bluuebunny/crossref_metadata_2025 huggingface dataset:
Les sites de hauteur en Crète pendant les siècles obscurs
Authors: Monio Nathalie
Published: December 2021

À la fin de l’âge du bronze en Crète, un phénomène particulier fait son apparition. En effet, avec la disparition du pouvoir centralisé et des grands palais, la population se disperse et abandonne les sites en plaine ou le long de la côte au profit de sites en altitude sur des éperons rocheux, ce qui permet aux habitants de profiter de fortifications naturelles. Cet état de fait semble alors montrer que certaines menaces peuvent peser sur les populations de l’époque : guerres civiles, ennemis venant de l’extérieur, bandes de pilleurs…
Une stratégie analytique et opérationnelle pour les transformations du territoire métropolitain de Vérone : paysage-infrastructure
Authors: Perrotti Daniela , Locardi Chiara
Published: December 2021

La recherche ici présentée élabore la méthodologie paysage-infrastructure dans son application au contexte métropolitain de Vérone. Elle se concentre sur l’influence des grandes transformations territoriales engendrées par les nouvelles infrastructures paneuropéennes sur le paysage urbain. Ce dernier est considéré comme infrastructure structurant la relation entre espace libre et espace construit et comme écosystème en évolution continue. La lecture qualitative du potentiel connectif géographique, structural et fonctionnel de chaque aire de développement est menée à travers la description analytique et morphologique de ses marges, lieux médians aux multiples facettes et points de concentration des qualités dynamiques des zones attenantes. La recherche requiert une analyse multicritère des objectifs du projet qui permet l’évaluation commune de différents facteurs, à travers un paramètre unique. Les trois critères évalués sont les microsystèmes qui composent le macrosystème du paysage-infrastructure : sol, patrimoine bâti et infrastructure.
Du tableau à la scène : la couleur dans le jardin paysager en France
Authors: Woronow Ilona
Published: December 2021

Les théoriciens du jardin paysager en France dans la deuxième moitié du XVIIIe siècle en appellent volontiers à la peinture comme modèle de leur art. Le paysagiste, expliquent-ils, doit savoir explorer divers moyens picturaux, dont la couleur. Cependant, le contexte néoclassique, assimilant la couleur au bariolage et à la coquetterie, nécessite sa redéfinition. Aussi, en tant que qualité visuelle, la couleur est admise dans l’arrangement des vues lointaines ou comme moyen d’éducation. Dans les scènes de plaisirs sensuels, elle s’empreint d’autres qualités physiques, comme la texture des matières ou l’arôme des lieux. Dans d’autres contextes, enfin, la couleur étant marginalisée, les nuances visuelles sont perçues en termes de jeux de lumière. L’exploration de la dynamique du clair-obscur rapproche l’art des jardins de l’art dramatique.
Évolution du jardin latin moderne », dans Du paradis au jardin latin
Authors: Rubió y Tudurí Nicolás Marías
Published: December 2021

L’architecte paysagiste Nicolás Marías Rubió y Tudurí naît en 1891 à Minorque. À Barcelone, où il fait ses études, il rencontre Jean Claude Nicolas Forestier avec qui il collabore pour l’aménagement des jardins de Montjuich. Il enseigne l’art des jardins, de 1916 à 1924, à l’Escola de Bells Oficis de Catalogne. En 1917, il est nommé directeur des parcs publics de Barcelone. Puis, pendant la seconde République, il devient responsable du Service de planification urbaine de Catalogne. Peu connue en France, l’œuvre de Nicolás Marías Rubió y Tudurí se partage entre l’architecture, la réalisation de parcs et l’écriture. C’est ainsi qu’il publie Del paraíso al jardín latino, vaste synthèse d’histoire des jardins. Il se propose de montrer comment l’essence du jardin latin ou, mieux, le jardin de la latinité se déploie à travers le temps et innerve tous les autres styles de composition. Dans l’« Evolución del jardín latino moderno », qui constitue le dernier chapitre de cet ouvrage, il traite de l’histoire des jardins de la Renaissance italienne à l’époque moderne. Nous espérons que la traduction de ce passage contribuera à faire connaître, en France, l’œuvre de cet architecte paysagiste et qu’elle ne trahira pas le lyrisme du texte espagnol.
A NOVEL IMAGE PROCESSING ALGORITHM TO AUTOMATICALLY EXTRACT AND CLASSIFY LIVER BEARING TUMORS USING PATTERN RECOGNITION AND FUZZY TRANSFORM
Authors: Narejo Ghous Bakhsh , Siddiqi Ayesha Amir , Hashmi Adnan
Published: December 2021

This study presents a novel liver disease classification method by applying pattern recognition technique to automatically segmented liver from the images of computed tomographic (CT) scans. The methodology comprises of disease classification by the extraction of textural features from focal liver region bearing tumors. Two types of liver textures are investigated in this study for classification accuracy judgement. First, original liver texture is considered for feature extraction. Second, liver is used for feature extraction. The CT image dataset comprises 308 liver samples with 193 samples of malignant tumor and 115 samples of benign tumor. The entire liver tissue bearing tumor is segmented from the CT image automatically in the pre-processing stage using fuzzy transformation function and morphological processing. Four sets of textural feature matrices are applied to the liver for feature extraction. Gray level co-occurrence matrix (GLCM), standard deviation gray level co-occurrence matrix (SDGLCM), seven-moment matrix (7MM) and seven-moment gray level co-occurrence matrix (7MGLCM) are the combinational feature matrices applied to classify the liver as malignant or benign using support vector machines (SVMs). The best classification accuracy is achieved for original liver texture by 7MGLCM, which is 97% with AUC = 0.99 for training dataset and 97.8% with AUC = 1 for test dataset.
Evaluation of a Scenario-Based Socratic Style of Teaching and Learning Practice
Authors: Pal Kamalendu
Published: December 2021

