bluuebunny/crossref_metadata_2025 huggingface dataset:
Cartas inéditas del Cardenal Spínola a los salesianos
Authors: Borrego Arruz Jesús
Published: April 2024

Es proverbial el orgullo que sentía el cardenal Marcelo Spínola por Don Bosco y su obra, la primera obra (1884) escrita en español sobre el santo sacerdote y educador de Turín. El inesperado hallazgo de cuarenta cartas dirigidas a los salesianos es una buena excusa para darlas a conocer, pues Spínola -como obispo de Coria y luego como arzobispo de Sevilla- las escribió para exponer con detalle los motivos de su profundo afecto a la Congregación Salesiana. La edición crítica de las cartas va precedida de una breve, pero necesaria introducción
TRANSFORMANDO A EDUCAÇÃO A DISTÂNCIA
Authors: Barros Elisângela Tavares da Silva , Macêdo Antonio Epitácio Soares de , Ramos Camila Aparecida Santi , Graffunder Magali Maristela , Barbosa Raquel Alves
Published: April 2024

Este artigo investigou a integração da Inteligência Artificial (IA) em cursos de Educação a Distância (EAD), com o objetivo de compreender como essa tecnologia pode personalizar e otimizar o processo educativo. A pesquisa se ancorou na análise da aplicabilidade e dos impactos da IA no ensino a distância, visando elucidar as estratégias para sua efetiva implementação. A metodologia adotada centrou-se em uma abordagem bibliográfica, conforme delineado por Lakatos e Marconi (2001), permitindo uma revisão sistemática de literaturas relevantes e a análise de estudos de caso pertinentes, como o do Colégio Lectus. Autores fundamentais como Semensato, Francelino e Malta (2015), Barpi et al. (2023) e Giraffa (1998, apud Semensato et al., 2015) foram referenciados para discutir a dinâmica entre a IA e a educação, destacando a capacidade de personalização e adaptação das ferramentas de IA. A análise dos dados revelou que a IA, através de estratégias como gamificação, chatbots interativos e learning analytics, pode significativamente enriquecer a experiência de aprendizagem e facilitar o acompanhamento e a avaliação do progresso dos alunos. Concluiu-se que a IA possui um potencial transformador na EAD, promovendo um ensino mais adaptativo e centrado no aluno. A pesquisa ressaltou a necessidade de futuros estudos para explorar o potencial completo da IA na educação, sugerindo uma abordagem integral que integre as inovações tecnológicas às práticas pedagógicas.
A statistical model for estimating size and productivity ratio in SDLC
Authors: Gupta Anuj
Published: April 2024

During a software development life cycle, one has to estimate the effort and schedule required to produce a software unit. Estimates for The effort and schedule are derived from other measurements such as size and productivity Ratio. Size may be estimated using methods such as Function Point, WBS, LOC, etc., and the Productivity Ratio is expressed as Size / Time to complete the Unit of Software. Such estimates are static and do not consider real-time Parameters which cause variations from the estimate. In this paper, a statistical model for Size and Productivity Ratios is derived using Historical values after considering several factors influencing the size and the productivity ratio of produced software. Typically, an estimate of the effort and schedule is required to complete. A software work product an enhancement request or a software fix. We use Function Points or WBS to estimate the size of the software in consideration. We use baseline values for estimating productivity Ratios. Real-time values however differ from Baseline values as they are influenced by several factors. Here are some factors which would influence the Actual Size of the software Later on we will use Statistical techniques of Multivariable Parameter estimation and logistic Regression to derive run time equations of Size and Productivity Ratio.
Outcomes of Autologous stem cell transplantation in patients with primary refractory Diffuse Large B-cell lymphoma who demonstrate chemosensitivity to salvage chemotherapy
Authors: Rauf M Shahzad , Maghfoor Irfan , Aseafan Muhammad , Al Shankati Khadijah , Alhanash Ali M. , Sohail Faateh , M. Elhassan Tusneem A. , Akhtar Saad
Published: April 2024

Rituximab with anthracycline-based combination frontline chemoimmunotherapy can cure 50–60% of patients with diffuse large B-cell lymphoma (DLBCL). However, studies on the outcomes of patients with DLBCL who experience partial response (PR), stable or progressive disease in response to frontline rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (RCHOP) therapy are limited, as are data on the outcomes of high-dose chemotherapy (HDC) and autologous stem cell transplantation (ASCT) in patients with primary refractory DLBCL who demonstrate chemosensitivity to salvage chemotherapy (SC). We assessed the latter among 184 patients, 144 of whom started SC, with 84 responding and 72 receiving HDC–ASCT. The 5-year survival rate was 58.9%; the median overall survival (OS) was not reached. The difference in response to SC (partial response versus complete response) was significant, with higher 2- and 5-year OS rates in patients with CR (78.1% and 74.9%, respectively) than in those with PR (55.3% and 47%, respectively). The median OS for the whole group was 15 months and particularly patients who had progressive disease after frontline R-CHOP had dismal outcomes. Our study suggests that in patients with primary refractory DLBCL without initial progressive disease after frontline R-CHOP, the depth of response to SC before HDC–ASCT is predictive of relapse.
Sensibilización y prevención del alcoholismo en adolescentes a través de talleres de educación en salud
Authors: Veloz Miño Silvia Patricia , Mejía Paredes Martha Cecilia , Muquinche Usca Maria de Lourdes , Veloz Miño María Fernanda
Published: April 2024

