bluuebunny/crossref_metadata_2025 huggingface dataset:
Sustrato de hidrogel de celulosa modificado con macroporosidad mediante microtomografía computarizada e impresión 3D para cultivo sin suelo
Authors: Belmonte Torres Ángel Iván , Aguilar Duque Juan Israel , Amaya Parra Guillermo
Published: October 2023

El cultivo sin suelo es una técnica de la agricultura que permite un mayor rendimiento en los cultivos, mostrando varias ventajas sobre la agricultura tradicional, esta técnica requiere de mejoras en los sustratos utilizados para obtener mayor producción y calidad. Los hidrogeles derivados de celulosa prometen ser una buena alternativa como sustrato por sus propiedades hidrofílicas sin embargo carecen de una buena aireación. Se propone utilizar la celulosa como materia prima para la síntesis de hidrogeles a base de celulosa asistido por la microtomografía computarizada para generar un modelo con una porosidad de 15-30% y reproducirlo mediante impresión 3D por procesamiento de luz digital (DLP). Por lo tanto, se busca obtener un sustrato de hidrogel de celulosa con mejores propiedades que los sustratos comerciales, e implementar la impresión 3D en la agricultura.
Energy and exergy analysis of an ejector-compression refrigeration cycle with double IHX
Authors: Rodríguez Muñoz José Luis , Pacheco Cedeño José Sergio , Valencia Castillo César Manuel , Ramírez Minguela José de Jesús
Published: October 2023

This paper shows an energy and exergy analysis of an ejector-compression refrigeration cycle, in which two heat exchangers are included to the system: 1) between the condenser and liquid separator (IHX-1) and 2) between the condenser and the evaporator (IHX-2), which is an alternative configuration proposed and this configuration is defined as ERC+IHX-1+IHX-2. The effect of evaporation temperature and the heat exchanger effectiveness on the energy and exergy efficiencies and the irreversibilities of each component of the cycle have been analyzed for refrigeration and air conditioning applications. The results show that for the alternative configuration and an effectiveness of IHX-1=80%, it results slightly with a higher COP than when the configurations work with an effectiveness of IHX-2=80%. However, the exergy efficiency increases when the evaporation temperature decreases. The components that show the highest contribution to the irreversibilities in the ERC+IHX-1+IHX-2 configuration are: the condenser, the compressor and the evaporator; whereas that the lowest contribution is due to the expansion valve and IHX-1. In addition, the alternative configuration proposed presents a higher exergetic efficiency and lower irreversibilities than the configurations ERC+IHX-1 y ERC+IHX-2 reported in the literature.
THE CRUCIAL ROLE AND FUNCTIONS OF SOCIAL WORKERS IN DISASTER MANAGEMENT
Authors: Patel Vipul
Published: October 2023

Disasters, both natural and man-made, have devastating effects on communities, leaving survivors traumatized and vulnerable. In the wake of such calamities, social workers emerge as indispensable actors in disaster management, providing vital support to affected individuals and communities. This article delves into the critical role and functions of social workers in disaster response and recovery. It explores their immediate response and assessment capabilities, emphasizing their unique expertise in delivering emotional and psychological support to survivors. The article highlights how social workers facilitate access to essential resources, their adeptness in community organization and mobilization, and their role as advocates in influencing disaster policies. Furthermore, it discusses the pivotal role of social workers in rehabilitation efforts, fostering resilience, and contributing to disaster preparedness and prevention initiatives. Through comprehensive analysis, this article underscores the significance of social workers' dedication and expertise in aiding communities to rebuild and recover, ultimately promoting a compassionate and collaborative approach to disaster management.
EXCELLENT ELEMENTS OF PRESENTATION IN BUSINESS ARENA
Authors: Chandravadiya D M
Published: October 2023

Presentation is very necessary part of organisation. One should be very careful to make presentation. Always keeps some points to make effective presentation like data collection, accuracy in speech, chronological order of content, use of Multimedia tools. Through an effective presentation it can be convey an aim and objectives. The presentation ideas should be well adapted to your audience. Relate your presentation message/idea to the interests of the audience. It has been creating overall image of organisation.
PATHOMORPHOLOGICAL CHANGES IN PIGLETS AT TRICHOTHECENE MYCOTOXICOSIS
Authors:   DSM Nutritional Products Russia, Animal Nutritional & Health, MAXIMOV T.P. , KUDRIASHOV A.A. ,   St. Petersburg State University of Veterinary Medicine, BALABANOVA V.I. ,   St. Petersburg State University of Veterinary Medicine
Published: October 2023

