bluuebunny/crossref_metadata_2025 huggingface dataset:
Diaphragmatic fenestration an effective treatment for refractory postoperative chylothorax: a case report
Authors: Akanbi Oluwaseun R. , Vaidyanathan Swaminathan , Agarwal Prakash , Musthafa Janeel , Solomon Neville A. G.
Published: January 2020

Postoperative chylothorax remains a clinical challenge to the surgeon with substantial morbidity and risk of mortality. Though an uncommon complication, it is known to complicate cardiac and non-cardiac thoracic surgeries. Conservative measures are first employed in managing this. Surgical options are adopted when the effusion is protracted, most recent of which includes diaphragmatic fenestration. A 9-year-old girl is presented who developed recurrent right chylothorax following thoracoscopic excision of a cystic lymphangioma. Following failed conservative therapy, she had thoracic duct ligation and right diaphragmatic fenestration (using fenestrated polytetrafluoroethylene patch) with satisfactory outcome. Aetio-pathologic mechanisms implicated in postoperative chylothorax have been classified into traumatic (iatrogenic injury to the thoracic duct or its branches) and non-traumatic. With initial conservative measures (repeated pleural aspirations and intercostal drainage, medium chain triglyceride/ low fat feeds or alternatively, fasting and total parenteral nutrition) spontaneous closure remains unpredictable. Diaphragmatic fenestration when employed resulted in faster resolution of effusion and earlier commencement of enteral feeding with no significant complication. Diaphragmatic fenestration is effective and safe for treating refractory post-operative chylothorax.
Retinoblastoma or Neuroblastoma: an imaging polemic issues
Authors: Giri Winda W. , Anandasari Yuli , Margiani Ni Nyoman , Ayusta Dwija Putra , Ariawati Ketut , Dewi Sri Mahendra
Published: January 2020

Both retinoblastoma and neuroblastoma are common childhood malignancy, which classified as malignant round cell tumors, but have different diagnostic, therapeutic, prognostic criteria and metastases pattern. A case was evaluated with an imaging examination resembled neuroblastoma metastatic process but was diagnosed as retinoblastoma. A 2-years-old boy came with chief complaint swollen right eye. Prior history was itchy and increasingly swollen right eye, decreased vision and gradually increases pain. There was no sign of leukocoria. Histopathology result confirmed malignant round cell tumor. Axial contrast-enhanced head CT image, depicted right intra orbital mass, 1.9x2x1.8 cm in size as well as mass in the right frontoparietal region which pushed the right frontal lobe, accompanied by erosion and periosteal reaction in the surrounding bone with meningeal and soft tissue involvement. In this case, although there was no leukocoria as the diagnostic criteria for retinoblastoma, we still found intraorbital and pineal body mass also malignancies in several long bones. The diagnosis of trilateral retinoblastoma has been established followed by retinoblastoma’s chemotherapy regiment, which showed good response, in spite of discrepancy in retinoblastoma’s metastases pattern. A complete systemic workup includes CT scan examination needs to be perform in order to help the clinicians determine the diagnosis of orbital mass with malignant round cell histopathology.
Clinicopathological features and management of gastric cancer in Port Harcourt
Authors: Manuel Amabra Dodiyi , Danagogo Okigbeye
Published: January 2020

Background: Gastric cancer is a relatively common cancer and has been documented as the 5th commonest cancer worldwide and the 3rd leading cause of cancer death. Surgery is the treatment of choice for operable cases while chemotherapy. It has a poor prognosis with a relative overall 5-year survival rate of 18%.Methods: This is a retrospective study of all patients that presented with gastric cancer to University of Port Harcourt Teaching Hospital between 1st January 2008 to 31st December 2017. Data were extracted and analyzed using the Statistical Package for Social Sciences (SPSS).Results: There were 14 males and 12 females seen within the study period making a male to female ratio of 1.2:1. Their ages ranged from 35 to 75 years with a mean of 54.7±4.8 years. The peak age incidence is in the 61-70-year age range. Four patients had curative surgery (D2 sub total gastrectomy) while 6 patients (23.1%) had D1 sub total gastrectomy. Post-operative complications occurred in 7 patients (26.9%). And the commonest was surgical site infection, seen in 4 patients (15.4%). Three patients died giving a mortality rate of 11.5%.Conclusions: Most patients with gastric cancer present with advance disease. The choice of treatment should be based on patient’s fitness, survival benefit and after an accurate assessment of extent of disease.
Comparison of two analgesic block techniques for circumcision: dorsal penile nerve block and caudal block
Authors: Gokalp Fatih , Karsli Onur
Published: January 2020

Background: Circumcision is most common and oldest surgery but also could be frightening for children because of postoperative pain. Authors aim to evaluate postoperative pain conditions of patients by using the visual pain scale (VPS).Methods: Between 2016 and 2018, 168 children undergone circumcision. The patients were splitted into three groups depend on their anesthetic care; the dorsal penile block (DPNB), caudal block (CB) and combine block.Results: The mean age were 95.3±20.9 (65-186) months. There was no significant difference between the CB and combine block in VPS at 1st, 3rd hours and second days (p=0.19, p=0.39 and p=0.9 respectively). The VPS significantly higher in the DPNB arm when compared with caudal and combine block arm at 1st and 3rd hours (p<0.01 and p<0.01 respectively) but there was no significant difference between the DPNB and caudal block at second days (p=0.9). There was no significant difference between groups for analgesic requirements (p=0.07). Incidences of nausea and vomiting were seen rarely especially in the DPNB arm and the difference was not statistically significant among the groups (p=0.9).Conclusions: CB and DPNB are effective techniques for pain relief following penile surgery. CB has superior to DPNB at 1st and 3rd hours but no difference at follow up. Both techniques are appropriate methods for postoperative pain relief.
Role of total calcium and corrected calcium in comparisons with computed tomography to predict severity of acute pancreatitis
Authors: Thakur Anjali , Goyal Gitanjali , Aggarwal Simmi , Singh Sarabjeet
Published: January 2020