This chapter presents the central features of a knowledge-based system, evaluation method, which is deeply rooted to the principle of the Socratic style learning in law school. Software system evaluation is placed in the context of a hybrid legal intelligent tutoring system, Guidance for Business Merger and Acquisition (GBMA) process. The legal knowledge for GBMA is presented in two forms, as rules and previously decided cases. Besides distinguishing the two different forms of knowledge representation, the chapter outlines the actual use of these forms in a computational framework designed to generate a plausible solution for a given case by using rule-based reasoning (RBR) and case-based reasoning (CBR) in an integrated environment. The nature of the suitability assessment of a solution has been considered as a multiple-criteria decision-making process in GBMA evaluation. The evaluation was performed by a combination of discussions and questionnaires with different user groups in a scenario-based teaching and learning practice.
Medical Device Security
Authors: Al Momin Md Abdullah
Published: December 2021

Implantable medical devices (IMDs) are miniaturized computer systems used to monitor and treat various medical conditions. Examples of IMDs include insulin pumps, artificial pacemakers, neuro-stimulators, and implantable cardiac defibrillators. These devices have adopted wireless communication to help facilitate the care they provide for patients by allowing easier transferal of data or remote control of machine operations. However, with such adoption has come exposure to various security risks and issues that must be addressed due to the close relation of patient health and IMD performance. With patient lives on the line, these security risks pose increasingly real problems. This chapter hopes to provide an overview of these security risks, their proposed solutions, and the limitations on IMD systems which make solving these issues nontrivial. Later, the chapter will analyze the security issues and the history of vulnerabilities in pacemakers to illustrate the theoretical topics by considering a specific device.
Examining the Role of NGOs in Community Water and Sanitation Improvement
Authors: Marley Gordon , Bazaanah Prosper , Oppong Patricia
Published: December 2021

This chapter examined the role of NGOs in water and sanitation improvement and the effects on the residence of Tunayilli in the Sagnarigu District. The design was descriptive. Questionnaires and interview guides were administered to household heads and key informants. Findings revealed that the water and sanitation condition in Tunayilli is generally poor. NGOs play diverse roles including the provision of water and sanitation facilities, community mobilization, and facility maintenance to ensure their sustained usability. However, inadequate funding, weak community mobilization, poor maintenance culture, and low education are challenges to water and sanitation improvement programmes of NGOs in the community. Measures to mitigate these includes increased central government funding, public education, community involvement, enforcement of sanitation by-laws, and regular maintenance of water and sanitation systems in the community. Stakeholders should intensify and sustain their educational campaigns. Meanwhile, by-laws on water and sanitation should be enforced and offenders prosecuted.
Integrated Water Resource Management, Sustainability, and Pollution Abatement in Malawi
Authors: Nojiyeza Innocent Simphiwe
Published: December 2021

With the introduction of IWRM, local government institutions are expected to control water-related pollution, which is often associated with new water resource management, supply, and sanitation responsibilities devolved to them as part of decentralisation. The aim of this study was to look into eco-efficiency, environmental performance, physical scarcity and economic scarcity trends, sustainable variables, and externalities associated with the introduction of IWRM in Malawi. Focus group discussions and interviews were conducted with policymakers and households in Ntcheu, Mangochi, and Balaka. Findings confirmed that the challenges local levels of government face in managing water infrastructure and formulation of pollution control measures are a result of the fact that adoption of IWRM happened without any readiness to do so, especially in terms of water-related pollution control.
Equitable Access to Water at Alfred Duma Local Municipality
Authors: Ndimande Nokuphila
Published: December 2021

Water plays a central role in the life of society. However, factors such as population growth, pollution, and poor allocation and distribution mechanisms place severe pressures on adequate and equitable water supply. The aim of this chapter was to look into equitable water access in the Alfred Duma Local Municipality as well as the ecological governance framework that supports water access in local areas. The chapter also looked at the position of local municipality in water access and the impact of ecological scale on water provision. Many people are still unable to exercise their constitutional right to water in Alfred Duma Local Municipality, where most women feel disempowered, marginalized, and excluded from the process of making water access decisions. This brings challenges to disadvantaged and arginalized groups socially, economically, and environmentally where vulnerable and marginalised groups have no opportunity to equitably benefit from water access.
The Scope and Potential for Mini-Grid Power Systems Based on Biomass Waste for Remote Areas in Sub-Saharan Africa
Authors: Charis Gratitude , Nkhoma Tafadzwa , Danha Gwiranai
Published: December 2021