The aim of the study was to identify pathomorphological changes in combined deoxynivalenol and T-2 toxicosis in piglets of the rearing group. The material of the study was 19 weaned piglets aged 52‒63 days, in which mycotoxicosis was suspected during their lifetime. The material for the study also served as 10 samples of full-grain granular compound feed SK-4 for piglets aged 1.5‒2 months, fed in groups of the studied animals. We conducted a pathoanatomic study using the method of complete evisceration according to G.V. Shor. During the autopsy, liver and kidney samples were taken from piglets for histological examination. The pathological material was fixed in a 10% solution of neutral formalin. Then the filling was carried out in paraffin and sections 5‒7 microns thick were made on a rotary microtome. The sections were stained with hematoxylin and eosin. The quantitative content of mycotoxins in feed samples was determined in the laboratory of biochemical analysis of the Federal Scientific Center All-Russian Scientific Research and Technological Institute of Poultry Farming using the method of high-performance chromatography in tandem with mass spectrometry (HPLC-MS/MS). As a result of the study, the content of T-2 toxin in the concentration from 0.03 to 0.89 mg/kg and the presence of deoxynivalenol (DON) toxin in the concentration from 0.5 to 4.9 mg/kg were found in the feed samples, which significantly exceeded the maximum permissible levels of these mycotoxins in pig feed. At the autopsy, hemorrhages, foci of necrosis and erosion in the skin, anemia, foci of necrosis, erosion, hemorrhages, catarrhal inflammation in the stomach, hemorrhages and inflammation in the intestines, pulmonary edema and acute reactive hepatitis were found in piglets. Histological examination of the liver revealed granular and watery dystrophy, necrosis of hepatocytes, leukocyte infiltration of Disse spaces. In the kidneys - watery dystrophy and necrosis of the epithelial cells of the renal tubules.
Optimized Selection of Motorcycle Battery Swapping Stations Under Flexible Demand by Using Distance Function And Gis Technique
Authors: On-Ouen Athita , Arbking Jirayus , Phakdee Nuttaporn
Published: October 2023

Our research proposes an approach to finding a suitable location for a motorcycle Battery Swapping Station (BSS) that considers multiple objectives. We developed a model based on Euclidean distance with K-NN, the AHP function, a desired number of stations, and GIS-based road infrastructure data. This model also considers the maximum coverage area and satisfies the number of stations and geographical features. Additionally, we consider the average driving distance of the battery swapping station location. To facilitate analysis, square grids form cells representing road type, environmental characteristics, places, and population density. Our proposed framework provides decision-makers with a multi-objective and visually optimized motorcycle BSS location, allowing for a more flexible selection of exact BSS locations shown on a map. Our demonstration can be used to resolve the uncertain problem related to finding a place for a motorcycle battery swapping station location. to finding a place for a motorcycle battery swapping station location.
Astley before Astley’s
Authors: Mayer Cassie , Mayer Lise , Mayer David
Published: October 2023

Our prevailing image of Astley’s is the 1808 Thomas Rowlandson-Auguste Pugin engraving in Rudolph Ackerman’s
The Microcosm of London
in which a rider, standing upright on the back of a capering horse (as a clown-to-the-horse stands by) performs before a packed auditorium of fashionable ladies and gentlemen. Our account precedes that moment by more than four decades when, in 1759, the teenage Philip Astley, escaping family poverty, enlists in the Earl of Pembroke’s 15th Light Dragoon regiment. Sent for cavalry training to Wilton House (near Salisbury in Wiltshire) and in the Earl’s indoor manège, young Astley was trained in military equitation and use of cavalry weapons by Pembroke, Col. George Eliot, and Pembroke’s riding master Domenico Angelo, the trio advocating and enforcing a style of riding which sharply differed from conventional cavalry horsemanship. This style and the very choice of horses on which he was trained would thereafter be the basis for Astley’s great skill, his feats in battle, the horses employed in his arenas, and the approach to riding which he would demand of his actors and performers.

Astley returned a war hero from the Seven Years’ War, rising to the rank of sergeant major and displaying exceptional equestrian skills. His feats in battle earned the patronage of George III which Astley was to repeatedly exploit. Discharged
c
.1768, Astley, now married, busked in the public parks, showing some of his trick-riding feats before opening a riding school in Lambeth. In this essay, we discuss how the vogue for riding amongst the emerging middle classes made the teaching of equitation a profitable enterprise, and we look closely at Astley’s riding school, his pupils, and the displays of horsemanship and other acts demanding physical skills at that school. These performances, initially in an outdoor venue subject to the vagaries of weather and to the hostilities of the Royal Patent holders, led to Astley’s enclosed Royal Grove Theatre and, after a 1794 fire, an even grander structure on the same site, just south of Westminster Bridge. We identify how Astley acquired his patent.
Les indicateurs de pauvreté monétaire dans les recherches féministes : bilan, état des lieux et perspectives
Authors: Berthonnet Irène
Published: October 2023

La critique féministe a désormais bien documenté le fait que les indicateurs de pauvreté monétaire officiels que sont l’International Poverty Line (Banque mondiale) et le taux de risque de pauvreté (Eurostat) sous-estiment la pauvreté des femmes. L’article présente deux indicateurs de pauvreté monétaire alternatifs introduits par les recherches féministes. La discussion de ces indicateurs met en évidence leur apport à la réflexion générale sur la façon de quantifier la pauvreté monétaire sans sous-estimer la pauvreté des femmes. En particulier, l’ensemble des recherches féministes sur ces indicateurs montre que pour une juste quantification d’une pauvreté – même définie en termes strictement monétaires –, il est impossible de faire l’économie d’une prise en compte des rapports de force existant au sein des ménages. À partir de ce constat, deux pistes sont proposées pour avancer vers la réalisation d’un nouvel indicateur de pauvreté monétaire.
Reduction of carbon emissions under sustainable supply chain management with uncertain human learning
Authors: Singh Richi , Yadav Dharmendra , Singh S.R. , Kumar Ashok , Sarkar Biswajit
Published: October 2023

