bluuebunny/crossref_metadata_2025 huggingface dataset:
The Impact of Symbolism in Ernest Hemingway’s Novel the Old Man and the Sea
Authors: Salim Hameed Fahmi
Published: July 2023

This research study and examine the masterful writer. The author exhibits their expertise of writing in a distinctive way by utilizing literary devices and approaches. We have a single example of significant authors and novels. The Old Man and the Sea by Ernest Hemingway is a notable symbolic work of American literature that demonstrates the author's skill in using symbols to enhance the literary value of the text. In order to decipher the symbols and determine the many meanings they stand for, the goal of this study is to investigate their application in the novel. This project is divided into: First, we'll discuss aestheticism in general and discuss typical literary style elements like simile, metaphor, irony, and so on. Secondly the study would be about the concept of symbol and the meaning of symbolism. Thirdly gives the general idea of American literature and the major works of Ernest Hemingway focusing on his novel The old man and the sea and its literary analysis . The last thing going to mention with the study all the symbols used in the novel and their meanings. The goal of this work that showing how was Hemingway interesting with his work and writing for symbols and his intention to represent themes behind the use of symbols in The old man and the sea.
Evaluation of the Financial Performance of the Ashur Bank According to (GAMELS) Standards: An Analytical Study
Authors: Jabbar Ali Hadeel
Published: July 2023

In recent years, the business environment has witnessed great developments as a result of technological development and openness to global markets, which led to an increase in competition between economic units. It serves as a control tool that shows the strengths and weaknesses of the economic unit, which helps in the decision-making process. Therefore, the research deals with the subject of performance evaluation of the Ashur International Bank, using the CAMELS criteria, and the research reached １. The application of the CAMELS evaluation system is of great importance as it supports the control and inspection process and achieves the goals of customers and shareholders, in terms of highlighting the negative and positive points in the banking work, which leads to an increase in the efficiency of the bank’s work and the search for the cause of shortcomings and addressing its causes. Ashur International Bank was classified according to the criteria of Kamles combined into the second category, as it was classified as category (B2) after obtaining (2.062). The research also recommended the need for the Central Bank of Iraq to reconsider the indicators of the CAMELS system in a way that suits the nature of the local banking environment and what can be added to these indicators, especially the customer satisfaction index. In addition to the necessity of urging banks to exploit liquidity, employ deposits and exploit them in new projects, and provide investment loans in order to increase profitability in particular and support the national economy in general .
Budaya Organisasi, Disiplin Kerja Terhadap Produktivitas Kerja Dimediasi Motivasi Pegawai PDAM Unit Kertapati Palembang
Authors: Hakimah Yusro , Suprani Yun , Said Muhammad
Published: July 2023

The results of this study can be concluded as follows: 1. Organizational Culture has an effect on employee motivation, 2. Discipline has an effect on motivation, 3. Organizational culture has an effect on Work Productivity, 4. Discipline has an effect on Work Productivity. 5. Motivation has an effect on Work Productivity. 6. Organizational Culture has an indirect effect on Motivation as a mediating variable with a P-Value value of 0.003 0.05, 7. Discipline has an indirect effect on Motivation as a mediating variable with a P-Value value of 0.013 0.05 . the value of R2 for the latent variable of motivation as a mediating variable is 0.894, which means that this value identifies that variations in employee discipline at PDAM Palembang can be explained by exogenous latent variables (organizational culture and discipline) of 89.4% while the remaining 10.6% is explained by other variables. and the R2 value for the latent variable of Work Productivity is 0.937, meaning that this value identifies that variations in Work Productivity can be explained by exogenous variables of 93.7% while the remaining 6.3% is explained by variables not included in the study.
Strategi Pengembangan Objek Wisata Kolam Renang Tirta Plamboyan Desa Talang Kering Kecamatan Air Napal Kabupaten Bengkulu Utara
Authors: Putri Dita Winastia , Hanila Siti , Prawitasari Andriyani
Published: July 2023

The Tirta Plamboyan swimming pool tourist attraction which is located in Talang Dry Village, Air Napal District, North Bengkulu Regency is very likely to be developed with adequate resources, but this tourist attraction is not widely known to the outside community and is still lacking in terms of existing facilities. Therefore, the author takes the title "Strategy for the Development of the Tirta Plamboyan Swimming Pool Tourism Object, Talang Dry Village, Air Napal District, North Bengkulu Regency" the aim is to be able to find out what kind of development strategy is suitable for the Tirta Plamboyan swimming pool tourist attraction. The purpose of this study was to determine the strategy of developing a tourism object for the Tirta Plamboyan swimming pool, Talang Dry Village, Air Napal District, North Bengkulu Regency with SWOT analysis. The method used is descriptive qualitative with data collection techniques distributing questionnaires to respondents. The analytical method used is SWOT, namely Strengths , Weaknesses , Opportunities and Threats . The results of this study indicate that the Tirta Plamboyan swimming pool tourism object, Talang Dry Village, Air Napal District, North Bengkulu Regency is in quadrant II position. This shows that the strategy used is a diversification strategy . In addition, the results of the SWOT diagram using the ST strategy explain that the Tirta Plamboyan swimming pool tourist attraction is can maintain a cheap swimming pool ticket price from others, keep the swimming pool clean and create comfort in the swimming pool area, and approach the public not to think badly about the Tirta Plamboyan swimming pool.
Pengaruh Inflasi Dan Tingkat Suku Bunga Bank Indonesia (BI) Terhadap Profitabilitas Bank Sumut Kantor Cabang Pembantu Syariah Karya Medan Tahun 2017-2021
Authors: Aulia M. Fauzi , Arif Muhammad
Published: July 2023

