bluuebunny/crossref_metadata_2025 huggingface dataset:
Projecting Voice in Political Discourse: A Study of Saulos Klaus Chilima’s Discursive Strategies, Malawi
Authors: Kondowe Wellman , Ngwira Flemmings Fishani
Published: April 2019

The study takes a stance to explore the political discourse speech in Malawi as the country draws closer to the May 2019 general elections. This is a war-like zone period with different political figures pursuing, negotiating, and struggling for power. We specially mount our research to investigate how Saulos Klaus Chilima strategizes to get the winning card by exploring his voice and voice projection techniques during the launch of his party. We have hence borrowed insights from Heffer’s (2013, 2018) Voice Projection framework (VPF) and used Nvivo 11 Pro software in the analysis. The study discovers that his launch speech is highly authorizing, persuading, converging, and highlighting with very few instances of centring, and indexing which made the speech more powerful, stimulating and impressive. The study brings a different dimension of analyzing political discourse by shopping a theory from Forensic discourse.
Research on Vocabulary in Chinese Commercial Contracts
Authors: Wu Chunxiang , Baccanello Jennifer
Published: April 2019

Business English has already become a major field in linguistics. In contrast, Business Chinese has not seen the same level of activity, which is reflected in the comparatively small amount of teaching resources and related research on Business Chinese. One important example of a context in which business language is used is the commercial contract. This study is an analysis of the classification and characteristics of vocabulary used in Chinese commercial contracts.
Posthuman Biopredicament: A Study of Biodystopia in Kazuo Ishiguro’s Never Let Me Go
Authors: Yan Kai
Published: April 2019

Ishiguro’s Never Let Me Go is a novel that depicts a typical biodystopia. By recollecting the clones’ tragic experience of organ donation for the benefit of humankind, it discusses the bleak posthuman prospects of science, the double manipulation of life by power, and the metaphorical dimension of posthuman lifewriting. Ishiguro approaches the theme from the clones’ perspective, taking the clones as a metaphor to demonstrate the actual circumstances of human life, therefore the novel could be seen as a parable about human nature. This paper proposes to analyze, from the aspects of science, power and metaphorical lifewriting, Ishiguro’s unique art in creating a biodystopian narrative that reflects universal human conditions and reveals the posthuman biopredicament.
Clinical and genetic characteristics of the syndrome of contractures of the limbs and face, hypothony and psychomotor retardation (OMIM: 616 266), caused by mutations in the NALCN gene
Authors: Borovikov A. O. , Sharkova I. V. , Ryzhkova O. P. , Chukhrova A. L. , Schagina O. A. , Markova T. V. , Dadali E. L.
Published: April 2019

A description of the clinical and genetic characteristics of the syndrome of congenital contractures of the limbs and face in combination with muscular hypotonia and psychomotor retardation of 2 patients from Russia is presented. As a result of full-exome DNA sequencing, 2 heterozygous missense mutations c 4355T C and c.3541C G were found in the NALCN gene, leading to amino acid substitutions at the functionally important center of the protein molecule. The effect of identified mutations in the NALCN gene on the function of its protein and approaches to the differential diagnosis of congenital contracture syndrome of the extremities and face in combination with muscular hypotonia and psychomotor retardation with monogenic variants of distal arthrogryposis with autosomal dominant type of inheritance are discussed.
Eğitim Amaçlı Sanal Gerçeklik Uygulamalarında Kullanılan Cihazların Daldırma Açısından İncelenmesi
Authors: EMRE İlkim Ecem , SELÇUK Murat , BUDAK Veli Özcan , BÜTÜN Mehmet , ŞİMŞEK İrfan
Published: April 2019