Background: The objective of the study was to evaluate corrected calcium levels in patient of acute pancreatitis and to evaluate role of corrected calcium as predictor of severity in acute pancreatitis in comparison to computed tomography (CT) scan.Methods: The study was conducted in Department of Biochemistry of G.G.S Medical College in collaboration with the Department of Surgery and Department of Radio diagnosis. 50 patients, with clinical diagnosis of acute pancreatitis, attending the Inpatient Department of Department of Surgery, were taken. 50 patients, of either sex of 18 to 70 age groups suffering from acute pancreatitis were enrolled for the study.Results: On exploring the data, highly significant negative correlation found between CT severity index (CTSI) and serum calcium (p≤0.001; r value=-0.520) whereas the non-significant correlation found between CTSI and amylase (p=0.778; r value=-0.041). The corrected calcium and CTSI shows highly negative significant correlation (p≤0.001; r value=-0.654). Serum albumin with CTSI also shows significant correlation (p=0.006; r value=0.385). But no significant association with lipase (p≥0.05).Conclusions: We observed that corrected calcium and calcium is better and alternative marker for predicating the severity of disease because corrected calcium and calcium is having good positive predictive value to indicate progression of damage and also a highly significant negative predictive value to rule out severity of acute pancreatitis.
An observational study on peritoneal fluid bacteriology in cases of gastrointestinal perforations, antibiotic management and outcome in tertiary care center
Authors: Kishore R. Venkata Ravi , Ashwin K. , Vasanth Kumar S. B.
Published: January 2020

Background: Perforative peritonitis is one of the most common surgical emergencies in India. Perforation of the intestines results in the potential for bacterial contamination resulting in peritonitis.Methods: A total of 65 patients (January 2018 to Dec 2018) who presented with features of perforative peritonitis admitted to various surgical units of PES institute of medical sciences, Kuppam were included in this study. The following study was conducted to analyze bacteriology of peritoneal fluid, to assess antibiotic sensitivity pattern, to assess its impact on morbidity, mortality pattern in these cases.Results: Males outnumbered females with a ratio of 4.9:1. The most common site of perforation was pre-pyloric part of stomach (35.3%), followed by an appendix (33.8%). Peritoneal fluid was negative for culture (21.5%) in the majority of cases. Culture was positive for E. coli in 27.6% of cases and Klebsiella in 18.4% of cases, respectively. Majority of the isolated strains were sensitive to cephalosporins, quinolones, aminoglycosides. Most common postoperative complications were wound infection, respiratory complications, death.Conclusions: Studies have shown that delay in management and treatment will affect the prognosis. Empiric antimicrobial therapy is initiated and changed accordingly with peritoneal fluid culture sensitivity reports. This may reduce the incidence of postoperative complications, morbidity, and mortality.
Plastic surgery in Ladakh: a novel initiative in trans Himalaya of India
Authors: Deskit Padma , Srivastava R. K.
Published: January 2020

Background: The super speciality care is not available in remote places in India. But the service of the plastic surgery can be taken to the remote district hospital by arranging plastic surgery camps thereby resulting in service to the poor, capacity building of the local doctors and infrastructure development of the remote hospital.Methods: It is a retrospective study, in which the author analysed the feasibility, management, difficulties and achievement of week long, annual plastic surgery camp in remote set up of a district hospital of Ladakh over three year from 2017 to 2019.Results: A total of 341 patients were included in this study of which 108 underwent various surgical interventions. The youngest operated was 5 months old and oldest was 86 years. Wide spectrum of deformity were seen and operated upon. Complication developed in only six patients (5.5%) which were managed successfully at Leh only. The immediate and long term follow-up result show no difference in surgical result as compared to those compared operated outside with negligible financial burden.Conclusions: Keeping in view the positive outcome, it is argued through this paper that such camps should be replicated in other remote locations all over India.
Patterns of complications and outcome of laparoscopic cholecystectomy
Authors: Chand Prem , Kundal Shivanshu , Singh Savijot , Papneja Sangam , Singh Jaspal
Published: January 2020

Background: Cholelithiasis is known to be one of the most common biliary pathologies. Laparoscopic cholecystectomy is the gold standard for the removal of the gallbladder, because of its cosmetic benefit, short stay, cost-effective and lesser side effects. But no procedure is immune to complications and other procedure-related side effects. The present study was conducted to study the patterns of complications and outcome of laparoscopic cholecystectomy.Methods: the present study was conducted prospectively on patients undergoing laparoscopic cholecystectomy for symptomatic gall bladder pathology. the patients undergoing laparoscopic cholecystectomy were distributed and analysed on various parameters i.e. age, sex, ultrasound abdomen findings, complications related to access, per-operative condition of gallbladder, per-operative and postoperative complication.Results: In our study cases major complication rate 1% leading to biliary stricture for which hepaticojejunostomy was done, minor complication rate 11% and conversion to open cholecystectomy rate 2%.Conclusions: It is concluded that laparoscopic cholecystectomy is the safe and standard procedure for the laparoscopic cholecystectomy and its major complication are preventable by strictly following the basic principles of laparoscopic cholecystectomy and keeping a low level of the threshold for converting to open cholecystectomy.
A clinical study of undescended testes
Authors: Shariff Nawaz A. , M. S. Ahmad Ashraf
Published: January 2020