This research is entitled "The Influence of Inflation and Bank Indonesia (BI) Interest Rates on the Profitability of North Sumatra Bank Karya Medan Syariah Sub-Branch Office in 2017-2021". The purpose of this study was to determine the effect of inflation on the profitability of the North Sumatran bank's sharia sub-branch office Karya Medan in 2017-2021, the influence of interest rates on the profitability of the North Sumatra bank's sharia sub-branch office Karya Medan in 2017-2021 and the effect of inflation and interest rates simultaneously on the profitability of North Sumatran banks. sharia sub-branch office Karya Medan in 2017-2021. The research method used in this study is a qualitative descriptive method with primary and secondary data. The research results obtained are interest rates and inflation simultaneously have a significant effect on profitability as measured by Return on Assets (ROA).
Quantitative Assessment of the Pharyngeal Recess Morphometry in Anatolian Population Using 3D Models Generated from Multidetector Computed Tomography Images
Authors: Erdem Hüseyin , Tekeli Mustafa , Çevik Yiğit , Kılıç Şafak Nazire , Kaya Ömer , Boyan Neslihan , Oğuz Özkan
Published: July 2023

Aim: It was aimed to analyze the detailed morphometry of the pharyngeal recess (PR) using three-dimensional (3D) models reconstructed from multidetector computed tomography (MDCT) images.
Material and Methods: This study was a retrospective analysis and performed on MDCT images of 97 patients (43 males, 54 females). 3D models of the PR were reconstructed using 3D Slicer software, enabling morphometric measurements according to established protocols. Measurements included PR depths, distances between the posterior nasal spine and torus levatorius (PNS-TL), distances between right and left TL (RTL-LTL) distances between the PNS and posterior wall of the nasopharynx (PNS-PWN), the angle (α) between the centerline of the PR and the sagittal plane. The morphologies of the PR classified into three types.
Results: The average measurements for the parameters were as follows: PR depth - 10.42 mm, distance between PNS and TL - 10.40 mm, distance between RTL and LTL - 19.13 mm, distance between PNS and PWN - 19.92 mm, and the angle (α) - 53.65°. The prevalence of PR types was 20.62%, 47.42% and 31.96% for type 1, type 2 and type 3, respectively.
Conclusion: Variations in reported measurements of the pharyngeal recess can be attributed to imaging techniques, patient positioning, anatomical differences, and sample sizes. The use of 3D models generated from MDCT datasets offers a high-resolution and comprehensive approach to understanding the PR's morphometry and spatial relationships, enabling accurate measurements and advancing our knowledge of this anatomical region.
Periodic Radio Emission from the T8 Dwarf WISE J062309.94–045624.6
Authors: Rose Kovi , Pritchard Joshua , Murphy Tara , Caleb Manisha , Dobie Dougal , Driessen Laura , Duchesne Stefan W. , Kaplan David L. , Lenc Emil , Wang Ziteng
Published: July 2023

We present the detection of rotationally modulated, circularly polarized radio emission from the T8 brown dwarf WISE J062309.94−045624.6 between 0.9 and 2.0 GHz. We detected this high-proper-motion ultracool dwarf with the Australian SKA Pathfinder in 1.36 GHz imaging data from the Rapid ASKAP Continuum Survey. We observed WISE J062309.94−045624.6 to have a time and frequency averaged Stokes I flux density of 4.17 ± 0.41 mJy beam−1, with an absolute circular polarization fraction of 66.3% ± 9.0%, and calculated a specific radio luminosity of L

ν
∼ 1014.8 erg s−1 Hz−1. In follow-up observations with the Australian Telescope Compact Array and MeerKAT we identified a multipeaked pulse structure, used dynamic spectra to place a lower limit of B > 0.71 kG on the dwarf’s magnetic field, and measured a P = 1.912 ± 0.005 hr periodicity, which we concluded to be due to rotational modulation. The luminosity and period we measured are comparable to those of other ultracool dwarfs observed at radio wavelengths. This implies that future megahertz to gigahertz surveys, with increased cadence and improved sensitivity, are likely to detect similar or later-type dwarfs. Our detection of WISE J062309.94−045624.6 makes this dwarf the coolest and latest-type star observed to produce radio emission.
Orbital stability of periodic traveling waves to some coupled BBM equations
Authors: Zhao Ye , Xing Chunfeng
Published: July 2023

In this work, we show some results concerning the orbital stability of dnoidal wave solutions to some Benjamin-Bona-Mahony equations (BBM equations henceforth). First, by the standard argument, we prove the existence of a smooth curve of positive traveling wave solutions of dnoidal type. Then, we show that this type of solutions are orbitally stable by perturbations with the same period L. The major tools to obtain these results are the Grillaks, Shatah and Strauss' general theory in the periodic case. The results in the present paper extend some previous stability results for the BBM equations.
An adaptive grid method for a singularly perturbed convection-diffusion equation with a discontinuous convection coefficient
Authors: Mai Xiongfa , Zhu Ciwen , Liu Libin
Published: July 2023

