bluuebunny/crossref_metadata_2025 huggingface dataset:
Hubungan antara perubahan iklim dengan jumlah kasus demam dengue (DD) di Denpasar, Bali tahun 2010-2015
Authors: Wiradarma I Gusti Agung Bagus Arya , Somia I Ketut Agus
Published: April 2020

Background: Dengue is one of tropical infectious disease that can give a serious public health problem in Denpasar. Several factors have been associated with the high prevalence of dengue fever; one of them is climate changes. This study aims to determine the relations between climate change and a number of dengue cases in Denpasar.Methods: The climate change and a number of dengue cases data take place in Denpasar from the year 2010-2015 using observational study. The Spearman correlation test was used to know the relation between climate change ( maximum and minimum temperature, rainfall, humidity, light duration, and wind velocity ) and a number of dengue cases. Data were analyzed using SPSS version 20 software for windows.Results: The highest prevalence of Dengue Fever infection was in 4,431 (38.16%) cases in 2010, followed by 1,837 (15,82%) cases in 2014, 1,766 (15.22%) cases in 2013, 1,576 (13.57%) cases in 2015, 1,009 (8.69%) cases in 2012, and 992 (8.54%) cases in 2011. Based on climate variables, rainfall has a weak significant relation affecting the number of dengue cases compared with others (r=0.247; p=0.036).Conclusion: Rainfall was the only climates variables significantly related to the high prevalence of dengue fever in Denpasar, Bali since 2010-2015. So, further efforts need to be done to prevent dengue cases on rainy season.
Faktor-faktor yang mempengaruhi kejadian kurang energi kronis (KEK) pada ibu hamil di wilayah kerja UPT Puskesmas I Pekutatan, Jembrana, Bali
Authors: Teguh Numbi Akhmadi , Hapsari Ayu , Dewi Putu Ria Asprila , Aryani Putu
Published: April 2020

Background: Common nutritional problems in pregnant women are chronic energy deficiency (CED). CED in pregnant women is a state of the mother lack of energy and protein intake during the period of pregnancy which can lead to the occurrence of health problems in the mother. This study aims to determine factors assoIKated with CED among pregnant women at UPT Puskesmas I Pekutatan, Jembrana, Bali.Methods: A case control study was conducted among 36 respondents, 12 cases (KEK) and 24 control (Non-KEK). The sampling technique used is purposive sampling technique. Affordable populations in this study were pregnant women recorded in medical records data at UPT Puskesmas I Pekutatan period 01 January-31 May 2017. The data were collected by interview using questionnaire and assessed using SPSS software version 20 for Windows. Existing data were analyzed by univariate and Fisher's exact bivariate with odds ratio calculation (OR).Results: About 13 respondents (36,1%) are <20 years old /> 35 years old with the most recent education is graduated from SMA that is 20 respondents (55,6%). Most respondents did not work (91.7%) and had low economic status (30.6%). Most of the respondents had children <2 (69.4%). Economic status (OR = 115; 95% IK: 9,3-1418), education level (OR = 2,3; 95% IK: 0,5-9,5), age (OR = 7,6; 95% IK: 1.6-35.9), gestational distance (OR = 11; 95% IK: 1.7-69), number of parities (OR = 7.6; 95% IK: 0.7-83.7) , And visit frequency of ANC (OR = 5; 95% IK: 0,9-26,4).Conclusion: The characteristic and frequency of ANC visit among pregnant women are risk factors of KEK occurrence in pregnant mother, so it is expected to provide information related to risk factors of KEK by health personnel in Puskesmas I Pekutatan, state of Jembrana.
Correlation between extracurricular activities and academic performances among preclinical medical students in Udayana University, Bali, Indonesia
Authors: Utomo Muhammad Faisal Putro , Dhyani Ida Ayu Dewi , Yusari I Gusti Agung Ayu Andra , Aryadi I Putu Hendri , Darmayanti Ni Putu Diah Utami , Ganesha I Gde Haryo
Published: April 2020

Background: Medical students are required to develop ability and clinical skill to carry out the profession. Soft skill is also important to enhance the studentsâ€™ performance when facing real-life situation in community. It can be developed through extracurricular activity which trains positive behavior, time management, and social aspect. This study was aimed to explore the correlation between extracurricular activities and academic performances among medical students in preclinical phase.Summary of Work: A cross-sectional study with total of 221 medical students of Udayana University in preclinical phase. Data were taken from data collecting by Student Executive Board for Credit Point of Participation which was the indicator of extracurricular activities and grouped into active and not active. Data were also taken from Academic Affairâ€™s registered data (Grade Point Average (GPA) and gender). GPA was the indicator of academic performance and grouped into good and average. Data were analyzed using univariate and bivariate analysis (Chi Square Test with Cramerâ€™s V).Summary of Results: From 221 medical students (males 43.9%; females 56.1%), 48% are active participants of extracurricular programs. Fifty-nine medical students had good GPA and 162 medical students had average GPA. The mean score of Credit Point of Participation are 116.545Â±65.79 and GPA is 3.3781Â±0.282 (out of possible 4). Our study showed a positive correlation between extracurricular activities and academic performance (r=0.2; p=0.003).Discussion & Conclusions: Medical students who are active participants in extracurricular programs have better academic performance than those who are passive. This finding may have similar result to some previous studies. Extracurricular activities lead to positive impact in academic achievement, because it can decrease any academic stress and tension, which lead into more productivity in their learning.
Profil hasil pemeriksaan CT-Scan pada pasien tumor paru di Bagian Radiologi RSUD Dr. Zainoel Abidin periode Juli 2018-Oktober 2018
Authors: Iqbalawaty Indrita , Machillah Nurul , Farjriah Farjriah , Abdullah Asnawi , Yani Muhammad , Ilzana Teuku Muhammad , Rahmi Cut Rizka , Khaled Teuku Muhammad
Published: April 2020

