack of correlation between tasks and methods; inappropriate use of methods; the lack of correlation between methods described in the introduction and those applied in the main text of the dissertations; the complete or partial absence of the description of research procedure that makes impossible to reproduce the research; the undifferentiated use of terms “method”, “reception”, and “approach”. The presence of these problems makes it difficult to meet the basic requirement for the scientific research, and the objectivity, validity, rationality, systematic and methodological relevance of such research remains questionable. In our view, a scientist who begins the research should already possess certain skills, knowledge and competencies in methodology. The development of these competences lies within the responsibility of the higher educational institutions, but should be also included in students’ and postgraduate/doctoral students’ self-education.

Our work is the first empirical-based study that examined the validity and reliability of the methodology applied in scientific research in the field of social communications. It results proves that scientific research in this field need significant improvement in use of methodology.
THE CORRELATION BETWEEN THE PARAMETERS OF PERIPHERAL BLOOD AND OXYGEN ABSORPTION AFTER REVASCULARIZATION FOR CORONARY ARTERY DISEASE
Authors: Bondarenko E T , Staroverov I N , Zotov A S , Maikov V O , Ilyin M M
Published: June 2018

Patients with coronary artery disease (CAD) are characterized by changes in the oxygen uptake and indices of peripheral blood. The aim of the study was to identify the relationship between the parameters of blood oxygen uptake and blood test in patients with CAD following coronary artery bypass graft surgery. We examined 8 patients with acute coronary syndrome (ACS) and 11 patients with chronic CAD (cCAD) at days of admission to hospital, discharge and 6 months after a CABG procedure. 10 healthy donors were included to the control group. We conducted a comparative analysis of the parameters of peripheral blood and blood oxygen uptake. We revealed a negative correlation between parameters of oxygen uptake and the platelets in patients with ACS and blood count of neutrophils in patients with cCAD on the admission to hospital. Also we established a strong relationship between blood oxygen uptake and white blood cells count in patients with cCAD at the discharge from hospital. We found a strong positive correlation between blood oxygen absorption and platelets and a negative correlation with count of lymphocytes in patients with cCAD 6 months after surgery.
IMPROVEMENT OF DIAGNOSTIC ALGORITHMS FOR LIVER, PANCREAS AND BILE DUCTS WITH THE USE OF MULTIPARAMETRIC ELASTOGRAPHY
Authors: Morozova T G
Published: June 2018

Aim: to improve diagnostic algorithms for liver, pancreas and bile ducts with the use of multiparametric elastography (MPE). Methods: From 2013 to 2017 in “Clinical hospital №1” were examined 387 patients with liver disease (n=180), diseases of the pancreas (n=127), diseases of the bile ducts (n=80). With the aim of improvement of the algorithms of surveys were conducted MPE: transient, compression elastography, shear wave elastography, compression elastography with endosonography. Results. It defined in terms of dynamic observation of the MPE. Additional conducting of any type of elastography with already-chosen option, and the obtained result is not reasonable: negative correla tion (r from -0,017 to -0,095). The MPE with diffuse liver diseases has greatest value in the dynamic observation of patients: AUC = 0,991 (95%, 0,944-0,997) and in focal liver disease (AUC = 0,991 (95%, 0,944-0,997), compared with its implementation at admission (AUC = 0,702 (95%, 0,602-7,443). Shear wave elastography and the comprassion elastography with endosonography, particularly in the definition of “zone of interest” for subsequent morphological studies, with the aim of diagnosis: AUC = 0,907 (95% CI 0,889 - 0,933), and AUC = 0,903 (95% CI 0,875 - 0,921), respectively. Conclusions. MPE was the most valuable in the dynamic observation of patients with diffuse liver diseases (AUC = 0,991 (95% CI 0,944-0,997), focal pathology (AUC = 0,991 (95% CI 0,944-0,997)). Biopsy remains the main method for primary diagnosis: AUC = 0,999 (95% CI: 0,901-1,000).
THE ROLE OF ABERRANT METHYLATED IN GENES APC, RASSF1A AND ITGA4 FOR DIAGNOSIS OF COLORECTAL CANCER
Authors: Brovkina O I , Gordiev M G , Toropovskiy A N , Khodyrev D S , Nikitin Au Vyacheslavovich , Averyanov A V
Published: June 2018

