bluuebunny/crossref_metadata_2025 huggingface dataset:
Existem bases tributárias dotadas de valor intrínseco? Uma reflexão político-filosófica sobre os fundamentos morais da tributação a partir dos escritos de Liam Murphy e Thomas Nagel
Authors: Godoi Bustamante Evanilda Nascimento de , Bustamante Thomas
Published: October 2020

Resumo: Neste artigo, são examinadas as principais teses de Murphy e Nagel sobre o fundamento político-moral do direito tributário. Sustenta-se, com os autores, que a distribuição de rendas realizada pelo mercado não pode ser tida como intrinsecamente justa, como supunham os teóricos da tradição liberal. Contrariamente aos autores, porém, entende-se que há bases de cálculo intrinsecamente justas, e que é possível analisar a justiça do direito tributário por meio do princípio metodológico da 'prioridade local', oferecido por Ronald Dworkin. Aplicando-se esse princípio, é possível analisar a justiça de certas bases tributárias independentemente da análise das despesas realizadas pelo Estado para o fornecimento de bens sociais.Palavras-chave: justiça tributária, Base de Cálculo, valor intrínseco, Murphy e Nagel.Abstract: In this article we examine the core theses of Murphy and Nagel about the moral and political foundation of tax law. We argue, with these authors, that the distribution of wealth made by the market cannot be considered intrinsically just, as the scholars from the liberal tradition assumed. Against these authors, however, we think that there are tax bases intrinsically just, and that it is possible to asses the justice of a tax system by means of the methodological principle of the "local priority", suggested by Ronald Dworkin. Once we apply this principle, it is possible to analyze the justice of certain tax bases regardless of the analysis of the expenses made by the state to provide social goods.Keywords: tax justice; Tax Base; intrinsic values; Murphy and Nagel.
Gender Diversity and the Firm Financial Performance of DSE Listed Companies in Bangladesh
Authors: Munira Shobnom
Published: October 2020

The effect of gender diversity on firm performance is a long debated topic in the business world. The percentage of women representation in the board of directors is comparatively low than women presence in the general population and in the corporate world. Some research suggests board diversity as one of the corporate governance mechanisms that improve firm performance whereas other research suggests the opposite. This study intends to investigate the association between women representation in the boardroom and the companies’ financial performance indicator of Dhaka Stock Exchange (DSE) listed companies in Bangladesh. Total 259 companies’ data from 18 different sectors of DSE are collected from the audited published annual reports. The sample are selected through simple random sampling technique. The data are analyzed using descriptive analysis, correlation analysis and ordinary least square regression method. The study findings indicate that there is positive association between women representation in the boardroom and firm financial performance indicator.
Endotoxemia-suppress cardiac function through dysregulation of mitochondrial biogenesis in mice model
Authors: Bracale Michele M.
Published: October 2020

Sepsis exaggerated proinflammatory response to infection that can progress to carries a significant cardiac dysfunction associated with morbidity and mortality. Mitochondrial biogenesis is involved in the control of cell metabolism, signal transduction, and regulation of mitochondrial reactive oxygen species (ROS) production. We are hypothesis that impairment of biogenesis has been invoked in the pathogenesis of myocardial endotoxemia. C57/BL6 mice were treated with LPS (0.5 mg/kg, iv) for 4 hrs. cardiac function was assessed using a microcatheter. Electronmicroscopy and confocal microscopy revealed that mitochondrial biogenesis is reduced after treatment the mice with LPS compared with control. Further, endotoxemic mice exhibited worse LV function than the control. The exaggerated cardiac contractile depression in LPS treated mice is associated with greater densities of neutrophils and mononuclear cells in the myocardium, and higher levels of TNF-α, IL-1β and IL-6 in the circulation and myocardium. This study will provide insights into mitochondrial biology, the relevance to sepsis, and therapeutic opportunities that possibly emerge.
First and second stages of labor: risk factors, diagnoses, management
Authors: Castro Brain
Published: October 2020

The aim of this review article was to discuss the risk factors, diagnoses, management options, and outcomes of the first and second stages of labor, and provides an evidence-based approach where one exists. Approximately one fifth of human labors have dystocia. Dystocia may arise due to incoordinate uterine activity, abnormal fetal lie or presentation, absolute or relative cephalopelvic disproportion. The American Congress of Obstetricians and Gynecologists (ACOG) guidelines recommend a full evaluation of the maternal-fetal status, the status of the cervix, and at least 39 completed weeks (full term) of gestation for optimal health of the newborn when considering elective induction of labor. In 2011, one in three women who gave birth in the United States did so by cesarean delivery, Although cesarean delivery can be life-saving for the fetus, the mother, or both in certain cases, the rapid increase in the rate of cesarean births without evidence of concomitant decreases in maternal or neonatal morbidity or mortality raises significant concern that cesarean delivery is overused. Good management of the first and second stages of labor can decrease the rate in cesarean delivery and reduce fetal and maternal complication.
Histomorphological effects of sodium arsenite on uterus of rats
Authors: Mir Amaidah , Butt Hammad Ahmed , Yasmeen Maria , Saleem Anber , Minhas Ruqqia Shafi , Abbasi Sumaira
Published: October 2020