Latar Belakang: Tumor paru masih menjadi penyebab utama keganasan di dunia. Tumor paru merupakan pertumbuhan abnormal benjolan pada jaringan paru yang dapat bersifat jinak ataupun ganas. CT scan merupakan salah satu modalitas yang digunakan untuk mengevaluasi dan mendiagnosis kecurigaan tumor paru. Penelitian ini bertujuan untuk mendapatkan gambaran profil hasil pemeriksaan CT scan pasien tumor paru.Metode: Jenis penelitian yang digunakan adalah studi deskriptif retrospektif. Pengambilan sampel dilakukan di Bagian Radiologi RSUD Dr. Zainoel Abidin periode Juli 2018 â€“ Oktober 2018. Data diperoleh dari hasil ekspertisi CT scan toraks dan kuisioner karakteristik responden. Didapatkan 66 kasus tumor paru yang memenuhi kriteria inklusi.Hasil: Berdasarkan diagnosis radiologis, ditemukan 66 kasus tumor paru, dimana sebagian besar pasien berjenis kelamin laki-laki (63,6%); dengan kelompok usia terbanyak pada usia 60-69 tahun (37,9%); merokok aktif meningkatkan faktor risiko pada tumor paru; pasien memiliki gejala klinis awal terbanyak nyeri dada dan sudah dalam stadium lanjut; lokasi tumor terbanyak adalah paru kanan; dan tulang merupakan lokasi metastasis terbanyak ditemukan pada kasus tumor paru penelitian ini.Simpulan: Penelitian ini diharapkan dapat memberikan umpan balik positif bagi manajemen tumor paru dan dapat digunakan sebagai dasar acuan untuk penelitian selanjutnya.Â Background: Lung tumor is still being the most common tumors in the world. Lung tumor is defined as the abnormal growth of lumps in lung tissue that might be benign or malignant. CT scan is one of the most appropriate modality to diagnose the supposition of lung tumors and evaluating the tumor itself. The purpose of this study is to identify the CT scan images of patients with a lung tumor.Method: The study was conducted by a retrospective descriptive design. In this study, sampling was performed at Radiology Department, Zinoel Abidin General Hospital, from July 2018 to October 2018. Data were obtained from the thorax CT scan examination request forms and questionnaire of respondent characteristics. There were 66 cases of lung tumors that met theÂ inclusion criteria.Results: There were 66 cases (53.2%) of lung tumors based on the radiological diagnosis. Most of the cases were males (63.6%); the largest age group consisted of patients aged 60-69 (37.9%); active smoking was the most important risk factor of lung tumor; patients mostly came with chest pain as an early symptom and at the final stage of lung tumor; the most common site of lung tumor was right lung; bone was the most common site of metastatic site.Conclusion: This study can provide positive feedbacks in the whole management of lung tumor, and can be used as a basis for further research.
Vad blev det av Gy2011 reformens intentioner för yrkesutbildning?
Authors: Wyszynska Johansson Martina , Dyne Ellinor , Mårtensson Åsa
Published: April 2020

Med utgångspunkt i tre studiers resultat handlar denna essä om utvecklingen av ett gymnasialt yrkesprogram, Barn- och fritidsprogrammet. Frågan är hur gymnasiereformens (Gy2011) intentioner om ökat samarbete med arbetsplatser i syfte att uppnå en yrkesmässig spetskompetens har förverkligats i lokala kontexter. Bf-lärares uppdrag har diversifierats genom Gy2011. För det första har yrkeslärares fokus flyttats från skolan och arbetet med eleverna där, till att även omfatta introduktion och ”fjärrstyrning” av handledare på arbetsplatsen. För det andra innefattar uppdraget att anpassa programmet till branschspecifika villkor som i sak inte nödvändigtvis erbjuder reella möjligheter till samarbete mellan skola och arbetsliv. Slutligen behöver yrkeslärarna också hantera svårigheten med att integrera det yrkesspecifika med det programgemensamma. Tre avgränsade och Bf-programspecifika utvecklingsområden som resultat av hur Gy2011 intentioner har fallit ut i förändrade praktiker har därmed identifierats. Utmaningen för yrkeslärarna handlar därför dels om att samordna handlingar i ett nät där andra aktörer ingår, t ex för yrkesutgången personlig tränare och väktare, dels att hantera strukturella problem med elevers tillgång till specialiserat kunnande.
Learning the Language of Software Errors
Authors: Chockler Hana , Kesseli Pascal , Kroening Daniel , Strichman Ofer
Published: April 2020