Sub-Saharan Africa (SSA) has been experiencing an energy crisis. Socio-economic balances depend on access to clean, convenient, and dependable energy. This is critical for remote areas which are off the national grid, necessitating the installation of renewable energy sources such as bioenergy plants. These plants could valorize waste using combustion and gasification or biogas plants. The challenge is to produce a competitive levelized cost of electricity (LCOE). Nations like Germany and Sweden have successfully launched these. SSA can benchmark from these and valorize its biomass wastes. Key issues to consider would be cost-effective supply chains, sustainable harvest rates, after sales support, and good regulatory frameworks. This study was mostly a desktop review with a few field study observations. It was concluded that the stoker fired boiler and landfill gas ‘biomass only' technologies would have the least capital costs, although gasification and anaerobic digestion are also competitive in terms of LCOE.
Unpacking the Resource Curse and Realism Challenges on Economic Development in the Democratic Republic of Congo (DRC)
Authors: Tshinu Germain Miteu
Published: December 2021

The third theme of the book seeks to understand the role of mineral resources in the African continent's socio-economic development. The case study of the DRC is used to understand the role played by the state-owned mining company Gecamines to socio-economic conditions of employees and the country's development at large. Resource curse and realism theories are utilised in this case study to unpack the role of mineral resources to Gecamines employees' access to education and healthcare in particular and to the entire country in general. The chapter employed a case study design with a qualitative approach research in its endeavour of exploring Gecamines' socio-economic contribution to its employees. Semi-structured interviews were conducted with Gecamines' managers, unskilled mine workers, and the Provincial Department of Mines' officers.
The Water-Waste Nexus
Authors: Nhubu Trust , Muzenda Edison , Belaid Mohamed
Published: December 2021

The management of water resources and waste is amongst the major challenges facing the majority of urban environments within developing nations due to the rapid population growth and urbanisation as well as improved lifestyles. The Greater Harare Metropolitan Province is not spared by these management challenges. This chapter proposes a number of scenarios that could be implemented in the short to medium terms to address these challenges within the GHMP from a water-waste nexus approach. The water-waste nexus approach is anticipated to significantly reduce the human health impacts and environmental impacts, specifically the water resources pollution which is responsible for the increase in cost of potable water production subsequently resulting in intermittent potable water supply in the GHMP. The study regards the recovery of energy from the waste generated in the GHMP as an integral component of the approach with the energy recovered used for water, wastewater, and waste treatment.
COMPETÊNCIAS TECNOLÓGICAS: UMA PESQUISA COM PROFESSORES DA EAD
Authors:   Universidade Federal do Amazonas (UFAM), Marihama Diego Kenji de Almeida ,   Universidade Internacional Iberoamericana (UNINI), Battistello Viviane Cristina de Mattos ,   Universidade Feevale, Campos Maria Aparecida Santos e ,   Universidad de Jaén
Published: December 2021

O presente artigo tem como objetivo analisar o nível de conhecimento tecnológico de professores que atuam na Educação a Distância - EaD em instituições de ensino superior no sul do estado de Minas Gerais- Brasil. Visto que o avanço tecnológico educacional representado aqui pelo uso das tecnologias, o acesso aos programas específicos e auxiliares ajudaram a revolucionar a educação no mundo, refletidos nos saberes docentes práticas e respectivamente no fazer docente. Neste sentido, tais necessidades devem estar alinhadas com as estratégias dos gestores, e vivenciadas nas instituições de ensino, como processo de formação continuada. Desse modo, a partir de metodologia quantitativa, analisou-se uma amostra composta por 100 professores de instituições privadas de ensino superior. Para tanto, utilizou-se questionário online, a fim de verificar quais são as competências tecnológicas do referido grupo, com base nos pressupostos teóricos de Moran (2020), Gomes; Saragoça & Domingues (2011) e Veloso & Mill (2018). Os resultados evidenciam que para desempenhar um papel diferenciado é relevante que os professores apresentem competências necessárias e intrínsecas à função dos docentes na EaD, ressaltando o acesso e a logística do Ambiente Virtual de Aprendizagem (AVA), das atividades nos polos presenciais e das intervenções nos diversos espaços e ferramentas tecnológicas.
PÓS-MODERNIDADE EXCLUDENTE PORQUE AS PEDAGOGIAS ALTERNATIVAS TORNAM-SE UMA NÃO-OPÇÃO PARA OS FILHOS DAS FAMÍLIAS MAIS POBRES
Authors:   Universidade Estadual Paulista, Bizelli Thaís Vargas , Barbosa Eliza Maria ,   Universidade Estadual Paulista, Bizelli José Luís ,   Universidade Estadual Paulista, Cruz José Anderson Santos ,   Universidade Estadual Paulista
Published: December 2021

O texto investiga, a partir de pressupostos da pedagogia histórico-crítica, as propostas do aprender a aprender utilizado em escolas Reggio Emilia e Waldorf a partir de métodos construtivistas. A análise é feita através de aprofundamento sobre a bibliografia disponível que trata a questão. Percebe-se claramente nas estratégias das pedagogias alternativas sua inadequação ao cotidiano da escola pública brasileira voltada especialmente aos filhos das camadas mais pobres da população. Três pontos negativos são importantes de serem desvendados sobre as escolas Reggio Emilia e Waldorf: a acomodação a uma lógica que não habilita professores e alunos a enfrentar seu papel histórico; o eximir a escola do seu papel de ensinar; a transferência para a mãe da tarefa de preencher as lacunas do sistema educativo.
TRANSFORMAÇÃO DIGITAL NA EDUCAÇÃO JURÍDICA UM CENÁRIO DISRUPTIVO PARA AS IES
Authors:   Universidade Federal do Amazonas, Paião Olivie Samuel , Rodrigues Horácio Wanderlei ,   Universidade Federal do Rio Grande (FURG), Giani Gutavo ,   Universidade Federal do Amazonas, Alves Felipe Freitas de Araújo ,   Universidade Federal do Amazonas
Published: December 2021