Customers' growing concern for environmentally friendly goods and services has created a competitive and environmentally responsible business scenario. This global awareness of a green environment has motivated several researchers and companies to work on reducing carbon emissions and sustainable supply chain management. This study explores a sustainable supply chain system in the context of an imperfect flexible production system with a single manufacturer and multiple competitive retailers. It aims to reduce the carbon footprints of the developed system through uncertain human learning. Three carbon regulation policies are designed to control carbon emissions caused by various supply chain activities. Despite the retailers being competitive in nature, the smart production system with a sustainable supply chain and two-level screening reduces carbon emissions effectively with maximum profit. Obtained results explore the significance of uncertain human learning, and the total profit of the system increases to 0.039% and 2.23%, respectively. A comparative study of the model under different carbon regulatory policies shows a successful reduction in carbon emissions (beyond 20%), which meets the motive of this research.
Mathematical modeling for the development of traffic based on the theory of system dynamics
Authors: Sánchez Juan Manuel , Valverde Adrián , Guirao Juan L. G. , Chen Huatao
Published: October 2023

This paper is concerned with mathematical modeling for the development of Shandong traffic. The system dynamics model of the development of traffic in Shandong is established. In terms of this model, it is shown that highway operation as well as rail transit promotes the development of traffic, while traffic accidents inhibit traffic development. Moreover, the maximum error between the output data and the statistics bureau, based on which some forecasts for the development of traffic in the future are given, is obtained, some suggestions and optimization schemes for traffic development are given. Finally, a neural network model of the development of Shandong traffic is also derived.
Reversible codes and applications to DNA codes over $ F_{4^{2t}}[u]/(u^2-1) $
Authors: Alsuraiheed Turki , Oztas Elif Segah , Ali Shakir , Yilgor Merve Bulut
Published: October 2023

Let $ n \geq 1 $ be a fixed integer. Within this study, we present a novel approach for discovering reversible codes over rings, leveraging the concept of $ r $-glifted polynomials. This technique allows us to achieve optimal reversible codes. As we extend our methodology to the domain of DNA codes, we establish a correspondence between $ 4t $-bases of DNA and elements within the ring $ R_{2t} = F_{4^{2t}}[u]/(u^{2}-1) $. By employing a variant of $ r $-glifted polynomials, we successfully address the challenges of reversibility and complementarity in DNA codes over this specific ring. Moreover, we are able to generate reversible and reversible-complement DNA codes that transcend the limitations of being linear cyclic codes generated by a factor of $ x^n-1 $.
A visual transformer-based smart textual extraction method for financial invoices
Authors: Wang Tao , Qiu Min
Published: October 2023

In era of big data, the computer vision-assisted textual extraction techniques for financial invoices have been a major concern. Currently, such tasks are mainly implemented via traditional image processing techniques. However, they highly rely on manual feature extraction and are mainly developed for specific financial invoice scenes. The general applicability and robustness are the major challenges faced by them. As consequence, deep learning can adaptively learn feature representation for different scenes and be utilized to deal with the above issue. As a consequence, this work introduces a classic pre-training model named visual transformer to construct a lightweight recognition model for this purpose. First, we use image processing technology to preprocess the bill image. Then, we use a sequence transduction model to extract information. The sequence transduction model uses a visual transformer structure. In the stage target location, the horizontal-vertical projection method is used to segment the individual characters, and the template matching is used to normalize the characters. In the stage of feature extraction, the transformer structure is adopted to capture relationship among fine-grained features through multi-head attention mechanism. On this basis, a text classification procedure is designed to output detection results. Finally, experiments on a real-world dataset are carried out to evaluate performance of the proposal and the obtained results well show the superiority of it. Experimental results show that this method has high accuracy and robustness in extracting financial bill information.
Elementi slovenstva v odnosu do matične domovine in do latinskoameriške kulture v narativnem gradivu, dokumentiranem pri argentinskih Slovencih
Authors: Ivančič Kutin Barbara
Published: October 2023

Prispevek temelji na enomesečni terenski raziskavi, ki je leta 2019 potekala na treh lokacijah v Argentini med slovenskimi priseljenci in njihovimi potomci z namenom dokumentiranja narativnega gradiva, predvsem slovstvene folklore. Večina pripovedovalcev, ki jih je raziskava zajela, so emigranti oz. njihovi potomci, ki so se v Argentino naselili po drugi svetovni vojni kot politični begunci. Ta slovenska skupnost je v novi deželi takoj po prihodu vzpostavila slovenske domove, ki so skrbeli za izobraževanje in gojenje slovenskega jezika in kulture (in s tem identitete) vse do danes. Analiza ugotavlja, kateri elementi slovenstva se v narativnem gradivu najbolj pogosto pojavljajo na nivoju jezika in »tradicionalne« kulture v odnosu do matične domovine Slovenije in do latinskoameriške kulture in katere distinkcije med kulturama so najbolj poudarjene.
Falaise, as marcas da história numa cidade da Normandia
Authors: Confins
Published: October 2023