Background: Arsenic is highly toxic agent and a risk factor for disease and disability. Arsenic is present in drinking water of many developing and developed countries including Pakistan and due to rapid industrialization its quantity in soil and water is increasing day by day.Methods: In an 18 month study in which we took two principal groups, labelled as control group A and experimental group B. The animals of experimental group B were administered 4 µg of sodium arsenite dissolved in 10 ml of distilled water by oral gavage daily for 14 days. The uterus was removed and processed for paraffin embedding and stained with hematoxylin and eosin (H and E). The histological parameters; uterine luminal diameter, height of uterine luminal epithelium, area occupied by epithelial component of uterine glands and the thickness of myometrium were measured and evaluated by civil AutoCAD 2013 software. The data was analyzed statistically with the statistical package for social sciences (SPSS).Results: Histological results showed the degenerative effects. The luminal diameter of uterine horns was reduced in experimental animals. The height of uterine epithelium was reduced. Area occupied by epithelial component of uterine glands was reduced along the reduction in the thickness of myometrium.Conclusions: The histological abnormalities observed in uterus showed that the degenerative effects may be due to oxidative stress produced by the exposure to sodium arsenite. As sodium arsenite produces the oxidative stress by the formation of free radicals and by the denaturation of proteins.
Two-year surgical review of elective hysterectomy for non-oncological indications: experience from a tertiary centre
Authors: Annan John J. K. , Konney Thomas O. , Asubonteng Gerald O. , Awortwi Wilfred S.
Published: October 2020

Background: This retrospective descriptive cross-sectional study was aimed at determining indications, surgical outcomes, complications and challenges of elective non-oncological hysterectomies performed at a tertiary referral centre over a 2-year period (1st December 2018 to 31st December 2019).Methods: With ethical approval, the medical records of all eligible women were retrieved, reviewed and analyzed. Measures of central tendencies, frequencies and percentages were used to compute the variables.Results: During the 2-year study period, a total of 245 elective non-oncological hysterectomies were performed. The age of the women ranged from 33 to 80 years with a mean age of 49.08 years; [standard deviation (SD): 8.88]. Women in the 40-49 year-old-age group constituted the majority 55.51% (n=136/245). Main indications were multinodular fibroid uterus (without menorrhagia), fibroid uterus with menorrhagia and genital prolapse. There was no case of laparoscopic hysterectomy. Majority (98.78%; n=242/245) of the hysterectomies were total hysterectomies. The commonest additional procedures performed was bilateral salpingo-oophorectomy (31.84%; n=78/245). Intra-operative complication rates were low: (0.40%; n=1/245) for bowel injury, bladder injury and bleeding from an ovary. Regional anaesthesia was the commonest type of anaesthesia (71.84%; n=176/245). The primary surgeon was above the level of a specialist in 99.19% (n=243/245) of cases.Conclusions: Most women had hysterectomy for non-oncological indications in their fourth and fifth decades of life on account of fibroid-related conditions and genital prolapse. There was no uptake of laparoscopic hysterectomy. Hysterectomies are generally safe in the hands of an experienced and skilled surgical team.
Histopathological features of relapse cases in leprosy
Authors: Kaur Navdeep
Published: October 2020

Leprosy is unique in terms of the nature of the causative organism (Mycobacterium leprae), the chronicity of the disease, its prolonged treatment and the definitions of “cure” and “relapse.” The principal mode of assessing the efficacy of therapeutic regimens in leprosy is the “relapse rate.” There are wide variations in estimates of relapse rates after the World Health Organization (WHO) multidrug therapy in different regions. The important predisposing factors for relapse include the presence of “persister” bacilli, monotherapy, inadequate/irregular therapy, presence of multiple skin lesions/thickened nerves and lepromin negativity. The conventional methods of confirming activity or relapse in an infectious disease (demonstration and/or culture of the etiologic agent) have limited utility in leprosy because of the difficulty in demonstrating bacilli in paucibacillary (PB) cases and absence of a method of in vitro cultivation of M. leprae. Bacteriological parameters are useful in multibacillary (MB) leprosy, whereas in PB leprosy, the criteria for relapse depend primarily on clinical features. Although there are no widely available serologic tests for leprosy other than in a research setting, various immunological tests may be useful for monitoring patients on chemotherapy as well as for confirming suspected cases of relapse. The main differential diagnoses for relapse are reversal reactions, erythema nodosum leprosum and reactivation/resistance/reinfection. The most reliable criteria for making an accurate diagnosis of relapse include clinical, bacteriological and therapeutic criteria. Additional ones that may be used, depending on the setting, are histopathological and serologic criteria.
The clinical efficacy of orlistat in the treatment of obesity
Authors: Peynirci Hande
Published: October 2020