The “gold standard” of diagnosis of colorectal cancer (CRC) is a colonoscopy. Despite the high reliability, this method is not applicable in large-scale population screening or in estimation of the disease dynamics in a particular patient. In this study, we conducted an investigation of aberrant methylation in the APC, RASSF1A and ITGA4 genes. The study included 150 pairs of tumor tissue samples with known mutation status of the RAS family genes and the surrounding histologically unchanged tissue of patients with rectal adenocarcinoma treated at the Republican Clinical Oncology Dispensary of the Ministry of Health of the Republic of Tatarstan. The methylation profiles were studied using MethyLight PCR. The most difference in the methylation between tumor and healthy tissue was observed for the ITGA4 gene (sensitivity 78%, specificity 92.7%). For the APC gene sensitivity was 32%, specificity -93.3%, for the RASSF1 gene sensitivity was 85.3%, specificity - 56.7%. Previous data on the aberrant methylation of the SEPT9 and VIM genes and new data on the APC, RASSF1A and ITGA4 genes were compared with the mutations status in the KRAS and NRAS genes. The DNA of tumor samples was significantly more often methylated in the SEPT9 (P= 0.0018) and ITGA4 (P = 0.0044) genes in the group of patients carrying mutations in the KRAS or NRAS genes, in contrast to the DNA of tumor samples of non-carriers. In statistical analysis of the effectiveness of the diagnostic test system, it was shown that our model, which includes five methylation markers (APC, RASSF1A, ITGA4, SEPT9 and VIM), has the best sensitivity and specificity (82.7% and 97.3%, respectively). The obtained model of the diagnostic test system is proposed to be used for diagnostic problems.
Data Transfer via UAV Swarm Behaviours
Authors: Smith Phillip , Hunjet Robert , Aleti Aldeida , Barca Jan Carlo
Published: June 2018

This paper presents an adaptive robotic swarm of Unmanned Aerial Vehicles (UAVs) enabling communications between separated non-swarm devices. The swarm nodes utilise machine learning and hyper-heuristic rule evolution to enable each swarm member to act appropriately for the given environment. The contribution of the machine learning is verified with an exploration of swarms with and without this module. The exploration finds that in challenging environments the learning greatly improves the swarm’s ability to complete the task.
The swarm evolution process of this study is found to successfully create different data transfer methods depending on the separation of non-swarm devices and the communication range of the swarm members. This paper also explores the resilience of the swarm to agent loss, and the scalability of the swarm in a range of environment sizes. In regard to resilience, the swarm is capable of recovering from agent loss and is found to have improved evolution. In regard to scalability, the swarm is observed to have no upper limit to the number of agents deployed in an environment. However, the size of the environment is seen to be a limit for optimal swarm performance.
The sleep quality of patients with insomnia under the influence of subtle energy fields
Authors: Kryzhanovskii Edvard V. , Yavorsky Alexander B. , Kwong Choong Lim
Published: June 2018

Background: The article evaluates the current state of insomnia treatment for patients without neurological, psychiatric, and somatic disorders. An important goal consists in developing non-drug therapies for insomnia, possessing no side effects. Following this research direction, we put a special emphasis on non-medicamental methods for correction of sleep disturbance in persons with psychophysiological insomnia.Methods: Authors propose a method of insomnia treatment in which patients sleep on the specialized Bio Velocity mattresses (the ‘activated mattress’ therapy). The conditions of patients before and after the treatment are assessed by clinical, psychophysiological, electroencephalographic methods, and by the Voll method, which studies the meridians of organs and systems, including the nervous system.Results: We show the effectiveness of the therapy by demonstrating improving psychological indicators, EEG data, and the Voll diagnostics data in a group of patients.Conclusions: The activated Bio Velocity mattresses can effectively be used by patients with the sleep disorders in addition to and, partially, as a replacement of conventional tools and medicine.
Risk factor of pneumonia on toddler at puskesmas (public health center) I South Denpasar
Authors: Yudiastuti Kadek Ethi , Ni Made Dewianti
Published: June 2018

Background: The death of toddler due to pneumonia is still high because its risk factor still exist and has not been managed properly. United Nations International Children’s Emergency Fund (UNICEF) states that in 2011 there was 1.3 million deaths of children below five years old (toddler) and 14% of the number was caused by pneumonia.Methods: The design for this research was case control with 27 cases and 27 controls. The case was toddlers who were diagnosed with pneumonia by doctor of public health center (hereafter Puskesmas), aged 0-59 months and were recorded in the ill toddler register from January 1, 2016 until December 31, 2016, meanwhile control was healthy toddlers who were invited to Puskesmas during the research. Data was collected through interview, observation and measurement using questionnaire. Univariate, bivariate, multivariate analyses were performed using Stata SE 12.1.Results: Bivariate analysis showed that two years of breastfeeding and ARI frequency, as the risk factors of pneumonia on toddler. From bivariate analysis, it was found that the risk factor which was proven to be significant and increased pneumonia on toddler was OR ARI with the value of 5.67 (95% CI:1.16-27.82).Conclusions: ARI frequency as the risk factor of pneumonia on toddler at Puskesmas I South Denpasar.
Affordable laparoscopic simulator to acquire basic skills in undergraduate surgery students
Authors: Banegas-Ruiz Rodrigo , Granados-Romero Juan J. , Valderrama-Treviño Alan I. , Méndez-Celis Carlos A. , Ceballos-Villalva Jesús C. , Mendoza-Barrera German E. , Barrera-Mera Baltazar
Published: June 2018