Teknolojide yaşanan gelişmeler, farklı araç ve yöntemlerin eğitim amaçlı kullanımına olanak sağlamaktadır. İlgili alanyazın incelendiğinde, son yıllarda giderek artan kullanım oranlarıyla sanal gerçeklik (SG) teknolojisinin eğitim amaçlı çalışmalarda sıklıkla tercih edilmeye başlandığı görülmektedir. SG, bireyin farklı duyu organlarını uyararak fiziki bir ortamdan sanal bir ortama geçişine olanak sağlayan bir teknolojidir. Bu çalışmada; SG uygulamalarıyla eğitim amaçlı gerçekleştirilen çalışmalarda kullanılan cihazlar, daldırma (bireyin sanal gerçeklik cihazlarıyla fiziki ortamla olan bağının belirli sınırlılıklarla kesilerek sanal ortamda bulunma hissi) etkileri yönünden ele alınmış, yeterlilikleri ve sundukları fırsatlar bakımından incelenmiştir. Scopus veri tabanında 2013-2017 yılları arasında yayımlanmış, “sanal gerçeklik (virtual reality)” kelime grubunu başlık ve “eğitim (education)” kelimesini başlık, özet ve anahtar kelime olarak barındıran ve daldırma etkisi sunan cihazları içeren, 30 çalışma içerik analizi yöntemi ile belirlenen kısıtlar çerçevesinde incelenerek araştırma  gerçekleştirilmiştir. İncelenen çalışmaların tamamında (%100) görme duyusuna hitap eden cihaz(lar)ın kullanıldığı, %50’sinde işitme ve %47’sinde dokunma duyusuyla etkileşim içeren cihaz(lar)ın kullanıldığı görülmüştür. Koku duyusuna hitap eden çalışmaya ise rastlanmamıştır. Araştırmaya dahil edilen çalışmaların %43’ünde tam daldırıcı SG uygulamalarının, %53’ünde ise yarı daldırıcı SG uygulamalarının kullanıldığı tespit edilmiştir. Kullanılan sistem tipi bakımından çalışmaların %66’sında SG gözlüklerinin (Head Mounted Display-HMD) tercih edildiği, %10’unda ise sanal mağaraların (CAVE) kullanıldığı görülmüştür. Araştırma kapsamında yapılan analizler sonucunda tespit edilen olan tüm bulgular detaylı bir şekilde aktarılmıştır. Bu çalışmanın, eğitim alanında SG ile ilgili çalışmalar yapan araştırmacılar için rehber niteliği taşıyan bir kaynak olacağı düşünülmektedir.
MSCT coronary angiography in non-invasive assessment of coronary artery bypass grafts patency
Authors: Patel Dinesh L. , Rana Yashpal R. , Sheth Megha M. , Patel Samir G. , Garachh Milin N.
Published: April 2019

Background: Coronary artery disease (CAD) is one of the leading cause of the morbidity and mortality in India and worldwide and last decade has seen a steep rise in incidence of CAD in India and its treatment as bypass surgery. Direct visualization of the grafts and native coronary arteries by invasive catheterization is now being replaced by non-invasive CT coronary angiography with higher slice machines and newer technology as it has good temporal resolution, high scanning speed as well as low radiation dose. We share our experience of graft imaging on 128 slice CT machine.Methods: This is a retrospective, single-center, observational study. We included 500 symptomatic patients who have undergone CT study between the year 2014 to 2018 post bypass surgery.Results: Arterial grafts have a better patency rate than venous grafts. (88% vs. 64.1%). Amongst the individual arterial grafts RIMA had the best patency rate (100%) followed by LIMA (90.8%), RA (68.7%). LAD was the most commonly involved artery (91%).Conclusions: Significant absolute concordance between CT and catheter angiographic findings have been documented for all arterial and venous grafts patency in the literature. The MSCT with retrospective gating permits an accurate and non-invasive evaluation of patent and diseased arterial and vein grafts and could replace conventional angiography for the follow-up of symptomatic, stable patients. Moreover, an optimal diagnostic accuracy was also documented in the appraisal of native vessels distal to the graft anastomoses.
The roles of stethoscopes and sphygmomanometers in hospital-acquired infections: a case study of some district hospitals in Enugu state, Southeast Nigeria
Authors: Umegbolu Emmanuel I.
Published: April 2019

Background: Hospital acquired infections (HAIs) are infections that patients acquire while receiving treatments for other conditions. Studies have shown that stethoscopes and sphygmomanometers can act as potential sources of these infections in patients accessing treatment in healthcare facilities. This study aimed to increase awareness among health workers in Nigeria of the potentials of stethoscopes and sphygmomanometers to transmit HAIs.Methods: Moist swab sticks were used to collect samples from 38 randomly selected stethoscopes and sphygmomanometers from some departments of four district hospitals. Collected samples were cultured using standard microbiological techniques. In addition, self-designed questionnaire was used to assess the knowledge and practice of doctors and nurses on the roles of stethoscopes and sphygmomanometers in HAIs.Results: About 83.8% of the health workers demonstrated some awareness of the roles of stethoscopes and sphygmomanometers in HAIs. 42.5% cleaned their stethoscopes, while 5% their sphygmomanometers. Staphylococcus aureus, (65.9% of stethoscopes), proteus mirabilis, Pseudomonas aeruginosa (67.6% of sphygmomanometers), Streptococcus and Coliform species were isolated. There was no significant difference between the contamination of stethoscopes and sphygmomanometers by the isolates, except for Pseudomonas aeruginosa (t=3.49, p=0.04).Conclusions: Awareness did not match practice in cleaning the stethoscopes and sphygmomanometers in the four facilities. Staphylococcus aureus and Pseudomonas aeruginosa were the two most common organisms isolated with a significant difference (t=3.49, p=0.04) between stethoscopes and sphygmomanometers in isolation of Pseudomonas aeruginosa. To curb HAIs, health workers need to improve on their practice of cleaning stethoscopes and sphygmomanometers.
Comparative efficacy of intravenous premedication of clonidine versus nalbuphine on intraoperative hemodynamic profile of patients during surgery under general anesthesia: a randomized study
Authors: Agarwal Salony , Samad Abdul , Gupta Kumkum , Singh Raj Kumar , Srivastava Ritesh , Baseer Ans M.
Published: April 2019