Background: The prevalence of obesity is gradually increasing worldwide and reaches an epidemic extent. Currently, treatment of obesity with pharmacological options has gained importance due to the frequent failure of lifestyle changes. Anti-obesity medications have an unfortunate history that make many clinicians uncomfortable with their prescription. In this study, we aimed to examine the effect of orlistat on weight loss and glycaemic parameters.Methods: Forty patients under orlistat treatment between November 2017 to October 2018 were recruited and their weight, body mass index (BMI), glucose, insulin, and the homeostatic model assessment of insulin resistance (HOMA-IR) values were recorded before and after treatment. Patients aged >18 years with BMI≥40 kg/m2 were enrolled to the study while having the diagnosis of diabetes mellitus, those with gastrointestinal diseases, who were pregnant or in lactation period, using drugs that have an effect on weight, and who did not come their follow-up after 12 weeks were excluded.Results: Thirty-four patients were female, 6 were male, and the mean age was 42.75±10.60 years. The mean height found as 161.10±8.98 cm. Before treatment, the mean weight was 120.62±16.56 kg, BMI was 46.43±4.61 kg/m2, and HOMA-IR was 5.84±3.58. After 12 weeks, it was observed that the mean weight decreased to 112.67±16.21 kg, BMI to 43.35±4.55 kg/m2, and HOMA-IR to 3.73±2.38. There was a statistically significant difference in these parameters compared to the pre-treatment values.Conclusions: Given the lack of non-surgical treatments, orlistat can provide significant benefits in the current clinical practice when combined with the appropriate diet.
Effect of chewing gum on bowel recovery following caesarean section: a randomized controlled trial
Authors: R. Gayathri , Sagili Haritha , G. Rajagopalan , T. P. Elamurugan
Published: October 2020

Background: Postoperative ileus is the most frequent complication of any abdominal surgery. In case of patients who under caesarean sections it adds to the prolonged hospital stay and morbidity. Chewing gum acts similar to sham feeding has been proven to hasten return of gastrointestinal motility in non-obstetric abdominal surgery. To study the effectiveness of chewing gum on recovery of bowel function following Caesarean section.Methods: This study, a randomized controlled trial was conducted in the Department of Obstetrics and Gynecology, JIPMER over a period of 2 months. Age, parity and details of patients who underwent caesarean section (type/indication/duration) were noted. They were randomised and allocated into two groups, group a (gum chewing group) and group B (control group). Using a verbal questionnaire time of first feeling of hunger, first passage of flatus and first passage of feces were noted.Results: Mean time of first passage of flatus in group 1 (gum chewing) was 16.04±5.7 as compared to 22.05±4.8 in group 2 (standard care) and the difference was found to be statistically significant (p<0.01). Mean time of first passage of feces in group 1(gum chewing) was 27.08±3.2 as compared to 32.04±4.3 in group 2 (standard care). None of the patients in our study had any side effects with use of chewing gum.Conclusions: Chewing gum significantly improves bowel motility when administered to patients following caesarean section and may help.
Comparative evaluation of intracorporeal lithotripsy techniques during ureteroscopy: a clinical experience
Authors: Trivedi Pankaj
Published: October 2020

Background: The objective of the study was to compare pneumatic lithotripsy and laser lithotripsy techniques for safety, efficacy, and complications in the management of ureteric stone.Methods: Patients underwent ureteroscopy for ureteral stones in a tertiary care teaching hospital were divided into 2 groups of 50 each. Group 1 patients underwent pneumatic lithotripsy and group 2 underwent holmium:yttrium-aluminium-garnet (Ho: YAG) laser lithotripsy. Both the groups were compared regarding demographic characteristics, stone dimensions, number of stones, operative time, stone migration rate, application of post-operative double J (DJ) stent, complications, and stone free rate.Results: Mean age of the patients in the group 1, and group 2 were 45.74±18.49, and 44.5±14.33 years, respectively (p=0.709). There was no significant difference in male to female ratio in both groups. Total operative times were found 29.12±10.83 min, and 28.44±7.49 min in the group 1 and group 2, respectively which was statistically non-significant (p=0.716). The stone free rate was 100% and 98% in group 1 and 2 respectively (p=0.130). Stone migration was also found in 5 (10%) patients in the group 1 and 1 (2%) in group 2 which was found statistically significant (p=0.037). Mucosal damage was found 3 (6%) in laser group as compared to 1 (2%) in pneumatic group. No significant difference between complications was seen in both the groups.Conclusions: This study concluded that pneumatic lithotripsy and laser lithotripsy have similar efficacy in terms of operative time, success rate and hospital stay time. However, stone migration rate was significantly more in pneumatic lithotripsy.
Knowledge and attitude regarding complementary feeding practices among medical interns in Yenepoya medical college, Mangalore
Authors: Nathan Sowmya R. , Nuwera Haleema , Sudhir Shyam , Shamshu Rasheena
Published: October 2020

Background: The health of the child depends on the attainment of the nutritional requirements, which include breast-feeding followed by complementary feeding. The mother’s knowledge on complementary feeding is greatly relied upon health workers. Therefore it is important for the health workers to know the recommended practices for Infant and Young Child Feeding practices so that they can impart the same to mothers.Methods: Cross sectional hospital based questionnaire study conducted among 120 medical interns at Yenepoya Medical College Hospital, Mangalore. A score of more than 75% was considered good, 50 -74% moderate, and less than 50% as poor. Statistical Package of social science (SPSS) software was used for analysis of data.Results: Of the 110 respondents, majority of them (88.18%) of them agreed to initiate complementary feeding at 6 months. 82% of them responded that it should be initiated with rice/cereal-based diet. Of the 110 responded 87 of them agreed that for a 6–8 month old breastfed child the frequency of feeds needed to be at least 2 times or higher. Regarding the type of complementary feeding, 89.09% were aware that it should be started with mono-cereals.Conclusions: This study concluded that majority of the medical interns had a good knowledge on the recommended feeding practices for the infant and young child. There were very few medical interns who had to be informed regarding the correct infant and young child feeding practices.
Perception of social stigma among patients attending a filariasis morbidity control clinic in South India
Authors: Ramanathan Parthasarathi , Prabhakar Ram , Anbu Ananthan Velmurugan
Published: October 2020