A crescente presença das novas tecnologias na realidade atual provoca impactos em todas as esferas da vida e em todos os lugares, tendo em vista que elas são um fenômeno global. Com efeito, essas incorporações e inserções do digital impactam diretamente na área do Direito, trazendo-se à tona a necessidade de discussão a respeito de como a Educação Jurídica no Brasil se comportará nesse novo cenário. Neste artigo, além da abordagem da educação jurídica sob o aspecto 4.0 – propiciado pela chamada quarta revolução industrial – discute-se como as Instituições de Educação Superior devem se adaptar a esse momento tecnológico, modificar sua postura e seu mindset e incorporar a transformação digital em seu modelo educacional. A pesquisa foi analítica, de base bibliográfica e documental.
Effects of Farinelli Breating Exercise on Respiratory Function and Symptoms in Patients with Chronic Obstructive Pulmonary Disease
Authors: Ittinirundorn Supawit , Wongsaita Naiyana , Somboonviboon Dujrath , Tongtako Wannaporn
Published: December 2021

Background: Farinelli breathing (FB) exercise is a typical breathing exercise used by singers. This study aimed to compare effects of FB exercise and diaphragmatic breathing (DB) exercise on respiratory function and symptoms in patients with chronic obstructive pulmonary disease (COPD).Methods: Sixteen patients aged 51–80 years with mild or moderate COPD were recruited for this study. They were divided into two groups: DB group (n=8) and FB group (n=8). Both groups received complete breathing exercise training five times per week for 8 weeks. Their respiratory functions, COPD symptoms, cytokine levels, and oxidative stress variables were analyzed during pre- and post-tests. Dependent variables were compared between pre- and post-tests using paired t-tests. An independent t-test was used to compare variables between the groups. Differences were considered significant at p<0.05.Results: The maximal expiratory pressure (MEP), maximum oxygen consumption (VO2max), and COPD Assessment Test (CAT) scores changed significantly in the DB group after the 8-week intervention compared to those at pre-test, whereas force vital capacity, forced expiratory volume in the first second, maximum voluntary ventilation, maximal inspiratory pressure (MIP), MEP, VO2max, CAT score, tumor necrosis factor-α, and malondialdehyde level changed significantly in the FB group at post-test compared to those at pre-test. Moreover, both MIP and MEP in the FB group were significantly higher than those in the DB group.Conclusion: FB exercise improved respiratory functions and COPD symptoms of patients with COPD. It might be an alternative breathing exercise in pulmonary rehabilitation programs for patients with COPD.
Basal cell carcinoma trends in Thailand: a 10-year retrospective study of demographic, clinical and histopathological features
Authors: Tiyawatanaroj Anakaporn , Sudtikoonaseth Poonnawis , Chayangsu Onjuta
Published: December 2021

Background: Basal cell carcinoma (BCC) is the most common skin cancer with globally increasing incidence. To date, the information regarding BCC in Thailand is limited.Objective: To evaluate the demographic, clinical, histopathological trends of BCC and other contributing factors.Methods: We retrospectively reviewed the demographic, clinical and histological data of all BCC outpatients from January 2009 to December 2018.Results: From 278 BCC patients recruited to this study, most of them (71.6%) were older than 60 years old. The most common histological subtype was nodular BCC (63.3%). A statistically significant association was observed between histological variant and location of the tumor; H and M area were associated with nodular BCC, L area was related to superficial subtype (p-value < 0.001). Misdiagnosis of BCC was observed in 53 cases, mostly as melanocytic nevus (30.2%), and about quarter (26.4%) was made by board-certified dermatologists.Conclusions: Nodular BCC is significantly associated with H and M area, while superficial subtype is related to L location. Quarter of the patients already have large tumors at their first presentation. Misdiagnosis of BCC is not uncommon.
A complex unit for a complex disease: the HCM-Family Unit
Authors: Vriz Olga , AlSergani Hani , Elshaer Ahmed Nahid , Shaik Abdullah , Mushtaq Ali Hassan , Lioncino Michele , Alamro Bandar , Monda Emanuele , Caiazza Martina , Mauro Ciro , Bossone Eduardo , Al-Hassnan Zuhair N. , Albert-Brotons Dimpna , Limongelli Giuseppe
Published: December 2021

Hypertrophic cardiomyopathy (HCM) is a group of heterogeneous disorders that are most commonly passed on in a heritable manner. It is a relatively rare disease around the globe, but due to increased rates of consanguinity within the Kingdom of Saudi Arabia, we speculate a high incidence of undiagnosed cases. The aim of this paper is to elucidate a systematic approach in dealing with HCM patients and since HCM has variable presentation, we have summarized differentials for diagnosis and how different subtypes and genes can have an impact on the clinical picture, management and prognosis. Moreover, we propose a referral multi-disciplinary team HCM-Family Unit in Saudi Arabia and an integrated role in a network between King Faisal Hospital and Inherited and Rare Cardiovascular Disease Unit-Monaldi Hospital, Italy (among the 24 excellence centers of the European Reference Network (ERN) GUARD-Heart).
 
