bluuebunny/crossref_metadata_2025 huggingface dataset:
Strengthening the pavement bases through the use of stabilizing additives
Authors: Stroev Dmitry , Sizonets Sergey , Kazaryan Vanik
Published: April 2019

The experience of recent years of road operation shows that one of the ways to reduce the accumulation of residual deformations in the layers of road construction, expressed in rutting, the appearance of a grid of cracks and other types of transverse and longitudinal irregularities, is used in the base layers of pavements reinforced with mineral binders of crushed-stone-gravel-sandy mixtures (HGPS). The strength and deformability of hardened HGPS is determined mainly by the structure and properties of the cement stone, which holds the aggregate grains in place. The structure and properties of reinforced HGHPs depend on: the mineralogical composition, the water-cement ratio, the fineness of the cement, the age, the preparation and hardening conditions, or the addition of additives. With the introduction of additives, you can significantly change the strength and deformability of reinforced HGPS.

Currently, stabilizing additives are widely used, the introduction of which allows to provide high water resistance, crack resistance and durability of the structural base layer. At the same time, a reinforced mixture with the use of additives has not only all the positive properties of HGPS on portland cement, but also eliminates its negative sides: low values of compressive strength, tensile strength in bending, and large shrinkage deformations. Based on the above, the introduction of stabilizing additives in fortified HGPS seems to be fruitful.

As an additive, the stabilizer «ARMADOR» was used. The additive is a dry bulk mixture based on polymers, salts of alkali and alkaline earth metals. With the introduction of the stabilizer «ARMADOR», the physico-mechanical parameters increase in the composition of the reinforced material. This stabilizer creates strong crystallization and coagulation bonds, the use of which is recommended in conjunction with a mineral binder.
Experimental studies of energy dissipation in the structure of the road structure under shock loading
Authors: Tiraturyan Artem , Bodrov Ilya , Simakova Anastasia , Farnieva Marina
Published: April 2019

The article deals with the issues of experimental research of energy dissipation processes in the structure of pavements under shock loading. The study of these processes is characterized by scientific and practical significance, since it is the energy dissipation that is determined by the state and mechanisms of deformation of all the constructive layers of flexible pavements without exception. As part of these studies, a comprehensive assessment of the state of three sites in different technical and operational conditions was carried out, as evidenced by the average score for visual assessment and, accordingly, the number and types of defects. In all the surveyed areas, measurements were carried out using the FWD shock loading installation, with registration of dynamic hysteresis loops at each point in the “load-deflection” coordinates. The area of dynamic hysteresis loops was used to calculate the density of dissipated energy under impact. In the course of the work performed, it was established that when the transport and operational state of the site deteriorates, the density of the dissipated energy increases significantly, so for sites with an average score by visual assessment Bav = 4.0, the density of dissipated energy is Sav1 = 13.215 J/m3 the mark on the visual estimate of Bav = 4.61 is the dissipated energy density Sav2 = 7.52 J/m3, in the section with the average score on the visual estimate of Bav = 4.78 the density of the dissipated energy is Sav3 = 5.00 J/m3. From a practical point of view, these results are an experimental basis for creating a new approach to technical monitoring of the state of flexible pavements, precisely from the standpoint of analyzing the total energy dissipated in its structure during the entire life cycle.
Phase II Trial of Continuous Regorafenib Dosing in Patients with Gastrointestinal Stromal Tumors After Failure of Imatinib and Sunitinib
Authors: Kim Jae-Joon , Ryu Min-Hee , Yoo Changhoon , Beck Mo Youl , Ma Jung Eun , Kang Yoon-Koo
Published: April 2019

Background

Regorafenib at the standard intermittent dosing schedule proved effective in the GRID trial for refractory gastrointestinal stromal tumors (GISTs). However, this dosing schedule requires frequent dose reduction, and the progression of GISTs or tumor-related symptoms during the off-treatment period has also been noted in some patients. Therefore, we conducted this phase II trial to evaluate the efficacy and safety of regorafenib at a lower dose on a continuous dosing schedule.

Methods

Patients with measurable, metastatic, or recurrent GISTs who failed to respond to both imatinib and sunitinib were eligible for this study. Regorafenib 100 mg p.o. daily was administered continuously. The primary endpoint was disease control rate (DCR: complete response plus partial response [PR] plus stable disease [SD]) lasting for at least 12 weeks using RECIST version 1.1.

Results

The best response was PR in 2 (8%), SD in 16 (64%), and progressive disease in 6 (24%) patients. DCR lasting for at least 12 weeks was 64% (16 of 25). The median progression-free survival was 7.3 months (95% confidence interval, 5.9–8.6), and the 1-year survival rate was 64.5%. Ten patients (40%) experienced grade 3–4 toxicities, including hand-foot skin reaction (n = 4, 16%) and elevation of alanine aminotransferase (n = 2, 8%). Only six patients (24%) needed dose modification with a relative dose intensity of 95.0% for eight cycles in all patients.