Background: The simulation emerges as an option that allows students to practice in a safe environment, all this in a scenario that resembles the real situation.Methods: We developed a prototype of a low-cost simulator that mimics the dimensions of the abdominal cavity and allows the undergraduate students to acquire the basic skills in minimally invasive surgery.Results: In the 10 competencies evaluated, statistically significant improvement was found in both groups being higher in the students who were trained by our simulator of laparoscopic surgery compared with students who attended surgeries and participated as seconds assistants, taking as reference a value of p ≤0.05.Conclusions: The simulation as new teaching strategy generates a real environment and scenarios that can be recreated in multiple occasions, being able to change depending on the objectives for the acquisition of skills. This simulator gives the user skills for more types of simulation as it progresses in its surgical training.
Study of prescribing pattern of drugs used in the treatment of hypertension in a tertiary care teaching hospital in North India: an observational study
Authors: Gupta Rohini , Malhotra Apoorva , Malhotra Pavan
Published: June 2018

Background: Hypertension is one of the most common chronic diseases leading to high mortality and morbidity. In order to prevent complications and to improve the patient survival, the early and efficient management of essential hypertension is very much needed. In this context, the use of established anti-hypertensives assumes paramount importance. Objective was to study the prescribing pattern of anti-hypertensive drugs in a tertiary care teaching hospital in north India.Methods: It was a cross-sectional observational study involving 205 prescriptions for patients suffering from primary essential hypertension in the Medicine Outpatient Department of Acharaya Shri Chander College of Medical Sciences and Hospital, Sidhra, Jammu, J and K. All hypertensive patients irrespective of age and sex visiting OPD and treated with at least one hypertensive drugs were included in the study. Data was obtained from the patients by scrutinizing the out patients regarding the demographic profile and details pertaining to the prescribing pattern of antihypertensive drugs used for the treatment of hypertension.Results: A total of 205 prescriptions were analysed during the study period. Out of which 131 (63.9%) were males and 74 (36.1%) were females. Maximum numbers of patients were in the age group of 50-59 years 60 (29.3%) patients. 145 (70.7%) of the patients had a family history of hypertension, (61.5%) of the patients were in stage-I hypertension and (56.1%) were of normal BMI. The results revealed that, the maximum number of 86 (41.9%) patients underwent dual therapy in 86 (41.9%) followed by monotherapy in 59 (28.7%) of patients.Conclusions: From the present study, it can be concluded that in hypertension calcium channel blockers are the most frequently prescribed classes of drugs alone and diuretics are the most commonly used class of drugs in combination. However, further studies are necessary to set up a rationale or pattern for the choice of medication; taking into consideration the demographic factors involved in the prevalence of hypertension.
A comparative study of intravenous versus perineural administration of dexmedetomidine in supraclavicular brachial plexus block using 0.75% ropivacaine by ultrasound guided technique in upper limb surgeries
Authors: Khan Fahad , Singh V. P.
Published: June 2018

Background: Comparative study of intravenous versus perineural administration of dexmedetomidine in supraclavicular brachial plexus block using 0.75% ropivacaine by ultrasound guided technique in upper limb surgeries.Methods: Patients in the age group 18-58 years both male and female, having ASA 1 and ASA 2, scheduled for elective surgery of unilateral upper limb surgeries were included and randomly divided into three groups’ i.e. group RD, group RDI and group R and patients with chronic pain or taking any analgesics, ASA grade III and IV, bleeding disorders, history of brachial plexus injury, known allergy to the study drug, previous shoulder surgery, any psychiatric disorders, peripheral neuropathy, failed block, significant respiratory disease, hearing impairment, pregnant women, study were excluded.Results: Time to sensory onset in group RD was as compared to group RDI and group R was found statistically significant (p<0.001). Duration of sensory block (analgesia) in group RD, group RDI and Group R was also statistically significant (p<0.001). The level of sedation of Group RDI and Group RD had highly significant value till 30 mins (p<0.001).Conclusions: The central effects of dexmedetomidine also play some role in prolongation of sensory and motor block duration, as explained previously.
Correlation of status of thyroid antibodies and thyrotropin hormone with prevalence of thyroid autoimmune disease in pregnancy
Authors: Mujawar Shahid A. , Patil Vinayak W. , Daver Rekha G. , Mulkutkar Sachin H.
Published: June 2018