Background: The aim of the present study was to study the clinical presentation of undescended testis (UDT) as regards to age, position, side and study the management on UDT.Methods: Total 41 patients, 50 UDT cases were studied prospectively. Patients below the age of 15 years with history of absent testes in the scrotum were included in the study and patients with retractile testes were excluded. Patients were subjected for ultrasonography (USG) scrotum. Palpable UDT and those were located on USG were subjected for open or laparoscopic assisted orchiopexy or 2 stage Stephen-Flower orchidopexy or orchidectomy.Results: 41.4% patients were between age group of 1 to 5 yrs. 43.9% patients were having right sided UDT. 76% testes were palpable only. 21.9% were having bilateral UDT. 48% testes were present in inguinal canal. In 80% patient’s orchiopexy was done. One patient (2.4%) had postoperative wound infection.Conclusions: In our study the maximum number of cases were recorded between 1 to 5 years of age. Right sided UDT were common presentation. Maximum UDT were palpable. We also concluded that USG remains the specific non-invasive modality of diagnosis and localization. Almost half of them were present in the inguinal canal. Orchidopexy is the most common technique for placement of UDT in the scrotum. There were low complications and high success rate in treating UDT. We concluded that there is need of coordinated campaign between surgeons, pediatricians, general practitioners and community workers for timely intervention of UDT and advice for early approach for treatment.
Increasing range of motion in total knee replacement using novel patellar resection technique
Authors: Suryavanshi Ashok
Published: January 2020

Background: Total knee arthroplasty (TKA) is a surgical procedure designed to alleviate pain and improve function in patients suffering from osteoarthritis. Range of motion is one of the most important factors for patient satisfaction after total knee replacement. The purpose of this study was to assess the effectiveness of a new TKA technique involving patellar resection to enable increased flexion of the knee joint.Methods: Eighty-four patients suffering from osteoarthritis with an indication for conducting TKA underwent the novel procedure. Pre-operative and post-operative flexion measurements were assessed.Results: Mean age of patients participating in this study was 62 years. Males and females were 63% and 37 % of total population respectively. The mean pre-operative and post-operative flexion measurements were 97.39±3.33 º and 131.35±4.27 respectively. The mean in flexion measurements was improved by 33.95±5.30 º (p<0.05). The joint was kinematically stable during full flexion, mid-flexion, and extension.Conclusions: The novel patellar resection technique can be beneficial for the patients. They can able to follow their native lifestyle and perform their daily activities without any hindrance. The mean increase in the range of flexion was 33.95±5.30 º (ranged 30-35 º, p<0.05). This technique allowed patients to have a greater range of flexion as compared to standard and high flexion designs.
Kuttner’s tumour: chronic sclerosing sialadenitis- a mimicker of malignancy
Authors: Sahoo Prakash Kumar , Rout Suman Saurav , Naidu A. Appala , Reddy K. Ujwal , Muddu Vishnu Teja
Published: January 2020

Background: Kuttner’s tumour is a condition of the submandibular gland which is underreported as a distinct entity. Also called as the chronic sclerosing sialadenitis it resembles a plasmocytic and lymphocytic inflammatory process and presents as a hard and painful mass which clinically mimics a malignancy and raises significant concerns. The objective of the present study was to evaluate cases of Kuttner’s tumor and discuss its clinical and pathological aspects to distinguish it from a definite malignancy and create a grown acceptance of the presence of such an entity in our setting.Methods: We collected 170 cases of submandibular swellings and evaluated in detail the clinical and pathological aspects of eight cases out of them which were later diagnosed to as Kuttner’s tumour.Results: The age of the patients varied between 23 to 61 years (mean age 42.5 years) with 3 males and 5 females. 6 patients reported with a firm to hard painless submandibular mass (5 left sided; 3 right sided) while 2 patients experienced intermittent discomfort. The mean duration of presentation of symptoms was 5.3 months. Fine needle aspiration cytology was done in 6 cases preoperatively. Following submandibular sialadenectomy histopathology showed salivary gland tissue with preserved lobular architecture, but with marked fibrosis, acinar atrophy, and a dense lymphoplasmacytic infiltrates.Conclusions: Kuttner’s tumor may be pre operatively distinguished from a malignancy with improved imaging and a good image guided FNA Cytology saving the clinician and the patient from a lot of dilemma. However, histopathology and immunohistochemistry would be the key in establishing the diagnosis.
Role of neoadjuvant chemotherapy in downstaging locally advanced breast carcinoma, selection of surgical procedure and its outcome
Authors: Nirhale Dakshayani S. , Sooraj Rizhin , Rawat Anshu
Published: January 2020

Background: In clinical practice all cases of locally advanced breast carcinoma (LABC) warrant chemotherapy followed by multimodality care. Neoadjuvant chemotherapy (NACT) has been the mainstay in the management of LABC. The main aim of NACT is to downstage and prevent systemic micrometastasis early.Methods: This was a prospective study conducted on 36 diagnosed cases of stage III locally advanced breast cancer coming to the Dept. of Surgery, Dr. D. Y. Patil Medical College and hospital, Pune for a period of 2 years from 2017-2019. The effectiveness of neoadjuvant chemotherapy was assessed based on clinical, pathological and radiological response.Results: Among 36 LABC cases, maximum number of patients fell in the 41-50 years (41.6%) and presented in the Infiltrating ductal carcinoma group with a clinical stage IIIA disease. The response to NACT showed that a total of 12 patients (33.3%) showed complete clinical response and 30 patients were downstaged after neoadjuvant chemotherapy which was statistically significant. Only 4 out of the total 12 complete clinical responders went for Breast conservative surgery. Seroma formation was found to be the most common post-operative complication.Conclusions: LABC subjected to neoadjuvant chemotherapy based on taxanes/Anthracyclines show good clinical and radiological response. Patients preferred modified radical mastectomy due to the lack of awareness and low socioeconomic strata.The type of surgery did not increase  the chance of recurrence in the follow up period.
Primary retroperitoneum mucinous cystadenoma
Authors: Bhatia P. K. , Goyal Kirti Savyasacchi , Tanwar Himanshu , Biswas Prakash
Published: January 2020