Background: Airway manipulation and surgical stimulation lead to variable changes in hemodynamic profile due to increase in plasma catecholamine levels, but these changes can be attenuated by appropriate premedication. The present study was designed to compare the clinical efficacy of intravenous premedication of clonidine with nalbuphine on intraoperative hemodynamic profile of patients during surgery under general anaesthesia.Methods: Sixty adult consenting patients of ASA physical status I and II of either gender were randomized into two groups of 30 patients each, to receive either intravenous clonidine (2 μg/kg) or nalbuphine (0.2 mg/kg), 10 min before induction with propofol. Direct laryngoscopy and intubation were facilitated with vecuronium bromide. Changes in heart rate, blood pressure and electrocardiogram were recorded at specific time intervals and were noted as primary variable. Any adverse effects and complications were recorded as secondary outcomes.Results: After laryngoscopy and intubation, the increase in mean heart rate and mean blood pressure occurred immediately in patients of both groups, but persisted up to 6 to 10 min in patients of clonidine group, thereafter the changes returned back to baseline values, while in patients of nalbuphine group, this increase persisted up to 8 to 10 min. The differences in hemodynamic changes between the groups were statistically significant throughout the surgery and post extubation.Conclusions: Intravenous clonidine was more effective than nalbuphine to attenuate the hemodynamics changes during stressful period of laryngoscopy, intubation and surgery.
Three-year follow-up after Woodward procedure in children with Sprengel’s deformity
Authors: Sananta Panji , Dradjat Respati S. , Vivayuna Inggra
Published: April 2019

Sprengel deformity is a rare congenital disorder characterized by a congenital high scapula caused by obstruction of the development of the scapula, which accompanies bone, muscle and cartilage during pregnancy. This scapular deformity can be associated with other congenital malformations such as rib abnormalities, scoliosis, and Klippel-Feil syndrome. This is a follow-up of 3-year-old children with Sprengel deformity, cavendish grade 3 who were treated with the Woodward procedure. Authors conclude that the Woodward procedure is an effective procedure for obtaining good functional and cosmetic results.
Broken stent of endoscopic retrograde cholangiopancreatography mimicking a common bile duct stone: a case report
Authors: Nelson Thirugnanasambandam , Pranavi AmudaRavichandar , Sureshkumar Sathasivam , Sreenath GubbiShamanna , Ramesh Ananthakrishnan , Bharathi Deepak , Kate Vikram
Published: April 2019

Long standing biliary stent for biliary stricture may have complications like cholangitis, cholecystitis, stent fracture and stent migration. Treatment includes re-do endoscopic retrograde cholangiopancreatography, removal of fractured stent and restenting. Authors report a case of fractured biliary stent mimicking as distal common bile duct stone. Patient presented with features of cholangitis with history of endoscopic stenting 6 years back but lost follow up thereafter. Ultrasound showed 2cm calculus in distal common bile duct and the stent was seen on endoscopy through the papilla in the duodenum. Contrast enhanced computed tomography of abdomen showed radio opaque dense shadow in the distal common bile duct suggesting possibility of broken biliary stent. Redo endoscopic retrograde cholangiopancreatography failed to remove the fractured stent. A new stent was placed without complications. Patient underwent open common bile duct exploration and the fractured stent was removed. Patient recovered completely after the procedure.
Neuropsychiatric manifestations in patient with normal pressure hydrocephalus improved with therapeutic lumbar tapping
Authors: Padma Kumari , . Chandini , A. Siddharth Shetty , T. Safeekh A. , S. Raghavendra B.
Published: April 2019