A história da cidade de Falaise, na Normandia, foi marcada por dois eventos históricos importantes: a construção de um castelo fortificado, o de Guilherme o Conquistador, e a batalha do “bolsão de Falaise”, que causou grande destruição no final da Segunda Guerra Mundial. Esses dois eventos podem ser vistos na paisagem urbana, especialmente durante os festivais medievais organizados todos os anos em torno do castelo, que ainda domina a cidade, e no memorial construído para manter viva a memória do sofrimento da população.
Acordo União Europeia-Turquia (2016) frente à crise humanitaria dos refugiados sirios : avanços, consolidações ou retrocessos ?
Authors: Silva Victor Albuquerque Felix da , Neto Tomaz Espósito
Published: October 2023

O presente artigo busca responder à seguinte questão: em que medida o Acordo União Europeia-Turquia (2016) cumpre a Convenção Relativa ao Estatuto dos Refugiados e o Protocolo Relativo ao Estatuto dos Refugiados? O objetivo geral desta investigação é analisar o Acordo União Europeia-Turquia, e os objetivos específicos são: analisar o surgimento, evolução e consolidação dos regimes internacionais para refugiados; abordar o contexto político, econômico e social da República Árabe Síria; e discorrer sobre as previsões do Acordo União Europeia-Turquia. Trata-se de uma pesquisa qualitativa, que questiona o Acordo União Europeia-Turquia sobre a violação do regime internacional para refugiados. Utilizou-se aqui o método de estudo de caso aliado à análise documental de fontes primárias e secundárias disponibilizadas pela União Europeia, República da Turquia, ONGs e agências da ONU, assim como uma revisão selecionada das literaturas sobre regimes internacionais e o instituto do refúgio.
Concentração no varejo alimentar brasileiro: o grupo Carrefour na encruzilhada?
Authors: Bezerra Juscelino Eudâmidas
Published: October 2023

O Brasil é um dos principais focos de expansão do varejo alimentar no mundo, tendo em vista seu gigantismo territorial e uma ampla base de consumidores nos espaços urbanos. Na última década do século XX, verificou-se um aumento importante da participação do capital de redes varejistas multinacionais no mercado doméstico, com a realização de fusões e aquisições de empresas com atuação nacional e regional. Destaca-se o grupo francês Carrefour, atual líder do setor e pioneiro no território nacional desde 1975. O objetivo do artigo é analisar a concentração supermercadista no Brasil mediante o fortalecimento do grupo Carrefour. Pretende-se destacar as implicações para a geografia do capital comercial do varejo alimentar, ressaltando-se as estratégias de aquisição de novas empresas, a topologia territorial, os investimentos no capital bancário e sumarizando os principais impactos socioeconômicos para a rede agroalimentar.
Les marges équatoriales en Amazonie Brésilienne : une frontière énergétique sous tension en Amérique du Sud
Authors: do Rio Gisela Pires
Published: October 2023

O objetivo deste artigo é apresentar uma reflexão a respeito do papel dos territórios do petróleo na transição energética e na transição para a sustentabilidade vis-à-vis os espaços vulneráveis. Nessa perspectiva, privilegia-se as interações terra-mar para ressaltar as peculiaridades da zona costeira e as articulações entre estruturas econômicas e institucionais que caracterizam esses territórios. A exploração de petróleo na margem equatorial, considerada uma nova fronteira energética na América do Sul, é o espaço a partir do qual elaborou-se a reflexão proposta. Situada ao longo da costa da Venezuela até o litoral norte do Rio Grande do Norte, o recorte espacial adotado neste trabalho considera exclusivamente a porção localizada na zona costeira brasileira. Conclui-se que as diferentes transições não dependem exclusivamente da evolução do aparato tecnológico, mas também de acordos políticos que interpelam tanto uma governança sul americana, como global dessas transições.
Tradicionais e novos atrativos nos balneários turísticos na Franças e no Nordeste do Brasil
Authors: Pereira Alexandre Queiroz , Cozic Bertrand , Dantas Eustogio
Published: October 2023

Tout au long du XXe siècle, les zones tropicales sont devenues de plus en plus attrayantes, et elles représentent aujourd'hui des lieux de premier plan au niveau international pour la pratique du tourisme et des loisirs. Par conséquent, conscient de la coexistence de générations de stations balnéaires, cet article propose de comprendre le rôle des pratiques nautiques, des marinas et des terrains de golf dans la formation ou la réinvention des stations touristiques et balnéaires de la côte nord-est du Brésil. Les résultats présentent l'organisation des stations à Fortaleza, Recife e Salvador. Le développement de nouvelles activités telles que les activités nautiques, avec les marinas, et les terrains de golf restent des pratiques peu développées dans la région et réservées à un public restreint d'utilisateurs. L'analyse de deux exemples français montre comment ces activités pourraient devenir fondamentales dans l'évolution des stations balnéaires et des territoires urbains qui les accueillent.
Inteligência Territorial e sua interface com as políticas públicas: o Painel de Segurança Hídrica (PSH)
Authors: Oliveira Júlia Diniz de , Rodrigues Lucas Costa
Published: October 2023

O Painel de Segurança Hídrica (PSH) é um projeto em desenvolvimento que conjuga diferentes atores de órgão públicos, de interesse da sociedade civil e da governança social. Este projeto visa a construção de estratégias de Inteligência Territorial para melhor analisar, demonstrar, visualizar a avaliar os dados sobre segurança hídrica no Brasil. Neste dossiê são analisadas as metodologias inovadoras desenvolvidas para este projeto.
Módulo de Dados Dinâmicos - MDD: o emprego prático da inteligência territorial
Authors: Amorim Rodrigo de Freitas , Simonetti Thiago França
Published: October 2023