We propose to use algorithms for learning deterministic finite automata (DFA), such as Angluin’s L* algorithm, for learning a DFA that describes the possible scenarios under which a given program error occurs. The alphabet of this automaton is given by the user (for instance, a subset of the function call sites or branches), and hence the automaton describes a user-defined abstraction of those scenarios. More generally, the same technique can be used for visualising the behavior of a program or parts thereof. It can also be used for visually comparing different versions of a program (by presenting an automaton for the behavior in the symmetric difference between them), and for assisting in merging several development branches. We present experiments that demonstrate the power of an abstract visual representation of errors and of program segments, accessible via the project’s web page. In addition, our experiments in this paper demonstrate that such automata can be learned efficiently over real-world programs. We also present lazy learning, which is a method for reducing the number of membership queries while using L*, and demonstrate its effectiveness on standard benchmarks.
An Exploration of First Year Pre-service Engineering Graphics and Design Teachers’ Spatial Visualisation Ability at a University of Technology
Authors: SINGH-PILLAY Asheena , SOTSAKA Douglas
Published: April 2020

The critical shortage of engineers in South Africa is linked directly to the schooling systems’ inability to develop fundamental skills required in engineering courses, such as spatial visualization ability. Not much is known on the factors that enable or constrain the development of students’ spatial visualization skills. This study aimed to explore first-year Engineering Graphics and Design (EGD) Pre-Service Teachers’ (PSTs) spatial visualization skills and the factors that enables or constrains their spatial visualization skills. A mixed-method approached was used to generate data. Data were from twenty-one first year EGD PSTs at a University of Technology, in Kwa-Zulu Natal in South Africa. The participants were purposively selected to participate in the study. The Purdue Spatial Visualization Test: Visualization of Rotations (PSVT: R) was used as a benchmark to establish participants level of spatial visualization skills. Collages and focus group interviews were used to explore the factors that enabled or constrained PSTs spatial visualization skills. The PSVT test results was analysed and categorized as per rotation. Qualitative data were subjected to content analysis. The findings of this study differ from that of other studies on student’s spatial visualization skills. Other studies provide consistent evidence that male students have better developed spatial visualization skills than females. First-year female participants in this study have higher scores than male participants in the PSVT:R. The factors that enhanced female students’ spatial visualization ability were playing with Legos, enjoying mathematics, working with indigenous patterns while teachers and violence at schools constrained the development of spatial visualization skills.
Affordable didactic material: An approach for the inclusion of impaired visual students v1
Authors: Cibelle de Oliveira Moreira Edith , Soares dos Santos Antonia , sayuri da Costa Oliveira Aline , Lira Sousa Marciely , Silva Diógenes
Published: April 2020

The production of affordable didactic material to Biology teaching enables both, the visually impaired student to get access to the content by touch and the normovident students to improving the learning of the theory. Thus, the affordable didactic material is considered of universal usage. However, most of the protocols proposed to the production of such a material normally do not consider its resistance, preventing its use for a prolonged period. Moreover, many other protocols involve the use of expensive material. The present protocol enables the production of very resistant material using recyclable and cheap material. Additionally, the proposed protocol can be used by teachers during the class, challenging the students to work in group, improving their artistic abilities and creative.
İkna Yoluyla Dolandırıcılık: Dolandırıcılık Faaliyetlerinde İkna ve Etkili İletişim Yöntemlerinin Tespiti Üzerine Bir Araştırma
Authors: BAHAR Atalay
Published: April 2020

İkna, bireylerin sosyal çevreleri ve toplumsal dinamikleri dikkate alınarak, fikirlerin içselleştirilmesi ve tavırların özümsenmesine yönelik çabaların bütünüdür. İletişimin kişilerarası boyutu, araştırmanın temelini oluşturmakla beraber, bu araştırmada paradoksal bir perspektifle ikna stratejilerinin olumsuz süreçlerde de kullanılabileceğine dikkat çekilmektedir. Çalışmada; iknanın, toplumsal reflekslere ve bireysel kayıplara neden olan, ikna yoluyla dolandırıcılık suçunun gerçekleştirilmesindeki başat rolü ele alınmaktadır. İkna yoluyla dolandırıcılık, sahte çağrı merkezleri vasıtasıyla iletişime geçilen mağdurların kurgulanmış senaryolarla ikna edilerek, haksız kazanç sağlanmasıyla meydana gelmektedir. Nicel araştırma yöntemi ile gerçekleştirilen bu çalışmada içerik analizi tekniği kullanılmıştır. İkna yoluyla dolandırıcılıkta kullanılan yöntemler vaat, korkutma ve yardım kampanyaları şeklinde tasnif edilmiş ve bu üç yönteme ilişkin değişkenler belirlenmektedir. İstanbul’da 01.01.2019 ve 01.12.2019 tarihleri arasında gerçekleştirilen ikna yoluyla dolandırıcılık suçları tekniğine ilişkin demografik değişkenler kapsamında, elde edilen veriler ışığında bir durum tespiti ortaya konulmaktadır. Bu suçta öne çıkan sahte çağrı merkezlerinin sistematiği ile mağdurların cinsiyet, yaş ve öğrenim durumları incelenmektedir. Bu çalışmanın amacı, bu türden eylemler hakkında farkındalık oluşturmaktır. İkna yoluyla dolandırıcılık yöntemlerinin teknik özellikleri ile örgüt üyelerinin ileri düzeydeki iletişim yetkinlikleri, aynı düzlemde ele alınmaktadır. Örgüt üyelerinin ikna yoluyla dolandırıcılık suçunun işlenmesini kolaylaştıran iletişimsel becerileri ile mağduriyet oluşturan iletişim dinamikleri ve teknikleri arasında bir ilişkisellik görülmektedir. Öğrenim seviyesi yükseldikçe mağduriyet azalmakla birlikte, her öğrenim seviyesinden ikna yoluyla dolandırıcılık suçuna maruz kalındığı ve 35 yaş üzeri bireylerde, ikna yoluyla dolandırıcılık mağduriyetinin %70’i aştığı elde edilen önemli sonuçlardandır.
In vitro Cytotoxic Effect of Ethanol and Dimethyl Sulfoxide on Various Human Cell Lines
Authors: AYAZOGLU DEMİR Elif , DEMİR Selim , ALİYAZICIOĞLU Yüksel
Published: April 2020