Introducción: El alcoholismo es un grave problema de salud pública, según la OMS provoca cerca de 3 millones de muertes anuales y se asocia a más de 200 enfermedades, las consecuencias afectan al consumidor y también al entorno familiar y social. Objetivo: Determinar la influencia de la intervención en Educación para la salud sobre los factores protectores y competencias en relación al consumo de bebidas alcohólicas. Metodología: Se aplicó un test antes y después de la intervención educativa desarrollada con 39 adolescentes de ambos sexos de entre 15 y 16 años de edad que cursaban el segundo año de bachillerato de la Unidad Educativa Capitán Edmundo Chiriboga en Riobamba - Ecuador. Resultados: Se comprobó la influencia de los talleres educativos en el incremento significativo de los criterios afirmativos relacionados con los factores protectores antialcoholismo, la media de respuestas positivas en los 39 adolescentes aumentó en todas las competencias; así: de 20.80 a 33.60 en tomar decisiones correctas en el cuidado de la salud, de 17.20 a 32.00 en la independencia frente a la presión de los amigos y de  13.20 a 34.20 en el discernimiento ante la publicidad de bebidas alcohólicas. Conclusiones: La intervención educativa basada en una metodología activa participativa fue efectiva; ya que se demostró la influencia positiva o el incremento de factores protectores que podrían incidir sobre decisiones correctas para evitar el alcoholismo. Se recomienda ampliar la investigación en esta temática para desarrollar programas de prevención destinados a mejorar la salud y el bienestar de los adolescentes.
Legal Protection of the Rights Children Born Out of Wedlock: A Comparative Study in Indonesia and Malaysia
Authors:   Institute Agama Islam Negeri Kediri, Tohari Ilham , Waseso Anggit ,   UIN Maulana Malik Ibrahim Malang, Herawati Erna ,   UIN Maulana Malik Ibrahim Malang
Published: April 2024

Children born out of wedlock have the same human rights as those born within a legitimate marriage. This research aims to discuss how the law can play a crucial role in providing strong protection for the rights of children born out of wedlock, comparing legal regulations in family law between Indonesia and Malaysia. The research utilizes normative method of comparative legal analysis to examine regulations related to the legal status of children born out of wedlock within the legal systems of Indonesia and Malaysia. The results of this research indicate that in Indonesia, the protection of children born out of wedlock in terms of their rights can be fulfilled by both parents, and a child born out of wedlock can be acknowledged by the father as long as it can be substantiated through scientific knowledge or concrete legal evidence. Conversely, in Malaysia, the decision regarding the lineage of a child born out of wedlock lies entirely with the mother and her family, following the Shafi’i school of thought, and this has not changed to date. As a consequence, children born out of wedlock in Malaysia may lose their civil rights, including financial rights, custody, inheritance, and other rights from their biological father. Malaysian law also regulates penalties for individuals engaged in relationships outside of marriage to protect their lineage and prevent mixed-race offspring.
Yoga as an Integrated Therapy for Stroke Rehabilitation – A Case Study
Authors:   Research Scholar Dept of Yogic Science and Human consciousness, Dev Sanskriti Vishwavidyalaya, Saini Neha Rani , Gurvendra Dr Amrit Lal ,   Associate professor, HOD dept of CAM, Dev Sanskriti Vishwavidyalaya
Published: April 2024

Background and Purpose: A stroke (cerebrovascular accident) is damage to the brain cells from an interruption of their blood supply due to blockage or rupture of an artery to the brain. It is the second-leading cause of death and long-term disability worldwide. The present study is a case report investigating the effect of yoga therapy in addition to acupressure and physiotherapy on activities of daily living and the quality of life of patients after stroke. Subject and method: It is a single case study of 38-year-old women diagnosed with acute ischemic stroke who have chief complaints of loss of function of the left upper and lower limbs, and hypertension. For better management of stroke and recovery, she was undergoing yoga, physiotherapy, and acupuncture treatment in the CAM department at DSVV. The primary outcome measures were activities of daily living by the Barthel index and quality of life by the stroke-specific quality of life scale. The subject received integrated treatment for 12 weeks consisting of 45-minute, 1-hour yoga sessions 6 days a week, regular physiotherapy in the subject’s home, and acupuncture every 2 weeks. The primary outcome data were collected before and after the treatment intervention phase. Result: The subject had improved Barthel’s activity and quality of life score. Discussion and Conclusion: The results suggest that yoga integrated with other complementary therapies may be beneficial to stroke survivors in rehabilitation.
Availability Evaluation of Warm Standby System with Fault Detection Delay and General Repair Times
Authors:   Department of mathematics, Dr. Bhimrao Ambedkar University, Agra, U.P. 282002, India, kanta Kanta , Chaudhary Sanjay ,   Department of mathematics, Dr. Bhimrao Ambedkar University, Agra, U.P. 282002, India
Published: April 2024