Primary retroperitoneal mucinous cystadenomas (PRMCs) are observed more frequently in women with no specific symptoms. A 35 Years old female patient presented with Intermittent abdominal pain in her left flank associated with fullness in abdomen. CECT confirmed a well-defined smoothly marginated homogenous non-enhancing unilocular cystic lesion in retroperitoneum in left lumbar region, separated from the pancreas, left kidney and ovary. On Laprotomy, the retroperitoneal tumor was completely removed, without spillage of its contents.
A rare case of varicella gangrenosum in adult
Authors: Sabari Girieasen M. , Viswanathan Naveenkumar , Kalyankumar M/ S.
Published: January 2020

Varicella gangrenosum is a gangrenous ulceration of varicella lesions involving the skin and soft tissues of the body. It most commonly occurs in children less than 5 years of age and life threatening. This is a very rare complication of chicken pox in adults which deserves early diagnosis and management. 21-year-old male presented with blackish discoloration in the lateral aspect of right thigh for 5 days. He has positive history of chicken pox for his brother and sister following which he acquired it 15 days back. During that episode he had fever, headache and blisters which ruptured to heal by scab. But scab in right thigh coalesced to form the gangrenous area with serous discharge. On presentation he had no fever with local lesion and surrounding erythema. Patient underwent radical surgical debridement and regular dressing. Pus culture was sent which showed no growth. He gradually improved and the ulcer granulated well and split skin graft is done. Varicella gangrenosum is a life-threatening condition which can be either wet, moist or purpura fulminans. Patients who develop disseminated intravascular coagulation and have a grave prognosis. Surgical debridement is the only proven treatment which has led to better outcome. Only about 10 cases reported in literature so far regarding this condition.
Radical resection of giant ameloblastoma mandible with free fibula reconstruction: a case report and review of literature
Authors: Vishwani Ankit , Goyal Kavita , Suman Dhirendra , Arora Vipin , Arya Suvercha , Yadav Manisha
Published: January 2020

The ameloblastoma is a rare odontogenic tumor of the oral cavity. It is slow growing, locally invasive benign tumor affecting mandible more than maxilla mostly in age group 30-60 years. It grows in bone and soft tissue causing facial disfigurement. Treatment is surgical taking wide margins. This case report describes the treatment of a 30-year-old female having right side jaw swelling since two years, fine needle aspiration cytology was suggestive of ameloblastoma. Right hemi mandibulectomy was done by head and neck surgery team and reconstruction was done by plastic surgery team using free fibula flap. The free fibula osteocutaneous flap is the most versatile and reliable option for microsurgical reconstruction of large mandibular defects.
Percutaneous balloon valvuloplasty of pulmonary valve stenosis: state of the art and future prospects
Authors: Talukder Md Faisal , Hongxin Li , Fei Liang , Bin Khashru Muhsin Billah
Published: January 2020

This study is aimed to delineate readers with an overview of percutaneous balloon pulmonary valvuloplasty (PBPV) of pulmonary valve stenosis (PVS) and highlighting outcome based on influential and recent studies. It has been four decades since Kan et al first introduce PBPV. Since then, PBPV has recognized as a gold standard therapy for PVS of all ages. Nowadays, PBPV is practiced for a broad range of indication such as PVS, PV dysplasia and pulmonary atresia. Typically, PBPV is recommended when gradient across the PV is >50 mmHg. The procedure involves the placement of one or more balloon catheters across the stenotic PV with the guidance of a guidewire; thereafter, inflation of the balloons is done by pressure, thus producing valvotomy. Nowadays, PBPV is done by echocardiographic guidance, but previously, it was done by fluoroscopic guidance. The main disadvantage of fluoroscopy was the radiation injury of patients. The recently recommended balloon/annulus ratio is 1.2 to 1.25. Following the procedure, the dramatic reduction of pressure gradient, free motion of the PV leaflets with less doming, the rise of cardiac output have been noted, whereas complications may occur but are unusual and minimal. Significant predictors of restenosis include balloon/annulus ratio <1.2 and immediate post-PBPV gradient ≥30 mmHg. Only a few percentages of patients needed repeat PBPV. Long-term follow-up results are surprisingly excellent. In conclusion, it is our opinion that PBPV is equally successful in patients of all ages, while worldwide recognized studies prove the safety, feasibility, and effectiveness. However, for early detection of any complication, life-long clinical follow-up is mandatory.
Mototaxismo y hurto a personas: evaluación de impacto a partir del modelo de diferencias en diferencias
Authors: Cerquera Losada Óscar Hernán , Orjuela Yacue Cristian Felipe , Ferrari Sebastian Esteban
Published: January 2020