In this paper, an adaptive grid method is put forward to solve a singularly perturbed convection-diffusion problem with a discontinuous convection coefficient. First, this problem is discretized by using an upwind finite difference scheme on an arbitrary nonuniform grid except the fixed jump point. Then, a first-order maximum norm a posterior error estimate is derived. Further, based on this a posteriori error estimation and the mesh equidistribution principle, an adaptive grid generation algorithm is constructed. Finally, some numerical experiments are presented that support our theoretical estimate.
Formas de paraboloides hiperbólicos en la arquitectura en Chile a mediados del siglo XX: materialización de la geometría en la escala del espacio
Authors: Susa Mahuzier Branko
Published: July 2023

El presente artículo es parte de nuestra investigación acerca del tema laminar de mediados del siglo XX en Chile, y se centra en obras y proyectos con paraboloides hiperbólicos poco estudiados pero que nuestra hipótesis valora al crear alternativas a los adintelados que predominan en el país. Son casos inusuales y heterogéneos, no siempre coherentes con hypars de concreto de pioneros en los 30s como B. Laffaille, G. Baroni y en los 50s Félix Candela. De hecho, no todos se construyeron en hormigón y no hay estudios sistemáticos como conjunto chileno. Nuestro análisis cualitativo tiene por objetivo formular un conjunto inédito con modelos gráficos para entender por qué su variedad formal y de materiales alcanzó un nivel destacable en eficiencia estructural y en significados del espacio fluido. Como resultado del estudio se revela un grupo pequeño de casos, algunos vinculados a universidades que experimentaron en estas estructuras, y descubrimos particularidades técnicas en base a modelos tridimensionales y nexos de sus protagonistas.
A produção e a circulação de saberes matemáticos na área da Geometria nas escolas jesuítas da Província Sul-Brasileira da Companhia de Jesus (1905 - 1945)
Authors: Rheinheimer Juliana Mercedes , Grazziotin Luciane Sgarbi Santos
Published: July 2023

Este artigo tem como objetivo analisar as produções didáticas, em forma de livros impressos e manuscritos, produzidas pelo professor Godofredo Schrader, S. J., que atuou em duas escolas localizadas na Província Sul-Brasileira pertencentes à Companhia de Jesus, entre os anos de 1905-1945. Para isso, atentamos para determinados aspectos acerca da formação e atuação do professor Godofredo Schrader, S. J., por meio de suas publicações na área da Geometria. Metodologicamente, este trabalho vale-se da Análise documental histórica, analisando fontes localizadas em três arquivos de Instituições Jesuítas. A pesquisa indica que as produções de Schrader se adequava a reforma Francisco Campos e ao currículo do Colégio Pedro II, do Rio de Janeiro e que circularam e foram utilizadas por professores de determinadas escolas da Ordem.
Physical properties of natural rubber latex foams produced with processed mica waste powder and creamed natural rubber latex
Authors: Dananjaya S. A. V. , Somarathna Y. R. , Karunanayake L. , Siriwardena S.
Published: July 2023

Incorporation of finely powdered mica waste into natural rubber latex processed into foam rubber, consuming a minimum amount of energy could contribute to progress towards a greener environment. In this study, mica waste generated in the mining industry was finely powdered and incorporated into creamed natural rubber latex which is an alternative form of concentrated latex manufactured using a green process known as the creaming process. Finely powdered processed mica waste (PMW) was added as a filler into latex varying the loading from 0 to 10 pphr at 2 pphr intervals. The latex foam was then converted into a vulcanized natural rubber latex foam (NRLF). Effects of mica loading on certain properties of the foam rubber produced from creamed natural rubber latex were studied. It was found that the density and hardness of the mica powder incorporated foam rubber increased with increasing filler loading. Fourier transformed infrared spectroscopy (FTIR) studies confirmed that no structural changes occurred in natural rubber due to the addition of PMW. The overall results of the study showed the potential of utilization of mica waste and creamed natural rubber latex to manufacture greener natural rubber foam composites in cottage-level foam manufacturing industries.
Assessment of clinical and epidemiological data of inflammatory bowel disease in Egyptian children attending Mansoura University Children Hospital
Authors: Elkasaby Khalid , El Regal Mohammed Ezz , Barakat Tarik , AbouBakr Othman
Published: July 2023

Context

Existing literature is poor with epidemiological studies handling Egyptian paediatric patients diagnosed with inflammatory bowel disease (IBD). Herein, we describe the epidemiological and clinical features of paediatric IBD cases (PIBD) attending Mansoura University Children Hospital (MUCH).

Aim

To evaluate epidemiological and clinical data of (PIBD) in Egyptian children.

Settings and design

This retrospective study included the data of Thirty-nine paediatric patients (age<18 years) admitted to the gastroenterology ward of MUCH and divided into two groups; ulcerative colitis group (UC 32 cases) and Crohn disease group (CD 7 cases).

Methods and material

Data were retrospectively reviewed, including history, examination, biochemical, endoscopic, and pathological findings.

Statistical analysis used: SPSS software (version 26 for macOS) to tabulate and analyse the collected data

Results

UC group had a mean age of 10.73 years compared to 13.2 years in the CD group (P=0.01). The prevalence of anoperineal disease significantly increased with CD. The age of symptom onset and diagnosis confirmation were insignificant between the same groups. Laboratory parameters were also comparable. Pancolitis and ileocolitis were the most common involvement patterns in the UC and CD groups, respectively. Pathologically, UC was distinguished by crypt abscess, while CD was distinguished by granulomas.