This study analyzed the availability of a warm standby system that works with fault detection delay and general repair times. The time-to-detection delay is also considered as exponentially distributed. The detection state is used to detect the faults in the failed unit. The steady state availability of the system is obtained by using supplementary variable technique. Three types of repair time distributions are compared to find the best one.
Immunopathogenesis and Therapeutic Insights into Cicatricial Pemphigoid: A Comprehensive Review
Authors:   Benemérita Universidad Autónoma de Puebla (BUAP). Hospital General Zona Norte Puebla. San Pedro, Puebla, Mexico., Leal Avalos Omar Alejandro , Morales Gloria Joanna Paola ,   Benemérita Universidad Autónoma de Puebla (BUAP). Hospital General Zona Norte Puebla. San Pedro, Puebla, Mexico., Rojas Cruz Gabriela ,   Benemérita Universidad Autónoma de Puebla (BUAP). Hospital General Zona Norte Puebla. San Pedro, Puebla, Mexico., Altamirano Ricardo Daniel Flores ,   Benemérita Universidad Autónoma de Puebla (BUAP). Hospital General Zona Norte Puebla. San Pedro, Puebla, Mexico., Torres Martínez Laura Leticia ,   Benemérita Universidad Autónoma de Puebla (BUAP). Hospital General Zona Norte Puebla. San Pedro, Puebla, Mexico.
Published: April 2024

Cicatricial Pemphigoid (CP), also known as mucous membrane pemphigoid, is a rare autoimmune blistering disorder characterized by subepithelial blistering and scarring of mucous membranes. The hallmark of CP is the formation of autoantibodies against structural proteins within the basement membrane zone, leading to an array of clinical manifestations affecting oral, ocular, and other mucosal surfaces. This review aims to elucidate the complex immunopathogenic mechanisms underlying CP, exploring the role of autoantigens such as BP180 and BP230, as well as the involvement of inflammatory mediators and immune cells. Additionally, the article provides a comprehensive overview of current diagnostic modalities and therapeutic approaches, ranging from systemic corticosteroids to novel immunomodulatory agents and biological therapies. The challenges in managing CP, including potential side effects of immunosuppressive treatments, are discussed alongside emerging strategies to enhance treatment efficacy and minimize adverse effects. A deeper understanding of the molecular pathways involved in CP pathogenesis is crucial for the development of targeted therapies, fostering improved patient outcomes and quality of life
Hyperbaric Oxygenation – Indications and Contraindications
Authors: Luciano Barreto Silva
Published: April 2024

The aim of this work was to conduct a literature review involving the basic concepts of hyperbaric oxygenation, the types of hyperbaric chambers, physiological mechanisms, their indications and contraindications, advantages and disadvantages, volumetric effects, solubility, biochemical and cellular effects; Therapeutic indications and complications associated with hyperbaric oxygenation.
Risk Factors of Community Acquired Pneumonia among Geriatric Population
Authors: Are Suryakari Sreekanth  , P Ajoy Kumar
Published: April 2024

Introduction: Pneumonia in the elderly is a common and serious problem with a clinical presentation that can differ from that in younger patients. Older patients with pneumonia complain of significantly fewer symptoms than do younger patients, and delirium commonly occurs. Clinically pneumonia is characterized by a variety of symptoms and signs. Cough (which may be productive of purulent, mucopurulent, or “rust-coloured” sputum), fever, chills, and pleuritic chest pain are among its manifestations. Material and methods: This is a prospective and observational study conducted in the Pulmonary Medicine, Kurnool Medical College from March 2018 to April 2019. Patients were questioned on clinical history, lifestyle habits and using a standard questionnaire. Anthropometry and a physical examination were performed for all participants in a standardized manner. This study carried out on 60 cases of community-acquired pneumonia of patients aged >65 years. Results: Patients presented with both typical and atypical symptoms. Among the typical respiratory symptoms, cough was present in 45 (75%) patients, expectoration in 39 (65%) patients, 23 had mucopurulent sputum, and 10 patients had mucoid sputum, fever in 33 (55%) patients, dyspnoea in 15 (25%), and pleuritic chest pain in 12 (20%) patients. The most common bacterial organism to be isolated from the sputum cultures was Klebsiella pneumoniae in 42 (70.0%), Pseudomonas aeruginosa in 30 (50 %), Candida albicans in 30 (50%) and Acinetobacter baumanni in 27 (45%). In blood culture however, the most common organism to isolated was Klebsiella pneumoniae in 10 (16.7%) followed by Pseudomonas aeruginosa in 5 (8.4%). Conclusion: Community-acquired pneumonia in elderly patients is a common and serious problem encountered in clinical practice. Elderly patients with community-acquired pneumonia have different clinical presentation and higher mortality. Elderly patients may present with atypical symptoms like altered sensorium and gastrointestinal symptoms, other than the typical respiratory symptoms of pneumonia.
Failures in Implantology: Epidemiological Survey of 100 Tunisian Dentists
Authors: Dr. Khanfir Faten  , Dr Meddeb Hamrouni Ali  , Dr Selmi Raki  , Dr Mouwahed Khedher  , Pr. Khalfi Mohamed Salah  , Pr Ben Amor Faten
Published: April 2024

Introduction: dental implant failure is a major concern for the clinician and the patient. Objectives: The aim of our study is to investigate the way in which 100 Tunisian dentists carried implant treatment for their patients from early phase of planning and selection of patients to the placement of the implant in order to look for the implant failure factors Results: significant correlations were found between failure rates > 5 and their corresponding factors as number of implants placed (p = 0.001<0, 05), smoking (0.046 <0.05), unbalanced diabetes (0.03<0.05), aseptic protocol (= 0.004< 0.05) and the drilling speed (0,002<0.05). Conclusion: It seems that number of implant placed, smoking, diabetes, aseptic protocol and the drilling speed may contribute to dental implant failure.
Pathophysiology of Neuro-COVID
Authors: Finsterer J, MD, PhD  , Scorza FA, MD  , Fiorini AC, MD
Published: April 2024