Although the cytotoxic effects of ethanol and dimethyl sulfoxide (DMSO) on some cell lines have been shown in the literature, there is no study about the cytotoxic effects of these solvents on common used human cell lines, such as melanoma (VMM917), lung cancer (A549), colon cancer (WiDr), normal colon (CCD 841 CoN) and fibroblast (BJ) cells. The aim of this study was to determine the cytotoxic effects of ethanol and DMSO on human breast (MCF-7), liver (HepG2) and cervix (HeLa) cancer cells in addition to above mentioned cells. For this purpose, the cells were treated with different concentrations (0.1%, 0.2%, 0.4%, 0.6%, 0.8%, 1%, 2%, and 4%, v/v) of ethanol and DMSO and then subjected to MTT assay. According to the results, ethanol and DMSO exhibited dose-dependent cytotoxicity in all cells studied. The most DMSO and ethanol sensitive cells were WiDr and VMM917, while the most resistant cells were determined as BJ and A549, respectively. The results revealed that the concentration range in which ethanol and DMSO exhibited cytotoxic effect in each cell line is different. In order not to cause false positive and negative results, the concentration range in which the solvents used in cell culture studies do not have cytotoxic effects should be determined.
A prospective comparative study to evaluate the efficacy and safety of olopatadine eye drops and bepotastine eye drops in subjects of vernal kerato conjunctivitis
Authors: Malahat Amatur R. , Kodudula Sudhakar , Gali Vijaya L.
Published: April 2020

Background: Vernal keratoconjunctivitis (VKC) is an allergic eye disease that especially affects young boys. Both olopatadine and bepotestine are dual acting drugs that provide rapid symptomatic relief coupled with the long-term disease-modifying benefit. The present study is conducted to compare the efficacy and safety of olopatadine eye drops and bepotastine eye drops in patients of vernal keratoconjunctivitis.Methods: A prospective, randomized, parallel-group, comparative study is conducted over a period of 4 weeks on paediatric patients with VKC. 50 patients are recruited and randomized into two treatment groups. They received the assigned drugs for 4 weeks and are called for follow up at the end of 1st week, 4th week and 12th week. At each follow-up, patients are examined and the clinical parameters are graded.Results: This study shows that both olopatadine and bepotastine are equally efficacious. Bepotastine provided quicker relief to symptoms of watering, ocular discomfort and conjunctival hyperaemia. Number of responders are also more in the bepotastine group. Absolute eosinophilic count improved with both the drugs but there is no statistically significant difference between them. Both drugs showed good safety profile. However, 24% patients reported aversion to bitter taste with bepotastine. There is no treatment related severe adverse effects in both the groups.Conclusions: Both olopatadine and bepotastine are effective in treating vernal keratoconjunctivitis. However, bepotastine performed better in reducing tearing, ocular discomfort and conjunctival hyperaemia.
Evaluation of anti-inflammatory activity of docosahexaenoic acid on carrageenan induced paw oedema in rats
Authors: Singhal Tulika , Chansoria Arvind , Kothari Saroj
Published: April 2020

Background: Inflammation is a tissue reaction to infection, irritation of foreign substance. It is a part of the host defence mechanism but if in excess it becomes harmful. Docosahexaenoic acid (DHA) is omega-3-derivative of alpha-linolenic acid. This study was conducted to determine the anti-inflammatory activity of DHA and its comparison with standard drug diclofenac.Methods: The study was carried out by using inflammatory models in male albino rats. Rats were divided into 4 groups of 6 animals of each. The anti-inflammatory activity was studied with carrageenan induced rat paw edema.  The anti-inflammatory activity of DHA was compared with standard drug diclofenac. The study parameters for acute inflammation was assessment of reduction in inflammation and the percentage inhibition of the paw edema.Results: DHA 200 mg/kg, DHA 300 mg/kg, and diclofenac 10 mg/kg showed 58%, 64%, and 67% reduction in paw volume, respectively. The DHA showed significant (p<0.05) anti-inflammatory activity in both dosages as compared to control and was dose dependent.Conclusions: DHA produced dose dependent anti-inflammatory activity which suggest its probable use in the treatment of inflammation.
A comparative study between cilnidipine and amlodipine on learning and memory in albino mice
Authors: H. Veena , S. Narendranath , G. H. Shashikala
Published: April 2020