Graphical Abstract
Insulin Resistance: From Mechanisms to Therapeutic Strategies
Authors: Lee Shin-Hae , Park Shi-Young , Choi Cheol Soo
Published: December 2021

Insulin resistance is the pivotal pathogenic component of many metabolic diseases, including type 2 diabetes mellitus, and is defined as a state of reduced responsiveness of insulin-targeting tissues to physiological levels of insulin. Although the underlying mechanism of insulin resistance is not fully understood, several credible theories have been proposed. In this review, we summarize the functions of insulin in glucose metabolism in typical metabolic tissues and describe the mechanisms proposed to underlie insulin resistance, that is, ectopic lipid accumulation in liver and skeletal muscle, endoplasmic reticulum stress, and inflammation. In addition, we suggest potential therapeutic strategies for addressing insulin resistance.
A Position Statement of the Utilization and Support Status of Continuous Glucose Monitoring in Korea
Authors: Kim Won Jun , Kim Jae Hyun , Yoo Hye Jin , Son Jang Won , Khang Ah Reum , Kwon Su Kyoung , Kim Ji Hye , Kim Tae Ho , Ryu Ohk Hyun , Park Kyeong Hye , Song Sun Ok , Lee Kang-Woo , Lee Woo Je , Jung Jung Hwa , Cho Ho-Chan , Gu Min Jeong , Lee Jeongrim , Ju Dal Lae , Lee Yeon Hee , Kim Eun Kyung , Eom Young Sil , Yu Sung Hoon , Kim Chong Hwa ,   Committee of the Health Insurance and Government Relation, Korean Diabetes Association
Published: December 2021

The accuracy and convenience of continuous glucose monitoring (CGM), which efficiently evaluates glycemic variability and hypoglycemia, are improving. There are two types of CGM: professional CGM and personal CGM. Personal CGM is subdivided into real-time CGM (rt-CGM) and intermittently scanned CGM (isCGM). CGM is being emphasized in both domestic and foreign diabetes management guidelines. Regardless of age or type of diabetes, CGM is useful for diabetic patients undergoing multiple insulin injection therapy or using an insulin pump. rt-CGM is recommended for all adults with type 1 diabetes (T1D), and can also be used in type 2 diabetes (T2D) treatments using multiple insulin injections. In some cases, short-term or intermittent use of CGM may be helpful for patients with T2D who use insulin therapy other than multiple insulin injections and/or oral hypoglycemic agents. CGM can help to achieve A1C targets in diabetes patients during pregnancy. CGM is a safe and cost-effective alternative to self-monitoring blood glucose in T1D and some T2D patients. CGM used in diabetes management works optimally with proper education, training, and follow up. To achieve the activation of CGM and its associated benefits, it is necessary to secure sufficient repetitive training and time for data analysis, management, and education. Various supports such as compensation, insurance coverage expansion, and reimbursement are required to increase the effectiveness of CGM while considering the scale of benefit recipients, policy priorities, and financial requirements.
Radar remote sensing for application in forestry: a literature review for investigators and potential users of SAR data in Canada
Authors: Werle D
Published: December 2021

Information provided in this document allows potential users of synthetic aperture radar (SAR) imagery as well as investigators participating in the Canadian Radar Data Development Program (RDDP) to obtain an overview of achievements, limitations and future
potential of radar remote sensing for application in forestry, as portrayed in the published literature. Investigations concerned with radar remote sensing and its potential for application in forestry are reviewed. The main focus of these studies was the determination of microwave backscatter
characteristics of forestry targets using different radar parameters, such as frequency, polarizations and incidence angle. Examples of selected targets include the following: coniferous and deciduous tree species, stands of different structure, age, tree height, clearcuts, or forestry environments
in general as they change with the seasons. More than 75 studies based on airborne imaging radar, spaceborne radar as well as scatterometer data have been considered. Previous reviews which summarize information available in western Europe and North America are briefly introduced. Then, recent
investigations covering the time period from the early 1980's onward are portrayed and discussed. The main results are summarized in a set of conclusions, followed by list of selected references and a list of Canadian institutions and organizations currently involved in radar remote sensing
R&D for application in forestry.
Quality of Care for Patients with Acute Coronary Syndrome
Authors: Zhao Dong , Smith Sidney C.
Published: December 2021

Acute coronary syndrome (ACS) is a severe clinical manifestation of ischemic heart disease with a high risk of death. The quality of care provided by the health system and medical providers to patients with ACS in daily clinical practice determines the likelihood of desired health outcomes or prognosis. This review provides an overview of several key issues in the quality of care for ACS, including how to measure the quality of care for ACS and the main strategies to improve the quality of care for ACS patients in both the acute and chronic phases. Efforts to improve the quality of care for ACS through specific programs in Western countries and in China are also described.
Study of Laboratory Parameters in COVID-19 Patients at a Tertiary Care Teaching Hospital in Uttar Pradesh
Authors: Puri Sarandeep Singh , Singhal Parul , Singhal Seema
Published: December 2021

Introduction:

COVID-19 infection has been affecting vast population all over the world since 2019. It is very important to make optimum use of routine laboratory parameters in evaluating severity of COVID-19 disease. This will help the clinicians to improve allocation of technical human resources to patients who require it the most. During the path of the COVID-19 disease, inflammatory indices such as lactate dehydrogenase (LDH), C-reactive protein (CRP), interleukin-6 (IL-6), biomarkers like serum procalcitonin (PCT), and ferritin and indices of coagulation profile like D-Dimer, PT levels, and hematological parameters like total leukocyte count, platelets carry prognostic value. The objective of the study is to estimate the utility of various laboratory Biochemical and Hematological parameters in COVID-19 disease.