Background: The psychological and social stigma associated with lymphatic filariasis can adversely affect productivity and quality of life. This study was carried out to assess the perception of social stigma among patients with lymphatic filariasis.Methods: A hospital based cross sectional study was done on 30 subjects with lymphatic filariasis who attended a filariasis morbidity control clinic in Tamil Nadu. Data was collected using a locally adopted, pilot tested interviewer administered questionnaire derived from explanatory model interview catalogue community stigma scale (EMIC-CSS).  Patients were categorized into none, mild, moderate and severe levels of social stigma based on their responses for questions related to stigma assessment. Data was analyzed using Epi-Info. Quantitative variables were presented as mean with standard deviation. Qualitative variables were presented as frequency with proportion. Results: Majority of the study subjects were males (60%), Hindu by religion (73.3%) and belonged to nuclear family (73.3%). The mean age (±SD) was 47 (±10.9) years. 66.7% of subjects were aged between 46-50 years. Majority (60%) of subjects had mild stigma. 13% had moderate while 3% had severe stigma. 23% of subjects had no stigma. Conclusions: 87% of this study subjects had perceived the social stigma towards lymphatic filariasis. Hence, apart from prevention and treatment measures for filariasis, importance has to be given in context of reducing social stigma towards the disease.
Knowledge, attitude and practice of nutritional counselling for tuberculosis patients amongst doctors practising in a tertiary care teaching hospital
Authors: Divhare Sujeet A. , Girish Sunita , Ingle Satyashil A.
Published: October 2020

Background: Knowing the knowledge of resident doctors in a tertiary care teaching hospital along with their attitude regarding counselling the tuberculosis patients and their way of  implementing their knowledge in their practices while treating the tuberculosis patients will not only lead to a healthy base for the core of the society but also keep the flow of knowledge regarding nutrition from doctors to tuberculosis patients and their relatives so as the peripheral aspect of the society too will get strengthen.Methods: A well-structured questionnaire was distributed among 147 resident doctors working in a tertiary care teaching hospital.Results: Overall it was found that there is slight and significant increase in the knowledge aspect among third year resident doctors. While in practices, first and second year resident doctors were contributing more than third year doctors.Conclusions: Overall all the resident doctors were knowing the importance of having adequate and balanced diet in the management of tuberculosis and also were aware about its role in prevention of tuberculosis.
Paediatric acquired cholesteatoma, our experience in a tertiary care: two year prospective study
Authors: Jain Akshay , Tripathi Smruti Milan , Gupta Poonji
Published: October 2020

Background: Aim of the study was to estimate the benefits of having high-resolution computed tomography (HRCT) of temporal bone on clinically evaluated paediatric patients of acquired cholesteatoma.

Methods: A total of 60 patients of paediatric age group (2-18 years) who were diagnosed with active squamosal type of chronic otitis media were selected for the study. HRCT of temporal bone was done in all the patients and findings were recorded.

Results: Most patients were in the age group of 11-15 years (46.6%). Findings of pars tensa were subtotal perforation in 2 patients (3.3%), small central perforation in 8 patients (13.3%) and postero-superior marginal perforation in 12 patients (20%). Pars flaccida retraction pocket with cholesteatoma was seen in 31 patients (51.6%) and perforation with cholesteatoma in 13 patients (21.6%). Scutum erosion was seen in 31 patients (51.6%), ossicular erosion in 12 patients (20%) and facial nerve paralysis in 2 patients (3.3%). On HRCT temporal bone we found soft tissue density in middle ear in 60 patients (100%), soft tissue density in mastoid in 53patients (88.3%), osscicular erosion in 54 patients (90%), scutum erosion in 46 patients (76.6%), facial nerve canal dehiscence in 5 patients (8.3%), semicircular canal dehiscence in 2 patients (3.3%) and dural plate dehiscence in 11 patients (18.3%).

Conclusions: HRCT of temporal bone is helpful in depicting a clearer picture of middle ear cavity structures involved by cholesteatoma and thus helpful in formulating a strategy for further management.
A comprehensive study on haematological and platelet related changes following septoplasty
Authors: Senniappan Shivakumar , Giritharan Naveen
Published: October 2020

Background: Septoplasty is an elective surgical procedure indicated for the improvement of anatomic nasal airway obstruction. Platelets have an important role in endothelium damage repair and regulating hemostasis. Platelets produce pro-inflammatory mediators such as cytokines and chemokines during vascular inflammation. Aim of the study was to determine various types of changes that occur in Haematology and Platelet profile in patients after they undergo Septoplasty.

Methods: The study was conducted between January 2019 to June 2020 on 50 patients attending ENT OPD in Vinayaka Mission’s KirupanandhaVariyar Medical College and Hospital, Salem. 50 patients fulfilling inclusion/ exclusion criteria who give informed consent were included in the study.  

Results: The parameters with no significant differences were found in red blood cells, white blood cells, platelet count, erythrocyte sedimentation rate, haemoglobin (Hb), hematocrit (Htc), mean corpuscular volume, mean corpuscular hemoglobin concentration (MCHC), and platelet distribution width values. mean platelet volume (MPV) value was decreased, platelet-to-lymphocyte ratio (PLR) and neutrophil to lymphocyte ratio (NLR) values were increased.