Background: Alzheimer’s disease (AD) is the leading cause of dementia, followed by vascular dementia (VaD). Animal studies have shown that amlodipine improves learning and memory. Since, cilnidipine produces lesser side effects than amlodipine, and animal studies have shown that it has neuroprotective action, this study was conducted to evaluate the effect of cilnidipine on learning and memory and its comparison with amlodipine in alprazolam induced amnesic albino mice.Methods: This study was carried out on albino mice, divided into three groups of six animals each. Amnesia was induced by intraperitoneal injection of alprazolam in all the three groups from day 1 to 14. In addition, group 1, 2 and 3 received normal saline as a control, amlodipine and cilnidipine as test drugs respectively, by same route for the same duration. Then, learning and memory of the animals was assessed using elevated plus maze and cook’s pole climbing models. Results were compared among the groups using one-way ANOVA followed by post hoc Tukey’s test.Results: In both the model’s amlodipine and cilnidipine groups showed statistically significant reduction in transfer latency and conditioned avoidance response duration in comparison with normal saline. But no difference was found between amlodipine and cilnidipine groups.Conclusions: Cilnidipine and amlodipine showed a non-inferiority response on learning and memory enhancing effect in this study. Since, cilnidipine has lesser side effects than amlodipine, it can be taken up for evaluating its effect on cognitive improvement in dementia patients.
Impact of internet on doctor-patient relationship
Authors: Banginwar Sandesh , Amruta Dashputra , A. S. Borker , Jaideep Nayse , R. T. Badwaik
Published: April 2020

Background: Widespread use of internet as a source of health information has an effect on health-related knowledge, attitude and practices of general population as well as doctor-patient relationship. This study has been planned to see perception of doctors about patients who take medical information by internet search. The objective of the study was to assess impact of internet on doctor-patient relationship among doctors of tertiary health care centre. Methods: After ethical approval a questionnaire based cross sectional study was conducted among teachers of a tertiary care hospital. Questionnaire was categorized in the two groups: i) negative impact of internet (14), ii) positive impact of internet (11), total= 25 statements, rated on Likert scale. Medical teachers who are involved in treating patients were included (n=54). Data was analysed using mean score and standard deviation for each item.Results: Most of the doctors opined that use of internet as a source of information has affected doctor-patient relationship (mean 4.35 SD 0.48) and that they were now questioned by already well-informed patients (4.76 SD 0.43).  Google search by patients may results in misguided self-treatment or wrong diagnosis (mean 4.85 SD 0.36). Conclusions: Doctors were agreed that patients are still having same faith on doctors in spite of doing google search on medical information.
Prevalence of urinary tract infection and sensitivity pattern amongst children less than 3 years of age with fever in a tertiary care hospital in South Karnataka
Authors: Ponvelil Jasmine John , Gowda Hema Narasimhe , Mysore Ram Raj Savitha
Published: April 2020

Background: Antimicrobial resistance is a major concern especially in urinary tract infections in children as improperly treated urinary tract infections (UTIs) on long term can cause renal scarring in young children, which leads to long term morbidities like hypertension, chronic renal disease and pre-eclampsia. The empirical therapy for UTI varies regionally due to their varied sensitivities and resistance pattern. This study aims to facilitate policy making in empirical antibiotic therapy of pediatric patients with urinary tract infections.Methods: A cross sectional study, which included a group of 140 children’s (6 months to 3 years) with fever were included in the study. All patients with colony count >1 lakh CFU/ml or colony count >50,000 CFU/ml, with leukocyturia (>5 WBCs/HPF in centrifuged urine) or colony count >1000 CFU/ml with urinary symptoms were diagnosed to be positive for urinary tract infection.Results: The prevalence of UTI in febrile children less than 3 years in our study was 0.1%. Out of 140 patients with fever, 35 were UTI positive. E. coli was the most commonly isolated organism (60%), followed by MRSA (14.2%) and Enterococci (11.4 %). E. coli was found to be most sensitive to nitrofurantoin (85.7%), followed by gentamicin (61.9%) and norfloxacin (38%). E. coli showed high resistance to cefuroxime (76.2%) and ceftriaxone (71.4%). MRSA was found to be most sensitive to linezolid and vancomycin, and resistant to norfloxacin.Conclusions: The data shows the increased resistance of E. coli to commonly prescribed antibiotics like cefuroxime and ceftriaxone. So, this study shows the empirical treatment of UTI in our region and the importance of having antibiotic prescription policies in every region.
Prospective study of the prescribing pattern of antibiotics and their outcome in patients admitted to intensive care unit at tertiary center
Authors: H. G. Pavithra , Ahmed Syed Mohsin , H. A. Krishnamurthy
Published: April 2020

Background: Antibiotics are currently the most commonly prescribed drugs in hospitals, worldwide. overuse of antibiotics has important economic implications. Periodic evaluation of drug utilization in the intensive care unit (ICU) is necessary for optimization of health care system, proper use of resources and making prescription policy because ICU is considered as the epi-center of antimicrobial resistance. The aim of this study is to evaluate antibiotic prescription and consumption patterns at admission into intensive care unit and to know the average costs of antibiotics.Methods: The prescription data on 250 consecutive patients at admission into the ICU was audited from January to March 2019. Total antibiotics, dose, route and cost of antibiotics were noted and the defined daily dose/100 bed days of most common antibiotics were calculated. Statistical analysis is done using SPSS software.Results: A total of 689 antibiotics were prescribed in the 250 patients studied that is, an average of 2.28 antibiotics/prescription. Empirical antibiotics were prescribed to all the patients admitted to ICU. Average cost of the antibiotics was rupees 163.89 per patients. The most commonly prescribed antibiotic at ICU admission was ceftriaxone (62%) of all prescription. Second most common is metronidazole (32%). In this study, 76 patients recovered while 174 patients expired.Conclusions: Our study reveals that antibiotics are widely prescribed in critically ill patients and form significant drug consumed in the ICU. At admission elderly patients are prescribed >2 antibiotics and prescribing antibiotics where the cost of antibiotic is high.
Ubrogepant: a new era in migraine treatment
Authors: Bhanwra Sangeeta , Ahluwalia Kaza
Published: April 2020