Materials and Methods:

The present study is a retrospective cross-sectional observational study conducted in tertiary care rural teaching hospital. The study was conducted from September 1, 2020, to January 31, 2021. The study was carried out on the patients who were hospitalized in Isolation Ward and COVID ICU in our L3 COVID hospital. All patients with positive SARS-CoV-2 nucleic acid test results were included in the study. A sample size of 310 patients was taken. The basic demographic details were collected from the admission records. The confirmatory test for SARS-CoV-2 was done using the WHO-approved kits based on real-time reverse transcription polymerase chain reaction for which suspected cases underwent nasopharyngeal/oropharyngeal swab testing. The levels of CRP, IL-6, PCT, ferritin LDH, D-dimer, complete blood counts, PT were based on standardized methods obtained using various biochemical and hematological laboratory analyzers. Data of investigation reports were gathered from electronic patient record system. Statistical analysis was performed using the Statistical Package for the Social Sciences for Windows (version 25.0).

Results:

Our study clearly shows that levels of IL-6, D Dimer, PT, and LDH are quite significantly raised in majority of patients while PCT and ferritin being somewhat nonspecific show an increase but not to that significant numbers. The hematological parameters show levels which indicate mild anemia, leukocytosis, neutrophilia, lymphopenia, and thrombocytopenia in patients infected with COVID-19 disease.

Conclusion:

COVID-19 is an unexplored, new entity with a sudden worldwide onset. The medical fraternity is yet to conquer and analyse this novel virus.
Cytological Grading of Prostate Carcinoma
Authors: Kala Chayanika , Bajpai Ashutosh , Kala Sanjay , Khan Lubna
Published: December 2021

Introduction:

The Gleason grading system is one of the most powerful prognostic predictors of carcinoma prostate. In 2014, a newer grading system, the International Society of Urologic Pathology (ISUP) grading system was proposed. The present study is a retrospective study conducted to compare the cytological grading of prostate carcinoma with the newly proposed ISUP grading system for prostate carcinoma.

Materials and Methods:

The present study is a retrospective study that included 42 cases of carcinoma prostate. The clinical data of the cases, fine-needle aspiration cytology slides, and histological slides were retrieved and reviewed. The cases were regraded using the ISUP grading system for prostate carcinoma. Statistical analysis was done using the Statistical Package for the Social Sciences (SPSS). Data were statistically analyzed and Chi-square testing was used to compare the two grading systems.

Results:

A total of 42 cases were studied. The preoperative grade was assigned to the smears and 26.19% (11 cases) were categorized as grade 1, 40.47% (17 cases) as grade 2, and 33.3% (14 cases) as grade 3. Histological sections were also graded according to the ISUP/grade groups (GG) system and 26.19% (11 cases) were graded as GG 1, 33.3% (14 cases) as GG2, 19.04% (8 cases) as GG3, 16.67% (7 cases) as GG4, and 4.47% (2 cases) as GG5.

Conclusion:

In the present study, it was concluded that there is a direct concordance between the histologic grade as proposed in the ISUP grading system and the cytologic grade on FNA.
The Impact of Interaction with Orphanage Children on Quality of Life of Elderly Females Residing in Old-Age Homes in a South Indian District
Authors: Jeeragyal Devika Pandurang , Udayar Sharvanan Eshwar , Annadani Rachana R , Undi Malatesh
Published: December 2021

Introduction:

Improving the quality of life (QOL) of the elderly has been one of the crucial challenges of public health with increasing life expectancy. The study was done to assess the impact on QOL and psychiatric morbidities among elderly females in old age homes (OAH) who had interaction with orphanage children.

Materials and Methods:

An analytical cross-sectional study was conducted among 105 elderly females who were residing in OAHs in Chittoor District, India, from Sep–Dec 2019. Data were collected using older people's QOL scale, Hamilton's Scales (HAM-A and HAM-D). Ethical approval was obtained from the Institutional Ethics Committee. Data were analyzed using the Statistical Package for the Social Sciences (SPSS), software version 20.

Results:

About 82.9% of elderly females in OAHs who were interacting with orphanage children had good QOL when compared to those who were not (8.6%). A significant difference was observed in domains scores for overall life, independent home and neighborhood, psychological and emotional well-being, and religion in the elderly who were interacting with orphanage children when compared to those who did not. Mean scores for depression and anxiety were significantly higher (P = 0.001) in those who were not interacting with the orphanage children (23.23, 43.74) than with interaction (13.46, 43.74).

Conclusions:

Overall QOL was better in elderly females who had interaction with orphanage children when compared to those who did not. Furthermore, psychiatric morbidities (depression and anxiety) were significantly higher in those who were not having interaction with orphanage children than those with interaction (P = 0.001).
A Rare and Challenging Renal Transplant in a Child with Complex Congenital Defects - A Case Report
Authors: Kumar Bharath N. , Baliga Krishna V. , Sandhu Arjun Singh
Published: December 2021

Renal insufficiency is a distinct possibility in patients with congenital lower urinary tract abnormalities even though they are managed right from early childhood. Previously, such patients were not considered candidates for renal transplantation due to the fear of abnormal bladder affecting the graft kidney too. In the current era, it has been shown that the graft and patient survival rates are similar in such patients to those with normal lower urinary tract, if the urological abnormalities are managed well, before the transplantation. We present a case of successful renal transplantation in a pediatric patient with renal insufficiency due to pure urogenital sinus.
A Comparative Analysis of Live-Related ABO-Incompatible and ABO-Compatible Renal Transplantation
Authors: Yachha Monika , Sharma Raj Kumar , Mehrotra Sonia , Prasad Narayan , Gupta Amit , Bhadauria Dharmendra S. , Kaul Anupama
Published: December 2021

Background:

ABO incompatible (ABOi) transplantation is a relatively newer option for renal transplant. Despite the encouraging results and the presence of organ shortage, it is still not routine in many developing countries. This can be attributed to the lack of experience, lack of technical infrastructure, and financial limitations.