Normal pressure hydrocephalus is a communicating hydrocephalus without evident obstruction of the normal pathway of CSF flow. Normal-pressure hydrocephalus is a common cause of reversible dementia and it can also present with various psychiatric symptoms. A 76-year old man was brought to psychiatry OPD with history suggestive of decreased need for sleep for 8 days, disinhibited behaviour, increased libido, increased activity and increased talk for 4 days. On examination patient was noticed to be having increased psychomotor activity with increased talk, mood reported to be happy with elated affect, no content or perceptual disturbances were elicited. Cognitive functions were within normal limits. Personal and social judgement was impaired with grade 0 insight. General physical and systematic examinations were within normal limits. MRI reports showed ventricular enlargement suggestive of normal pressure hydrocephalus. Patient underwent diagnostic and therapeutic lumbar tapping. There was significant improvement in patient’s behavioural symptoms following therapeutic lumbar tapping. Therapeutic lumbar tapping in this case of normal pressure hydrocephalus was effective in the management of manic symptoms. Early identification of organic cause in late onset psychiatric disorders is necessary. Prompt intervention of the organic cause was effective in the management of manic symptoms.
Clinical profile of pediatric patients with urinary tract infection in a tertiary care centre in Kashmir, India
Authors: Kawoosa Khalid , Malla Rahid Rasool , Dar Sheeraz Ahmad , Kubravi Syed Heena
Published: April 2019

Background: The urinary tract is a common site of infection in pediatric patients. Author studied the clinical and microbiological profile along with the antibiotic resistance in children with UTI attending centre.Methods: It was a prospective study was conducted in the Department of Pediatrics, Sheri-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India over a period of one year from August 2017 to August 2018.A total of 250 children aged 1-36 months were included in the study. A proper history and examination were done in each case. A clean catch mid-stream urine sample was obtained from each child. Quantitative microscopy and urine culture were performed. Standard biochemical tests were done to identify the isolates and for determination of antibiotic sensitivity.Results: Out of the 250 children studied , a total of 216 children were diagnosed as UTI by positive urine culture.102 were males and 114 were females. Significant pyuria was detected in 85%patients. Fever with irritability was the most common presenting symptom (71%) followed by vomiting (63%) and abdominal pain (52%).The most common uropathogen detected was E. coli (57%) followed by Klebsiella spp. (20%), proteus (16%), pseudomonas (5%), and candida (2%). Majority of the patients responded to treatment with ceftriaxone followed by cefixime. Antibiotic resistance in vitro was least seen with amikacin (25%) followed by nitrofurantoin (11%). 91.3% of UTI detected was nosocomial. Vesicoureteral reflux was found in 49% of patients while 13% were diagnosed with posterior urethral valve.Conclusions: Urinary tract infection should be considered as one of the most important differential diagnosis in patients with fever attending pediatric OPD. Urine microscopy and culture should be a part of routine diagnostic evaluation in all febrile children. Early treatment of UTI is important to prevent later sequelae including pyelonephritis and renal scarring.
A study on screening of high risk children for tuberculosis infection
Authors: V. K. Kishore V. R. , M. Hemasundar Rao
Published: April 2019

Background: Tuberculosis (TB) continues to be one of the most devastating and widespread infections in the world. Of the 9 million annual tuberculosis cases, about 1 million (11%) occur in children (under 15 years of age). Childhood tuberculosis is a neglected aspect of the tuberculosis epidemic. The objective of the study was to screen the children who are household contacts of TB, HIV and TB -HIV patients and identify the children with the type of tuberculosis (Latent and symptomatic) and treat accordingly there by reducing the transmission of disease, as these children may become open cases in the future.Methods: All the registered cases of active TB, TB-HIV and HIV were traced out from district unit of RNTCP, PHC, CHC in and around Nellimarla town (10 kms radius). These patients were interviewed for medical history, treatment history, duration of treatment and degree and duration of house hold contacts (primarily children between 1 to 14 years.Results: Out of 160 registered patients 91 patients were diagnosed as having symptomatic TB infection and 69 were diagnosed having latent TB infection, with most of the affected children being in the age group of 1 to 5 years). Majority of the symptomatic patients (46.15%) were household contacts of TB- HIV patients and majority of children (40.57%) with latent TB Infection are direct household contacts of open cases of TB alone. Of the symptomatic TB infection 74.72% had pulmonary TB and 25.28% had extra pulmonary TB.Conclusions: Tubercular lymphadenopathy is the most common manifestation of extra pulmonary TB followed by tubercular meningitis and among the tubercular lymphadenopathy the cervical lymphnodes are most commonly involved.
Comparative evaluation of nebulised 3% saline versus nebulised 0.9% saline in the treatment of acute bronchiolitis
Authors: A. Pragalatha Kumar , Rajarathinam Indhuja , Gowdra Aruna
Published: April 2019