Migraine is the most common neurological disorder that leads to incapacitating neurological symptoms. Acute attacks of migraine have been dealt with effectively with non-steroidal anti-inflammatory drugs (NSAIDs), ergot derivatives and triptans since long, but their use is limited by various adverse effects. Recent studies have shown that a neuropeptide, calcitonin gene related peptide (CGRP) plays a major role in pathophysiology of migraine by increasing the pain perception, both at the peripheral and central nervous system levels. So, in the last few years, some CGRP antagonists have found their way in the treatment of both episodic and chronic migraine. Ubrogepant is the first oral CGRP antagonist, that was approved by USFDA (United States food and drug administration) in December 2019, for the acute treatment of migraine with or without aura. It is more potent than the earlier CGRP receptor antagonists, has a good oral bioavailability and the risk of hepatotoxicity is also lesser than the previous Gepants.
A study of correlation of pre-operative fine needle aspiration cytology and ultrasonography with post-operative histopathology in thyroid swellings
Authors: Parameshwar Narayanakar Rajkumar , Govinda Shetty Darshan Saligrama
Published: April 2020

Background:Diseases of the thyroid gland can be due to inflammatory and neoplastic causes. Many diagnostic tests like ultrasound, thyroid nuclear scan and fine needle aspiration cytology (FNAC) are available for their evaluation. Histopathologically, they can be adenomas, colloid nodules, cysts, infectious nodules, lymphocytic or granulomatous nodules, congenital abnormalities or hyperplasia, or various types of malignancy. It is therefore crucial to have a clear diagnostic approach to ensure patients are managed appropriately and are not over or under-treated. Present study was done to evaluate FNAC and ultrasonography (USG) as a diagnostic method in thyroid swellings and to plan surgery accordingly.Methods: A prospective observational study was conducted among 60 adult patients undergoing thyroid surgery at Victoria and Bowring and Lady Curzon Hospital. They were investigated with FNAC and USG of thyroid, and were subjected to surgery and subsequent histopathological examination. The histopathological examination reports were correlated with the findings of FNAC and USG in order to evaluate their findings by statistical methods.Results:The sensitivity and specificity of FNAC was 87.5% and 98% respectively. All malignant lesions on FNAC were confirmed by histopathology indicating its excellence. Therefore FNAC helps in planning the correct management and avoids second surgery. And the sensitivity and specificity of USG was 75% and 86% respectively. Therefore combination of both FNAC and ultrasonography will improve the diagnostic accuracy to higher level and helps in better management. Conclusions:FNAC has high sensitivity and specificity, so it is closest to ideal test. However, a combination of both FNAC and ultrasound will give desirable results and so that we can avoid mismanagement.
Quantum of cortico-cancellous bone safe for harvest from anterior iliac wing of pediatric patients: a finite element analysis with clinical correlation
Authors: Tarun Swetha , Pendem Sneha , Raja Krishna Kumar
Published: April 2020

Background: Objective was to assess the maximum quantum of cortico- cancellous bone that can be harvested from the Anterior Iliac Wing (AIW) of paediatric population.Methods: All patients reporting to the unit for the correction of bilateral cleft alveolus were included. A Computed Tomogram (CT) of the hip was recorded and the volume of cancellous bone available for harvest was assessed. Finite element model of the hip was generated using D2P and Geomagic Free form software and the impact of bone harvest on stress distribution along the anterior iliac wing was assessed by substituting the muscle forces (hip abductors and sartorius group) and was clinically correlated to volume harvested and donor site morbidities.Results: 10 patients were enrolled, 5 patients were excluded. CT volumetric evaluation revealed an average 0.5 cc to 4.7 ccof cancellous bone and 6.7 cc to 11 cc of cortical bone was available for harvest. Harvest of 50% of available graft volume was safe with minimal stress distributed along the line joining the tuberosity to the area between Antero Superior and Inferior spines (4.2 MPa at rest and 18.5 MPa at stance). The stress levels increased with increase in volume of bone harvested. Intra operatively 1.9 cc to 6.2 cc of cortico cancellous graft was harvested, which was equivalent to 60% of the graft available with no long-term morbidities.Conclusions: The volume of bone graft harvest should be restricted (up to 6 cc) to avoid long term morbidities.
Comparative study of preservation versus elective division of ilioinguinal nerve on chronic groin pain after lichtenstein tension free inguinal hernia repair
Authors: Chaudhary Renuka , Salim M. , Rao M. Rafik
Published: April 2020