Background: Thyroid antibodies alterations were observed because of physiological and immunological changes occurring during pregnancy and after delivery. The aim was to evaluate serum anti-thyroid peroxidase antibodies (anti-TPO-Ab), anti-thyroglobulin antibodies (anti-TG-Ab) and total triiodothyronine (total T3), total thyroxine (total T4), thyrotropin hormone (TSH) levels in pregnant women of resident of Western India.Methods: Samples for 100 pregnant women with no apparent thyroid disorders were analyzed, using enzyme amplified chemiluminescent immune assay detection technology, in order to determine levels of total T3, total T4, TSH, anti-TPO-Ab and anti-TG-Ab in sera sample.Results: Of these women 24% gave biochemical evidence of hypothyroidism and remaining 76 % subjects were euthyroid in pregnant study group. In study group, 90% had normal values for anti-TPO-Ab and anti-TG-Ab and 10% had results revealing the presence of autoimmune diseases of the thyroid.Conclusions: n the present study, it was found that the level of anti-TG-Ab was found unaltered but it was found to be detected along with anti-TPO-Ab. These investigations should be performed routinely during pregnancy. Otherwise, lack of appropriate and early diagnosis and treatment can lead to neurological impairment of fetal brain as well as maternal cardiovascular diseases.
A scientific validation of In vitro anti-inflammatory activity of Punica granatum L. by human red blood cell membrane stabilization
Authors: Kota Karunakar , Sharma Sandhya , Tahashildar Jameela
Published: June 2018

Background: In recent years there has been growing interest in therapeutic use of natural products, especially those derived from plants. P. granatum is very common dietary ingredient in many parts of India and has remarkable biological and medicinal properties.Methods: In the present study, the methanolic extract of fruit peels of Punica granatum Linn. (MEPG) were investigated for anti-inflammatory activity by simple, reliable, less toxic and less time consuming HRBC membrane stabilization method. The presentation of hypo tonicity induced HRBC membrane lysis was taken a measure of anti-inflammatory activity. Their activities were compared with standard drug diclofenac.Results: The results of the study demonstrated that P. granatum contains active constituents, which possess anti-inflammatory activity which is probably related to the inhibition of prostaglandin synthesis.Conclusions: It is concluded that methanolic extract of P. granatum fruit peel possesses significant anti-inflammatory activity and this is a possible rationale for its folkloric use as an anti-inflammatory agent.
Clinical profile of snake bite patients in tertiary care hospital in Himachal Pradesh: a prospective study
Authors: Kaushik Madan , Banyal Vikas , Sondhi Sachin , Thakur Manish K. , Kaushik Aseem
Published: June 2018

Background: To study clinical profile of snake bite patients in tertiary care hospital in Indra Gandhi Medical College at Shimla, Himachal Pradesh of North India.Methods: Hospital based prospective observational study was conducted in the Department of Medicine, for the duration of one year from 1st June2013 to 31st May 2014.Results: A total of 78 patients were admitted with mean age of 38.46 years with male to female ratio of 1:1.6. Seasonal variation with peak incidence during rainy season was seen. Most common snake identified was green coloured and peak timing of snake bite was between 07:00am-04:00pm. There was delay in admission of more than 6 hours in 66.67% of cases. Hemotoxicity was predominant manifestation seen in 62.82% of cases and persistence of coagulopathy was most common complication (51.02%) despite giving optimal ASV. There was paucity in ASV administration seen in only 59.46% of referred patients. Mean ASV vials used were 23.41 vials ±8.72 vials.Conclusions: Mass education is required at both general population and health professional levels to improve snake bite management and monovalent ASV against Green pit viper is more practical option to manage cases in this region.
Effect of benzalkonium chloride-preserved latanoprost and benzalkonium chloride-free latanoprost on intraocular pressure in patients of primary open angle glaucoma
Authors: Kaur Anjleen , Palta Shikha , Chhabra Hema , Singh Gursatinder , Gupta Anita
Published: June 2018

Background: To evaluate the change in mean IOP with BKC-preserved latanoprost versus BKC-free latanoprost in patients of primary open angle glaucoma (POAG).Methods: This was an open-label, randomized, interventional, switch trial. Thirty patients of primary open angle glaucoma (POAG) who were already on benzalkonium chloride (BKC)-preserved latanoprost for a minimum of three months were recruited. Their intraocular pressure (IOP) was recorded at the baseline. Then, they were switched over to benzalkonium chloride (BKC)-free latanoprost for another three months. Their intraocular pressure (IOP) was recorded at both 6 and 12 weeks of follow-up.Results: IOP decreased from 15.57±0.85mm Hg at baseline to 15.40±0.89mm Hg at 6 weeks to 15.30±0.70mm Hg at 12 weeks. p value was found to be 0.209 and 0.115 at 6 and 12 weeks respectively. No statistically significant change was observed between mean IOP at both 6 and 12 weeks as compared to the baseline.Conclusions: BKC-free medications have equal IOP lowering effect as BKC-preserved medications in glaucoma patients.
Evaluation of ultrasound guided verses nerve stimulator technique of interscalene brachial plexus block: insights from Indian multi-super specialty hospital
Authors: G. V. Kiran Kumar , Gurram Rammohan , Fultambkar Gajanan , Gupta Amit Omprakash , Swami Onkar C.
Published: June 2018