Conclusion

Regorafenib at a lower dose on a continuous schedule might be an alternative treatment in patients with GISTs after failure of imatinib and sunitinib. Clinical trial identification number. NCT02889328

Implications for Practice

Regorafenib at the standard intermittent dosing schedule proved effective in the GRID trial for refractory gastrointestinal stromal tumors (GISTs). However, this dosing schedule requires frequent dose reduction, and the progression of GISTs or tumor-related symptoms during the off-treatment period has been noted in some patients. This study was to evaluate the efficacy and safety of regorafenib at a lower dose on a continuous dosing schedule. With good efficacy and acceptable safety profiles, regorafenib at a lower, continuously administered dose might be an alternative treatment in patients with GISTs after imatinib and sunitinib. Rechallenge of regorafenib may slow the disease progression.
Evaluation of reverse faulting effects on the mechanical response of tunnel lining using centrifuge tests and numerical analysis
Authors: Baziar Mohammad Hassan , Nabizadeh Ali , Khalafian Nader , Lee Chung Jung , Hung Wen Yi
Published: April 2019

The present study refers to the effects of reverse faulting in dry sand on the mechanical response of a tunnel lining. Seven centrifuge tests (five tests with tunnel and fault rupture and two tests without tunnel and with fault rupture as free field) were performed in this research and finite-element models are utilised to gain further insight into the interaction between reverse faulting and the tunnel. The effects of tunnel location and tunnel rigidity are investigated based on the experimental results. Results show that the tunnel location with respect to the location of the fault tip and the rigidity of the tunnel are important parameters affecting the mechanical response of the tunnel lining. The centrifuge tests, in prototype scale, were simulated numerically using a two-dimensional explicit finite-element model in a plane-strain condition. Good agreement between the numerical analysis and centrifuge test results was obtained, indicating proper numerical modelling. A numerical parametric study was then conducted to investigate the safe zone around the fault region for tunnel construction. Finally, it was concluded that the internal forces in the tunnel lining are highly affected by soil stress redistribution caused by faulting.
A Randomized Trial of Magnesium Oxide and Oral Carbon Adsorbent for Coronary Artery Calcification in Predialysis CKD
Authors: Sakaguchi Yusuke , Hamano Takayuki , Obi Yoshitsugu , Monden Chikako , Oka Tatsufumi , Yamaguchi Satoshi , Matsui Isao , Hashimoto Nobuhiro , Matsumoto Ayumi , Shimada Karin , Takabatake Yoshitsugu , Takahashi Atsushi , Kaimori Jun-Ya , Moriyama Toshiki , Yamamoto Ryohei , Horio Masaru , Yamamoto Koichi , Sugimoto Ken , Rakugi Hiromi , Isaka Yoshitaka
Published: April 2019

Significance Statement

Developing strategies for managing coronary artery calcification (CAC) in patients with CKD remains a clinical challenge. Previous experimental studies showed that magnesium inhibits vascular calcification, whereas the uremic toxin indoxyl sulfate aggravates it. In a 2-year, open-label, randomized, controlled trial with a two-by-two factorial design, the authors investigated whether oral magnesium oxide or the oral carbon adsorbent AST-120 affected CAC progression in patients with stage 3−4 CKD with risk factors for CAC. In an interim analysis with 125 enrolled patients (96 of whom completed the trial), patients taking magnesium oxide experienced a significantly smaller percentage change in CAC score compared with controls (11.3% versus 39.5%). AST-120 was not associated with a similar significant slowing of CAC. Larger-scale trials are warranted to confirm these findings.

Background

Developing strategies for managing coronary artery calcification (CAC) in patients with CKD is an important clinical challenge. Experimental studies have demonstrated that magnesium inhibits vascular calcification, whereas the uremic toxin indoxyl sulfate aggravates it.

Methods

To assess the efficacy of magnesium oxide (MgO) and/or the oral carbon adsorbent AST-120 for slowing CAC progression in CKD, we conducted a 2-year, open-label, randomized, controlled trial, enrolling patients with stage 3−4 CKD with risk factors for CAC (diabetes mellitus, history of cardiovascular disease, high LDL cholesterol, or smoking). Using a two-by-two factorial design, we randomly assigned patients to an MgO group or a control group, and to an AST-120 group or a control group. The primary outcome was percentage change in CAC score.

Results

We terminated the study prematurely after an interim analysis with the first 125 enrolled patients (of whom 96 completed the study) showed that the median change in CAC score was significantly smaller for MgO versus control (11.3% versus 39.5%). The proportion of patients with an annualized percentage change in CAC score of ≥15% was also significantly lower for MgO compared with control (23.9% versus 62.0%). However, MgO did not suppress the progression of thoracic aorta calcification. The MgO group’s dropout rate was higher than that of the control group (27% versus 17%), primarily due to diarrhea. The percentage change in CAC score did not differ significantly between the AST-120 and control groups.

Conclusions

MgO, but not AST-120, appears to be effective in slowing CAC progression. Larger-scale trials are warranted to confirm these findings.
Sınıf Öğretmeni Adaylarının İlkokuma Yazma Öğretimi Dersine İlişkin Tutumları
Authors: GÖZÜKÜÇÜK Meral
Published: April 2019

İlkokuma yazma öğretimi dersi sınıf öğretmenliği
lisans programının temel derslerinden birisidir. Bu çalışmanın amacı sınıf
öğretmeni adaylarının ilkokuma yazma öğretimine yönelik tutumlarını
belirlemektir. Araştırmada karma araştırma yaklaşımı benimsenmiş olup nitel
boyutta fenomenoloji deseni, nicel boyutta tarama yöntemi kullanılmıştır.
Araştırmanın çalışma grubu, amaçlı örnekleme tekniklerinden biri olan ölçüt
durum örnekleme tekniğiyle belirlenmiştir. Çalışma grubunu 2017-2018 akademik
yılında Kafkas Üniversitesi Sınıf Öğretmenliği Anabilim dalında eğitim gören öğrenciler
oluşturmaktadır. Araştırmaya ilişkin nicel veriler Arslan ve Aytaç (2010)
tarafından geliştirilen “İlkokuma Yazma Öğretimi Dersine İlişkin Tutum Ölçeği”
aracılığıyla toplanmıştır. Nitel veriler, öğretmen adaylarıyla yarı
yapılandırılmış görüşmeler yapılarak toplanmıştır. Araştırma sonuçlarına göre öğretmen
adaylarının ilkokuma yazma öğretimi dersine yönelik tutumlarının olumlu olduğu;
derse istekli oldukları, dersi gerekli gördükleri ve derse ilgi duydukları
görülmektedir. İlkokuma yazma dersine ilişkin tutumlarının sınıf seviyesine
göre farklılaşmadığı; dersin teorik ve uygulamalı şekilde işlenmesine,
cinsiyete, akademik başarı notuna göre farklılaştığı belirlenmiştir. Öğretmen
adayları dersin uygulamalı olmasını ve süresinin artırılmasını önermişlerdir.
Türkçenin Eklemeli Yapısının İlkokul 1. Sınıf İlk Okuma Yazma Kitabında Kullanımı
Authors: ÇORA Hülya , SÖZER ÇAPAN Aylin
Published: April 2019