Objectives:

Our study aimed to compare the outcomes of living-donor ABOi renal transplantation with matched recipients of ABO-compatible (ABOc) transplantation. We also assessed the impact of Vitamin D deficiency on posttransplant outcomes in terms of graft function and rejections in these groups.

Methods:

We retrospectively analyzed the results of 33 ABOi living-donor kidney transplants performed between January 2013 and June 2016 at our center. We compared patient and graft survival, acute rejection episodes, Vitamin D status, and graft function of the ABOi group with an equal number of matched live-related ABOc KTs done during the same time period.

Results:

The patient survival in both the groups was 97%; however, death-censored graft survival was 94% in the ABOi recipients versus 100% in ABOc group over a mean follow-up of 14–15 months, respectively. Graft function was overall better in the ABOc recipients, with statistical significance seen at 6 and 12 months posttransplant. We also observed a significantly higher incidence of acute antibody-mediated rejections (ABMRs) in the ABOi cohort, with 11 episodes of ABMR versus just 2 in the ABOc recipients (P = 0.005). Vitamin D deficiency was associated with higher levels of anti-ABO antibody and increased development of ABMR due to anti-ABO antibodies (P = 0.01).

Conclusions:

ABO incompatible transplantation is an option with excellent patient and graft survival; results almost comparable to the ABO compatible grafts. However, in our study, ABOi transplants were associated with higher risk of acute ABMR. These episodes were amenable to treatment, and thus, the overall graft survival had similar outcomes. Vitamin D deficiency was associated with increased ABMR in ABOi cohort of renal transplantation.
COVID-19–Associated Rhino-Orbital-Cerebral Mucormycosis
Authors: Bhattacharyya Anusuya , Sarma Phulen , Kaur Hardeep , Kumar Subodh , Bhattacharyya Jaimini , Prajapat Manisha , Prakash Ajay , Sharma Saurabh , Reddy Dibbanti Harikrishna , Thota Prasad , Bansal Seema , Gautam Bhaswati Sharma , Medhi Bikash
Published: December 2021

BACKGROUND:

Till now, no meta-analysis is available to address the clinical profile, risk factors, different interventions, and outcomes among COVID-19–associated rhino-orbito-cerebral mucormycosis (C-ROCM) cases.

MATERIALS AND METHODS:

Eight literature databases were screened using appropriate keywords from November 1, 2019, to June 30, 2021. The objectives were to analyze the clinical and microbiological profile, risk factor/comorbidity, intervention, and outcome. “R-metafor package” was used for analysis.

RESULTS:

A total of 23 studies were included. The mean age of presentation of C-ROCM was 54.6 years. The most common presentation was ptosis (72.7%), lid edema (60.6%), proptosis (60.6%), ophthalmoplegia (57.3%), loss of vision (53.7%), facial edema (34.7%), and nasal-blockage (11.8%). Evidence of intracranial spread was seen in 42.8% of cases. Rhizopus was the most common fungus (57.1%) isolated in fungal culture. Among C-ROCM patients, diabetes was the commonest comorbid condition, and the use of corticosteroids related to COVID-19 treatment was the most common risk factor (85.75%). Compared to controlled diabetics, C-ROCM was significantly higher among uncontrolled diabetics (odds ratio [OR] 0.15, 95% confidence interval [C.I.] 0.041–0.544, P = 0.0010). However, no significant association was seen between C-ROCM and COVID-19 severity (OR 0.930, 95% C.I. 0.212–4.087, P = 0.923). For treatment, amphotericin-B was the most common antifungal drug used which was followed by surgical options. However, mortality was high (prevalence 0.344, 95% C.I. 0.205–0.403) despite treatment.

CONCLUSION:

Although local rhino-orbito symptoms were the first to appear, rapid intracranial extension was seen in a significant number of C-ROCM cases. Uncontrolled diabetes and excessive use of corticosteroid were the most common risk factors present among the C-ROCM cases. High index clinical suspicion is imperative (specifically among COVID-19 patients with diabetes), and routine screening may be helpful.
Pharmacodynamic and pharmacokinetic interaction of losartan with glimepiride-metformin combination in rats and rabbits
Authors: Nagaraju Beere , Anilkumar KV
Published: December 2021

OBJECTIVES:

The presence of comorbidities such as cardiovascular disease, peripheral vascular disease, and chronic renal disease, or and the prevention of these ailments in diabetics, frequently demands multiple drug treatments, increasing the risk of drug-drug interactions (DDIs). The current study was focused on identifying possible DDIs on concomitant administration of losartan, a drug used to regulate hypertension along with a combination of glimepiride + metformin, widely used to treat diabetes mellitus. Possible pharmacodynamic and pharmacokinetic interactions were observed for, following single-dose as well as multiple-dose treatment protocols in normal and alloxan-induced diabetes in albino Wistar rats and rabbits.