O planejamento e a gestão do território são temas complementares e amplamente discutidos, na Geografia e demais ciências que buscam formas de aperfeiçoar os mecanismos de atendimento às demandas socioespaciais. Nesse sentido, calcado no escopo deste dossiê, que visa discutir metodologias para o desenvolvimento e implementação de um Painel de Segurança Hídrica (PSH), atendendo às demandas em escala nacional e regional, o presente artigo tem a pretensão de propor um Módulo de Dados Dinâmicos (MDD), uma ferramenta a ser usada na gestão dos recursos hídricos. Considerando a natureza multiescalar da presente proposta, se fez necessário abordar diferentes unidades, com um foco na região do Semiárido, onde há uma maior insegurança hídrica. Os dados foram integrados através do uso de API - Application Programming Interface (Interface de Programação de Aplicativos), um conjunto de regras e protocolos que permite que diferentes sistemas interajam e se comuniquem entre si, de maneira padronizada. É necessário aproveitar ao máximo toda rede de infraestrutura disponível, utilizando o compartilhamento de dados entre diferentes órgãos públicos para avançar nas tomadas de decisão com mais eficiência, potencializando os resultados e reduzindo os custos operacionais. Ou seja, permitir maior celeridade nas respostas às demandas, à gestão, ao mesmo tempo em que se possibilitam os meios para discussões e amadurecimento nas decisões, em nível de planejamento, que terá maior abrangência espacial e permanência.
Geografia e Inteligência Territorial: conceitos, métodos e práticas aplicados à pesquisa em Segurança Hídrica
Authors: Junior Raimundo Nonato
Published: October 2023

Este artigo apresenta o conceito de inteligência territorial, os efeitos de aprendizagem territorial e a noção de Geoinovação a partir de ativos tangíveis e intangíveis, discutidas na perspectiva da Ciência Geográfica contemporânea, dialogando com conceitos e métodos que compõem a perspectiva denominada pelo autor como Geografia do Conhecimento. Estes fundamentos serviram de embasamento ao projeto de pesquisa Painel de Segurança Hídrica (PSH), na perspectiva de articular teoria e pratica entre Geografia e Tecnologia da Informação. O texto ainda situa esta discussão diante o cenário temático da segurança hídrica e destaca os desafios para inovação territorial nesta área. Os principais resultados apontam para a elaboração de cinco grupos metodológicos de ações inovadoras desenvolvidas para as políticas públicas (Gestão integrada de dados geoespaciais, plataforma de geotecnologia Smart GeoLayers, dashboards interativos, modulo de dados dinâmicos e prognóstico analítico).
Organizational Change in Times of Crisis
Authors: Plimakis Iosif
Published: October 2023

The Covid-19 pandemic was the greatest crisis to face humanity, at least, during the last century. A crisis that had a significant negative impact beyond public health, on society, the economy, and the public administration. At the core of both central and local government response to Covid-19 pandemic, were standing the promotion of organizational change and the strengthening of strategic planning resilience, in order to safeguarding and guarantee the provision of public services to the citizens. In this context, the purpose of the research is to analyze, and comparatively evaluate the impact of Covid-19 pandemic on organizational change in municipal government, focused on the introduction of planning. Research's results are based on a national level, mixed methods, empirical survey conducted with the participation of 32 municipal authorities in Greece, to identify and evaluate the factors affecting organizational change in municipal planning.
The Tao of Soft Power
Authors: Nguyen Van Thanh Tien , Vo Thi Minh Nhut , Truong Van Chinh
Published: October 2023

In our interconnected world, diplomacy fosters understanding, cooperation, and harmony among nations. This chapter delves into using Chinese wisdom from the Tao Te Ching in modern soft power diplomacy. The authors examine principles such as wu wei (nonaction), humility, and balance within the context of relations. By highlighting their relevance and effectiveness in building trust and influence, the authors explore how these principles can inspire strategies that promote benefit shared values and sustainable development. The chapter showcases case studies in cultural and economic diplomacy to demonstrate how Taoist teachings can shape practices for positive outcomes. Additionally, the authors discuss the challenges and opportunities of incorporating principles into diplomacy while emphasizing the significance of cultural literacy and dialogue in overcoming obstacles and creating global harmony. Ultimately this chapter argues that drawing from the timeless wisdom of the Tao Te Ching enables us to shape a harmonious international landscape through the skillful application of soft power.
Acute lymphoblastic leukemia presenting as hepatitis in a young adult: An autopsy presentation
Authors: Rastogi Maj Anukriti , Baveja Puneet
Published: October 2023