Conclusions: In our study, MPV value was decreased, PLR and NLR values were increased significantly after septoplasty. Also, the decrease in nasal obstruction symptom evaluation (NOSE) score after surgery is the confirmatory parameter proving that septoplasty not only improves the quality of life but also significantly corrects the altered blood and platelet related parameters in nasal septal deviation patients.
Clinical study to compare the effect of intratympanic injection of lidocaine and dexamethasone in tinnitus of cochlear origin
Authors: . Surabhiraj , Megalamani Somanath B. , Gadag Raveendra P.
Published: October 2020

Background: Due to various aetiologies and the less known mechanism involved in tinnitus no treatment modality gives consistent results. Here, we are comparing the efficacy of intratympanic injections of lidocaine and dexamethasone.  

Methods: Out of 100 selected patients, consecutive patients who fulfilled the inclusion and exclusion criteria are randomly allocated into one of the 2 study groups (50 members each). Intratympanic injection of lidocaine and dexamethasone are given to respective group weekly for 3 consecutive weeks and response is assessed at 1 month and 2nd month of injection.  

Results: In our study, maximum patients were in the age group of 56-65 yrs. When the effect of lidocaine and dexamethasone on tinnitus (based on THI-tinnitus handicap inventory questionnaire) is compared, dexamethasone is found to be more efficacious than lidocaine with a p value<0.005. Out of total, 96% of dexamethasone group and 68% of lignocaine group have got improved THI score during second follow up. While assessing the effect of lidocaine and dexamethasone on pure tone audiogram (PTA) it is found that, dexamethasone is showing more improvement when compared to lignocaine (p value<0.05). Regarding the adverse effects of injection, side effect is more with lidocaine (50%) than that of dexamethasone (36%), most common adverse effect which we came across was burning type of pain, followed by giddiness which last only for few seconds.  

Conclusions: Dexamethasone is effective in reducing the overall THI score hence reduces handicap when compared with that of lidocaine with added advantage on hearing.
A study to compare the outcomes of laser myringotomy and conventional incision myringotomy
Authors: Pudukulangara Shruthi , Megalamani Somanath B. , Gadag Ravindra P.
Published: October 2020

Background: The objective of the study was to compare the outcomes of laser myringotomy and incision myringotomy in terms of operating time, patency of opening, hearing improvement, and disease recurrence.

Methods: This study is a prospective study done among 35 children and 68 ears. All cases which were diagnosed to have otitis media with effusion were randomly assigned into two groups: group 1 was treated with diode laser myringotomy and group 2 was treated with conventional incision myringotomy without grommet insertion. These patients were followed up at regular intervals and compared in terms of operating time, patency of opening, recurrence of disease and hearing improvement.   

Results: Diode laser myringotomy took an average operating time of 6.38 minutes and the patency of opening was maintained for an average of 13.59 days, compared to the average operating time for incision myringotomy of 9 minutes, and the patency of opening being 12.35 days. These differences were statistically significant (p<0.0001 for operating time and p=0.041 for patency of opening). Hearing improvement was also found to be better in laser myringotomy group (p=0.021).  

Conclusions: Diode laser myringotomy is an effective, easy and less time-consuming modality than incision myringotomy for the treatment of otitis media with effusion.  
A study of clinical and dermoscopic features in alopecia areata at a tertiary referral center
Authors: N. Nikhil , P. Mamatha , K. Hanumanthayya
Published: October 2020

Background: Alopecia areata (AA) is a common chronic inflammatory disease causing unpredictable non scarring form of hair loss. Dermoscopy is a clear cut as well as valuable method done in a noninvasive manner to study the signs of alopecia areata. Aim was to elucidate the various clinical characteristics and dermoscopic findings of alopecia areata.

Methods: A total of 150 patients were examined using a dermlite dermoscope at dermatovenereology OPD of Vydehi Hospital. Detailed history, clinical features, associated changes, severity and dermoscopic findings were noted.

Results: In our study males (54.7%) were more than females (45.35%) with the ratio of 1.2:1. Mean age of the patients was 25 years. Mean duration of the disease was around 6 months. The most common type noted in our study was patchy alopecia (76%) and most common affected site was scalp (frontal and parietal region) (49.35%). 28% of the people have itching, otherwise it is mostly asymptomatic. Stress was a triggering factor in 24.70% patients. Nail changes in the form of pitting seen in 20.7% patients. The various dermoscopic findings observed in our study are yellow dots (80%), short vellus hair (74.7%), exclamation hair (34%), black dots (28%), broken hair (25.3%).

Conclusions: Short vellus hair and yellow dots are seen in most cases of our study. They vary according to the activity of the disease and treatment. Yellow dots, black dots and tapering hair indicate active disease, while short vellus hairs indicate remission.