With interest we read the review article by Battaglini et al., 2020 about the pathophysiology of neurological disease in SARSCoV- 2 infected patients with COVID-19. The authors discuss three possible mechanisms, viral neurotropism, hypercoagulability and inflammation, and brain-lung crosstalk. We have the following comments and concerns.
Undernutrition as a Predictor of Post- Operative Morbidity, An Institutional Study
Authors: Dr. Jason Andrade  , Dr. Leo F Tauro  , Dr. Reshmina Chandni Clara Dsouza  , Dr.Shubha N Rao
Published: April 2024

Background and objective: In view of all the above , we at a tertiary care teaching hospital decided to evaluate the role of Body Mass Index as predictors of postoperative morbidity and mortality both in elective and emergency major surgeries. Materials and Methods: Descriptive Analytical Observational Study was conducted on164 patients chosen by Convenience sampling. Who had undergone laparotomy at the Father Medical College Hospital, , Mangalore who were admitted in any of the surgical departmentsduring the period of October 2018 to October 2020 Details of cases were recorded including demography co-morbidities , blood transfusion post-operative complication ,mortality and BMI status. Data tabulation and statistical analysis to be employed: All data was analyzed using Statistical Package for the Social Sciences (SPSS) for Windows, Version 23.0. Continuous variables were expressed as mean±SD.Percentages were used to express categorical variables. Results And Analysis: In the present study the most common age was 31-40 years with 40 cases ,24.39% followed by 41-50 years with 36 cases ,21.95%, 51-60 years with 32 cases ,19.51% , and 61-70 years with 20 cases ,12.20%, More than 70 years with 16 cases ,9.76% , and less than 20 years with 4 cases ,2.44%. The mean age was 43.06 years with SD 8.04 years. We had 62 cases, 37.80% were females and 102 cases ,62.20% were males. Co Morbidities were in 82.93%, the most common was Diabetes Mellitus in 68 cases, 41.46%, Hypertension in cases, 15.85% , COPD in 12 cases ,14.63% , IHD in 9 cases ,10.98%.
Exclude Alternative Causes before Attributing Exacerbation of Myasthenia to COVID-19
Authors: Finsterer J, MD, PhD
Published: April 2024

Myasthenia gravis (MG) may not only exacerbate by the infection but also by application of new drugs, which could worsen MG, it is crucial to know if any of the included patients received drugs known to deteriorate MG. Drugs commonly given to COVID-19 patients include chloroquine, remdesivir/lopinavir, azithromycin, steroids, tocilizumab, or muscle relaxants and opiates if intubated.
Comparing Ophthalmic and Microscopic Findings in the Patients of Psuedo Exfoliative Syndrome With and Without Glaucoma in a Tertiary Care Referral Hospital of Western Himalayas: An Analytical Cross-Sectional Study
Authors: Sharma S  , Sharma RL  , Sharma V
Published: April 2024

Pseudoexfoliation is an age-related systemic disorder with primary ocular manifestation having strong genetic component liking to LOXL-1 gene.The findings from Non-Contact Specular Microscope such as Central corneal thickness (CCT) in subjects with PEX and PEXG, are conflicting.The present cross-sectional analytical study was conducted in the Department of Ophthalmology, Indira Gandhi Medical College, Shimla among the selected patients of pseudo exfoliation with glaucoma over a period of one year with an objective of comparing the ocular as well as intra ocular manifestations among the patients suffering from PEX in comparison to PEXG attending an ophthalmic Out Patient Department clinic. There were 46 study participants in each group of which there were 24 males and 22 females in PEX and 32 males and 14 females in PEXG group. The mean age of patients with Pseudoexfoliation without Glaucoma was 68.43±9.88while that of the patients with glaucoma was 66.52 ± 8.38 years. The mean vertical cup disc ratio of PEX patients was 0.36±0.14 while that of patients of PEXG was 0.84±0.32.There was no significant difference in the central corneal thickness (p=0.492) and the coefficient of variation (p=0.310) between both the groups.
Laparoscopic Cholecystectomy and find out Risk operator for Conversion in Al- Ramadi Teaching Hospital: A Retrospective Analysis
Authors: Asaad Oleiwi Khalaf  , Ahmed Qasim Zighir  , Jassim Mohamed Khalaf
Published: April 2024

The research aims at Risk Factor for Conversion during Laparoscopic Cholecystectomy Retrospective Analysis, which is considered the true balance for treating symptomatic cholelithiasis, and cholecystectomy becomes necessary. It may be the cause of severe colic and sometimes cause symptoms that the patient cannot live with and there is treatment with drugs, but severe progress in Methods of surgically removing the gallbladder makes surgery an ideal solution for some cases and the process of removing the gallbladder becomes a necessity if the pain becomes unbearable and cannot be lived with, and the fear of gallstones sliding to block the main channel and cause pancreatitis, it is necessary to perform the operation although the surgery to remove the gallbladder has become easy After the emergence of new advanced methods on top of the laparoscope, there are some steps that the patient must follow after the operation to avoid complications and method was laparoscopic cholecystectomy in Al-Ramadi Teaching Hospital The data were recorded which indicated the gender and age of the sample in addition to that indication of the LC with several evaluations, including the evaluation of the performance of the surgeon who performed the operation with the evaluation of the complications that occurred after the operation and noting the period during which the patient stayed in the hospital.
Rare Presentation Heterogeneous Pregnancies
Authors: Imad Abedzaid Mohan Aljanabi  , Nada Kadm Karem  , Marwa Habeeb Nazal
Published: April 2024