Acute lymphoblastic leukemia (ALL) is a disease of children and is rarely found in adults where it is associated with poor prognosis. It typically presents with signs and symptoms of bone marrow failure. Hepatitis is rarely noted as a presenting feature in such cases and may cause delay in diagnosis and treatment if not suspected. A high index of suspicion for hematological malignancies is required if these patients are not responding to conventional management for hepatitis. We report an unusual systemic presentation of ALL in a 21-year-old previously healthy male. He initially presented with jaundice and was being managed conservatively, however, the absence of clinical recovery and the absence of any viral, immune, toxic, or metabolic cause of liver injury along with the presence of lymphocytosis in blood prompted us to consider a hematological malignancy. Hematological workup of the patient revealed a B-cell ALL and the patient was put on preinduction steroid therapy. The patient initially showed signs of improvement; however, 8 days posttherapy, he developed febrile neutropenia and went into septic shock. An autopsy was performed, which revealed infection by Klebsiella and Mucormycosis apart from leukemic infiltrates in multiple organs leading to multiorgan failure.
Broca’s Aphasia as an Only Presenting Feature in Neurocysticercosis with Multiple Cysts: A Rare Case Report
Authors: Reddy Harshitha , Shah Divit , Reddy Venkat , Kumar Sunil , Acharya Sourya , Aggarwal Sachin
Published: October 2023

Neurocysticercosis is a parasitic infection in the brain. Speech involvement is rare in the case of neurocysticercosis. Here we discuss a 60-year-old man with multiple brain cysticercosis who had Broca’s aphasia and responded well to treatment with corticosteroids and albendazole. Lesions affecting the anterior perisylvian speech region cause Broca’s aphasia, which was evident on brain imaging.
Modified Nutrition Risk in Critically Ill (m-NUTRIC) score to assess nutritional status and outcome in patients of chronic kidney disease: 2-year cross-sectional study
Authors: Verma Prerna , Kumar Sunil , Phate Neha , Acharya Sourya , Wanjari Anil , Bawankule Shilpa , Agrawal Sachin
Published: October 2023

Introduction: Chronic kidney disease (CKD) is a major health concern in India and has high prevalence, morbidity, and mortality due to significant percentages of subjects with poor socioeconomic status as well as poor management of health resources. Many apparatuses are available to assess nutrition status among patients of CKD. This study was conducted to identify nutritional risk in CKD patients using a modified Nutrition Risk in Critically ill (m-NUTRIC) score without using interleukin-6 values. Method: This prospective observational study was conducted at a tertiary care teaching hospital for a time period of 2 years from 2020 to 2022. The modification of diet in renal disease approach was used for the staging of the CKD. m-NUTRIC scores were calculated and scores ≥5 were graded in high-risk categories and were associated with adverse outcomes, whereas scores <5 were categorized as low risk. Result: Among 250 patients with CKD enrolled, 65 patients were in the age group 18 to 40 years having a mean m-NUTRIC score of 4.46 ± 1.76; in the age group 40 to 60 years 5.18 ± 1.67; and in the age group older than 60 years 5.88 ± 1.77. The mean (standard deviation [SD]) m-NUTRIC score in hemodialysis group was 5.69 ± 1.63 and in nonhemodialysis group was 4.15 ± 1.66. At m-NUTRIC cutoff of 5, predicted hemodialysis is having 66% specificity and 77% sensitivity. It predicts mortality with a sensitivity of 93% and a specificity of 89% at a cutoff of m-NUTRIC of 6. Conclusion: This study showed that m-NUTRIC score may be an important tool that determines requirement of hemodialysis and mortality in CKD patients. Moreover, these scores were higher in stages 4 and 5 of CKD.
Promoting South Asian primary care research and projecting family medicine practitioner-scholars: A matter of critical importance
Authors: Jawaid Hina , Prasad Ramakrishna
Published: October 2023

ABSTRACT

South Asia, constituting India, Pakistan, Bangladesh, Nepal, Sri Lanka and Bhutan represents the most populous region in the world burdened with significant multilevel poverty. Primary care is well-documented to reduce the burden of diseases (both chronic and acute) and associated morbidity and mortality; be cost-effective and improve health outcomes and health equity for both individuals and populations. Any field, for it to stay relevant and to effectively achieve its stated mission, needs to produce its own knowledge through research. This translates into patient care, practice models, education, and advocacy for health systems strengthening and reform. In primary care, weaving experiential wisdom with clinical evidence lies at the heart of translation. In this editorial, we highlight: a) that local context, in terms of geography, community, culture, language and beliefs, influences the clinical context and practice and therefore research. Thus, relying on primary care research done elsewhere in the globe will not suffice; b) effective primary care is based on a generalist approach that involves certain ways of being, knowing, perceiving, and doing guided by the values of humility and intellectual curiosity, diversity and inclusion, equity, holistic approach to evidence, integrity, transparency, accountability and adaptability, and communication; and c) that the South Asian Region (SAR) has a number of groups experimenting and innovating with various healthcare delivery systems, much of which is not known to the larger field. The WONCA SAR Primary Care Research Network has been set up to facilitate and support scholarship, writing, and publication in primary care especially by practising family physicians. In conclusion, it will be critical to simultaneously promote grounded theory research that integrates both the family medicine/primary care perspective and the voices of families and address the ‘hidden curriculum’ that shapes the attitudes and aspirations of young doctors at both the undergraduate and postgraduate level. Family Physicians treat a variety of patients on a daily basis, in order to improve the quality of care and impact of primary care, it is imperative that the understanding and application of research is enhanced by specialists of this discipline.
The assessment of knowledge and awareness about iron deficiency anemia among the population of Riyadh province
Authors: Alsaab Saad , Alhussayn Omar S. , Altokhais Ziyad A. , Alotaibi Abdulmalik I. , Alsahli Fahad A. , Alotaibi Bader A. , Alrawais Naif M. , Arshad Mohammad
Published: October 2023