Background: To provide adequate intraoperative anaesthesia and postoperative analgesia for orthopaedic surgery continues to be a procedural challenge. The administration of brachial plexus anaesthesia can be facilitated through nerve stimulation or by ultrasound guidance. Hence study was conducted to compare differences in these techniques in patients undergoing interscalene brachial plexus block (ISSB).Methods: In this prospective, randomized, observer-blinded study, 60 patients (Male=41, Female=19) were scheduled for orthopaedic shoulder and upper arm surgeries matching inclusion and exclusion criteria. Patients were randomly allocated to either Ultrasound (US, n=30) group or Nerve Stimulator (NS, n=30) group through a computer-generated randomization.Results: There was significant difference between US and NS group with respect to average number of attempts taken, block performance time (BPT), onset of sensory and motor block, duration of motor block and patient satisfaction score. Whereas not much significant difference was observed in duration of sensory block, block success rate and incidence of post operative side effects.Conclusions: The results suggest that US guided ISBB is significantly superior to NS guided block in terms of faster onset of action; lower number of attempts to locate Interscalene brachial plexus; longer duration of block and overall success rate with favourable tolerability at real-life scenario.
Nausea and vomiting as major presenting symptoms of thyrotoxicosis after bilateral adrenalectomy for Cushing's disease
Authors: Kogan Yana , Elias Nizar , Sheikh-Ahmad Mohammad , Odeh Majed
Published: June 2018

Thyrotoxicosis has a variety of presentations which depend on its severity and duration, as well as the age of the patient. In elderly patients, thyrotoxicosis may present with a variety of nonspecific symptoms. Nausea and vomiting as major presenting symptoms of thyrotoxicosis have rarely been reported. Thyrotoxicosis after adrenalectomy in patients with Cushing's syndrome and normal thyroid function, or with autoimmune thyroid dysfunction has rarely been reported previously. We describe a very rare case of an elderly patient with hypothyroidism due to Hashimoto's thyroiditis who presented with persistent nausea and vomiting as major presenting symptoms of thyrotoxicosis, which developed after bilateral adrenalectomy for Cushing's disease. Similar case has not been reported previously. In reporting this patient we aim at drawing attention to these forgotten symptoms of thyrotoxicosis, nausea and vomiting, and to emphasize that, at times, these symptoms may be the only presenting features of thyrotoxicosis, leading to considerable difficulty in diagnosis. Furthermore, cessation of glucocorticoid excess may sometimes be accompanied with thyrotoxicosis.
Parasite helminthes, class cestode, diagnosed by hooklets on FNAC
Authors: Verma Nidhi , Sharma Bhavna , Singh Chhaviraj , Sharma S. P.
Published: June 2018

Parasitic infestation is a common cause of morbidity in several parts of the world. Helminthes constitute a significant number of parasitic diseases, out of which large number of cases are due to cestodes. Cestodes can affect various organs, including skin, subcutaneous tissue, liver, brain, spinal cord, orbit, muscle, gastrointestinal tract and heart. Parasites are routinely diagnosed by histopathology, serology, radiology and stool examination however FNAC can also serve as low cost out-patient procedure for diagnosis of certain parasites especially in cases of sub cutaneous nodules. Subcutaneous nodule is a relatively uncommon presentation and is often misdiagnosed clinically. This study includes case series of five cases of subcutaneous parasitic infestation by cestodes that were diagnosed by FNAC.
Thyroid nodule size as an indicator for surgery
Authors: Hatem Mohamed Abdulhameed , Farheen Sumayya
Published: June 2018

Background: Several authors have questioned the accuracy of fine- needle aspiration cytology (FNAC) in large thyroid nodules. It's the current practice to provide thyroidectomy to patient with thyroid nodules 4 cm or larger regardless of the FNAC results. The aim of the study is to answer two questions: is the size of nodule associated with higher risk of malignancy and is the size indication for surgery.Methods: Authors conducted a retrospective review of 201 patients who underwent thyroidectomy between 2011 and 2017 at Bahrain defense force hospital. Authors compared all thyroid nodules with benign FNAC and their final histopathology reports. Patients were divided into two groups based on the size of the nodule (< 4cm or >4cm) and indication of surgery.Results: 201 patients with thyroid nodule underwent thyroid surgery. 136 patients had nodule <4cm and 65 patients were ≥4 cm. For patients with nodules <4 cm, 37 patients (18.4%) had a malignancy, and for those with nodules ≥4 cm, 13 patients (6.4%) had a malignancy. comparison between size of the nodule, FNAC result and final histopathology: FNAC diagnosed 55 cases (27.3%) are malignant, final histopathology reported only 50 cases are malignant. But for benign cases FNAC and histopathology reports are showing same results, (p<0.05).Conclusions: Thyroid nodules ≥4 cm are not risk factor of malignancy. Thyroid nodules ≥4 cm with benign FNAC should not undergo thyroidectomy as false negative rate is low. Therefore, the decision for surgery ought not to be taken based on the size of the nodule.
A forgotten risk factor for surgical site infection: Hypocholesterolemia
Authors: D. Manjunath B. , R. Harindranath H. , Razak Abdul , Ali Mohammed Arafath
Published: June 2018