It is done and corrected two cases in General Hospital, Babylon, Iraq Vaginal bleeding, scanty discharge that differs from the timing and amount of a normal menstrual cycle and / or abdominal pain may indicate pregnancy loss (uterus or ectopic) in the early stages. Pregnancies with unclear viability to the fetus can be detected by chance during a routine or antenatal ultrasound. For a correct clinical diagnosis, it is important first and foremost to exclude ectopic pregnancy, gestational trophoblastic disease and spontaneous abortion. When evaluating a pregnancy in the womb, a differential diagnosis is made between a normal pregnancy, a miscarriage (complete or incomplete), or an ectopic pregnancy. The susceptibility and location of pregnancy should be determined at the same time during a visit to a pregnant woman with symptoms of bleeding and pain. The single test most useful to distinguish between an uterine pregnancy and an ectopic pregnancy is an ultrasound scan with the-hCG blood test. The primary diagnostic test for women with an ectopic pregnancy is to measure the levels of the hormone hCG in the blood. A negative test excludes pregnancy, including ectopic pregnancy. Detection of a uterine pregnancy with a transvaginal ultrasound in most cases excludes an ectopic pregnancy, because the so-called "ectopic" pregnancy (having an uterine pregnancy and an ectopic pregnancy) is extremely rare ─ only in 1: 7000-1: 30,000 cases. However, the risk of a possible heterogeneous pregnancy increases with the use of assisted reproductive technologies, when their frequency reaches 1%. Maternal serum β-hCG and highresolution ultrasound are complementary. Levels of Β-hCG in an ectopic pregnancy may be higher or lower than the discriminant level. An abnormal ectopic pregnancy can occur at any level of hCG. To diagnose an ectopic pregnancy, dynamics or urgent hospitalization is required.
TO EVALUATE THE TRIGGER FACTORS AND HORMONAL ABNORMALITIES IN ADULT FEMALE ACNE
Authors: B. M. Monisha  , Kannan Gopalan  , Keerthana. S
Published: April 2024

Introduction: Acne is affecting an increasing number of adult females and so can no longer be considered as a disease of adolescence. Genetic and hormonal factors are thought to play key roles in the pathogenesis of adult female acne and the disease is characterized by a chronic evolution with frequent relapses requiring long-term maintenance therapy. Material and Methods: This is a prospective and observational study conducted over a period of 1 year. Patients over the age of 25 years presenting with acne in a tertiary care hospital were included in the study. A detailed history and examination was carried out, with a stress on aggravating factors. Hormonal imbalances were investigated in females with alopecia, obesity, hirsutism and menstrual irregularity. Severity of acne and complications like scarring and psychological stress were included. Results: Out of 90 patients included in the study 100% were women. The mean age of the patients was 31.2 years. Persistent acne was observed in 60%, while it was late onset in 40%. The most common lesion at presentation was papule (63.21%) followed by mixed lesions including pustules, nodules, and comedones. The patient acne severity was graded as mild (80%) to moderate (21%) with a mean GAGS of 13.45 ± 3.63. Facial involvement was seen in all, except two patients in whom only truncal involvement was present. On the face, cheek was the most common site involved (78.8%) followed by chin (58.8%), mandibular area (54.4%), forehead (41.5%) and nose (21.1%). Conclusion:Adult acne is predominant in women, and as compared to adolescent acne is more inflammatory, with involvement of the cheeks and lower half of the face, while comedones are rare.
Study on Prevalence and Etiology of Early Neonatal Deaths in Jasin district, Melaka from 2014-2017
Authors: Sujata Khobragade MBA  , Siti Zaleha Binti Suleiman MMed Fam Med  , Adinegara Lutfi Abas MPH  , Intan Azura Mohd. Din MPH  , Noor Razliyana Yahya MBBS  , Yadneshwar Khobragade MD
Published: April 2024

Background: Neonatal mortality rate is in the range of 3.2- 4.2 since 2013 in Melaka state but records of Jasin district which is a part of this state, had shown higher early neonatal deaths. Hence, this study was conducted to find out prevalence of early neonatal deaths and its causes from 2014-17. Material and methods: This cross-sectional study was done in Jasin district using universal sampling method from 1st January 2018 to 30th June 2018. Initially records of all perinatal deaths from 2014-17 were checked and proforma was filled in and later early neonatal deaths were segregated from the main excel sheet and analyzed for prevalence and etiology. Results: We found prevalence of early neonatal mortality rate of 5.56/1000. Forty-one percent deaths occurred in 24 hours of life followed by 22% on day 2. Preterm birth accounted for ¾ of the total deaths and 63.44% deaths seen in low birth weight (<2500grams). Fifty-one of all deaths had congenital malformation, 17.8% had infection, 15.5 % each died due to asphyxia and immaturity. Conclusion: Prematurity, low birth weight and congenital malformation are the main causes during 0-6 days of life. Hence provision of good obstetric care, educating pregnant women on nutritious diet, vaccination and follow up is necessary. Apart from this there is a need to have upgradation of neonatal resuscitation services.
Management of Mucormycosis in patients associated with COVID-19
Authors: Mohd Shaeq Mirza  , Md Siddique Ahmed Khan
Published: April 2024