Conclusions

PIBD was related to the male sex, with early diagnosis and a low prevalence of the early-onset disease. Although it is crucial to exclude common infections causing similar manifestations, the paediatrician should consider the possibility of IBD.
Prevalence of acute bronchiolitis during COVID-19 era: an observational study of a tertiary center
Authors: El-Desoky Tarek , Sobh Ali , Osman Engy , Zeid Mayada S. , Osman Amal
Published: July 2023

Background

Recent application of unrivaled public health measures for COVID-19 pandemic could have significant implications on other infectious diseases.

Objectives

We aim to detect the influence of the recently applied health measures on acute bronchiolitis-associated hospitalizations.

Methods

We analyzed patients’ electronic records at our tertiary hospital to obtain data of hospitalized patients with acute bronchiolitis for the period between November 1, 2017, to February 28, 2021. We compared the frequencies of hospitalizations in the peak respiratory syncytial virus epidemic months (November–February) in 2020 with those in 2017–19.

Results

There were 16,466 all-cause hospitalizations during the period (November-February) from 2017 to 2021. We observed significant lower frequencies of acute bronchiolitis-associated hospitalizations in 2020/2021 compared with 2019/2020, 2018/2019, and 2017/2018 (0.6% vs. 8.2%, 7.4%, and 9.9%, respectively) (P <0.05).

Conclusion

The social isolation measures adopted during the COVID-19 pandemic have significant unexpected effects on the seasonality of acute bronchiolitis in our population, which could be due to inhibition of diseases transmission practiced by adults and older children.
Smoking habits among covid-19 patients
Authors: Saeed Adel M , Daif Marwa S , Kamal Ahmed N
Published: July 2023

Background

This study intended to evaluate the effect of smoking propensity on Coronavirus Disease 2019 (COVID-19) infection and the effect of COVID-19 infection on smoking propensity. The COVID-19 outbreak has forced people toward a better approach to life owing to limited developments, confinement in closed areas, and severe hygiene maneuvers for long periods. This period has been considered as a ‘transition’ stage and appears to require a look forward toward an altered life approach.

Aim

The aim of the work was to evaluate the effect of smoking on COVID-19 infection and the effect of COVID-19 infection on smoking propensity.

Patients and methods

A cross-sectional study was conducted through self-reported surveys. The study was conducted on 101 COVID-19-infected patients aged from 17 to 70 years old, who presented to the Department of Chest of Ain Shams University after approval of the Medical Ethical Committee. The study was conducted through self-reported surveys, which included data on risk factors such as diabetes mellitus, hypertension, ischemic heart disease, chronic obstructive pulmonary disease, interstitial lung disease, and the severity of COVID-19 infection.

Results

Regarding the associated comorbidities, hypertension was the most frequent disease found in 19.8% of patients followed by diabetes mellitus, which was found in 14.85, then ischemic heart diseases in 9.9%, and then chronic lung disease in 7.92%. Regarding general symptoms of COVID-19, fever was the most common symptom found in 42.57% of patients followed by anosmia in 19.8%, dyspnea in 13.86%, cough in 6.93%, bony aches in 6.93%, loss of taste in 6.94%, and then joint pain, fatigue, chest pain, and vomiting in 0.99% for each. Overall, 17.82% of COVID-19-infected patients required hospital admission, whereas 11.82% required oxygen therapy and 5.94% of patients required ICU admission. Only one COVID-19-infected patient had undergone spirometry after COVID-19. Overall, 47.56% experienced smoking cessation, 45.12% never tried to quit smoking, and 7.32% tried multiple times to quit. Multiple factors have affected smoking habit as follows: marriage has increased smoking in 61.9% of participants, and also work, depression, and happiness have increased smoking in 92.31, 95.12, and 64.63% of participants, respectively.

Conclusion

COVID-19 pandemic has led to unexpected changes in daily activities and alteration in health behaviors. The effects of smoking on human health are serious and profound. Smoking has increased the severity of COVID-19, symptoms, and hospital admission, especially in persons with multiple comorbidities. In the present study, there was a significant relation between admission to hospital and age, period of smoking, and frequency of smoking. Smoking cessation programs should be conducted for individuals, as they help smokers recognize and cope with problems that come up during quitting.
Obstructive sleep apnea in type 2 diabetes mellitus patients
Authors: Morsy Nesreen Elsayed , Sheta Amany Mustafa Fathy , El Desoky Abo Shehata Mohammed , El Metwally Ali Raed , Samaha Hala Mohamed Shalabi
Published: July 2023

Objective

The study aims to identify the prevalence and risk factors for OSA in a group of Egyptian patients with type 2 diabetes.

Methods

125 type 2 diabetes mellitus patients visited Mansoura University Hospital (Diabetes Mellitus Outpatient Clinic (OPC) at Specialized Medical Hospital and the Sleep Disordered Breathing Unit of the Chest Department), all of them exposed to history taking, the patients underwent anthropometric measurements (weight, height, body mass index, neck circumference), a test of their tonsillar size, Malampati score, Friedman OSA score, Epworth sleepiness scale (ESS), Berlin questionnaire, STOP BANG questionnaire, full-night polysomnography, fasting, and postprandial blood sugar.