İlkokul düzeyinde kazanılan okuma-yazma
becerisi, dil edinim sürecinin en önemli basamaklarındandır. Okuma-yazma
öğretilirken hangi yöntem kullanılırsa kullanılsın, her dilin kendi yapısal
özellikleri çerçevesinde hareket edilmesi gerekmektedir. Bu araştırmada
2017-2018 eğitim-öğretim yılında devlet okullarında okutulmaya başlanan İlkokul
1.Sınıf İlk Okuma Yazma Kitabı incelenmiş ve Türkçenin eklemeli dil olma
özelliğinden yararlanılarak kelime oluşturma durumu tespit edilmiştir.
Araştırmada,  İlkokul 1.Sınıf İlk Okuma
Yazma Kitabı’nda 547 farklı sözcüğe rastlandığı, bu sözcüklerin 86’sının yapım
eki alarak oluşturulduğu, yapım eklerinin sistemli bir şekilde kullanılmadığı,
kullanılan yapım eklerinin ağırlıkla hece değeri taşımadığı, türetilen
sözcüklerin tekrarlanmadığı, kelime oluşturma sürecinde öğrencilerin üretici
kelime hazinesinin dikkate alınmadığı tespit edilmiştir.
Análise do conhecimento dos acadêmicos das áreas biológicas e saúde sobre o dogma "DNA – RNA – Proteína"
Authors: Andrade Vera Regina Medeiros , Staudt Keli Jaqueline , Moerschbacher Sandra Wilhelm , Ajala Ediele Ricardo , Fiorin Tanise Maria , Santos Antônio Vanderlei dos , Lawall Ivani Teresinha
Published: April 2019

O dogma “DNA-RNA” descreve a transferência da informação contida no DNA para síntese proteica, por um intermediário de RNA. Não é um processo simples, sendo sugerido que a representação causa confusão ao entendimento do processo. O objetivo foi acompanhar o processo de construção de conceitos do dogma central da biologia por acadêmicos dos cursos de graduação da área da saúde e das ciências biológicas. Os acadêmicos participantes que responderam a questionários e elaboraram mapas conceituais, para avaliar a aprendizagem. Como resultados, observamos que falta compreensão do dogma pelos estudantes, principalmente quando 68% responderam que DNA faz, cria ou se transforma em RNA. Nos mapas conceituais, 32% usaram conceitos corretos, hierarquia e palavras-chave representativas. Concluímos que os mapas conceituais podem ser utilizados como recurso didático e avaliativo da aprendizagem, porque os alunos citam conceitos fazendo relações entre eles, e nesse momento se consolida o conhecimento.
Association of serum chemerin and inflammatory factors with type 2 diabetes macroangiopathy and waist-to-stature ratio
Authors: Yang Mengxue , Zhou Xue , Xu Jie , Yang Bo , Yu Jie , Gong Qihai , Zhang Xuan , Sun Xiaohua , Zhang Qun , Xia Jinying , Li Jianhui
Published: April 2019

Chemerin is an adipocytokine that participates in glycolipid metabolism; however, its association with type 2 diabetes (T2DM) with lower extremity macroangiopathy (T2DM-V) has rarely been reported. This study explored the association of chemerin and inflammatory factors with body fat parameters, glucolipid metabolism, and insulin resistance (IR) in T2DM and T2DM-V. Patients were classified into normal glucose regulation (NGR), T2DM, and T2DM-V groups. Serum chemerin, glucolipid metabolic parameters, transforming growth factor (TGF)-β, interleukin (IL)-6, monocyte chemoattractant protein (MCP)-1 and fasting insulin levels were measured along with HOMA-IR, body mass index (BMI), and waist-to-stature ratio (WSR). Serum chemerin, TGF-β, IL-6 and MCP-1 levels were significantly higher in T2DM groups than in NGR group, and BMI, WSR, fasting plasma glucose (FPG), 2hPG, glycated hemoglobin (HbA1c), triglycerides (TG) and HOMA-IR were higher in T2DM-V subgroups with moderate or severe lower extremity macroangiopathy than in NGR group, simple T2DM group, and T2DM-V subgroup with mild macroangiopathy. FPG, 2hPG, HbA1c, TG and HOMA-IR were higher in T2DM-V subgroup with severe macroangiopathy than in T2DM-V with moderate macroangiopathy (p < 0.05). In all groups, serum chemerin levels were positively correlated with BMI, WSR, FPG, 2hPG, HbA1c, fasting insulin, aspartate transaminase, TG, TGF-β, IL-6 and HOMA-IR (p < 0.05) and negatively correlated with high-density lipoprotein cholesterol [HDL-c] (p < 0.05). Multiple stepwise regression analysis showed that 2hPG, HbA1c, and HDL-c were independent predictors of serum chemerin levels (β = -0.768, -0.122, -0.115, and 3.261, respectively; p < 0.01). Collectively, chemerin, factors associated with obesity, pathological and physiological changes in glucolipid metabolism, and inflammatory factors may promote the development of T2DM macroangiopathy.
Additional Methods and Protocols, Detection of Pneumonia Pathogens from Plasma Cell-Free DNA v1
Authors: Langelier Charles , Fung Monica , Caldera Saharai , Deiss Thomas , Lyden Amy , C. Prince Brian , Moazed Farzad , Chin-Hong Peter , L. DeRisi Joseph , S. Calfee Carolyn
Published: April 2019