Background: Post-hernioplasty chronic groin pain is one of the most important complications encountered after inguinal hernia repair. Routine ilioinguinal nerve excision has been proposed to avoid chronic post-hernioplasty neuralgia. The study aimed to evaluate the effect of routine ilioinguinal nerve excision compared to nerve preservation on chronic groin pain and other sensory symptoms in lichtenstein inguinal hernia repair.Methods: The study was conducted in the department of general surgery, at S.P. Medical College and PBM Hospital, Bikaner for duration of 15 months from august 2018 to November 2019. A total of 60 patients of uncomplicated inguinal hernia, who met the inclusion criteria, planned for lichtenstein hernioplasty were randomly divided into 2 groups with 30 cases with ilioinguinal nerve preservation (group A) and 30 cases with elective division of the nerve (group B). Follow up was done upto1 year and patients were inquired regarding pain, hypoesthesia and numbness and data was compared and analysed.Results: The incidence of post-operative neuralgia was 23.33% vs 6.67% (p=0.05) at 1 year in group A and group B respectively. The difference in pain was significant in both groups. The incidence of post-operative hypoesthesia was 10% vs 16.67% (p>0.05) at 1 year follow up in group A and group B respectively. The incidence of numbness was 11.11% vs 16.67% (p>0.05) at 1 year in group A and group B respectively. No statistically significant difference was found in both groups.Conclusions: The prophylactic exicision of ilioinguinal nerve during lichtenstein mesh repair decreases the incidence of chronic groin pain after surgery.
Evaluation of pattern and prognostic factors of head injury cases in a tertiary care centre
Authors: Anand Ashish , Verma Surender , Garg Pradeep , Noori M. Taquedis , Kajal Ankur , Verma Anjali
Published: April 2020

Background: Head injury is a major public health problem worldwide and requires appropriate attention both regionally and globally. This study was done to find the patterns and to evaluate prognostic factors for final outcome of cranio-cerebral trauma.Methods: A prospective study of 200 cases of head injury was conducted in a tertiary care hospital during one year duration. Apart from patient’s demographic profile detailed history and examination was recorded. Final outcome of all patients was noted at discharge and during follow up, various prognostic factors were studied by taking Glasgow outcome scale (GOS) at 3 months of head injury.Results: This study included 156 (78%) males and 44 (22%) females with average age of 35.95 years. Assault followed by RTI was the main cause of TBI. The factors which correlated with poor prognosis are presence of increasing age, less GCS at admission, alcohol intoxication and multiple lesions on CT scan.Conclusions: Prognostication of patients with head injury will help to provide timely multimodality approach which will ultimately help in improving outcome of these patients.
Morbidity and mortality in minimally invasive esophagectomy: where do we stand
Authors: Shanmugam Subbiah , Hussain Syed Afroze , Reddy Kishore Kumar
Published: April 2020

Background: The objective of the study was to study morbidity and mortality patterns in patients with carcinoma oesophagus who underwent minimally invasive esophagectomy (MIE) in a tertiary centre for oncology in South India.Methods: This was a retrospective observational study of 20 patients with carcinoma esophagus who underwent minimally invasive esophagectomy in center for oncology, Government Royapettah Hospital. Medical records of all these patients treated from September 2016 to August 2019 were collected from medical records department and details regarding the type of lesion, site of the lesion, preoperative chemoradiotherapy, type of surgery performed and post-operative complications were analyzed.Results: Out of 20 patients who underwent minimally invasive esophagectomy 13 were female and 7 were male. Among these 18 had squamous cell carcinoma, 2 had adenocarcinoma. Thirteen patients had lesion in middle third oesophagus and 7 patients had lesion in lower third oesophagus. Nineteen patients underwent surgery after chemoradiation and one patient underwent upfront surgery. Twelve patients underwent thoracolaparoscopic esophagectomy and 8 patients underwent trans hiatal esophagectomy. Perioperative complications were seen in 8 patients of whom pulmonary complications seen in 6 were most common. Anastomotic leaks occurred in 4 patients of which 2 patients were reoperated. One patient died within 30 days of surgery. Voice change and ECG abnormalities occurred in 2 patients each.Conclusions: Minimally invasive esophagectomy is safe and associated with comparable morbidity. Though the initial learning curve is steep, it helps in faster recovery of the patient. Also, the peri-operative outcome tends to improve with experience.
A prospective study: role of prophylactic antibiotics versus no antibiotics in elective laparoscopic cholecystectomy
Authors: Verma Renu , Mittal Sushil Kumar , Singla Navdeep Kumar
Published: April 2020

Background: Elective gallbladder surgery is the most common abdominal surgical procedure. Antibiotic prophylaxis is a common conduct in open cholecystectomy, but there is ambiguity about the use of prophylactic antibiotics in laparoscopic cholecystectomy. Some surgeons suggest that the elimination of prophylactic antibiotics in patients undergoing elective laparoscopic cholecystectomy increase the incidence of postoperative infective complications but not to a statistically significant degree. The aim of this study was to evaluate the role of prophylactic antibiotics in laparoscopic cholecystectomy.Methods: A total of 100 patients were included and they were randomized in 2 groups of 50 each. Group A was given prophylactic intravenously (IV) antibiotic within 1 hour before surgery and group B was not given any antibiotics. Results were compared and data analyzed statistically using chi-square and t test. Complications in both the groups were compared.Results: Rate of surgical site infections were 6% (n=3) and 4% (n=2) in group A and B respectively; and the difference between them was not found statistically significant. All infections which occurred in present study were superficial surgical site infection. There was no evidence of deep-seated infections and none of the patients developed distant infection. There was no derangement in any of the biochemical parameter in this study.Conclusions: We were not able to demonstrate any significant benefit from addition of prophylactic antibiotics in elective laparoscopic cholecystectomy.
A simplified prognostic scoring and grading system for Fournier’s gangrene
Authors: Sharma Subhash Chandra , Kumar Vipin , Vadher Lalit Govind
Published: April 2020