Background: Postoperative infection is one of the most common complications after any surgery. In the present study, surgical site infection (SSI) is described as; superficial (i.e., skin and subcutaneous tissues) and deep (i.e., fascia and muscles) infections occurring in the short term (i.e., 1-month) after surgery. The objective of this study was to detect various risk factors for SSI development.Methods: In this study, we prospectively enrolled 217 patients undergoing spinal surgery over an 8 months period. In a prospective study from January 2017 to August 2017, 217 patients who were admitted and operated for elective hernia surgery in hospitals attached to Bangalore Medical College and Research Institute, patients with immunodeficiency disorders and obstructed hernias were excluded.Results: Of 217 patients 35 (16.12%) patients developed SSI, multi-variant data analysis indicated that multiple factors correlated with an increased risk of SSI of which one of the important factor was hypocholesterolemia with 32.8% people developing SSI with p-value <0.01 along with Hypoalbuminemia and diabetes. Whereas other factors shuch as age had a minor role in increasing the incidence of SSI other factors such as smoking, alcoholism, gender, hypertension was found not to have much significant contribution in the development of SSI in the present study.Conclusions: Hypocholesterolemia is one on the forgotten factors which is usually brushed aside whose consideration can lead to significant decrease in this preventable complication especially in a malnourished population presenting in a government setup.
Gamma nail in the management of intertrochanteric fractures of femur in adults
Authors: Shah Faisal Younis , Gul Irfan Andleeb , Kotwal Hilal Ahmad
Published: June 2018

Background: Intertrochanteric fracture is an extracapsular fracture of the proximal femur. Gamma nail is a cephalomedullary nail that is emerging as the treatment of choice for intertrochanteric fractures. For intertrochanteric fractures, the use of cephalomedullary devices has increased dramatically to 67% among surgeons over the years. Aims of this study was to observe the results of operative treatment of intertrochanteric fractures with Gamma 3 trochanteric nail.Methods: This prospective study was conducted in the Post Graduate Department of Orthopaedics of Government Medical College, Srinagar. This study included 30 cases of intertrochanteric fractures who attended hospital for bone and joint surgery.Results: Excellent results were obtained in 80% patients and good results were obtained in rest 20% with an average Harris hip score of 93.8. Average time to union was 11.6 weeks. There were no non-unions, screw cut outs or peri-implant fractures. The most common complication was varus malunion occurring in 20% patients. However, significant malunion (greater than 10 degrees) was present in only one patient among them.Conclusions: This study finds Gamma 3 nail to be a versatile, easy to use and dependable implant in intertrochanteric fractures. Gamma 3 nail is an ideal implant for stable as well as unstable intertrochanteric fractures and is a distinct advance over the previous methods of treatment, though it has an initial learning curve.
Efficacy of the P-POSSUM scoring system in prediction of post-operative mortality and morbidity in patients undergoing emergency laparotomy in a tertiary institute
Authors: Thirunavukkarasu Sivakumar , Subramanian Atreya M.
Published: June 2018

Background: The Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) scoring system and its modification P-POSSUM (Portsmouth-POSSUM) has been studied in various clinical settings, with varied results. Due to its simplicity and wide application, the efficacy must be verified in individual settings. We wish to assess the system’s efficacy among emergency laparotomies in a south Indian clinical scenario.Methods: A prospective study was undertaken with a sample size of 50. All cases taken for emergency laparotomy were included. 12 physiological and 6 intra-operative characteristics were taken and according to the equation the predicted rates of mortality and morbidity were predicted. This was compared with the observed rates. With these results, the efficacy of the scoring system was assessed.Results: Of the 50 cases included 5 expired (10%) and 29 (58%) experienced some form of morbidity. The P-POSSUM score was found to be an accurate predictor of mortality (x2 =1.174, d.f=8) with a p-value of 0.997.  The POSSUM score was not found to be an accurate predictor of morbidity (x2 =16.949, d.f=8) with a p-value of 0.0403, as the p-value was <0.05.Conclusions: The P-POSSUM scoring system produced accurate results even in the setting of emergency laparotomies in a south Indian setting. It has proved to be a useful tool for predicting mortality, though not completely accurate to assess post-operative morbidity (POSSUM) due to post-operative factors playing a major role in its determination.
A one year cross sectional study on role of Wagner’s classification in predicting the outcome in diabetic foot ulcer patients
Authors: L. Praveena D. , Uppin Shashi M. , Shimikore S. S.
Published: June 2018