Culture-confirmed bacteremia occurs in only a fraction of pneumonia cases. The degree to which microbial DNA circulates in blood of patients with pneumonia, however, is unknown. Detection of cell-free microbial DNA from plasma is a promising new tool for infectious disease diagnosis. We conducted unbiased metagenomic next-generation sequencing (mNGS) of paired plasma and respiratory fluid from 25 subjects, 18 with pneumonia (four with concurrent bloodstream infections) and seven with non-infectious respiratory illnesses. Cell-free plasma mNGS identified one or more culture-confirmed bacterial or fungal pathogens in 72% of patients with pneumonia, compared to 100% for respiratory mNGS. In two patients who developed probable ventilator-associated pneumonia (VAP), plasma mNGS afforded early detection of the eventual culture-confirmed VAP pathogens. Our findings suggest that in a majority of patients with severe pneumonia, circulating microbial DNA from confirmed respiratory pathogens can be detected in the bloodstream, even in the setting of negative blood cultures.
Determination of total hydrogen cyanide levels in fresh cassava roots using the picrate paper method v3
Authors: LE Imakumbili Matema
Published: April 2019

This protocol describes how to analyse total cyanide (HCN) levels in fresh cassava roots using the picrate paper method. The method gives the potential cyanide content of cassava roots on a fresh weight basis. The picrate paper method for root cyanide determination relies on endogenous enzymes to breakdown the cyanogenic glucosides (linamarine) in fresh cassava root samples. The hydrogen cyanide liberated in the process reacts with picrate papers that have a colour pigment which darkens with released cyanide. The variations in the darkening of picrate papers is then used to measure the amount of hydrogen cyanide released from fresh cassava root samples. The picrate paper method is argued to not be a very reliable method for cassava cyanide determination. However, if you are going to have to work far from a laboratory where you cannot perform another preferred method, then the picrate paper method is your best option as you may not be able to avoid root deterioration and cyanide loss during transportation of cassava root samples. The key to using this method is focus, precision and timeliness. If these three are maintained throughout the analysis then chances of introducing errors are reduced making the obtained results more comparable with other cyanide determination methods. This protocol has been already well outlined by Dr J.H. Bradbury and his team, so please refer to their document (see the attached document below). A kit for cyanide analysis in cassava roots called PROTOCOL A: DETERMINATION OF TOTAL CYANIDE IN CASSAVA ROOTS, has also been designed by them. This protocol describes how the Protocol A kit can be used to determine cyanide in cassava roots. This protocol is not a replacement of the original protocol. Some of the contents of this protocol have however been directly copied from the original protocol; they are indicated in bold text. This protocol however contains additional insights from things encountered during the use of the kit; this information is in normal text. In addition to this, this protocol includes insights that Dr Bradbury shared to help troubleshoot a few unforeseen issues; these insights are in italics.
Assessing the Effect of Low Calorie Soda Beverages on Primary Tooth Enamel: An In Vitro Study
Authors: Korte Alexandra , Angelopoulou Matina V , Maroulakos Georgios
Published: April 2019

Objective: The purpose of this study was to evaluate the effect of low calorie soda beverages on the enamel of primary teeth. Study Design: Fifty enamel slabs were prepared from twenty primary extracted teeth and were equally divided into five groups: a) 0.9% NaCl (Control), b) Coca-Cola Classic (Sucrose), c) Diet Coke (Aspartame), d) Zevia Cola (Erythritol), e) Coca-Cola Life (Stevia). Each specimen was exposed to the beverage for a total of sixty minutes. Enamel surface roughness was measured before and after the exposures using a LEXT OLS4000 3D Laser Measuring Microscope. Results: All tested sodas resulted to a statistically significant change on the surface roughness of the enamel (p =.000). However, this effect did not differ significantly between the different treatment groups (p =.103). Conclusions: Both regular soda and low calorie soda containing different commercial sweeteners appear to have an effect on the surface morphology of primary tooth enamel. Thus, it is important to discourage the intake of any type of soda as part of the dietary advice provided in the dental office.
¿Hacia el social commerce? El valor de las redes sociales en la MiPyME de Córdoba, Argentina
Authors: Alderete María Verónica , Jones Carola
Published: April 2019

La difusión del comercio electrónico constituye una gran oportunidad para las empresas como instrumento de competitividad. El uso de las redes sociales brinda una plataforma nueva para el desarrollo de las transacciones comerciales online. El objetivo de este trabajo consiste en analizar la relación entre el nivel de adopción del comercio electrónico y la valoración de las redes sociales en las empresas. Con este fin, se utiliza una muestra de 100 Microempresas, Pequeñas y Medianas firmas de la ciudad de Córdoba, Argentina. Sobre la base de un análisis de conglomerados de k medias, se obtienen tres grupos de empresas: empresas avanzadas en e-commerce; empresas únicamente en redes sociales y empresas orientadas al e-commerce. Estos grupos presentan diferencias significativas por sector de actividad, pero no por tamaño de las empresas.
Maternal near miss: an Indian tertiary care centre audit
Authors: Samant Padmaja Y. , Dhanawat Juhi
Published: April 2019