 
Community pharmacists’ evolving role in Canadian primary health care: a vision of harmonization in a patchwork system
Authors: Raiche Taylor , Pammett Robert , Dattani Shelita , Dolovich Lisa , Hamilton Kevin , Kennie-Kaulbach Natalie , McCarthy Lisa , Jorgenson Derek
Published: October 2020

Canada’s universal public health care system provides physician, diagnostic, and hospital services at no cost to all Canadians, accounting for approximately 70% of the 264 billion CAD spent in health expenditure yearly. Pharmacy-related services, including prescription drugs, however, are not universally publicly insured. Although this system underpins the Canadian identity, primary health care reform has long been desired by Canadians wanting better access to high quality, effective, patient-centred, and safe primary care services. A nationally coordinated approach to remodel the primary health care system was incited at the turn of the 21st century yet, twenty years later, evidence of widespread meaningful improvement remains underwhelming. As a provincial/territorial responsibility, the organization and provision of primary care remains discordant across the country. Canadian pharmacists are, now more than ever, poised and primed to provide care integrated with the rest of the primary health care system. However, the self-regulation of the profession of pharmacy is also a provincial/territorial mandate, making progress toward integration of pharmacists into the primary care system incongruent across jurisdictions. Among 11,000 pharmacies, Canada’s 28,000 community pharmacists possess varying authority to prescribe, administer, and monitor drug therapies as an extension to their traditional dispensing role. Expanded professional services offered at most community pharmacies include medication reviews, minor/common ailment management, pharmacist prescribing for existing prescriptions, smoking cessation counselling, and administration of injectable drugs and vaccinations. Barriers to widely offering these services include uncertainties around remuneration, perceived skepticism from other providers about pharmacists’ skills, and slow digital modernization including limited access by pharmacists to patient health records held by other professionals. Each province/territory enables pharmacists to offer these services under specific legislation, practice standards, and remuneration models unique to their jurisdiction. There is also a small, but growing, number of pharmacists across the country working within interdisciplinary primary care teams. To achieve meaningful, consistent, and seamless integration into the interdisciplinary model of Canadian primary health care reform, pharmacy advocacy groups across the country must coordinate and collaborate on a harmonized vision for innovation in primary care integration, and move toward implementing that vision with ongoing collaboration on primary health care initiatives, strategic plans, and policies. Canadians deserve to receive timely, equitable, and safe interdisciplinary care within a coordinated primary health care system, including from their pharmacy team.
Determination of Some Pesticides Harmful To Environment and Human Health in Bogazköy(Turkey) Dam Water by LC-MS/MS
Authors: YILMAZ İbrahim , ERDOĞAN Gülbin
Published: October 2020

Abstract: Pesticides are the most dangerous organic pollutants for human and environmental health. These are substances that are harmful to health, the use of which has increased in recent years, to kill pests in agricultural production. The areas of use of pesticides, apart from agricultural activities, are in the fight against mosquitoes, which cause malaria, which creates a significant health problem for human health, in landscape, construction industry, timber protection, forestry, control of aquatic organisms, industrial insect control, food storage, transportation and community hygiene there are multiple uses such as. Excessive intake of the body leads to many diseases, cancer formation, even death. This study, it was aimed to analyze of Atrazin, Chlorfenvinfos, Chlorpyrifos, Diuron, Isoproturon and Simazin pesticides simultaneously with LC-MS/MS, in Boğazköy Dam in Bursa(Turkey) and the branches that feed the dam in Bursa İnegöl district. The samples were taken from 12 locations and were given to LC-MS / MS device by direct injection. Atrazin, Chlorfenvinfos, Chlorpyrifos, Diuron, Isoproturon and Simazin pesticides, which are among the priority substances for surface water resources, were analyzed in the Surface Water Quality Regulation in the dam waters. Environmental quality standards referred to in this regulation are taken as reference points for calibration. For the accuracy of the method, validation studies such as LOD, LOQ, linearity and recovery were performed. As a result, it has been determined that the pesticide derivatives analyzed in the waters feeding Boğazköy Dam and the dam doesn't exceed the limit values of the Environmental Quality Standards, pose no risk in irrigation of agricultural areas and in surface waters.
Measurement invariance of the satisfaction with life scale across gender and time
Authors: AKIN ARIKAN Çiğdem , ZORBAZ Selen
Published: October 2020

The aim of this research is to determine whether the Turkish version of Satisfaction with Life Scale (SWLS) has measurement invariance according to gender and longitudinal invariance for Turkish university students. First study’s data were collected from 500 university students (366 female, 134 male) whereas 388 students (296 female, 92 male) participated in Study 2 for three times over four-month intervals. Confirmatory factor analysis was used for measurement invariance. According to the results of the Study 1 which was invariance study according to gender, all items on the SWLS provide configural, metric and scalar invariance. In this context, the differences in points obtained on the SWLS by university students according to gender can be used to perform comparison studies. Also, Study 2 revealed that strict longitudinal invariance was found to hold. This means that equality of factor patterns, factor loadings, intercepts and residual variance were determined for university students at four-month time intervals. The SWLS can be used to make longitudinal mean and gender comparisons for Turkish university students.
A reappraisal of the stratigraphy of the upper Miocene unit X in the Maaseik core, eastern Campine area (northern Belgium)
Authors: LOUWYE Stephen , VANDENBERGHE Noël
Published: October 2020