Background: Acute bronchiolitis is the most common respiratory tract infection in young children. Despite the high prevalence of acute bronchiolitis, no consensus exists on the management. Studies have shown that except oxygen therapy, no other treatment found to be effective. Hence, the present study was conducted to find out the efficacy of nebulised 3% saline versus is 0.9% saline for the treatment of acute bronchiolitis.Methods: A prospective randomized controlled study of 150 children between the age group of 2 months to 24 months with signs and symptoms of Acute Bronchiolitis admitted to Indira Gandhi Institute of Child Health, Bangalore from January 2016 to December 2016 formed the study group, they were randomized into 2 groups, one received 3% saline nebulization and the other received 0.9% saline.Results: A total of 150 children were enrolled in the study, 75 children (group A) received 0.9% saline and 75 children (group B) received 3% saline. At 24 hours, the mean clinical severity score for group A was 2.49±1.03 and group B was 2.16±0.49 (P=0.013). The duration of hospital stay was shorter (1-3 days) in 3% saline with a mean of 2.35 days and was longer (3-5 days) in 0.9% saline with mean value of 4.04 days which was statistically significant (p <0.001).Conclusions: 3% saline nebulization can be used as an effective treatment for acute bronchiolitis. It significantly reduced the clinical severity score and length of hospital stay compared to 0.9% normal saline.
Clinical and imaging correlation of cerebral palsy: a retrospective study in a tertiary care centre
Authors: Sanjee Swathi S. , Shettigar Chandrashekhara G. , Soans Santosh T.
Published: April 2019

Background: Cerebral Palsy is the most common chronic motor disorder of childhood. Clinical spectrum is different in developing and developed countries. Aim of the study was to evaluate the clinical profile, co-morbidities and the imaging correlate of children with CP.Methods: Data was collected retrospectively from individual case records from March 2016 to October 2018. All children aged 2 years and above with clinical signs of cerebral palsy were included in the study.Results: A total of 78 children had the diagnosis of cerebral palsy, out of which 63 cases were included which satisfied the inclusion criteria. Most of the children were born out of singleton pregnancy (90.4%). The mean gestational age was 36.94±1.48 weeks. Most common type of cerebral palsy noted in present study was spastic quadriplegic type (n=34) followed by diplegic type (n=14). Epilepsy was associated in 36.5% (n=23) of children, and most commonly associated with spastic quadriplegic type of cerebral palsy(n=16). Other associated abnormalities included mental retardation, speech, hearing, cognitive, and behavioral abnormalities. Magnetic resonance imaging was normal in 60.3% (n=38) of children and abnormal in 39.68% (n=25) of children. Diffuse cerebral atrophy was the most common abnormal finding (n=9). Other abnormal findings included periventricular leucomalacia, basal ganglia lesions, cortical/subcortical lesion, focal infarcts and miscellaneous lesions.Conclusions: MRI helps in knowing the pathological basis of the disease, but clinical findings carry utmost importance. MRI positivity was seen in only 39.68% of cases. Hearing abnormalities being the most common association, proper screening tests and regular follow up is very essential.
Predictors of mortality among neonates transported to tertiary care centre
Authors: Malhotra Preeti , Thapar Karuna , Kaur Gurpreet
Published: April 2019

Background: The neonatal transport in India has taken a giant leap in last years. For reducing the death among transported newborns, transport in well-equipped ambulance could play a vital role. As there is not much data available in Punjab on neonates being transported to tertiary care center so the present study was conducted to know the predictors of mortality in newborns transported to tertiary care center.Methods: The present study was an observational study conducted in neonatal intensive care unit of department of Pediatrics at SGRD institute of medical science and research, Amritsar, Punjab, India over a period of 18 months from 1st January 2017 to 30th June 2018. Total 121 neonates were enrolled in the study. History and clinical examination were done at the time of admission and the various study variables were statistically analysed.Results: Out of total 121 neonates, 76 were discharged, 12 expired and 33 left against medical advice. Mortality rate was 9.9%. Mortality was higher in neonates who had hypothermia, hypoglycemia, poor perfusion and bradycardia at the time of admission. Neonates with extremely low birth weight (<1 kg) and those admitted after 6 hours of age also had higher mortality.Conclusions: Predictors of mortality were hypothermia, hypoglycaemia, poor perfusion and bradycardia at the time of admission. New-borns require special care for stabilization before and during transport, which can be achieved by using specially equipped neonatal ambulances. So, these neonatal ambulances should be started in all states to decrease the neonatal mortality rate.
Meconium aspiration syndrome and neonatal outcome: a hospital based study
Authors: S. B. Siva Saranappa , Devaraj Shiva , E. Nithya
Published: April 2019