Este trabajo analiza la efectividad de las políticas, adoptadas por las principales ciudades capitales de Colombia para controlar la circulación de motocicletas con pasajero, sobre el hurto a personas durante el periodo 2012-2017. La metodología desarrollada consiste en la aplicación de un modelo de diferencias en diferencias, utilizado generalmente para evaluar el impacto de políticas, mediante la aplicación de un modelo de panel de datos, tanto de efectos fijos como aleatorios; además, se estimó un modelo de regresión lineal múltiple agrupado. Los resultados obtenidos muestran que las políticas adoptadas por estas ciudades han sido efectivas para disminuir el hurto a personas.
Consideraciones acerca del desarrollo de un modelo de educación ambiental emancipatoria para la formación del profesional contable
Authors: Alves Dios Selma , Cosenza José Paulo
Published: January 2020

Este trabajo presenta una revisión teórica acerca de la integración de la temática ambiental en la educación contable; además, vincula los principios básicos de una sociedad sostenible y discute las limitaciones del modelo convencional de academia y sus reflejos en la formación del contable respecto al conocimiento sobre el medio ambiente. Para esto, se analizan alternativas constructivas de una visión sistémica, crítica e innovadora en el desarrollo académico del profesorado, revertida para la formación del alumnado desde una perspectiva humanitaria y social, que incluye la vida biológica y colectiva de todas las especies como punto central de las preocupaciones con la sociedad y la sustentabilidad. La investigación tiene un carácter cualitativo, en cuanto a la forma de abordaje del problema, y se clasifica como descriptiva en cuanto a su objetivo, y documental por el tipo de procedimiento de investigación. En relación con el tratamiento de los datos, se hizo un análisis de contenido de artículos de investigación publicados en revistas de contabilidad, para producir datos a partir del examen de la naturaleza y del contexto del fenómeno estudiado. El estudio de los resultados muestra que el modelo de educación ambiental dominante no proporciona una formación contablevalorando el pensamiento crítico, reflexivo y propositivo, y apunta a mantener las cuestiones económicas, sociales y ambientales en armonía con el desarrollo sostenible y la naturaleza.
A Case Report of a Variation from the third Part of the Axillary Artery
Authors: Ezatiyazdani Daniyal , Vardiyan Reyhane , Shahedi Abbas
Published: January 2020

Introdcution: The axillary artery extends to the subclavian artery, which gives blood the axillary region. This artery is starting from the outset of the first ribAnd ends near the inferior terse major muscle, and then goes on with the name of the Brachial artery,the axillary artery variation is common and given the blood supply to the upper limb Clinically important .These variations seem to be an important finding that a rare case of anatomical presentation in an underground cavity to the right of a male body with an age of approximately 60-65 years was found in ShahidSadoughi University of Medical Sciences in Yazd, which was as followed:, external thoracic artery that is normally separated from the second part of the axillary artery;In this case, the third branch of the Thoracodorsal artery is separated. Since the axillary artery was exposed to damage, especially in cases of abdominal tenderness or removal of the axillary lymph nodes, the use of upper limb arches for coronary artery bypass surgery, Therefore, knowledge of natural anatomy and axillary artery changes will be useful for medical professionals, especially surgeons and anatomists.
Evaluation of the Results of Arthroscopic Release in Limits of Movement in Knees
Authors: Sobhan Mohammad Reza , Saeed Banadaky Seyed Hossein , Shafiee Mohammad , Gheisari Mohammad
Published: January 2020

Introduction: Limits of movement in knees is one of the most common complications following trauma and surgery. With early diagnosis and appropriate treatment choices, knee replacement and performance improvement are expected in many patients. However, limits of movement in knees is unpleasant and should be corrected as soon as possible. In this study, we decided to evaluate the results of arthroscopic release in motion limits of knees.
Methods: This was a descriptive cross-sectional study.14 patients who referred to the Shahid Sadoughi Hospital of Yazd from 2014 to 2016 and diagnosed with knee limitation (flexion or extension restriction of more than 10 degrees) were selected. Patients were undergone arthroscopic release and followed-up for 6 months. Lysholm knee score, degrees of flexion and extension, and patient satisfaction were evaluated. The results were analyzed by SPSS-18 and statistical tests Paired T-test as well as Spearman correlation.
Results: The mean age of the patients was 28.92±10.99 years. The most common type of trauma in the patients was femoral distal fracture (46.7%). The frequency of the patients' satisfaction with arthroscopy was as followed: 50% (7 patients), had moderate satisfaction, 28.6% (4 ones), high satisfaction, and 21.4% (3 ones) had low satisfaction.The mean difference in Lysholm Knee Score, improvement in degree of extension, improvement in degree of flexion and pain score before and after arthroscopy were 26.21±14.11,64.78±26.13,3.57±2.92 and 4.13±1.65,respectively.There was a significant difference between the mean values of these factors before and after arthroscopy.
Conclusion: According to the results obtained, we can conclude that arthroscopic release is an effective and low-complication method in motion limits of knees.
Effect of Nebulized Morphine vs. Intravenous Morphine in Decreased Pain in Renal Colic Patient
Authors: Nikouyeh Mehrnaz , Jafari nedoushan Mohammad ali , Vakili Mahmood , Hajimaghsoudi Majid , Bagherabadi Mehdi , Saadatyar Ali
Published: January 2020