The stratigraphy of the Tortonian-Messinian sequence from the Maaseik core, located on the shoulder of the Roer Valley Graben (RVG) in the eastern Campine area in northern Belgium, was improved. The analysis of the marine palynomorphs (dinoflagellate cysts and acritarchs) from the uppermost part of the Breda Formation, the unnamed unit X and the basal part of the Lower Waubach Member led to the recognition of the mid to upper Tortonian Hystrichosphaeropsis obscura biozone. Therefore deposition of this entire analyzed sequence took place sometime between 8.8 to 7.6 Ma. Paleoenvironmental interpretation of the palynomorphs points to shallow marine conditions and most probably a stressed environment during the deposition of unit X. A comparison with the time equivalent stratigraphy in the nearby Belgian Campine, the Dutch RVG and the German Lower Rhine Basin allowed the identification of the Inden Formation and required a shift in the base of the Kieseloolite Formation compared to the earlier lithostratigraphic interpretation of the Maaseik core. The regional stratigraphic scheme shows the progressive northwestward extension of the river facies from the Lower Rhine during the late Tortonian.
Teoría del campo y el sentido del sueño: Continuando la comparación de la teoría interpersonal y la teoría del campo Bioniana
Authors: Stern Donnel B.
Published: October 2020

This paper is a continuation of the comparison of interpersonal/relational theory and Bionian field theory that I began in two articles that appeared in Psychoanalytic Dialoguesin 2013 (Stern, 2013a,b). The paper has two sections. In the first, I discuss differences between Bionian field theory and interpersonal and relational psychoanalysis. In the second, I turn to what the two schools of field theory share.
Enfrentar el dolor
Authors: Buechler Sandra
Published: October 2020

In this extraordinary reflection and life story, the author reviews her own experiences and questions about how to face human pain, how the human being may or may not be able, and to what extent, to share the suffering of the other.
Escisión, simbolización e integración de la identidad
Authors:   Instituto de Psicoterapia Relacional, Rodríguez Sutil Carlos
Published: October 2020

The inner-outer dualism, with its associated conception that the mind is a reality isolated from the world, permeates our everyday thinking. This article begins by demonstrating from the philosophy of the twentieth century the unreality of this separation and the stability of internal constructions. Once we isolate the mind in our imagination, we feel authorized to dream of magical shortcuts to overcome the isolation, such as telepathy or, in the psychotic, transparency or the sounding of thoughts, the theft of ideas, the imposition of ideas from the external world. We are not minds, permanent or eternal, inserted in a world that we see passing around us; we are temporary beings. The self is a representation, an internalized metaphor that we turn into a stable but fragile metaphor in the face of a changing reality, which endows us with immortality and consoles us. The psychotic is the one who lives the split because he has not been able to handle the conventionality of that double language, and accept that reality is at the same time fixed and changing, for this reason they need to adhere to permanent objects, with the quality of stable things. The psychotic is the one who believes in the official language at face value, is sick of conventions. If everyone knows the patient's thoughts, in some way this means that the thoughts are not locked in the head, an idea contrary to cultural belief, which produces terror because it is experienced as unnatural, cancels the division of interior and exterior, which means the experience of loss of identity and agency, the lost of control. Delirium is developed as a way of clinging to reality in the face of extreme disavowal of one's perceptions or feelings.
El caso "Pierre". Comentarios al tratamiento de un paciente narcisista
Authors:   Instituto de Psicoterapia Relacional, García Gil Fernando , Rodríguez Sutil Carlos ,   Instituto de Psicoterapia Relacional
Published: October 2020

We present here a case of a patient with a narcissistic personality disorder. We must take narcissism, like the rest of the personality patterns, as the response of an individual to a context, as the result of a relational matrix (Mitchell). The origin of pathological narcissism is to be found in caregivers who emotionally neglected the child, victim of isolation, on the one hand, and who share and promote narcissistic fantasies of the child, confused with their own fantasies. Dysregulation of narcissism occurs when the child's needs have been ignored, causing severe disturbances in self-esteem or the creation of a great defensive shield (Morrison). At first, our patient could not accept any fault in himself, assuming that the therapist would not accept his faults either. The challenge as therapists is to assume the disability that the patient attributes to us, the incompetence that the patient pursues, without us falling into disaster or in the most absolute hell, which is ultimately what he fears the most. Accepting the faults that the patient displaces in the therapist is a surprise for the patient, it was even a corrective experience in the encounter with himself.
Phenotypic and genetic spectrum of isolated macrodactyly: somatic mosaicism of PIK3CA and AKT1 oncogenic variants
Authors: Tian Wen , Huang Yingzhao , Sun Liying , Guo Yang , Zhao Sen , Lin Mao , Dong Xiying , Zhong Wenyao , Yin Yuehan , Chen Zefu , Zhang Nan , Zhang Yuanqiang , Wang Lianlei , Lin Jiachen , Yan Zihui , Yang Xinzhuang , Zhao Junhui , Qiu Guixing , Zhang Jianguo , Wu Zhihong , Wu Nan
Published: October 2020