Results

The study included 125 T2DM Egyptian patients with a mean age of 54.63 ± 9.47 years. Males accounted for 35.2 percent of patients, while females accounted for 64.8%. According to the study of co-morbidity, hypertension constituted 77 (61.1%), ischemic heart disease 28 (22.4%), other cardiac diseases 11 (8.8%), bronchial asthma 6 (4.8%), liver diseases 6 (4.8%), hypothyroidism 3 (2.4%), and renal diseases 3 (2.4%). A total of seven patients (5.6%) had no OSA symptoms, 87 had borderline symptoms, and 31 had positive symptoms. There were 51 (40.8%) normal patients, 12 (9.6%) borderline patients, and 62 (49.6%) sleepy patients on the Epworth scale. According to the Stop-Bang questionnaire, 121 (96.8%) patients answered positively. It was determined that 122 patients (97.6%) were at high risk based on the Berlin questionnaire. There were 17 patients (13.6%) with OSA on polysomnography, of which six were moderate (35.3%) and 11 were severe (64.7%). Among moderate and severe OSA patients, glycosylated hemoglobin levels differed significantly. Multivariate logistic regression analysis for independent predictors of OSA, chronic renal disease patients is the most common associated risk factor (OR = 14.3, CI = 1.2–67) then hypertension (OR = 5.6,CI=1.2–25.5) and heart failure (OR = 4.4).

Conclusions

OSA affects 13.6% patients with type 2 diabetes patients who are hypertensive are at higher risk of OSA, chronic renal failure is considered another risk factor

Furthers studies are needed on a big scale of Egyptian diabetic patients to detect the prevalence of OSA
Efficacy of baricitinib in severe coronavirus disease 2019
Authors: Amer Ahmed M A E F , Mousa Doaa B , Ahmed Azza A
Published: July 2023

Background

Coronavirus disease 2019 (COVID-19) binds to angiotensin-converting enzyme through a viral spike protein prompting an inflammatory cascade. Baricitinib, an oral drug, is a selective inhibitor of Janus kinase (JAK) 1 and 2 and interferes with the intracellular signaling pathway of many cytokines and in combination with remdesivir may give good results in severe COVID-19 infection.

Aim

The aim was to assess the effect of baricitinib in severe COVID-19 pneumonia.

Patients and methods

A total of 30 patients with SARS-CoV-2-confirmed positive cases by nasopharyngeal swab/reverse transcriptase PCR with severe pneumonia received oral baricitinib 4 mg daily, and patients were followed for at least 14 days, unless previously discharged or dead.

Results

Patients were admitted to the ICU, with a mean duration of 11 days. All patients received high-flow oxygen with nonrebreathing mask. A total of 18 (60%) patients improved and 12 (40%) patients died. Moreover, 15 patients had comorbidities, and mortality was high in this group (10 patients). No serious adverse effects of baricitinib were detected in our study. All patients were hypoxic at admission. The mean oxygen saturation on room air was 70%. There was a statistically significant improvement in oxygenation on discharge after receiving treatment, with mean oxygen saturation of 90% on room air.

Conclusion

Baricitinib with remdesivir improves clinical status and oxygen saturation in patients with severe COVID-19 pneumonia with no serious adverse effects.
Could pleural fluid lactate level have an added diagnostic value in para pneumonic effusion?
Authors: Shehta Mohammed , Fathy Amr M , Ibrahim Mohammed A
Published: July 2023

Background

Pleural effusion is the accumulation of fluid in the pleural space, can be classified into transudative and exudative effusion. A parapneumonic effusion is a pleural effusion that forms adjacent to pneumonia. Para pneumonic effusion can be sub-typed into uncomplicated and complicated effusion. The aim of our work was to identify accuracy of pleural fluid lactate level to discriminate transudative from exudative effusion and uncomplicated from complicated parapneumonic effusion.

Methods

Thoracocentesis was done with subsequent evaluation of pleural fluid PH, protein, LDH, glucose and lactate.Also, gram stain, microbiological cultures, cytological examination was performed. Medical thoracoscopy was done whenever indicated.

Results

Our study included 52 males and 38 females with mean age 57.14 ± 11.69 years. Transudative effusions were detected in 22 patients (24.4%). Parapneumonic effusions accounted for 39 cases (43.3%), of these 23 cases were uncomplicated and 16 cases were complicated. The median pleural fluid lactate level in exudative effusion was significantly higher than transudative effusion (P value<0.001), in complicated parapneumonic effusion was significantly higher than uncomplicated parapneumonic effusion (P value<0.001). Pleural fluid lactate cut-off value of 2.68 mmol/l or more yielded 97% sensitivity, 90.9% specificity for detection of exudative effusion (Auc 0.968). A cut of value of 6.22 mmol/l had 87.5% sensitivity, 91.3% specificity for detection of complicated parapneumonic effusion. (Auc 0.971).

Conclusion

The pleural fluid lactate level has a high accuracy to discriminate transudative from exudative pleural effusion and uncomplicated from complicated parapneumonic effusion.
Prevalence of Non-Alcoholic Fatty Liver Disease in Urban Adult Population in a Tertiary Care Center, Chennai
Authors: Anton Mary Chandrika , Shanthi B. , Sridevi Chaganti
Published: July 2023

Background:

Non-alcoholic fatty liver disease (NAFLD) is becoming one of the most common liver diseases among the Indian population. The predisposing factors for NAFLD are diet, lifestyle modifications, and lack of exercise. There is a paucity of research on NAFLD in the South Indian population. Hence, the present study aimed to assess the prevalence of NAFLD among the urban adult population in Chennai.

Material and Methods:

This analytical cross-sectional study was conducted in General Medicine outpatient departments at a tertiary care center in Chennai. The study included 510 non-alcoholic adults (both male and female) aged between 21 and 40 years. Ultrasonography was performed to rule out fatty liver in all participants. All the results obtained were statistically analyzed using SPSS software version 22.0. The frequency was given in percentage.