Introduction: There are increasing case reports of rhino-orbital mucormycosis in people with coronavirus disease 2019 (COVID-19), especially from India. Diabetes mellitus (DM) is an independent risk factor for both severe COVID-19 and mucormycosis. Material and Methods: This is a prospective study among mucormycosis patients, admitted to tertiary care teaching centre over a period of 3 months. These cases were admitted for the management of mucormycosis. They were assessed and treated by the relevant specialties at various time points, which included infection disease specialists, intensivists and otolaryngologists. Data pertaining to demographics, clinical features, comorbidities, laboratory investigations, histopathology, management and outcomes were collected. Results: In our study, maximum number of patients were history of diabetes mellitus (71.5%) while 51.5% were on medications for hypertension. Based on the CT thorax severity score, majority (60.7%) had moderate-to-severe COVID-19 pneumonia. Imaging investigations revealed that maximum patients had features of maxillary sinusitis (83.8%). All individuals were treated with liposomal amphotericin B while majority of them underwent surgical treatment. Conclusion: Preventive measures may need to focus on identification and optimal management of risk factors for Coronavirus Disease Associated Mucormycosis, including aggressive glycemic control, avoidance of steroid overuse, and possibly environmental measures.
Ophthalmic manifestations of thyroid disease and the association of serum levels of T3, T4 and TSH with thyroid eye disease
Authors: Dr. Raghu MS  , Dr. Rakesh Boppana  , Dr. Haritha Galla
Published: April 2024

Introduction: Thyroid-associated orbitopathy (TAO) frequently termed Graves ophthalmopathy is part of an autoimmune process that can affect the orbital and periorbital tissue, the thyroid gland and rarely the pretibial skin or digits (thyroid acropachy). Material and Methods: This is a Retrospective study conducted in the Department of Endocrinology, Sapthagiri Institute of Medical Scinences and Research center, Banglore . The patients included in the study their demographic data was recorded along with the serum levels of T3, T4, TSH at the time of diagnosis and examination. All the patients detailed ocular examination was carried out with the help of torch light, and slit lamp for anterior segment evaluation, direct ophthalmoscopy for posterior segment evaluation, indirect ophthalmoscopy whenever necessary. Result: A total of 60 patients were examined. Of the 60 cases, male predominent was noted. The highest incidence of thyroid orbitopathy, the patients were arbitrarily divided into four groups and least one less than 20 years of age group. Among 60 patients, 11 (18.3%) were hypothyroid, 46 (76.6%) were hyperthyroid, and 3 (5%) patients were euthyroid. The frequency of different symptoms among the study group. Most of the patients came with complaint itching of (31.6%). The second most common symptom was foreign body sensation (23.3%). Conclusion: We recommend to ophthalmologists to be aware of TED clinical signs and suspect it even if the patients have a normal thyroid function. The assessment for these patients should be based on orbital images, serum T3, free T4, TSH, TRAbs, and interdisciplinary management with the endocrinologist.
Evaluation of Amblyopia in School Children
Authors: Dr Renuka  , Dr Anusha. N. Sangapur  , Dr Savitha D P
Published: April 2024

Background: Amblyopia is a form of cortical visual impairment which can result from many condition which prevents normal visual stimulation in children in younger age group causing childhood visual impairment. The term “lazy eye” is often used for Amblyopia. It accounts to be the second common cause of blindness. Materials and Methods: A cross sectional study was conducted during the school health check up visits conducted by ophthalmology department of tertiary care teaching hospital for screening of eye disorders in school children who belongs to the age group of 5-15 years over a period of 1 year in which 813 children underwent screening ,among them 110 children with the reduced vision were referred to hospital for detailed ophthalmic evaluation which includes cycloplegic refraction and dilated fundus examination. Amblyopia was detected in children with reduced best corrected visual acuity. Results: A total of 813 study subjects were screened. Out of them 110 (13.5%) were found to have diminished vision. When the study subjects with diminished vision were subjected for further tests, 18 (2.2%), (p value is 0.494 )of them were found to have amblyopia. Amblyopia was present in 10 ( 18.9%) of females and 8( 14%) of males. Anisometropic amblyopia was the most common type of amblyopia found in 10 ( 55.6%) of the study subjects, followed by meridional and strabismus type of amblyopia in 4 cases each (22.2%). Among strabismus ,exotropia was seen in more study subjects 4(0.5%) than esotropia in 2 cases(0.2%). A higher number of moderate grade of amblyopia was seen than mild grade of amblyopia. Conclusion: The prevalence of amblyopia in our study is 2.2%. Anisometropic refractive errors are the most common underlying cause in our study subjects. We recommend implementation of visual screening programs for children of schoolgoing age group for early detection and proper management of Amblyopia.
A case-control study of hypertension and associated risk factor on kidney Volume
Authors: Gouse Bin Mohammad Shaik  , Dr. Manila Jain
Published: April 2024