ABSTRACT

Background:

Iron deficiency anemia (IDA) is considered the most common micronutrient deficiency and the greatest health concern throughout the globe. The main causes of anemia are iron deficiency, parasitic infestations, viral infections (human immunodeficiency virus), hemorrhage, and renal and hepatic diseases. Therefore, it is mandatory to be equipped with the proper knowledge regarding the causes, signs, symptoms, and diets containing iron, which can be a good initiative for the proper treatment and management of the health hazards; also, it will help primary care physicians to differentiate the degree of the disease and further treatment, planning, and management. The recent study was performed to understand the level of knowledge and awareness about IDA and its causes, prevention, and treatment.

Methods:

The study was carried out through an online survey using Google forms, which were distributed to the population residing in Riyadh Province

Results and Discussion:

The responses received about the knowledge regarding IDA and its symptoms indicated weakness [565 (52.9%)], cold hands and feet [593 (55.5%)], and hair loss [663 (62.1)], and the majority (84.3%) of the participants believed that the major cause for IDA is malnutrition

Conclusion and Recommendations:

Conclusively, it was believed that the presented study will be helpful to primary care physicians, the patients suffering from IDA, and the general population with a better understanding of the causes, additional signs and symptoms, proper treatment, timely management, sources of iron, and how to avoid the worse outcomes and complications of the disease. It will also help the health agencies in the kingdom to set further planning for the treatment and management of the disease through awareness platforms.
Health care workers’ concerns during COVID-19 times
Authors: Gupta Harish
Published: October 2023

ABSTRACT

Ground -level health care workers provide us a unique perspective of immunization programs. While our official data may be too rosy to be true, a casual / unscheduled /anonymous conversation with such foot- soldiers may bring us face -to- face with reality through another angle If we want our programs to be robust having a wide coverage, Mantra of success lies not only in making good policy while sitting in ivory -towers but also in folding our sleeves up, sweating under the tropical hot Sun, going to hinterlands and initiating a dialogue with those humble low- level workers who sometimes are invisible to us otherwise, not listened to and with whom sometimes promises are not kept. Promised amount for achieving some target may be small for us but for them that may not necessarily be true. Let’s just enter their shoes for a while and try to observe the situation from their point -of- view. In our siloed system of administration when everyone has knowledge of his/ her territory, let us share our wisdom and field -experience. As an expert in one field may not be having much knowledge about another one.
Trends and clinico-epidemiological profile of patients with Giardiasis: Five-year experience from a university hospital of northern India
Authors: Tejan Nidhi , Siddiqui Tasneem , Singh Pooja , Ghoshal Uday C. , Ghoshal Ujjala
Published: October 2023

Background:

Giardiasis is an important cause of diarrheal disease and is associated with morbidity in children and adults worldwide. We aimed to study the prevalence of Giardiasis, its clinical presentations, seasonal trends in detection, and coinfection with other intestinal parasites along with comparison of fecal antigen and microscopy for the detection of Giardiasis.

Materials and Methods:

It is a retrospective study conducted from Jan. 2017 to Dec. 2021 at our university hospital. Iodine and normal saline mounts and enzyme-linked immunosorbent assay (ELISA) were used for the detection of Giardiasis in stool samples. Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of tests were computed.

Results:

Of 8364 patients, 432 (5.2%) had Giardiasis by microscopy and/or ELISA. Giardiasis was more common in males compared to females (318/5613 [5.6%] vs. 114/2751 [4.1%]; P = 0.003) and among those ≤10 y compared to older individuals (102/560 [18.2%] vs. 330/7804 [4.2%]; P <0.0001). Most cases were detected in the month of May to October. The most common clinical presentation was diarrhea (80.1%) and abdominal pain (72.9%) followed by malnutrition (60.2%) and loss of appetite (46.8%). Using microscopy as gold standard, sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of ELISA were 95%, 91%, 91%, 95%, and 93%, respectively.

Conclusion:

Awareness and knowledge amongst the primary healthcare professionals and family physicians will help in early diagnosis and treatment of Giardiasis. Fecal antigen detection should be done along with microscopy for detection of Giardiasis.
A study on bacteriological profile in suspected cases of neonatal sepsis and its correlation with various biomarkers in the rural population of a university hospital
Authors: Sethi Khilika , Verma Rajesh K. , Yadav Rajesh K. , Singh Dharmendra P. , Singh Sweta
Published: October 2023

ABSTRACT

Introduction:

Neonatal sepsis is an infection in newborns that may be caused by bacteria, fungi, or viruses and has a high death and morbidity rate. The clinical presentation of sepsis may be rather general, making it challenging to make a diagnosis. While blood culture is the most accurate method to diagnose sepsis, it is also time-consuming. Because of this, it is crucial to locate other biomarkers like C-reactive protein (CRP), high sensitive C-reactive protein (hs-CRP), and procalcitonin (PCT) that may aid in early identification.