Results:

The proportion of participants who screened positive for NAFLD was 61.5%. The participants with higher body mass index (BMI) were found to be significantly 23.09 times higher risk of developing NAFLD. An increase in age was also found to be a predictor of NAFLD. This study also supports that males are more prone to develop NAFLD and are at a 1.59% higher risk of developing the disease than females.

Conclusion:

Fatty liver has become one of the common non-communicable diseases in India, the high prevalence of NAFLD in the present study supports it. Therefore, people should have regular screening and diagnosis to rule out fatty liver disease. Proper diet patterns and exercise must be followed to prevent fatty liver.
Assessment of Prevalence of Hypertension and its Risk Factors among Adult Tribal Population Residing in Lohandiguda Block of Bastar District of Chhattisgarh
Authors: Meshram Nisha , Verma Nirmal , Shrivastava Neha , Prasad Manish A. , Jain Kamlesh , Shinkar Swapnil V.
Published: July 2023

Background:

Hypertension is known as the silent killer. It comprehends the top rank in non-infectious disease amongst adults; accountable for the deaths every year across the world. It is essential to consider the individual impact of risk factors and their impact on hypertension. This study thus elicited the socio-demographic characteristics, the prevalence of hypertension and associated risk factors, and its impact on adults with hypertension. To estimate the hypertension prevalence and its associated risk factors among adult tribal populations aged 25–60 years residing in Lohandiguda block of Bastar district of Chhattisgarh.

Material and Methods:

A community-based cross-sectional analytical study was used and the setting was done at the field practice area under the three primary health centers of Lohandiguda block, Bastar district of Chhattisgarh. It was carried out among 330 adult tribes residing for ≥1 year in the present locality. Data was collected by door-to-door visits through pre-designed, pretested, semi-structured questionnaire via face-to-face interview method and anthropometric measurement was done by using standard guidelines. The sampling method was multistage sampling. IBM SPSS STATISTICS-20.0 (IBM Corp., Armonk, NY, USA) software.

Results:

The overall prevalence of pre-hypertension and hypertension among tribal subjects was 34.9% and 47.3%, respectively. Of total hypertensive 27.3% were having stage-1 hypertension, 13.9% were having stage-2 hypertension and 6.0% were already diagnosed cases. Risk factors found in multivariate analysis are occupation (unemployed 0.012), frequency of smokeless tobacco used per day (0.,017) and central obesity (0.000).

Conclusions:

As hypertension is a multi-factorial disease the study found strong predictors like occupation, frequency of smokeless tobacco per day and having central obesity with significant difference.
CoWIN: The Future of Universal Immunization Program in India
Authors: Arjun M. C. , Singh Arvind Kumar , Parida Swayam Pragyan
Published: July 2023

CoWIN (Covid Vaccine Intelligence Network) is a web-based platform owned and operated by the Government of India for facilitating COVID-19 vaccination of the citizens. This project is considered a tremendous success, apparent from the sheer number of hassle-free and successful COVID-19 vaccinations. We believe that the CoWIN system is an ideal platform for capturing all the vaccine-related data in the Universal Immunization program (UIP) as well as providing an all-inclusive vaccine certificate in digital format. Advantages and challenges of upscaling the CoWIN system to include UIP and a vision statement of how this can be achieved are discussed in this article. We also enlist the state-level solutions currently in use for digital immunization records, which can serve as case studies for upscaling the CoWIN system.
Differentiation value of miR-26b for major depressive disorder, schizophrenia, generalized anxiety disorder
Authors: Kong Lingming , Zhu Xiaoli , Zhang Liyi , Chen Shengdong
Published: July 2023

Introduction:

First episode and drug naive schizophrenia (SZ) patients comorbid with major depressive episode and generalized anxiety disorder (GAD) comorbid with major depressive disorder (MDD) are common in clinical practice, overlapping symptomatology during first presentation of MDD, SZ and GAD challenged the diagnostic process.

Materials and Methods:

This study aimed to investigate the differentiation value of peripheral microRNA-26b expression in 52 patients of MDD, SZ, and GAD, respectively, and 52 controls. Quantitative real-time reverse transcription polymerase chain reaction was used to further verify aberrant miRNAs of previous identified in MDD and investigate expression level of these peripheral miRNAs in SZ and GAD.

Results:

The expression levels of miR-26b and miR-4743 were significantly upregulated and of miR-4498, miR-4485, and miR-1972 had no significant difference. There were no significant differences of expression levels of miR-26b, miR-4498, miR-4485, and miR-1972 except miR-4743 between SZ patients and control group and of miR-26b, miR-1972, miR-4498, and miR-4485 between GAD group and the controls. The receiver operating characteristic (ROC) curve of miR-26b in MDD patients showed that its sensitivity and specificity for diagnosis were 0.540 and 0.830, respectively, with the area under curve (AUC) being 0.728; the ROC of miR-26b for SZ and MDD differentiation showed that its sensitivity and specificity were 0.580 and 0.710, respectively, with AUC being 0.631; the ROC of miR-26b for GAD and MDD differentiation suggested that sensitivity and specificity were 0.560 and 0.750, respectively, with AUC being 0.637.