Introduction: Hypertension (or HTN) or high blood pressure is defined as abnormally high arterial blood pressure. According to the Joint National Committee 8 (JNC8), normal blood pressure is a systolic BP < 120 mmHg and diastolic BP < 80 mm Hg. Hypertension is defined as systolic BP level of ≥140 mmHg and/or diastolic BP level ≥ 90 mmHg. Material and Methods: This is a prospective, descriptive, cross sectional and observational study conducted at Department of Physiology, General Medicine and Radiology, Index Medical College, Hospital and Research center Indore. Period of the study from January 2020 December 2021. Using ultrasonographic methods, absolute renal size, relative renal size (renal length/body length), renal volume (length × width × depth × 0.52), and renal shape (width/length) were calculated. Results: The case group Mean Systolic Blood Pressure is 147.45 ± 5.87 mm of Hg (Mean±SD) and control group Mean Systolic Blood Pressure of 117.35 ± 5.67 mm of Hg (Mean±SD). However, this reduction in Systolic Blood Pressure is statistically significant. (P value < 0.05). The case group Mean Diastolic Blood Pressure is 97.03 ± 5.824 mm of Hg (Mean±SD) and Mean Diastolic Blood Pressure is 76.93 ± 5.688 mm of Hg (Mean±SD). This reduction in Diastolic Blood Pressure is however statistically significant. (P value < 0.05). Conclusion: The data presented in this work showed that renal size and volume were more than in hypertensive than normotensive subjects. The cortical size for both kidneys was greater in our study group compared to cortical size in normotensive subjects.
Acute Poisoning Cases Treated in Intensive Care Unit at Rural Tertiary Care centre
Authors: Dr. M.A. WAHAB ZUBAIR
Published: April 2024

Background: Acute poisoning with various substance is common everywhere. Earlier initial resuscitation, gastric decontamination and use of specific antidotes, better is the outcome. The aim of the study was to characterize the poisoning cases admitted to the tertiary care teaching Hospital. Material and Methods: This is Prospective, observational, descriptive study was conducted to investigate the clinical characteristics and epidemiological patterns of acute poisoning admission into ICU of 137 cases. The inclusion criteria were: Either gender with Age > 13 years and chief complaint of acute poisoning included those who had undergone exposure to poison either by household or agricultural pesticides, stings bite, snake bite, industrial toxins, toxic plants, drug or miscellaneous products. Results: 137 of poisoned cases were enrolled in this study, the majority of poison cases were between 21-30 years accountable 60.6 % were male and gender ratio of the patients’ male: female was 1.53:1. The majority of all cases (61.3%) were due to suicidal poisoning. The exposure substances identified as most commonly encountered in the ICU included OPP (37.2%), Food Poisoning 15.3%, Alcohol intoxication, followed by overdose of drugs, (16.7%, 10.9%, respectively). Specific antidote 66.4% were given and Ventilator not received by 68.6% patients. Conclusions: The tertiary care hospitals of the Moinabad region, indicate that significant opportunities for reducing mortality are achieved by better medical management.
Correlation between Glycosylated Haemoglobin and Dyslipidaemia in Patients with Type 2 Diabetes Mellitus
Authors: Dr. M.A. WAHAB ZUBAIR
Published: April 2024

Introduction: Diabetes mellitus is one of the leading noncommunicable diseases all over the world including India. Diabetes ischaracterized by chronic hyperglycemia and disturbances of carbohydrate, lipid and protein metabolism. Glycated hemoglobin (HbA1c) level of ≥6.5% has been included as a criterion for diagnosis of diabetes. Impaired lipid profile is commonly present in type 2 diabetes. Materials and Methods: This observational cross-sectional study was carried out in the Department of General Medicine at Tertiary Care Teaching Hospital over a period of 6 months. A total 90 patients with T2DM of age more than 30 years were selected for the purpose. Fasting blood glucose (FBG), total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), triglyceride (TG) and glycated haemoglobin (HbA1c) levels were evaluated. Test of significance was calculated by unpaired Student's 't' test. Correlation studies (Pearson's correlation) were performed between glycated haemoglobin (HbA1c) and serum lipid profile. Result: In our study, among 90 Type 2 diabetic individuals included in this study, 39 were male and 51 were female. Distribution of Glucose Triad results of FBS, PPBS and HbA1c levels of patients presented as Mean±SD, mean FBS was 187.62±48.32, mean PPBS was 227.46±83.14 and mean HbA1c was 7.97±0.69. Mean total cholesterol was 193.34 ± 13.73, mean total triglyceride was 201.65 ± 14.94, Mean HDL was 36.38 ± 3.74, mean LDL was 116.63 ± 8.74 and VLDLwas 40.33 ± 1.73. HbA1c positively and significantly correlated with total cholesterol (r=0.204), LDL (r=0.297), HbA1c negatively and significantly correlated with HDL (r= - - 0.136), and did not show any show correlation with VLDL (r=0.053) and total triglycerides (r=0.027). Conclusion: The study concluded that HbA1c value correlate well with lipid profile in-diabetes patients. So, HbA1c can be used as a predictor of dyslipidemia in type 2 diabetes. This may help in predicting the lipid profile levels from the degree of glycemic control and therefore, identifying the patients with increased risk of diabetic complications.
Assessment of Stress among Doctors due to Covid-19
Authors: Dr. P. Manoj Kumar  , Dr. Dasika Sree Keerthi  , Dr. Purkanti Shwetha
Published: April 2024