Background: Fournier’s gangrene is life threatening, necrotizing fasciitis, affecting external genetalia of male greater than female with mortality 7 to 53%. Fournier gangrene severity, LRINR and LNR scoring used to evaluate morbidity and mortality. Aim and objective of our study was to simplify a system, especially for Indian peripheral health centers which can predict mortality, morbidity.Methods: This study was conducted in department of surgery of Teerthankar Mahaveer University. Body mass index, blood urea nitrogen and patient demography used to develop the scoring system with minimum and maximum points and correlated our results.Results: Our simplified scoring system also has a direct bearing on mortality, morbidity, recovery and hospital stay. In our study 3 male and 2 females died.Conclusions: Simplified scoring and grading system will be helpful in predicting the morbidity and mortality, early surgical intervention, hospital stay, time for reconstruction.
Primary lumbar hernia: a rarely encountered ventral hernia
Authors: B. B. Sunil Kumar , Choudhary Ashwini Kumar Kumar , Raghupathi Lavanya
Published: April 2020

Ventral hernia is a fascial defect located on the abdominal wall. Primary ventral hernias are named as umbilical, epigastric, spigelian and lumbar hernias. A lumbar hernia is a parietal wall defect that may occur anywhere in the lumbar region between the 12th rib and the iliac crest. A 47-year-old female, came with complaints of mass in left lower abdomen since 2 months. On clinical examination a defect of 8 × 8 cm was felt in the left lumbar region with positive cough impulse. CECT abdomen and pelvis was done to confirm lumbar hernia. Patient underwent mesh repair for the same. Lumbar and flank hernias are uncommon and are a challenge to treat for any general surgeon. Surgery is considered gold standard either an open mesh repair or laparoscopically.
Gastric Schwannoma mimicking gastrointestinal stromal tumors: a rare case with review of literature
Authors: Bheerappa Nagari , Sharma Digvijoy , Gondu Gangadhar Rao , Raj Nirjhar , Bishnoi Kamal Kishore , Thumma Venu Madhav , Gunturi Suryaramachandra Varma
Published: April 2020

Gastric schwannoma (GS) is a rare neoplasm of the stomach. It accounts for 0.2% of all gastric tumors and is mostly benign, slow-growing, and asymptomatic. Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors and up to 60-70% of GIST occur in the stomach. Schwannoma and GIST have similar radiological and endoscopic features making it extremely difficult to differentiate them preoperatively. Differential diagnosis of these two submucosal tumors is important because of the malignant potential of GIST and the relatively benign course of gastric schwannomas. This case stresses on the importance of including gastric schwannomas in the differential diagnosis of a submucosal gastric mass as it has the ability to mimic a gastrointestinal stromal tumor, which is a leading differential diagnosis because of its common occurrence at this site.
A rare case of spontaneous nephrocutaneous fistula
Authors: Bansod Atish N. , Mirajkar Girish N. , Umalkar Rohan , Mishra Sarvagya , Kumar Ankur , Nadar Premalatha
Published: April 2020

Acute and chronic pyelonephritis are known afflictions to the kidney in diabetics and in patients of abnormal urinary anatomy. And its presentation as a spontaneous sinus opening on the anterior abdominal wall is a rare phenomenon. We present one such rare case of a 71-year-old male with pus discharge from the anterior abdominal wall for 7 months. On investigating, it was found to be a nephrocutaneous fistula arising from the left non-functional kidney. This was dealt with left nephrectomy along with excision of the sinus tract. Though a very rare condition, a possibility of nephrocutaneous fistula must be kept when dealing with discharging sinus in lumbar region.
Comparing the effect of zinc gluconate and placebo in the treatment of tachypnea, dyspnea and fever in children aged 2 to 23 months with acute bronchiolitis
Authors: Ahadi Adel , Mirzarahimi Mehrdad , Barak Manouchehr , Ahari Saeid Sadeghieh , Reyhanian Maryam
Published: April 2020

Background: Acute viral bronchiolitis is the most common infection of the lower respiratory tract in infants under 2 years and is one of the reasons for their admission all around the world. The aim of this study was comparing the effect of zinc gluconate and placebo in the treatment of tachypnea, dyspnea and fever in children aged 2 to 23 months with acute bronchiolitis.

Methods: This randomized clinical trial study has been done on 100 infants aged 2 to 32 months with the diagnosis of bronchiolitis who divided in two groups. 50 patients received zinc gluconate and 50 patients received placebo. The symptoms and sign of the disease at baseline and then at 24, 72, and 7 days after starting treatment and duration of hospitalization were compared between the two groups.

Results: The treatment and placebo groups were similar in respect to mean age and gender distribution. Two groups were similar in terms of clinical symptoms and signs at the time of admission. Bronchiolitis recovery was better in the treatment group than in the placebo group. This positive effect was statistically significant for vising (p=0.023) and rhinorrhea (p=0.027) at 72 hours after starting treatment. The mean duration of hospitalization was significantly less in the treatment group than in the placebo group (4.14±1.21 versus 4.64±1.2 days; p=0.016).

Conclusions: Results showed that the use of zinc gluconate as a zinc supplement in infants with acute bronchiolitis could improve their clinical symptoms and signs and decrease the duration of hospitalization.