Aim:

To learn about the bacterial composition of suspected cases of neonatal sepsis in a tertiary care hospital in western Uttar Pradesh and how that composition relates to the biomarkers CRP, hs-CRP, and PCT

Materials and Methods:

Hundred people who fulfilled the study’s inclusion criteria were included. All neonatal venous blood samples have been obtained after receiving written informed permission from either parent. The conventional method was used to perform the blood culture. The ELISA technique has been used to determine hs-CRP along with serum PCT levels, while the latex agglutination test was utilized for CRP detection.

Result:

A total of 100 cases were enrolled, 78% presented within 3 days of birth. Blood culture was positive in 33 neonates (33%). There were 17 Gram-positive, 15 Gram-negative, and in all 2 cases with poly bacterial culture. CRP positivity rate was significantly higher in culture positive (57.6%) as compared to culture-negative neonates (25.4%). It was shown that a CRP >6 mg/l level was sensitive at 57.6% and specific at 74.6%. hs-CRP has a 100% sensitivity and 47.8% specificity. The PCT’s sensitivity was 69.7%, whereas its specificity was 89.6%.

Conclusion:

PCT is more specific for detecting sepsis, but hs-CRP is more sensitive than CRP. The combination of PCT along with hs-CRP has a negative predictive value and high sensitivity compared to other markers. Thus, the most accurate predictors of neonatal sepsis would be a combination of factors.
Perception of family medicine as the career option among young Indian graduates
Authors: Dasappa Hemavathi , Esthappan Unnimary , Govind Srihari , Anand Arjun , Mohan Joseph , Shri R Amrutha , Ravindran G. D.
Published: October 2023

Aims and Objectives:

1. To estimate the number of graduates who had exposure to family medicine specialty. 2. To estimate the number of graduates who consider family medicine as the carrier option. 3. To compare the perception of family medicine as career option among the young graduates who had exposure to family medicine during their training or practice with no exposure.

Materials and Methods:

It is a cross-sectional, questionnaire-based study. The doctors graduated 2018 onwards were contacted through SIMSA (South Indian Medical Students Association) and WhatsApp groups (students doing the rural health service and intern WhatsApp). Subjects who consented for the study filled the google form. Filled Google forms were evaluated.

Results:

First choice of among the graduates is general medicine followed by general surgery and paediatrics. Family medicine is 4th in the order. There is overall a very positive perception about the family medicine among the respondents irrespective of exposure to family medicine. Majority of them feel that it gives good financial gain (55.55%), interesting (67.03%), work and family balance (75.55%), which contributes to individual and community health (84.07%) and essential part of healthcare system (83.33%). Graduates feel that career growth (26.66%) and academic growth (33.70%) are less and it is not popular (38.88%). If there is an opportunity, majority would choose family medicine (54.44%).

Conclusions:

Around 5.9% are open to choose family medicine as the career option. Medical graduates perceive family medicine subject to give them good work and family balance and the subject is essential part of healthcare system and contributes to the individual and community health, and at the same time, it may not give them great financial gain, academic and career growth.
Evaluation of dermatoglyphics patterns as predisposition factor for occurrence of oral submucous fibrosis: A hospital-based case–control study
Authors: Malvania-Damani Ekta , Sharma Ashish , Chag Noopur , Parikh Mishri , Trivedi Mahima R. , Mehta Parshad
Published: October 2023

Background:

One of the key factors in the prevention of the disease is the identification of the risk factors early in life. Based on multifactorial causation of oral submucous fibrosis (OSMF), apart from habit history, the genetical predisposition may be considered as an important risk factor in the occurrence of OSMF disease. The dermatoglyphic pattern may prove a salient genetic marker for the determination of OSMF as both are having similar intrauterine development period.

Objectives:

To find out and compare the association between dermatoglyphics and OSMF.

Materials and Methods:

The present study was conducted on total 108 subjects divided in three groups where Group A was subjects with OSMF, Group B was subjects with tobacco related habits but without OSMF, and Group C was healthy controls. Fingerprint patterns of both hands were recorded and classified into whorls, loops and arches.

Results:

The loop pattern was significantly higher in subjects having OSMF (Group A) as compared Group B and Group C in general as well as for left and right hands. The maximum prominence of loop patterns was noted in the little finger among the subjects with OSMF. Results for subjects with OSMF and without OSMF under five years of having tobacco chewing habits had also clearly demonstrated prominence of loop patterns in the subjects with OSMF.

Conclusion:

The results of our study show that there is a staunch possibility of genetically determined factors in the form of loop finger prints can be responsible for the occurrence of OSMF.
Dysautonomia in ‘long COVID’: Case report
Authors: Banerjee Arijita , Kumar Sumit
Published: October 2023

Background:

The reason for autonomic dysfunction in COVID-19 is yet to get clear, though we tend to notice a few dysautonomia cases during post-COVID-19 manifested most commonly in the form of postural orthostatic tachycardia syndrome (POTS).

Case Presentation:

A case of autonomic dysregulation is presented in a COVID-19 patient as a post-COVID-19 sequelae. On doing an active stand test and two basic autonomic function tests, dysautonomia was diagnosed in the patient, after going through all routine investigations for six months. Cardiac parasympathetic integrity was assessed by measuring the heart rate response to standing by continuous electrocardiographic tracing. The management of these patients is usually conservative.

Conclusion:

Family physicians must be aware of such cases in future for early diagnosis and management of the patients.