Background: The incidence of meconium stained amniotic fluid is 8-20% among all deliveries. The Aspiration of meconium into the airway results in various short term and long term morbidities and mortality. Timely management of these neonates with meconium in amniotic fluid may prevent Meconium aspiration syndrome.Methods: This prospective cohort study was conducted at Kempegowda Institute of Medical Sciences, Bangalore. All live Term neonates born between December 2016 and July 2018 with meconium in amniotic fluid were enrolled in the study. Details of the neonate was entered in the pre-designed Proforma. The objective of this study the outcome of MAS neonates and find factors associated with Meconium aspiration syndrome when compared with Meconium stained amniotic fluid neonates as a whole. These associated factors were presented as Odds Ratio (OR) and 95% Confidence Interval. Chi-square test was done where applicable and a p-value <0.05 was taken as significant.Results: Meconium aspiration syndrome was seen in 79 out of the 188 neonates born with meconium stained amniotic fluid.Conclusions: The morbidity and mortality in a neonate with Meconium stained amniotic fluid (MSAF) to develop meconium aspiration syndrome (MAS) can be avoided with timely antenatal care. Meconium-stained babies should be aggressively managed to prevent complications like perinatal asphyxia and respiratory failure which may lead to the mortality. Those neonates with risk for adverse outcome should be managed with special focus on respiratory care with use of assisted ventilation and inhaled nitric oxide and extracorporeal membrane oxygenation, where available.
Clinical presentations of congenital hypothyroidism in pediatric age group
Authors: N. Prasad Nayak , Maben Roshan
Published: April 2019

Background: Hypothyroidism (HT) in pediatric age group is of prime importance because of it’s varied presentations. Missing a diagnosis of hypothyroidism is disastrous since it results in mental retardation (MR). Hence, it is mandatory to know the various types of clinical presentation in clinical practice.Methods: Study includes 30 children who were diagnosed to have hypothyroidism. Detail history were taken thorough examination carried out and thyroid function tests were obtained in all the cases. Results were statistically analyzed in Microsoft office excel 2007.Results: Majority of the children were diagnosed at the age of 1-3 month of age. Males and females were almost equally affected, 70% of the children had constipation, 26.7% of the cases presented with umbilical hernia, feeding difficulties were seen in 23.3%, abdominal distention and prolonged jaundice were seen in 20% of the cases. 10% of the cases presented with short stature and 6.6% children showed obesity.Conclusions: Detailed history and examination of each infant will help in early diagnosis of congenital hypothyroidism (CH). High index of clinical suspicion should be made when any of clinical features of hypothyroidism are present.
Bronchoalveolar lavage for etiological diagnosis of childhood pneumonia
Authors: Kartikeswar Gouda Ankula Kartikeswar , Rahman Helina , Dutta H. K. , Satapathy Amit Kumar
Published: April 2019

Background: Pneumonia is the most common cause of childhood morbidity and mortality in age group less than 5 years. Identification of causative organism is a real challenge in these children though many of them are responding to the first line antibiotics therapy. Isolation of the organism is of paramount importance those who fails to respond to first line therapy. The objective of this study was to determine the relative efficacy of Bronchoalveolar Lavage (BAL) over blood culture in finding out causative organisms of childhood non responder community acquired pneumonia and to study antibiotic-sensitivity pattern of causative organisms.  Methods: BAL and blood culture was performed in 17 patients of age 2 months to 5 years with pneumonia or severe pneumonia. Lavage fluid was cultured and growth of organism 10000CFU/ml was considered positive. Blood culture was taken on the same day. Antibiotic sensitivity was tested.Results: BAL isolated the organism in 82.35% (n=14) cases out of 17 patients and in 11.76% (n=2) by blood culture (p=0.002). Streptococcus pneumoniae was the most common organism isolated (58.82% (n=10)), followed by K. pneumoniae (23.53% (n=4)). Antibiotic therapy was changed in 58.82% (n=10) cases according on culture report. Transient rise in temperature, tachycardia and tachypnea was noted after procedure but no major complication was associated with BAL.Conclusions: BAL fluid culture in childhood pneumonia has high diagnostic value and better efficacy over blood culture in isolating causative organism without increased risk of complication and decreases unwanted exposure to empiric antibiotic in children with community acquired pneumonia who did not respond to initial 1st line therapy.
A study of brainstem evoked response audiometry in children with severe hearing loss
Authors: Kumari Rakhi , Jain Rajiv Kumar , Kumar Dhananjay
Published: April 2019