Background: In practical terms, women are considered near-miss cases when they survive conditions which threaten their life i.e. organ dysfunction. Despite advances in medical science and increased awareness of measures for safe childbirth, unacceptably high maternal morbidity and mortality continues to plague developing countries like India. Our’s being a tertiary care centre, draws a lot number of high-risk patients and referrals. By auditing these near miss cases, we aim to identify the causes, factors leading to near miss, to identify management gaps to prevent near misses and maternal death.Methods: Retro-prospective cross-sectional study done over one and a half year. Patients were included based on the inclusion criteria. A questionnaire was used to evaluate the prospective cases and the indoor case sheets were used for retrospective cases. After data entry in excel sheet, data analysis was done using SPSS 21. Results were tabulated.Results: High number of Near Miss cases with preeclampsia being the commonest. Lack of proper facilities at the periphery health centers was the most common cause for referrals. Level 1 and level 2 delays were found in most cases.Conclusions: Timely referral, with adequate treatment at the peripheral hospitals will majorly reduce Near miss. Hence, proper development and functioning of peripheral hospitals are needed.
B-lynch suture in the management of uterine atony during caesarean section section
Authors: C. Sudha H. , Pairu Jaganathan , . Kamalakshi
Published: April 2019

Background: Third stage of labour is still the “sword of Damocle’s” hanging above an obstetrician , inspite  of  today’s advanced technologies and personal care .The importance in the management of this deadly stage lies in the anticipation of complications and being quick enough to treat them timely.  Hence in such scenarios, B-lynch suture is most popular method in treatment of uterine atony during caesarean section. The objective is to study and evaluate the cases in which the B-Lynch suture was used to treat the uterine atony during caesarean section.Methods: A prospective randomized study consisting of 50 women with high risk factors for atonic pph during caesarean section were included as study group patients were subjected to B-Lynch suture application when conventional drugs failed to control PPH. Blood loss was measured using a measuring jar. The fall in Hb% and the need for blood transfusion, and the need for hysterectomy as a last resort to save the life was evaluated.Results: The average blood loss was 1490 ml and the majority of patients had reduction in Hb% from 1.1-1.5 gm% (52%), 36% of the patients did not receive any blood transfusion after B-Lynch suture, and in 80% of cases hysterectomy was avoided.Conclusions: Our study shows cases treated with B-Lynch procedure showed that it is an effective method of containing pph.  It has the advantage of being applied easily and safely. It should be attempted when conservative management fails and before any radical surgery is considered.
Analysis of caesarean delivery using Robson ten group classification system at a tertiary care teaching institute in Kerala, India
Authors: T. Heera Shenoy , Shenoy Sheela T. , T. Anaswara , K. Remash
Published: April 2019

Background: Globally, the caesarean delivery rate is rising continuously, making caesarean one of the most common surgical procedures. The Robson classification, appreciated by WHO in 2014 and FIGO in 2016 is widely accepted, risk-based, ten-group classification system (TGCS) developed specifically to assess caesarean section rates. The aim of this study was to know the rate of Caesarean section in present hospital, to analyse the Caesarean sections based on Robson’s classification and to determine the contribution and significance of each group on the overall number of Caesarean sections.Methods: All women, who gave birth by Caesarean deliveries done over a period of 1 year (January 2018-December 2018) in Travancore Medical College Hospital in South Kerala India.Results: Group 5 (previous LSCS, single, cephalic >37 weeks) made the greatest contribution to the Caesarean section rate (27.24%). The second highest contributor was Group 2 (Nulliparous, singleton, cephalic, >37 weeks induced labour or caesarean section before labour followed by Group 10 (all single cephalic <36 weeks including previous CS) 18.78%.Conclusions: Limiting the CS rate in low-risk pregnancies is key to lowering the trend of increased CS. If TGCS is used uniformly, CS rates can be compared over time and between units, both nationally and internationally.
Comparative study of labetalol and nifedipine in management of non- severe preeclampsia and its fetomaternal outcome
Authors: Rose Delphine T. , P. Jeyarani
Published: April 2019

Background: In developed countries, 16 percent of maternal deaths were attributed to hypertensive disorders. Of hypertensive disorders, the preeclampsia syndrome, either alone or superimposed on chronic hypertension, is the most dangerous. The incidence of preeclampsia in nulliparous populations ranged from 3 to 10 percent.Methods: The present study was conducted at Government Raja Mirasudhar Hospital, Thanjavur Medical College, Thanjavur, Tamil Nadu, India from October 2017 to October 2018. The study consisted of 100 antenatal women with non-severe preeclampsia. The efficacy of labetalol verses nifedipine in its management was studied along with the fetomaternal outcome.Results: In this study, in the labetalol and in the nifedipine groups adequate control of blood pressure was achieved. However, labetalol was well tolerated by our women without much side effects.Conclusions: The present study indicates both labetalol and nifedipine are equally efficacious in the control of hypertension in non-severe preeclampsia. Pathology of the disease was not altered significantly in both the groups. There was no significant difference in the neonatal outcome between the two groups.
A comparative analysis of serum lipid profile between normotensive and hypertensive pregnant women
Authors: K. Sridhara S.
Published: April 2019

Background: The pregnancy results in the development of the placenta which is characterized by the hormonal changes in the women body, which results in the alteration of lipid profile, diabetic state of the pregnant mothers and many others. Objective of this study was to compare the of serum lipid profile between normotensive and hypertensive pregnant women.Methods: A hospital based cross sectional study was conducted by the department of OBG, Hassan Institute of Medical Sciences, Hassan from July 2018 to December 2018. A total of 6 months the study was conducted. A total of 50 pregnant mothers who were more than 20 weeks of gestation and suffering from Preeclampsia were include in the study group and 50 Pregnant mothers who were more than 20 weeks of gestation and normotensive were included in the controls.Results: Majority of the study subjects in both the groups were less than 25 years of age. The mean age of mothers in study group was 23.19 years and 24.19 years in the control group. The mean HDL level was more among the normotensive group than the pre eclamptic group and the p value was found to be statistically insignificant. The VLDL, LDL and triglyceride level was more in the pre eclamptic group than the normotensive group and the association was also found to be statistically significant.Conclusions: Hormonal changes in pregnancy results in physiological Hyperlipidemia, in conditions like pre-eclampsia triglyceride are elevated more than the normal rise seen in normal pregnancy. Increased lipid profile with raised TG, VLDL, LDL levels leads to the development of Preeclampsia by increasing the oxidative stress and the endothelial dysfunction.
Occurrence of hypothyroidism and its correlation with reproductive health problems: a cross sectional study
Authors: Kumar Selvi , Kotur Pushpa
Published: April 2019