Background: Isolated macrodactyly is a severe congenital hand anomaly with functional and physiological impact. Known causative genes include PIK3CA, AKT1 and PTEN. The aim of this study is to gain insights into the genetics basis of isolated macrodactyly. Results: We enrolled 24 patients with isolated macrodactyly. Four of them were diagnosed with Proteus syndrome based on skin presentations characteristic to this disease. Targeted next-generation sequencing was performed using patients’ blood and affected tissues. Overall, 20 patients carry mosaic PIK3CA pathogenic variants, i.e. p.His1047Arg (N=7), p.Glu542Lys (N=6), p.Glu545Lys (N=2), p.His1047Leu (N=2), p.Glu453Lys (N=1), p.Gln546Lys (N=1) and p.His1047Tyr (N=1). Four patients who met the diagnostic criteria of Proteus syndrome carry mosaic AKT1 p.Glu17Lys variant. Variant allele frequencies of these mosaic variants obtained through next-generation sequencing range from 10% to 33%. In genotype-phenotype correlation analysis of patients with PIK3CA variant, we found that patients with the macrodactyly of the upper and lower limbs tend to carry PIK3CA variants located in the kinase and helical domain (P=0.011). Conclusions: Mosaic PIK3CA and AKT1 variants can be found in all of our samples with isolated macrodactyly. Insights into phenotypic and genetic spectrum of isolated macrodactyly may be helpful in perusing a more precise and effective management of isolated macrodactyly.
Total versus conventional laparoscopic cyst excision and Roux-en-Y hepaticojejunostomy in children with choledochal cysts: a case-control study
Authors: LIU FEI , Xu Xiaogang , Lan Menglong , Tao Boyuan , Li Le , Wu Qiang , Chai Chengwei , Zeng Jixiao
Published: October 2020

Background : To compare the efficacy of total and conventional laparoscopic hepaticojejunostomy (TLH and CLH) in children with choledochal cysts (CDCs).
Methods: Data from patients undergoing TLH and CLH between August 2017 and December 2018 were retrospectively analyzed. Intraoperative blood loss, time for jejunum-cojejunum anastomosis, time to oral intake, postoperative hospital stay, hospitalization expenses, and postoperative complications were compared.
Results: All 55 patients (TLH=30, CLH=25) were successfully treated without conversion to open surgery. In the TLH and CLH groups, the time to oral intake was 3.57±0.19 d and 4.56±0.27 d, respectively (t=3.07, P<0.01), the postoperative hospital stay was 5.50±0.28 d and 7.00±0.74 d (t=2.03, P<0.05), and the hospitalization expenses were CNY 40085±2447 and CNY 26084±2776 (t=3.79, P<0.001). There were no significant differences in intraoperative blood loss (9.57±3.28 ml vs 8.2±1.13 ml, t=0.37, P=0.72) or time for jejunum-cojejunum anastomosis (80.5±2.46 min vs 75.00±2.04 min, t=1.68, P=0.10). The median follow-up periods of the TLH and CLH groups were 17 and 16 months, respectively. Overall complication rates were comparable between the two groups (10% vs 8%, c²=0.07, P=0.79).
Conclusions: TLH in children with CDCs has the advantages of rapid gastrointestinal functional recovery and a short hospitalization. However, hospitalization is relatively expensive.
Keywords: Total laparoscopic; Choledochal cyst; Children; Congenital
People and water: understanding integrated systems needs integrated approaches
Authors: Carr Gemma , Barendrecht Marlies H. , Debevec Liza , Kuil Linda , Blöschl Günter
Published: October 2020

As we rapidly modify the environment around us, researchers have a critical role to play in raising our understanding of the interactions between people and the world in which they live. Knowledge and understanding of these interactions are essential for evidence based decision-making on resource use and risk management. In this paper, we explore three research case studies that illustrate co-evolution between people and water systems. In each case study, we highlight how different knowledge and understanding, stemming from different disciplines, can be integrated by complementing narratives with a quantitative modelling approach. We identify several important research practices that must be taken into account when modelling people-water systems: transparency, grounding the model in sound theory, supporting it with the most robust data possible, communicating uncertainty, recognising that there is no ‘one true model’ and diversity in the modelling team. To support interdisciplinary research endeavours, we propose a three-point plan: (1) demonstrating and emphasising that interdisciplinary collaboration can both address existing research questions and identify new, previously unknown questions at the interface between the disciplines; (2) supporting individual interdisciplinary learning at all career stages and (3) developing group practices and a culture of interdisciplinary collaboration.
Molecular detection of beta-lactamase blaCTX-M group 1 in Escherichia coli isolated from drinking water in Khartoum State
Authors: Altayb Hisham N. , Salih Eman Khalid , Moglad Ehssan H.
Published: October 2020

This study aimed to detect the blaCTX-M group 1 in Escherichia coli (E. coli) isolated from drinking water in Khartoum State. Two hundred and eighty water samples were collected randomly from different areas, places, and sources from the state and examined for the presence of E. coli as a fecal contamination indicator. Isolation and identification of E. coli were performed using culture characteristics on different culture media and biochemical reactions. An antimicrobial sensitivity test was performed for all isolated E. coli using agar disk diffusion method. DNA was extracted by boiling method, and bacterial genomic DNA used as a template to detect blaCTX-M group 1 by PCR. Results showed 86 (30.7%) E. coli were isolated out of 280 water samples. Antimicrobial susceptibility testing revealed the highest resistant percentage was 59% for tetracycline, followed by 35% for gentamycin, while for chloramphenicol and cefotaxime was 22 and 20%, respectively. blaCTX-M group 1 was detected in about 40% of all isolates. This study concludes that drinking water in Khartoum State may be contaminated with feces and might be a possible source for transferring resistant bacteria. Thus, it may be one of the critical causes of increasing reports of antimicrobial resistance in Khartoum State.