Background: Diabetes mellitus-related foot ulceration is very common. Several classification systems for diabetic foot ulcers have been proposed. The present study was intended to assess the role of Wagner wound classification in predicting the outcome of diabetic foot ulcer and also know the grade of Wagner’s classification to which majority of diabetic foot ulcer patients.Methods: This present one year cross sectional study was carried out at the Department of General Surgery. A total of 100 patients with diabetic foot ulcer who presented during the study period were included. The diabetic foot ulcers were graded according to the Wagner’s classification. The relative risk of amputation in different grades of diabetic foot ulcer based on Wagner classification was determined.Results: In this study majority of the patients were males (79%) and the male to female ratio was 3.76:1. The mean age was noted as 55.8±10.45 years. Majority of the patients had duration of ulcer less than one month (88%). Surrounding skin was inflamed in 60% of the patients, necrosis was present in 40% and slough was noted in 98% while 44% of the patients had necrotic tissue. Based on Wagner’s Classification, most of the patients (48%) had Grade II diabetic foot ulcers. With regard to management, in 44% of the patients’ debridement was done and 36% of the patients had disarticulation or amputation in 36%. Of the 48 patients with grade II ulcer, 79% of the patients had healing without amputation. Of the 58 patients with grade I and II diabetic foot ulcers, 82.76% had healing without amputation compared to 17.24% of the patients who needed amputation. Patients with Grade III, IV and V had 3.59 times higher risk of amputation compared to patients with grade I and II. (p<0.001; 95% CI- 1.95 to 6.62).Conclusions: Grading of diabetic foot ulcer based on Wagner’s classification affects and predicts the outcome and the risk of amputation increases with increasing grade. Most of the patients admitted for diabetic foot ulcers in our hospital belonged to Wagner’s grade II (48%).
Review the experience: role of propranolol in infantile hemangioma (IHs) on pediatric patient
Authors: More Santosh , Budhwani K. S. , Ghritlaharey R. Kumar
Published: June 2018

Background: Although not being licensed for the treatment of infantile hemangiomas (IHs) on pediatric patient 5 weeks or older than 5 months, propranolol is often used in these age groups to prevent or to treat potentially severe complications. The objective of the present study was to review the experience on pediatric patients with efficacy and adverse effects after use of oral propranolol treatment for IHs started before 5 weeks or after 5 months of age.Methods: This was an observational study performed pediatric patients with IHs treated with oral propranolol at the department of pediatric surgery, Gandhi Medical College and Associated Kamla Nehru Hospital, Bhopal from Nov 2012-Nov 2014. Using a proforma, data was collected on dosing, efficacy and adverse effects.Results: A total 40 patient of IHs from 2 months to 3yr were included in this study. The majority of patients were ≤6month of age 24 (60%) patient and 16 (40%) patients were >6month of age. Female 28 (70%) are more affected than male 12 (30%). The IHs most common lesion was 23 (57.5%) in head, face and nose region. No adverse effects were observed in our series; none of our patients had symptoms of hypoglycemia or hypotension. The patients with clinically significant more than 50% volume reduction were found in 26 (65%) patient and 25-50% volume reduction were found 14 (35%) patient after 5months long propranolol therapy for IHs.Conclusions: In present study of patients propranolol 2mg\kg\day divided into two doses was a well-tolerated and effective treatment of IHs. Propranolol is clinically more effective treatment with no adverse effect and cost effective. The percentage of regression of size and color clearance was sufficient to justify the use of propranolol as the first line option for treatment of IHs.
Predictors for conversion to open appendicectomy in patients undergoing laparoscopic appendicectomy: a prospective study
Authors: Peedikathara Lakshmi M. , Mandumpala John M. , Vallon Suresh M. , Kavalakat Alfie J.
Published: June 2018

Background: Laparoscopic appendicectomy is a common surgery performed by emergency surgeons now-a-days. The conversion from laparoscopic to open appendicectomy  increases operating  time and post-operative morbidity. Identifying the variables associated with the risk of conversion pre-operatively would avoid wasteful laparoscopic attempts by proceeding directly to an open surgery. Therefore, developing a pre-operative criterion to decide ideal operative approach for individuals may be useful.Methods: Patients admitted to the Department of General Surgery with appendicitis, who got converted to open appendicectomy were studied prospectively based on the reasons for their conversion and were compared with primary open appendicectomy patients with respect to postoperative morbidity and mortality. There were 385 cases among which there were 307 (79.74%) laparoscopic appendicectomies, 42 (10.9%) primary open appendicectomies and 36 (9.35%) conversion appendicectomies.Results: Fourteen significant predictors of conversion were identified by univariate analysis. Ten independent risk factors were identified by stepwise logistic regression.Conclusions: The commonest reason for conversion was appendix mass. Post-operative pain, complications and duration of hospital stay were higher in conversion appendicectomy when compared to open appendicectomy. A conversion predicting score of >4 had good sensitivity and negative predictive value.
Role of intraoperative wound irrigation with antibiotics in reducing surgical site infection in patients undergoing contaminated and dirty midline laparotomy surgical wound: a pilot study
Authors: P. Sandhiya , S. Sureshkumar , C. Vijayakumar , C. Palanivel
Published: June 2018