Background: Thyroid dysfunction is 10 times more common in women than in men. Hypothyroidism among women of reproductive age group is linked to menstrual irregularities, polycystic ovarian syndrome (PCOS), miscarriage and infertility. Several studies are available in the literature reporting regarding impact of hypothyroidism on one or the other isolated problems of reproductive health problems.Methods: This cross-sectional study is conducted including 290 participants having various reproductive health problems attending the gynaecology OPD of a rural based tertiary care hospital of Tamil Nadu during the year 2017-2018.These participants were investigated for thyroid dysfunction and its correlation of hypothyroidism with reproductive health problems viz. menstrual irregularities, Polycystic ovarian diseases (PCOS), infertility and pregnancy loss was studied.Results: It was observed that 80.6% of the 290 participants were euthyroid and 16.97% were hypothyroid, who presented with menstrual irregularities like menorrhagia (28.6%), oligomenorrhea (20.8%), amenorrhoea (21.3%), PCOS (28.6%), infertility (21.6%) and 23.8% hypothyroid women had pregnancy losses of varying number.Conclusions: In present study the occurrence of hypothyroidism was found to be 16.89%. Since hypothyroidism has close association with problems like menstrual irregularities, PCOS, miscarriages and infertility, thyroid function test should be routinely recommended for these women. Thyroid dysfunction can be corrected with simple, cost-effective treatment.  This will help in improvement in pregnancy outcome and also avoid subjecting women for major surgeries for menorrhagia.
Hotdog in bun: a recent technique for oophoropexy
Authors: Shah Nitin H. , Joshi Aditi V. , Belekar Gitanjali
Published: April 2019

Ovarian torsion is an acute gynaecological emergency. It may present at any age group, however it is more common in the reproductive years. The patient may present with a myriad of clinical features which are often non-specific posing a diagnostic dilemma. Ultrasonography is the best initial modality of imaging. Once diagnosed a surgical approach is the mainstay of treatment. Preservation of ovaries and preventing recurrence in young patients is crucial. We present a case of a young adolescent girl diagnosed with an ovarian torsion who was managed laparoscopically. Oophoropexy was done to avoid future recurrence by an emerging method called the “Hotdog in bun” technique.
A study of the prevalence and severity of vitamin D deficiency in patient with diabetic foot and its association with vascular calcification and effect on healing
Authors: Kamble Ajonish , Swarnkar Manish
Published: April 2019

Background: With the increasing prevalence of diabetes mellitus (DM), vitamin D (vit D) deficiency and vascular calcification is frequently observed in DM and is an indicator of diabetic peripheral vascular disease with variable implications. Due to the current limited understanding, this research was initiated. Aims and objective was to critically assess the prevalence and severity of vitamin D deficiency in patients with diabetic foot infection, the association between vascular calcification and vitamin D deficiency and effect on healing in diabetic foot patient with and without vitamin D deficiency.Methods: This observational study was conducted on 50 patients with diabetes mellitus. A detailed clinical history was recorded. Infection was confirmed by culture positivity and Doppler was used to detect vascular calcification. A follow-up for 3 weeks was done after which wound healing rate was assessed by change in wound surface area. Data was analyzed by Chi-square test and multivariate regression analysis.Results: 58% patients were diagnosed with vitamin D deficiency. 40% of patients found to have VC associated with DM. 100 % association of VC was found in patients with severe vitamin D deficiency. Vitamin D deficiency significantly correlated with vascular calcification (p=0.0001). A significant difference was observed in wound healing between the patients with and without vitamin D deficiency i.e.  3.14±2.04mm.sq and 4.36±1.39mm.sq.Conclusions: This study opens up an issue of recognizing vitamin D deficiency as a possible risk factor for diabetic foot infections and suggests the need for vitamin D supplementation.
The non traumatic acute abdomen and its clinical spectrum
Authors: Srujan Kumar M. , B. Bharath , Balasubramanya K. S. , Thinagaran K.
Published: April 2019

Background: Acute abdomen poses a big challenge to the general surgeons in terms of both diagnosis and management. The aim of this study was to know in detail the clinical and postoperative outcome in non traumatic acute abdomen.Methods: Prospectively collected data of 326 patients with non traumatic acute abdomen admitted in PES institute of medical sciences and research, Kuppam from November 2016 to June 2018. All patients were subjected to clinical examination, relevant blood and imaging investigations, Intra and postoperative findings events were recorded.Results: Non traumatic acute abdominal pain was more common in 2nd to 5th decade of life. Males are more affected than females with a male to female ratio of 3.4:1. Acute appendicitis forms the commonest cause of acute abdomen (n=160=49%) followed by perforative peritonitis (n=85=26%). Most common surgical procedures done were laparoscopic/open appendectomy for acute appendicitis, exploratory laparotomy with Graham’s omentoplasty for perforative peritonitis.Conclusions: Systematic approach in history taking and a proper clinical examination with supportive imaging findings are most important in making an accurate diagnosis and need of appropriate surgical intervention in patients with non traumatic acute abdomen.
A study on acute urinary retention in patients with benign prostatic hyperplasia at a rural setup
Authors: Addepalli Jagadeeswar , K S Balasubramanya , Francis John M. , Thanneru Karthik
Published: April 2019