MATERIALS AND METHODS:

Blood samples from surviving rats/rabbits obtained through orbital venous sinus bleeding/marginal ear vein bleeding, respectively, at predetermined intervals and put through to biochemical estimations of sugar level in the blood by Glucose oxidase/peroxidase method; insulin levels in serum using the enzyme-linked immunosorbent assay and serum glimepiride levels using the high-performance liquid chromatography.

RESULTS AND DISCUSSION:

Losartan, when treated as a single drug, resulted in a slight lowering of blood glucose levels in normal rats, diabetic rats and normal rabbits. Hypoglycemic activity of a combination of glimepiride + metformin was enhanced when losartan was co-administered as a single dosage schedule as well as a multiple dose schedule as indicated by a reduced blood glucose level and enhanced levels of insulin in rats as well as in rabbits. Serum glimepiride levels were also higher and pharmacokinetic parameters of glimepiride including mean residence time, Cmax, T1/2, AUMC0-∞, AUMC0-t, and AUC0-∞, were significantly higher, whereas its clearance was decreased in the two regimens of losartan that was followed.

CONCLUSION:

It can therefore be concluded, that in diabetics with hypertension as a comorbidity condition, co-administration of losartan with glimepiride + metformin should be avoided or the dosage of a combination of glimepiride + metformin needs to be tittered to avoid recurrence of hypoglycemic episodes.
Age at Natural Menopause; A Data Mining Approach (Data from the National Health and Nutrition Examination Survey 2013-2014)
Authors: Alinia Tahereh , Khodakarim Soheila , Tehrani Fahimeh Ramezani , Sabour Siamak
Published: December 2021

Background:

The timing of the age at which menopause occurs varies among female populations. This variation is attributed to genetic and environmental factors. This study aims to investigate the determinants of early and late-onset menopause.

Methods:

We used data from the National Health and Nutrition Examination Survey 2013-2014 for 762 naturally menopause women. Data on sociodemographic, lifestyle, examination, and laboratory characteristics were examined. We used random forest (RF), support vector machine (SVM), and logistic regression (LR) to identify important determinants of early and late-onset menopause. We compared the performance of models using sensitivity, specificity, Brier score, and area under the receiver operating characteristic (AUROC). The top determinants were assessed by using the best performing models, using the mean decease in Gini.

Results:

Random forest outperformed LR and SVM with overall AUROC 99% for identifying related factors of early and late-onset menopause (Brier score: 0.051 for early and 0.005 for late-onset menopause). Vitamin B12 and age at menarche were strongly related to early menopause. Also, methylmalonic acid (MMA), vitamin D, body mass index (BMI) were among the top highly ranked factors contributing to early menopause. Features such as age at menarche, MMA, sex hormone-binding globulin (SHBG), BMI, vitamin B12 were the most important covariate for late-onset menopause.

Conclusions:

Menarche age and BMI are among the important contributors of early and late-onset menopause. More research on the association between vitamin D, vitamin B12, SHBG, and menopause timing is required which will produce invaluable information for better prediction of menopause timing.
Female anterior urethral wall leiomyoma
Authors: Reddy Pogula Veda Murthy , Galeti Ershad Hussain , Qazi Ifrah Ahmad , Galeti Ayesha
Published: December 2021

Leiomyomas are benign mesenchymal tumors commonly presenting as uterine masses. They are most frequently seen in females during the reproductive age. Extrauterine leiomyomas are rarely seen and primarily observed in the genitourinary tract. In general, patients come up with soft-tissue mass near the urethral meatus and urinary symptoms. We report a case of distal urethral leiomyoma in a 34-year-old woman who presented with periurethral mass with a history of hematuria and dysuria. She underwent complete excision of the mass. Due to their unusual location, these leiomyomas should be treated with great care during surgery. Postsurgery, the patient remained asymptomatic, and there was no evidence of recurrence in the follow-up.
Atypical cutaneous manifestations in lupus erythematosus
Authors: Koshy Soumya Mary , Rajamohanan Remya Raj , Ganguly Satyaki , Ramdas Anita , Kuruvila Sheela
Published: December 2021

Systemic lupus erythematosus (SLE) can present with a wide morphological spectrum of cutaneous manifestations. In addition to its classical cutaneous presentations such as malar rash, discoid rash, annular, or papulosquamous lesions, there can also be a few unusual manifestations. We present a report of three patients evaluated in a tertiary care center satisfying the Systemic Lupus International Collaborating Clinics criteria for SLE and presenting with unusual manifestations such as bullous lesions, toxic epidermal necrolysis like picture, and coexisting with pemphigus foliaceous.
Use of hydrocolloid dressing to achieve seal in vacuum-assisted closure therapy in anatomically challenging regions
Authors: Victor Jonathan , Jaganathan Vijay , Rao Tanvi , Lingam Pappu
Published: December 2021

In certain anatomical regions achieving seal in the VAC, dressing is challenging. Inadequate seal during VAC therapy can make the therapy ineffective and also leads to wastage of resources. The use of strips of hydrocolloid dressing around the wound can achieve seal when using VAC therapy in these regions. We present our clinical experience with a case series of four patients in whom this technique was used. Hydrocolloid dressings being easily available in most clinical settings and being cost-effective also, this technique can be a simple, readily available solution for a commonly encountered problem during VAC therapy.