Background: This study was carried to assess the effect of antibiotic wound irrigation in reducing the surgical site infection (SSI) in the patients undergoing midline laparotomy with contaminated and dirty surgical incision wound.Methods: All patients operated with class-IV- dirty and class III (contaminated) abdominal operative wound according to CDC (Centre for Disease Control and Prevention) were included in this pilot study. Study patients were divided into antibiotic irrigation group and control group. In control group, after rectus sheath closure, the wound was irrigated with 100 mL of normal saline before the skin closure. In antibiotic irrigation group, after rectus sheath closure, the wound was irrigated with Ceftriaxone (10 mL) and Metronidazole (100 mL). Incidence of SSI, degree of SSI and length of hospitalization were compared between two groups.Results: A total of 40 patients were included in the study, 20 in each group. Both the groups were comparable with respect the age, gender, co-morbidities and class of surgical wound. The incidence of SSI was lesser [10% versus 35%; p=0.06] in the antibiotic irrigation group compared to control group. However, the difference was not statistically significant. The length of hospitalization between the groups were comparable [13.5 versus 14.7 days; p=0.74]. The pain score was also not significantly different between the two groups.Conclusions: On comparing to saline irrigation, antibiotic irrigation in patients with contaminated and dirty operative wound results in a lesser SSI with comparable hospital stay and postoperative pain. However, the difference was not statistically significant.
Comparison of Szmyd incision over envelope incision during the surgical removal of impacted third molar for evaluating postoperative prognosis: a prospective randomized study
Authors: Chiramel Siji J. , Chammanam Shaju , Kalliath Ranjith , Gopinath Arjun
Published: June 2018

Background: Manipulation of both hard and soft tissues during the surgical removal of mandibular third molars is usually associated with a number of postoperative complications. This study was aimed to compare the effects of two types of flap designs used during the impacted mandibular third molar removal and the consequences of choosing Szmyd incision over envelope incision in terms of primary wound healing and periodondal healing.Methods: A prospective, randomized study was conducted in healthy 50 patients with partially or completely impacted mandibular third molars were selected. The patients were divided into two groups of 25 each. In one group envelope flap design was used and in the other group Szmyd flap design was used. The influence of these incisions on accessibility to third molar, primary wound healing and periodontal healing was evaluated and compared.Results: The incidence of wound dehiscence at 7th day follow-up is more in envelop incision (p=0.123) and 20% more at 14th day follow-up (p=0.087) when compared to Szmyd design. Significant differences were noted with respect to the periodontal healing distal to adjacent second molar. Distal periodontal pocket depth was significantly lower for the Szmyd incision as compared to the Envelop incision. Effect size of Envelop flap is 1.84 times more than Szmyd flap.Conclusions: The Szmyd flap design makes primary wound healing easier, less wound dehiscence and periodontal complication than envelop flap design.
Metaplastic carcinoma breast (IDC and chondrosarcoma): a rare entity
Authors: Kalra Deepesh , Kaushik Bhanu , Gupta Shalu , Tanwar Pradeep , Khan Sami Anwar
Published: June 2018

Metaplastic breast carcinoma is very rare neoplasm. Authors report a case of metaplastic breast carcinoma containing characteristic features of infiltrating ductal carcinoma and chondrosarcoma. A 62-year-old female presented with complaint of a lump in the right breast for the last 2 years. FNAC was suggestive of mucinous tumour. Tru-cut biopsy had been performed outside the institution, which was suggestive of a Ductal carcinoma with mucinous component. Modified radical mastectomy of the right breast was performed and histopathology was suggestive of infiltrating ductal carcinoma and chondrosarcoma of the right breast. All resected lymph nodes were free of metastasis. Immunohistochemistry was suggestive of a metaplastic carcinoma with components of ductal carcinoma and chondrosarcoma with moderately positive ER, negative PR, positive Pancytokeratin in ductal carcinoma component, positive S-100 and KI-67.
Giant solitary trichoepithelioma masquerading as basal cell carcinoma
Authors: Rao Venkata Mahipathy Surya Rao , Sundaramurthy Narayanamurthy , Rajamanohar Vimal Chander , Durairaj Alagar Raja , Ramachandran Manimaran
Published: June 2018

Trichoepithelioma is a rare benign adnexal tumour which can be of solitary non-familial type or multiple familial trichoepitheliomas. Here authors describe a middle-aged patient who presented with a swelling of the left nasolabial region diagnosed clinically as a basal cell carcinoma but proved to be a giant solitary trichoepithelioma (GST) following histopathological examination. This case is presented due to the rarity and the difficulty encountered in diagnosis of the case.
Presentación del dossier. La cultura del razonamiento constitucional en América Latina
Authors: Fröhlich Johanna
Published: June 2018

Presentación del dossier. La cultura del razonamiento constitucional en América Latina.