Background: Acute urinary retention (AUR) is one of the most significant complications of benign prostatic hyperplasia (BPH). Aim was to discuss the management of AUR in BPH in a rural setup.Methods: It was a prospective study, at PESIMSR, Kuppam, on 100 BPH patients who presented to the ER or OPD with AUR from November 2016 to June 2018. All were catheterized initially. Patient clinical characteristics, prostate size, type of AUR and management one (type of catheterization, hospitalization, trial without catheterisation (TWOC), use of medication, immediate and elective surgery) were recorded.Results: Mean age was 68.33±9.1. Most patients (74 %) had spontaneous AUR and rest had precipitating factors. A per-urethral catheter (PUC) was inserted in most cases (96%), rest had supra-pubic cystostomy (SPC). Patients with prostate volume of <30 ml (n=8) were started on alpha-blocker (AB) alone and those with >30 ml were given AB with 5 alpha-reductase inhibitor (ARI) combination. TWOC had an overall success rate of 72% (n=72), of them 38 opted for elective surgery. TWOC failed in 28 patients who were re-catheterized and underwent transurethral resection of prostate (TURP) on an elective basis. 66 out of 100 patients underwent TURP in the course of management of AUR in BPH.Conclusions: Management of AUR in BPH patients in real-life practice in a rural setup hospital has been evaluated. It shows that urethral catheterization, medication, TWOC and finally continuing medical management or planning TURP based has become standard practice.
Diagnosis and management of acute acalculous cholecystitis in an outpatient: a case report
Authors: Arockia Singh Maria Dass Scott , Anish Kumar Meethala Peedikayil
Published: April 2019

Acute acalculous cholecystitis (AAC) is defined as acute necrotic inflammation of the gall bladder without stone disease. It commonly occurs in ICU patients associated with major trauma, burns, multiorgan failure patients, post major surgery, end stage malignancies, severe sepsis. Here we present a case of acute acalculous cholecystitis with gangrenous formation in a middle-aged outpatient without any prior illness. He was a hypertensive on medications came with complains of abdominal pain. Clinical examination and ultrasound revealed features suggestive of infective acalculous gall bladder disease. Emergency laparoscopic subtotal cholecystectomy done, discharged in a healthy state on 3rd postoperative day. We present this case to raise awareness among primary care physicians of AAC in patients with acute right hypochondrial pain. Prompt diagnosis and urgent surgical management gives the best outcome in these patients.
THE ASSOCIATION BETWEEN FRAGMENTED QRS ON ELECTROCARDIOGRAPHY AND BLOOD PRESSURE PATTERN IN PATIENTS WITH HYPERTENSION
Authors: Kadı Hasan , Avcı Eyüp
Published: April 2019

OBJECTIVE: Fragmented QRS (fQRS) complexes on electrocardiography (ECG) signify areal scar and fibrosis in the myocardium. Our aim was to investigate association between fragmented QRS and blood pressure pattern in hypertensive patients.MATERIAL AND METHODS: Patients underwent ambulatory blood pressure were studied retrospectively. Patients whose systolic blood pressure was 10-20% lower during the night when compared to the day were grouped as “dipping group”, while those who had a decrease less than 10% during the night were grouped as “non-dipping group”. The fQRS was defined as the presence of a second R wave, notching of R or S wave or fragmentation in two contiguous leads on ECG corresponding to epicardial major coronary artery region.RESULTS: The dipping group had 98 patients, while the non-dipping group had 89 patients. The groups were similar in terms of age, sex, body mass index, lipid profile and antihypertensive drugs. The fQRS was observed in 14 patients in the dipper group and 27 patients in the non-dipping group (p=0.008). The fQRS on ECG was found to be an independent predictor of non-dipping blood pressure pattern (p=0.046, odds ratio=2.27).CONCLUSIONS: The presence of fQRS was more than in hypertensives with non-dipping pattern compared with dipping pattern and this variable was a predictor of non-dipping pattern.
Spinal Anestezi Eşliğinde Transüretral Rezeksiyon Uygulanan Hastaların İntraoperatif Hemodinamik Parametrelerinin ve EKG’deki QT Değişikliklerinin Preoperatif Değerler ile Karşılaştırılması
Authors: Sarpdağ Cafer , Kaygusuz Kenan , Avcı Onur , İsbir Ahmet Cemil , Özdemir Kol İclal , Gürsoy Sinan
Published: April 2019

AMAÇ: Çalışmamızda spinal anestezi altında transüretral prostat rezeksiyonu (TUR-P) uygulanan hastalarda intraoperatif hemodinamik değişikliklerin ve QT mesafesi değişikliklerinin preoperatif değerler ile karşılaştırılmasını amaçladık.GEREÇ VE YÖNTEM: Çalışmaya transüretral prostat rezeksiyonu uygulanacak 40-65 yaş arası ASA I-II (American Society of Anesthesiologists) toplam 45 hasta rastgele olacak şekilde 3 gruba ayrıldı. I. gruba (n=15) %0.9 NaCl, II. gruba Jelatin, III. gruba Hidroksietil nişasta 18 gauge intraket ile açılan intravenöz (IV) damar yolundan verildi. Hemodinamik parametreler olarak ortalama arteriyel basınç (OAB), periferik oksijen saturasyonu (SpO2), kalp atım hızı (KAH) operasyon öncesi ve operasyon süresince 5 dakika aralıklarla ve operasyon sonrası kaydedildi. QT intervali değerleri operasyon öncesi ve operasyon süresince 5., 15., 30., 60. dakikalarda ve operasyon sonrası kaydedildi.BULGULAR: Gruplar arası ve her bir grup kendi içinde değerlendirildiğinde ortalama arteriye basınç (OAB), periferik oksijen saturasyonu (SpO2), kalp atım hızı (KAH) açısından anlamlı bir fark bulunmazken (p>0.05), QT mesafesi grup I’de preoperatif değerler ile 5.dk ve 10.dk ile postoperatif ölçümler arasındaki farklılık anlamlı olup ve bu değerlerde artış bulunmuştur (p<0.05). Grup II’de preoperatif ve postoperatif ölçülen QT değerleri arasındaki fark anlamlı olarak artmıştır (p<0.05). Grup III’de preoperatif değerler ile, 15. dk, 20. dk, ve postoperatif değerler arası fark anlamlı olup (p<0.05) bu değerlerde artış bulunmuştur. Grup III’de 5. dakika ile diğer ölçümler arası fark anlamlı olup (p<0.05) ve bu değerlerde artış bulunmuştur.SONUÇ: Transüretral prostat rezeksiyonu operasyonu planlanan hastalarda intraoperatif ve postoperatif QT intervalinin uzadığı gözönüne alındığında; özellikle koroner kalp hastalığı bulunan ve preoperatif edinsel ya da konjenital uzamış QT intervali saptanan hastalarda daha dikkatli olunmalıdır.
GÜNCEL BİR ADİPOKİN: CHEMERİN
Authors: Çelik Menşure Nur , Ünlü Söğüt Mehtap
Published: April 2019