Background: Brainstem evoked response audiometry (BERA) is a non-invasive diagnostic tool which can be used to assess the early hearing loss. The objectives of the study were to find out the risk factors for severe hearing loss in children and to evaluate the role of BERA in early diagnosis of severe hearing loss in children.

Methods: The present hospital based cross sectional study was conducted on 105 children suffering from severe hearing loss. Risk factors of hearing loss was assessed in these children and brainstem evoked response audiometry was performed.  

Results: Out of 105 children studied risk factors for hearing loss were present in 69 cases (65.71%) in which several cases had multiple risk factors. History of prolonged stay at NICU was present in 23 cases (21.9%). 11 (10.5%) cases had suffered from meningitis while history of cerebral malaria was present in 2 cases (1.9%). History of cerebral palsy was present in 5.7% cases. The family history of hearing loss was present in 15 patients (14.3%). Bilateral severe hearing loss was present in 76 cases (72.4%) while in 13 cases (12.4%) there was bilateral severe to profound hearing loss assessed using BERA test.

Conclusions: Early detection and timely intervention can not only help prevent this silent handicap of deafness but also contribute to social and economic productivity of a community.
A case report on meal time syndrome
Authors: Jacob Anu , . Regina
Published: April 2019

Sialolithiasis is the formation of calculi within the parenchyma of salivary gland or its duct. These cases present with pain and swelling of salivary gland. The exact aetiology of salivary stones is not completely understood and various hypotheses have been put forward. They include agglomeration of sialomicroliths, anatomical variations of salivary ducts and altered biochemical composition of saliva. Here we are reporting a case of 45 year old gentleman with a giant sialolithiasis in submandibular region. He came with pain and pus discharge from left side of floor of mouth for one week. On inspection a bludge was seen in left side of floor of mouth. On bimanual palpation, a stony hard mass was felt which was tender and not mobile. Under local anaesthesia surgical removal of stone done. Sialoliths are equally distributed between left and right side of the oral cavity. Mean size of sialolith is reported as six to nine mm and they infrequently measure more than 1.5 cm. The majority of salivary calculi is formed from phosphate and oxalate salts. Sialography allows whole duct system to be visualised, demonstrating calculi of all sizes and also the glandular percentage. Sialodochotomy is a well-reported technique for the intra-oral removal of ductal stones, including giant calculi. Giant sialolith is a rare entity worth reporting. Though conventional methods are still useful for diagnosis and therapy many innovative techniques are evolving around it.

 
Results of surgical treatment of fractures of the distal humerus at the Brazzaville university hospital
Authors: Marius Monka , Terence Olivier Ohoya Etsaka , Regis Massouama , Albert Ngatsé-Oko , Armand Moyikoua
Published: April 2019

Background: The objective of the study was to evaluate the functional and anatomical results of the surgical treatment of fractures of the distal humerus at Brazzaville University Hospital using non-anatomical plates.

Methods: This was a retrospective study of patients operated by screwed plates for fracture of the distal humerus at Brazzaville University Hospital between January 2014 and December 2017. The study included 11 patients operated by non-anatomical plates and responding the inclusion criteria. Fractures of the distal humerus were distributed according to the AO classification of Müller and Nazarian. The functional results were evaluated according to the Mayo Clinic score based on 4 criteria: pain, mobility bow, stability and functional capacity.

Results: There were 8 men and 3 women. The average age was 35 years (range 23 to 50 years). Causes of the trauma were a road accident in 7 patients and a fall in 4 patients. The site involved in the trauma was lateral right in 7 patients and left in 4 patients. The average time to surgery was 7 days (range 5 to 12 days). All our patients have consolidated in first intention. The average time to consolidation was 3 months (range 3 to 4 months). Results at the average follow-up of 9 months were considered excellent in 3 patients, good in 6 patients and average in 2 patients.