Conclusion:

MiR-26b might have potential value of differentiation biomarker for MDD, SZ, and GAD.
Insight in patients with bipolar disorder: Findings from the bipolar disorder course and outcome study from India (BiD-CoIN study)
Authors: Grover Sandeep , Avasthi Ajit , Chakravarty Rahul , Dan Amitava , Chakraborty Kaustav , Neogi Rajarshi , Desousa Avinash , Nayak Omkar P. , Praharaj Samir Kumar , Menon Vikas , Deep Raman , Bathla Manish , Subramanyam Alka A. , Nebhinani Naresh , Ghosh Prasonjit , Lakdawala Bhaveshkumar , Bhattacharya Ranjan
Published: July 2023

Background:

There are limited number of studies evaluating insight among patients with bipolar disorder (BD).

Aim:

This study aimed to examine insight and its correlates in BD using the data from the multicenter BD course and outcome study from India (BiD-CoIN). The additional aim was to evaluate the insight in patients with BD using different scales and understand the correlates of insight.

Materials and Methods:

773 BD patients presently in clinical remission were evaluated on the Insight Scale for Affective Disorders (ISAD), insight items of the Hamilton Depression Rating Scale (HDRS), and the Young Mania Rating Scale (YMRS).

Results:

The assessment scales influenced the prevalence of poor insight. Poorer insight irrespective of the assessment scale was consistently associated with higher residual depressive and manic symptoms, and a higher level of cognitive impairment and disability. Poor insight as assessed by ISAD was associated with a higher number of episodes in the lifetime, shorter duration of current remission, a higher number of depressive episodes, a higher amount of time spent in depressive episodes, higher depressive affective morbidity, a higher number of manic episodes, and higher residual depressive and manic symptoms.

Conclusion:

Poor insight in BD is consistently associated with higher residual depressive and manic symptoms and a higher level of cognitive impairment and disability. However, in terms of course variables, the correlates vary depending on the assessment method.
Management of post-COVID antral gastritis associated with hiatal hernia as Urdhwaga-amlapitta through Ayurveda: A case report
Authors: Bhatted Santosh Kumar , Malhotra Nishant
Published: July 2023

Gastroesophageal Reflux Disease (GERD) is a condition where the gastric contents come back up into the esophagus. Hiatal hernia is a condition, in which the upper part of the stomach or other internal organs bulges through the hiatus of the diaphragm. When there is a laxity in the hiatus, there may be acid reflux, and the symptoms of GERD may arise. In the present case, a 40-year-old female after recovering from COVID-19 in May 2021 started complaining of symptoms such as severe acid reflux, nausea, vomiting, unsatiety/increased appetite, and gradual weight gain. She consulted general physicians/surgeons who diagnosed the condition as mild antral gastritis and hiatus hernia. After getting allopathic treatment for about three months, no significant relief was observed. After that, the patient visited Ayurveda Hospital in November 2021 and was diagnosed as a case of Urdhwaga-amlapitta (~upward hyperacidity). She was treated with Pitta (~Dosha responsible for regulating body temperature and metabolic activities) pacifying medicines (Avipattikara churna, Madhuyashti churna, Shatavari churna, and Kamadudha rasa) for 42 days along with diet and lifestyle modifications. All the symptoms were reduced during the treatment and after follow-up on the 56th day, the patient completely recovered. This case report gives insight that Ayurveda management can be effective for the management of antral gastritis associated with hiatal hernia.
Evaluation of efficacy of simvastatin in bone regeneration following local application in third molar extraction socket: A randomized control trial
Authors: Harsha Gorrela , Madhavi Sunnam , Arthi Sirivore , Haritha Siripuram
Published: July 2023

Aims and Objectives:

The aim of this study is to study the efficacy of simvastatin in bone regeneration following the local application in third molar extraction sockets.

Materials and Methods:

This is a randomized controlled trial done on 50 patients involving 100 third molar teeth extraction sockets. The patients were randomly divided based on the placement of simvastatin. Extraction sockets which were treated with simvastatin were considered study sockets and without simvastatin were considered control sockets. The study socket was assigned for the placement of simvastatin (10 mg) powder along with gelfoam as carrier moistened with normal saline solution and control socket was assigned for the placement of gelfoam moistened with saline. Intraoral periapical radiographs were taken on the 1st, 4th, 8th, and 12th weeks, and mean gray scale values indicating bone density were evaluated for both the groups. Cone-beam computed tomography (CBCT) was taken by the end of the 12th week to further evaluate the osseous regeneration. Patients were compared and evaluated for bone density, pain, and swelling. Pain and swelling were evaluated on postoperative days 1 and 7.

Results:

The mean gray-level histogram values (bone density) were statistically highly significant in the study group compared to the control group in the 1st, 4th, 8th, and 12th weeks, and CBCT also showed statistically significant difference between the control and study group by the end of the 12th week.

Conclusion:

The present data suggest that the local application of simvastatin promotes and enhances bone formation in the extraction sockets, which provides a very cost-effective way for faster bone regeneration.
Assessment of soft- and hard-tissue changes following combined anterior segmental bi-jaw orthognathic surgery
Authors: Mishra Madan , Singh Gaurav , Gaur Amit , Mondal Shubhamoy , Singh Abhishek , Bharti Pallavi
Published: July 2023

Background:

Anterior segmental Bi-jaw orthognathic surgery is indicated primarily for the correction of dentoalveolar protrusion. They are also indicated for correcting apertognathia, closing interproximal spaces between segments and can be incorporated with other osteotomies to obtain better results.