Introduction: Renal colic refers to one or more acute and painful short-term attacks due to the movement and excretion of kidney stones. The aim of this study was to determine the effect of intravenous morphine and inhaled morphine on pain relief in renal colic patients.
Methods: This clinical trial study was performed on 50 patients of Shahid Sadoghi Hospital and Shahid Rahnemoon Hospital with renal colic symptoms who were randomly divided into two groups. The first group received 5 mg intravenous morphine and 5 cc normal saline (placebo) and the second group received 10 mg inhaled morphine and 5 cc normal saline. Severity of pain was assessed at the time of emergency and onset of Visual Analog Scale and then questionnaires were completed at 10, 20 and 30 minutes intervals.  The data through SPSS Inc., Chicago, IL; Version 16 and the Friedman, Mann-Whitney, and Chi-square tests were analyzed.
Results: Our study showed the mean intensity of pain was 9.52±1.12 (nebulized) and 9.24±1.51 (intravenous) on admission without significant difference (p=0.46). After 10 minutes, mean pain intensity in both nebulized and intravenous groups was 7.76±1.3 and 6.68±2.03, respectively. There was a significant difference between the two groups (p=0.03). After 20 minutes, the mean pain intensity was 5.68±1.72 and 4.32±2.17, respectively, and the difference between the two groups was significant. After 30 minutes, the mean intensity of pain in two groups of nebulized and intravenous was 3.88±3.14 and 3.36±3.34, respectively. The difference between the two groups was not significant (p = 0.57).The mean pain intensity in the intravenous method was lower than the nebulized, but in the nebulized method it was showed a decreasing trend.
Conclusion: Nebulized morphine relieves pain in the patients with renal colic, but pain relief is faster by intravenous morphine. Accordingly, this method is more preferred in renal colic patients.
THE USE OF POWERPOINT AS MEDIA OF LANGUAGE TEACHING ON STUDENTS’ SPEAKING SKILL
Authors: Nur Aziz Imam , Ani Setyo Dewi Yuli
Published: January 2020

Purpose of the study: Powerpoint is one of the communication tools which used to presenting learning material, and this article aims to know the use of PowerPoint as media that can improve students’ speaking skill.

Methodology: The researcher uses the Pre-experimental method one group Pretest-Posttest design by regulating pretest to measure the subordinate variable, test treatment, and regulating posttest.

Main Findings: The result shows that posttest frequency is higher than pretest frequency by compering median 12.6> 12.2. it means that PowerPoint provides video, audio, animation, slideshow, etc. can improve students’ speaking skills.

Applications of this study:  The population in this research are all of the students of MA Al-Asyhar Bungah Gresik with 20 social learners and 23 science learners class.

Novelty/Originality of this study: Media makes the students more understand, the instructor must prepare the exciting material, by using interesting media it helps students more understand. Because the use of media will stimulate students' understanding, the teacher can use interested and straightforward media which can make them focus on the material.
PENGARUH MEDIA PEMBELAJARAN POHON ANGKA TERHADAP KEMAMPUAN MENGENAL KONSEP BILANGAN PADA ANAK USIA 5-6 TAHUN DI TKK SATAP St. THERESIA WOLOMELI KABUPATEN NGADA
Authors: Rawa Natalia Rosalina , Meka Marsianus , Nai Virginia
Published: January 2020

Penelitian ini bertujuan untuk mengetahui pengaruh hasil media pembelajaran pohon angka terhadap kemampuan mengenal konsep bilangan sebelum ada perlakuan dan sesudah ada perlakuan pada TKK Satap St. Theresia Wolomeli. Penelitian ini merupakan penelitian “Pre-Experimental jenis The One Group Pretest-Posttest Design”. Populasi dalam penelitian adalah anak TKK Satap St. Theresia Wolomeli berjumlah 22 anak dengan jumlah pria 7 dan wanita 15. Pengujian hipotesis menggunakan program SPSS 16.00 from windows pada kolom y nilai t-test 25.084 > 1,98 (dengan db n1 – 1) (22-1=21, taraf sig. 5%), dan nilai signifikansi = 0.000 < 0,05 maka keputusan H0 ditolak dan H1 diterima. Dari rata-rata hasil media pembelajaran pohon angka pada tabel One-Sample Statistic variabel y lebih besar dari variabel X (14.86 > 8.000). Berdasarkan hasil analisis data tersebut dinyatakan ada pengaruh media pembelajaran pohon angka terhadap kemampuan mengenal konsep bilangan pada anak usia 5-6 tahun.
A Shared Decision-Making Toolkit for Mode of Birth After Cesarean
Authors: Chinkam Somphit , Steer-Massaro Courtney , Damus Karla , Shorten Brett , Shorten Allison
Published: January 2020

This study evaluated a shared decision-making (SDM) Toolkit (decision aid, counseling guide, and provider scripts) designed to prepare and engage racially diverse women in shared decision-making discussions about the mode of birth after cesarean. The pilot study, involving 27 pregnant women and 63 prenatal providers, assessed women's knowledge, preferences, and satisfaction with decision making, as well as provider perspectives on the Toolkit's acceptability. Most women experienced knowledge improvement, felt more in control and that providers listened to their concerns and supported them. Providers reported that the Toolkit helped women understand their options and supported their counseling. The SDM Toolkit could be used to help women and providers improve their SDM regarding mode of birth after cesarean.
A Quality Improvement Initiative: Improving Mammogram Screening Rates Among Low-income Hispanic Women in Primary Care
Authors: Walker-Smith Tammy Lynn , Baldwin Sara
Published: January 2020

Background

Low-income women of predominantly Hispanic ethnicity between the ages of 50–74 who receive primary care services in a South Texas region experienced a 12% disparity gap for women completing a screening mammogram in the last 2 years when compared to Hispanic women nationally.

Objective

The purpose of this quality improvement (QI) initiative is to design and implement interdisciplinary evidence-based interventions to improve the screening mammogram completion rates in a primary care clinical setting.

Methods

Following a systematic review and selection of two evidence-based breast cancer risk screening tools, a pre-post intervention was conducted. The Knowledge-to-Action (KTA) framework was used to train staff and providers to implement the screening tools. The Breast Cancer Risk Assessment Tool (BCRAT) and the National Health Interview Survey (NHIS) provided triggers for initiating a screening mammogram.