AMAÇ: Adipoz dokudan salgılanan chemerin kısa bir süre önce adipokin ailesine katılan, çeşitli otokrin ve parakrin etkileri olan bir sinyal molekülü ve yeni bir kemotaktik proteindir. Son yıllarda chemerin ve reseptörünün adipositlerde yüksek oranda olmak üzere karaciğer, böbrek, pankreas, hipofiz, plasenta, yumurtalık ve testislerde eksprese edildiği saptanmıştır. Bu organ ve dokular aracılığıyla enerji homeostazı, glukoz metabolizması, inflamasyon ve birçok fizyolojik sürece etki ettiği bilinmektedir. Adipogenezis, enerji metabolizması ve inflamasyonda rolü olduğu gösterilen bu adipokinin metabolik sendrom (MetS), obezite, Tip 2 Diabetes Mellitus (T2DM), kardiyovasküler hastalıklar, Crohn hastalığı, artrit ve kanserde rolü hakkında artan kanıtlar mevcuttur. Özellikle chemerin, obezite ile T2DM’ nin gelişimi arasında olası bir bağlantının hipotezi olarak öne sürülmüştür. Aynı zamanda plazma chemerin düzeylerinin vücut kütle indeksi, açlık serum insülini, açlık kan glukozu, plazma trigliseridleri ve total serum kolesterolü ile pozitif korelasyon gösterdiği ve yüksek yoğunluklu lipoprotein (HDL) ile negatif korelasyon gösterdiği saptanmıştır. Genel olarak, bu bulgular dolaşımdaki chemerin düzeylerinin yağlanmaya ve metabolik sendroma bağlı olduğunu, viseral adipozun obez bireylerde chemerinin değiştirilebilir bir kaynağı olduğunu düşündürmektedir. Chemerin; insulin seviyesini azaltıp, glukoz kullanımını artırarak glukoz homeostazını; glikojen sentetazı inhibe ederek T2DM’u; adiposit farklılaşmasını ve kemotaksisi düzenleyerek inflamasyonu; GLUT-4, yağ asidi sentaz, adiponektin ve leptinin salınımını düzenleyerek MetS belirteçlerini etkilemektedir. Bu nedenle obezite, T2DM, kardiyovasküler hastalıklar, inflamasyon, metabolik sendrom ve daha birçok hastalıkla ilişkisi bulunan chemerin adipokininin dolaşımdaki seviyelerini belirlemek ve düzeylerini kontrol etmek önem taşımaktadır. Literatür taramasında sıklıkla obez ve metabolik sendromlu bireylerde dolaşımdaki chemerin seviyelerinin yüksek olduğu göze çarpmaktadır. Bu derlemede chemerinin obezite ve metabolik sendromdaki etkileri ile birlikte daha az ele alınan inflamasyon, polikistik over sendromu ve diğer metabolik etkilerine yer verilmektedir.
Caso Clínico: Colgajo de lengua de base anterior para cierre de fístula palatina
Authors: Túquerres Mosquera Viviana , Díaz Mora René
Published: April 2019

Las fístulas palatinas son una de las secuelas más comunes de las cirugías de paladar hendido. Debido a su gran vascularidad el colgajo de lengua se ha convertido en una de las opciones más versátiles para el cierre de fístulas palatinas que incluyen defectos amplios o en aquellos casos de secuelas de cirugías hechas anteriormente y que han fracasado. Los colgajos de lengua pueden ser creados de la cara ventral, dorsal o lateral de la misma, varios estudios demuestran su éxito en ambos ya sea de base anterior o posterior usados en el cierre de defectos de fístulas palatinas. El objetivo de este reporte de caso es presentar la experiencia de un caso clínico acerca de la corrección de una fístula palatina amplia (mayor a 5 mm) mediante la elaboración de un colgajo lingual de base anterior, cuyo uso es reportado en la literatura como el de elección en estos casos (defectos de gran dimensión) presentando un alto porcentaje de éxito.
The effect of renewable energy resources on regional development at the Thrace Region in Turkey
Authors: Dursun Bahtiyar
Published: April 2019

Countries seek to increase their economic growth and development levels effectively by using their production factors. The living standards at the aforementioned regions to rise up to the desired level via regarded economic development. The main purpose of the local and regional development is to enhance underdeveloped and developing regions’ limited income level and increase the business opportunities when compared with the developed regions. One of the prominent actors in the local and regional development is undoubtedly energy. Especially, recently, the demand to the renewable energy sources usage has been increasing.  Renewable energy sources are evaluated according to their potentials. When a region has a renewable energy potential, establishing and running renewable energy sources based power plants will have positive effects on regional development. In this study, energy concept, which is one of the most important inputs of regional development, is discussed. Current usage potential of the Thrace Region’s current energy sources are presented and the effects of renewable energy sources on regional development are studied when they are used.