Aim:

The aim of this study was to analyze and compare the soft- and hard-tissue changes in patients who underwent combined anterior segmental bi-jaw orthognathic surgery.

Settings and Design:

To compare and evaluate soft- and hard-tissue changes before and after combined anterior segmental bi-jaw orthognathic surgery by assessing (a) parameters in vertical dimension and (b) parameters in horizontal dimension and patient satisfaction was also assessed following surgery at 6 months’ time interval.

Materials and Methods:

It is a prospective, single center and analytical study with sample size of 20 patients. It required routine setup for orthognathic surgery and manual tracing of lateral cephalograms. The surgical outcomes were assessed by hard tissue (Sella Nasion Point A (SNA) angle, Sella Nasion Point B (SNB) angle, Point A Nasion Point B (ANB) angle, NAPg, U1-NF, L1-MP angles; NA, NB, B-Pg, Nasion-Anterior nasal spine (N-ANS) distance, Anterior nasal spine-Gnathion (ANS-Gn) distance, and overjet and overbite) and soft tissue (facial convexity, NL, LM angles; LM fold, UL and LL protrusions, Upper lip length (ULL), Lower lip length (LLL), Sn-A, Si-B, Pg-Pg*, Ls-U1, Li-L1 distances, interlabial gap, and U1 exposure) variables pre and postsurgery.

Statistical Analysis:

Descriptive statistics involved the mean and standard deviation, and recorded data were subjected to the statistical analysis using IBM SPSS 20 statistical package. The paired t-test, Pearson correlation coefficient were used. The level of significance P < 0.05 was taken as statistically significant and P < 0.01 as very significant.

Results:

Overall improvement after surgery in both hard- and soft-tissue parameters was observed and significant changes were seen in every variable, except Si-B (P > 0.05). Correlations between soft- and hard-tissue changes were significant in both sagittal and vertical planes. Patients’ satisfaction score showed that all patients had the high overall rate of satisfaction.

Conclusions:

Our study concludes that combined anterior segmental bimaxillary orthognathic surgery is a simple technique with minimal postoperative complications and limited relapse. The changes in facial esthetics and occlusion following orthognathic surgery depend highly on the stability achieved during the postoperative period.
Clinical indications for radical resection of odontogenic keratocyst: A systematic review
Authors: Bushabu Fidele N. , Titinchi Fadi , Bing Liu , Davda Latha
Published: July 2023

The aim of this study was to identify clinico pathological indications for radical resection of odontogenic keratocysts (OKCs) in the literature and formulate clinical guidelines for the management of OKCs based on these findings. A systematic review of the literature was undertaken in September 2021 in PubMed/Medline, Scopus, Web of Science, Google Scholar, and Cochrane databases. The following MeSH Keywords terms were used in the search strategies: (odontogenic keratocyst) OR (keratocystic odontogenic tumor) OR (primordial cyst) AND (treatment) OR (Radical resection) OR (Resection of OKC) OR (Treatment methods). Eligibility criteria included publications of clinical studies on histologically confirmed OKCs which underwent radical resection. Studies with less than 5 OKCs, experimental studies, epidemiological studies, studies that included orthokeratinized odontogenic cyst, and review papers were excluded. Ten studies on OKCs reporting on segmental or marginal resections were identified and analyzed qualitatively. Of the total of 221 OKCs that underwent radical resection, 67 OKCs were primary, 30 were recurrent, and the remaining were unclear whether they were primary or recurrent. Segmental mandibulectomy was performed in 131 OKCs, marginal mandibulectomy in 87 OKCs, and 3 OKCs were treated by partial maxillectomy. The main indications for radical resection were multilocular appearance, large OKCs (> 5 cm), multiple recurrent OKCs with or without cortical perforation, and malignant transformation. In conclusion, radical resection has its place in the management of OKC. It is indicated when there is an aggressive lesion with bony perforation, involvement of the pterygoid musculature or skull base, and malignant transformation. The surgeon should aim to identify these features to manage OKC appropriately and to prevent multiple recurrences. Clinical guidelines for the management of OKCs are proposed.
Modernizing Contracts Across Industries: A Review of Smart Contract Applications and the Evolving Legal Landscape
Authors: Bohyer Kiran , Hayajneh Thaier
Published: July 2023

We provide (1) an overview of various present and future applications of smart contracts across various industries including real estate, finance, and healthcare and (2) an assessment of the efficacy of smart contracts as a means of replacing or supplementing traditional contracts. Disclosed in this paper are (1) present and future applications of smart contracts and potential risks and downsides, and (2) legal considerations when using smart contracts to replace or supplement traditional contracts. Aspects of blockchain technologies can be applied to traditional contracts, in part or in whole, to reduce common challenges associated with contracts. Specifically, smart contracts can be integrated with or replace traditional contracts with the benefit of ensuring reciprocal obligations are enforced and aid in ensuring mutual consent, offer and acceptance, consideration and legal purpose.
Market-Based Analysis: Apriori approach to analyze purchase patterns
Authors: Lekireddy Bharadhwaj Reddy , Reddybathina Naga Sai Ram , Michael G , Mohanty Sachi Nandan
Published: July 2023

In this paper, a data mining approach has been developed to analyze customer behavioral patterns and to get a further idea of the scale of the products purchased. Using the approach we found the best and least performing products, the average number of the products that the customer is interested in buying, And using the apriori algorithm we can generate the frequent items which can be bought together which will help us in suggesting products for the customer to buy. Each pattern is supported by the support and confidence generated using the apriori algorithm.