Results

Evidence-based screenings triggered mammogram initiation resulting in a 7.21% improvement in screening mammogram completion rates over a 3-month time period.

Conclusion/Implications for Nursing

The outcomes discussed in this report provide guidance for new policy considerations and clinical protocol initiatives along with processes to improve mammogram completion rates.
МОТИВ БРВНАРЕ (ШУМСКЕ КУЋИЦЕ) У ПОЕЗИЈИ МИЛАНА ДЕДИНЦА
Authors: Перић Сања П.
Published: January 2020

У раду се истражује однос традиције и надреализма у поезији Милана Дединца на примеру традиционалног мотива брвнаре, „шумске кућице“, који највише простора добија у последњем циклусу песничке књиге Од немила до недрага (1957), Песнички огледи с путовања по Црној Гори. Песник је при томе у уводном делу рада постављен у контекст авангарде, односно надреализма, како би се утврдио значај надреалистичких тенденција у његовој поезији. У фокусу рада је начин на који је мотив брвнаре функционализован у оквиру песничке структуре, специфичне због необичног односа песника и самог лирског субјекта, представљеног кроз фигуру усамљеног путника по црногорским врлетима. Шумска кућица је наглашено лиминални простор у којем лирски субјект истовремено покушава да оствари комуникацију са трансцедентним, и сједини се са природом која га окружује. Сумња и упитаност константе су у појавама овог мотива у Дединчевој поезији. Контемплација у пустој брвнари покушај је да се властити идентитет заштити под кровом куће замишљене у оквиру фолклорног наслеђа, при чему се у песмама уочава нарастајућа свест лирског субјекта да таква заштита више није могућа. Циљ рада је анализа значења и симболике традиционалног мотива шумске кућице у песмама Милана Дединца, у контексту сложеног односа традиције и авангарде уопште.
ПРЕДВИЂАЊЕ И ЕФЕКАТ ПРВОГ СВЕТСКОГ РАТА У РОМАНИМА ИЗЛЕТ НА ПУЧИНУ И ЏЕЈКОБОВА СОБА ВИРЏИНИЈЕ ВУЛФ
Authors: Бабић Драган Б.
Published: January 2020

При читању и истраживању дела Вирџиније Вулф, већина истраживача и читалаца се задржава на неколицини наслова: романима Госпођа Даловеј, Ка светионику и Таласи, те обимним есејистичким делима Сопствена соба и Три гвинеје. Док је тај поступак услед квалитета тих наслова апсолутно разумљив, он није потпуно праведан. Улазећи дубље у њен рад, можемо открити и друге наслове вредне пажње, као што су њен први роман Излет на пучину, те трећи, Џејкобова соба. Значај ових дела није само у њиховом антиципирајућем фактору – јер они заиста антиципирају Госпођу Даловеј, Таласе и друга прозна дела која је ауторка писала након њих – већ и у начину на који се опходе према теми Првог светског рата. Наиме, иако је овај догађај изразито битан у животу и раду ауторке, он не заузима централно место у овим романима. Они су објављени током и након рата – 1915, односно 1922. године – и садрже јунаке који учествују у рату и погођени су њиме, али се ка њима не односе на очигледан и отворен начин. Уместо тога, они наговештавају рат и његове последице употребом више различитих приповедних и стилских техника, а управо ће те технике, као и њихов значај, бити у фокусу овог рада.
OTHERNESS IN NABOKOV’S HERMANN, HUMBERT AND KINBOTE
Authors: Stamenković Slađana
Published: January 2020

As one of the key notions in postmodern theory, Otherness is defined as a quality of being different and separate from the Self. Within the postmodern theory, it is defined within the center-margin binary opposition discussed by theoreticians such as Linda Hutcheon. Yet, long before the theory, three of Nabokov’s novels depicted the concept of Otherness in their respective protagonists. Hermann in Despair, Humbert in Lolita and Kinbote in Pale Fire are assigned the role of the Other in their communities on different levels, all of which lead them to construct their own alternative realities where the margin is the center. This paper discusses the occurrence of the theoretical concept of the Other in the novels that predate the official theory of Otherness. The reoccurrence of the concept of the Other in literature, (especially in the period before the theoretical framework officially appeared) testify to the high relevance of the theory and the concept for discussing different phenomena of the human spirit and artistic experience.
THE USE OF MODAL VERBS IN ENGLISH LEGAL TEXTS AND THEIR SERBIAN EQUIVALENTS
Authors: Erić-Bukarica Aleksandra
Published: January 2020

The aim of this paper is to examine and describe similarities and differences in the use and distribution of modal verbs by contrasting English and Serbian legal texts. The corpus consists of an English version of The Convention on the Rights of the Child and its official Serbian translation. We started from an assumption that modal verbs are more frequent in legal texts in English than in Serbian, where we expected to find examples of lexical items with modal meanings instead. In addition, we assumed that due to its specific use in legal texts of this kind, the English modal ‘shall’ will show the highest frequency of occurrence. A total of one hundred and twenty six (126) modal verbs and a semi-modal ‘need not’ were found in the source text. The results of the analysis support the initial presumption that ‘shall’ will stand out as the most frequent of all modal verbs (60% of all occurrences). Despite the high occurrence rate of the legalistic ‘shall’ in the source text, translation solutions in the target language only rarely take the form of the modal verb. Most often deontic notions of imperative directness and necessity in Serbian legislative writings are expressed by means of the present indicative. The analysis also indicates that translation solutions for the remaining English modal verbs most often take the form of a modal verb or a modal lexeme with a corresponding meaning in Serbian.
SUKOB TELESNE I DUHOVNE LJUBAVI U STVARALAŠTVU MARGERITE NAVARSKE
Authors: Gorgiev Anastasija B.
Published: January 2020