Introduction: During infectious disease outbreaks, doctors are at high risk of infection, infecting others, and psychological distress. This study aimed to determine the prevalence of stress and anxiety in physicians during the COVID- 19 outbreak in India. Material and Methods: This is a cross-sectional surveybased study conducted at the Department of Psychiatry of a tertiary care medical college and hospital. For the purpose of this study, a Google survey form was created and circulated among all the doctors through WhatsApp groups in June and August 2021. The doctors included JRs, SRs and faculty. All the doctors were included except those who had themselves suffered from COVID-19 or if their family members had suffered since that could have led to increased stress and skewed the findings. The Perceived stress scale (PSS-10) was used to assess perceived stress. Results: In this study total subjects are 217 among 128 were males and 89 females. The maximum number of subjects were in the age group of 31-40 years which were 31.7% (n =69) followed by age group 41–50 years having 36.4% (n = 78) in this group and 17.9% were >51 years. This participant worked at different duties during Covid-19 pandemic era. 23 participants were High stress degree of stress on PSS, 135 (62.2%) Participants displayed moderate degree and 59 (27.1%) shows low level of stress during pandemic era. Further inspection in context of department wise stress distribution reveals that 217 subject among Non-clinical department pool shows high degree of stress were 4.1% moderate degree were 24.8% and 10.5% found having low level of stress. Conclusion: Doctors working in COVID-19 wards perceive considerable stress. Stress management should be an integral part of the curriculum of doctors so that they can serve the humanity efficiently and effectively during the pandemic and in future.
Psychological Effects of COVID -19 among Doctors
Authors: Dr. Dasika Sree Keerthi  , Dr. P. Manoj Kumar  , Dr. Purkanti Shwetha
Published: April 2024

Background: Doctors caring for patients during infectious outbreaks such as COVID 19 have reported negative psychological effects. However, little is known about how the experience influences their professional self-image. Material and Method: This is an observational, cross-sectional and multicentre study. The present paper’s ultimate objective is to measure the PsychologicalEffects of COVID -19 among Doctors while engaging the COVID-19 treatments in the study area. The participants of the study are doctors who were engaging in the COVID 19 treatments in hospitals. The doctors are requested to fill the responses through Google forms. The responses are obtained from the doctors from May 2021 to August 2021. Result: In table 3, Feeling down, depressed, or hopeless were for few days 5% and 10% nearly every day. On the other hand, Trouble falling or staying asleep, or sleeping too much were 13.3% for few days and 38.33% was not at all. Trouble concentrating on things, such as reading the newspaper or watching television were 61.6% not at all trouble. Conclusion: Medical staff that performed COVID -19 -related tasks showed the highest risk for Psychological Effects even after time had elapsed. The risk increased even after home quarantine. Prompt and continuous psychiatric intervention is needed in high mortality infectious disease outbreaks.
Effect of hypertension on kidney Volume: A Case-control Study
Authors: Gouse Bin Mohammad Shaik  , Dr. Manila Jain
Published: April 2024

Background: According to world health organization (WHO) blood pressure is the force exerted by circulating blood against the walls of the body’s arteries, the major blood vessels in the body. According to the WHO, hypertension is a major risk factor for cardiovascular disease (CVD, excluding congenital CVD) as well as renal impairment, peripheral vascular disease, and blindness. Material and Method: This is a prospective, descriptive, cross sectional and observational study. Department of Physiology, General Medicine and Radiology, Index Medical College, Hospital and Research center Indore. A curvilinear probe with transducer frequency of 2–8 MHz of a Sonoace X6 ultrasound machine was used. Each individual was laid supine on the couch with the abdomen adequately exposed from upper abdomen to the symphysis pubis. Result: The mean right renal cortical thickness in case group 1.5±0.32 cm and in control group 1.4 ± 0.38 cm. On the other hand, left renal cortical thickness in case group 1.6±0.32 cm and in control group 1.4 ± 0.37 cm. The mean right renal volume in case group 82.58± 1.47 cm and in control group 78.16±1.02 cm. The left renal volume in case group 93.19 ± 1.221 cm and in control group 79.27±0.91cm. Conclusion: The cortical size for both kidneys was greater in our study group compared to cortical size in normotensive subjects. In agreement with published studies, our study showed that renal volume is higher in the left than in the right kidney for both sexes.
Role of fluid optimization in Acute Pancreatitis
Authors: Sudarshan N  , Narasimha Swamy P  , Karthik B
Published: April 2024

Background: Acute Pancreatitis is one of the commonest cause for admission to the surgical emergency ward. In view of this, fluid management remains the main stay of treatment in the immediate period. Optimal fluid management avoids further complications including Organ failure and Pancreatic Necrosis. Objective: Proper management of the Acute Pancreatitis is very essential, early identification of the patients and Optimization in Fluid remains the main stay of treatment. To understand the pathophysiology of fluid depletion in Acute Pancreatitis. Material and Methods: Records of patients who were admitted with Acute Pancreatitis in Mandya Institute of Medical Sciences, Mandya between June 2018 and May 2019 (1-year period) were studied and analysed. 76 acute pancreatitis cases were admitted during this period. Those diagnosed with acute pancreatitis on the basis of epigastric pain, serum amylase and serum lipase levels more than 3 times normal were subjected to the investigations and fluid management was analysed at the time of admission and after 48hours. Results: In our study, out of 76 cases admitted with the diagnosis of Acute Pancreatitis 22% had Severe acute pancreatitis, 72% affected were males,60% of the total were in 4th decade, alcohol was the most common aetiology 55%, followed by biliary pancreatitis 35% and idiopathic 10%. Patients managed with optimal fluid recovery rate was 87% in Mild Acute Pancreatitis, 67% in moderately severe Acute Pancreatitis and 54% in Severe Acute Pancreatitis. Conclusion: Optimal Fluid management remains the main stay of therapy in Acute Pancreatitis. Early identification of the disease and optimal fluid management reduces the mortality and morbidity in Acute Pancreatitis.