Ovaj rad se bavi ispitivanjem odnosa telesne i duhovne ljubavi u delima renesansne kraljice Margerite Navarske. Glavna problematika ovoga rada fokusirana je na sukobu telesne i duhovne ljubavi, pre svega kroz analizu nekih novela iz Heptamerona, ali i kroz Margeritin Komad u Mon de Marsanu i poemu „Razdor što ga u čoveku pravi sukob između duha i ploti“. Kroz odabrana dela može se zaključiti da se u mnogim situacijama duhovna ljubav preobražava u putenu, te da ona teško opstaje u svom izvornom obliku i svojoj prvobitnoj nameri. Kao takva, putena ljubav izaziva najniže strasti kod književnih likova pa ona ima ili tragičan kraj za junake novela, tj. završava se smrću jednog ili dvoje ljubavnika, ili pak muškarac nasilnim putem želi da pridobije ženu. Premda po kvantitetu preovladavaju teme koje prednost daju ovom zaključku, ipak u Margeritinim delima postoje primeri kada duhovna i telesna ljubav mogu biti u skladu. Srećan ishod po ljubavnike je redak ali nije nemoguć po Margeriti, a on se postiže usmeravanjem profane ljubavi ka veri.
Analisis Kepuasan Pelanggan Terhadap Sarana Prasarana dan Lokasi Perumahan Menggunakan Metode Quality Function Deployment (Studi Kasus Perumahan Griya Pesona Karangrejo Banyuwangi)
Authors: Putri Mangesti Carissa , Koesoemawati Dewi Junita , Trisiana Anita
Published: January 2020

Perumahan merupakan kebutuhan yang sangat penting bagi masyarakat. Kepuasan konsumen atas pembelian rumah yang ditawarkan merupakan impian dari setiap pengembang. Perumahan Griya Pesona Karangrejo Banyuwangi  merupakan kawasan perumahan yang sedang berkembang ke tahap 4. Penelitian ini bertujuan untuk mengetahui kondisi eksisting perumahan sudah sesuai dengan standar  perumahan yang ada, mengetahui variabel apa saja yang menjadi priorotas dari konsumen berdasarkan kualitas produk, sarana prasarana, lokasi dan kualitas pelayanan menggunakan metode QFD (Quality Function Deployment) dan penentuan strategi perbaikan yang harus dilakukan pengembang menggunakan analisis IPA (Importance Performance Analysis). Pengumpulan data dilakukan dengan cara wawancara dan penyebaran kuisioner kepada penghuni perumahan.Dari hasil penelitian didapatkan hasil identifikasi kondisi eksisting dilapangan, Perumahan Griya Pesona Karangrejo Banyuwangi belum sepenuhnya memenuhi standar perumahan yang ada. Urutan variabel yang diprioritaskan diambil 5 variabel yang terbesar dari raw weight yaitu sarana ruang terbuka hijau, perkerasan jalan/paving, keamanan terhadap banjir, lebar dan kondisi jalan utama dan fasilitas pembuangan air kotor/drainase. Dalam penentuan strategi perbaikan berdasarkan analisis IPA pengembang harus melakukan perbaikan jalan sesuai dengan standar dan membangun saluran drainase sesuai standar serta melakukan pengecekan terhadap kualitas produk sebelum diserahkan kepada konsumen.
Pola Sidik Jari Tangan dan Ciri Fisik Penderita Sindrom Down di Sekolah Luar Biasa (SLB) Kota Jember
Authors: Oktarianti Rike , Yunitasari Indah , Mahriani Mahriani
Published: January 2020

Sindrom down merupakan kelainan akibat penambahan jumlah kromosom tubuh nomor 21 sehingga mempengaruhi ciri fisik, pola dan jumlah sulur ujung jari tangan. Tujuan dari penelitian ini untuk mengetahui ciri fisik, pola sidik jari dan jumlah sulur penderita sindrom down. Pengambilan sampel dilakukan di SLB Kota Jember, data ciri fisik didokumentasikan, dideskripsikan dan dianalisis dengan Uji Wilcoxon untuk mengetahui signifikansi perbedaan dengan orang normal. Pola dan jumlah sulur dilakukan perekaman dengan menempelkan ujung jari pada bantalan tinta selanjutnya ditempelkan pada kertas HVS. Selanjutnya ditentukan pola sidik jari dan dihitung jumlah sulurnya. Jumlah sulur selanjutnya diuji Independent Sampel T-Test untuk mengetahui perbedaan dengan orang normal. Hasil penelitian menunjukkan bahwa ciri fisik siswa SLB Kota Jember mempunyai perbedaan yang signifikan dengan orang normal meliputi hidung pesek, mulut kecil dan cenderung membuka, jari tangan pendek. Ketiga parameter tersebut pada Uji Wilcoxon menunjukkan perbedaan yang nyata dengan orang normal. Karakter lain yaitu mata sipit dan membujur keatas serta terdapat lipatan mata (epikantus), ujung lidah yang melebar, telapak tangan siswa umumnya mempunyai garis simian, jari kelingking yang bengkok, serta pada jari kaki pertama dan kedua mempunyai jarak lebar. Pola sidik jari siswa adalah loop ulnar (84,17%) dengan jumlah sulur rata-rata 145,59 sulur, lebih banyak dari orang normal. Hasil uji Independent Sampel T-Test menunjukkan perbedaan yang signifikan antara siswa penderi sindrom down dengan orang normal