Conclusions: Osteosynthesis of fractures of the distal humerus remains a challenge in developing countries. Our experience shows that surgical treatment of fractures of the distal humerus by non-anatomic plates can give good results when bone stabilization is satisfactory and rehabilitation is undertaken early.
Biometria de frutos e sementes de jambo-vermelho (Syzygium malaccensis (L) Meer & Perry) nativo em Capitão Poço, Pará
Authors: Souza Nayane Da Silva , Silva Maria Kalyane Farias da , Oliveira Larissa Jaina Da Silva de , Carvalho Hemerson Doglas Campos , Lima Ironeide Lima e , Santa Brígida Marluce Reis Souza
Published: April 2019

A biometria dos frutos fornece informações necessárias para desencadear diversos estudos de interesse econômico permitindo o incremento contínuo da busca racional e uso eficaz dos frutos. O objetivo do presente trabalho foi caracterizar fisicamente frutos e sementes de indivíduos de jambo-vermelho nativo no município de Capitão Poço-PA através da avaliação biométrica de seus caracteres físicos. Os frutos maduros de jambo foram colhidos na última semana do mês de agosto do ano de 2016, final da época de frutificação na região, estes coletados em 4 progênies diferentes. Foram selecionados visualmente 200 frutos sadios para as análises biométricas estabelecidas, sendo avaliados os caracteres biométricos: peso do fruto (Pf), peso da polpa (Pp) e peso da semente (Ps) em gramas, comprimento do fruto (Cf), largura do fruto (Lf), comprimento da semente (Cs) e largura da semente (Ls) em mm e volume do fruto (Vf) em ml. As características biométricas de frutos e sementes foram analisadas por distribuição de frequência. Os frutos apresentaram variabilidade para todas as caraterísticas biométricas analisadas. O rendimento total de polpa foi diretamente influenciado pelo peso do fruto, bem como o tamanho e peso da semente. Os maiores frutos apresentaram valores de peso em torno de 68 a 78 g, comprimento e largura de 59 a 62 mm e 49 a 54 mm sendo estes resultados de grande influência para o rendimento de polpa.
Extrato de neem no tratamento de sementes de tomate
Authors: Cardozo Leomara Vieira de França , Pinhão Neto Moisés Vieira
Published: April 2019

Os sistemas de produção orgânica devem ser implantados utilizando sementes orgânicas livres de microrganismos e sem utilizar produtos químicos. Extratos de neem têm apresentado eficiência no controle de microrganismo, porém o efeito do neem na qualidade fisiológica das sementes tratadas por ele é pouco conhecido. Objetivou-se, no presente trabalho, propor extrato aquoso de folha de neem, alternativo ao tratamento químico de semente de tomate cultivar Super Marmande. O experimento foi realizado na Universidade Estadual do Piauí campus Corrente. Produziram-se diferentes concentrações de extrato aquoso de neem utilizando 0, 40, 80, 120, 160 e 200 g de folha para cada L de água destilada. Doses de cada concentração contendo 8 ml do extrato aquoso foram utilizadas para tratar 100 sementes de tomate, além da dose de Thiran utilizando 3 gramas por quilo de semente (testemunha químico). Após tratadas as sementes foram submetidas às avaliações de germinação, primeira contagem da germinação, frio, emergência a campo, índice de velocidade de emergência, matéria seca das plântulas e índice de frequência de contaminantes. Utilizou-se o delineamento inteiramente ao acaso com 7 tratamentos em 4 repetições. Nenhuma das concentrações com extratos aquosos de folha de neem alteraram a qualidade fisiológica das sementes de tomate, porém apenas as concentrações contendo 160 e 200 g L-1 foram eficientes na redução de contaminantes presentes nas sementes. Diante dos dados obtidos recomenda-se para o tratamento orgânico de sementes de tomate utilizar extrato aquoso de neem nas concentrações entre 160 e 200 g L-1 como alternativa ao tratamento químico.
Consorciação de caupi-hortaliça e beterraba sob diferentes quantidades de flor-de-seda incorporadas ao solo
Authors: Medeiros Maria Luiza De Souza , Demartelaere Andréa Celina Ferreira , Lima Jailma Suerda Silva , Silva Maiele Leandro , Pádua Guilherme Vinicius Gonçalves
Published: April 2019

Visando fornecer subsídios às pesquisas e cultivos dos consórcios de caupi-hortaliça com beterraba e adubação com espécies espontâneas, o objetivo desse trabalho foi determinar a quantidade de flor-de-seda que deve ser incorporada ao solo com a finalidade de promover o melhor rendimento dessas culturas. O experimento foi conduzido na Fazenda Experimental Rafael Fernandes, localizada no distrito de Alagoinha, Rio Grande do Norte. O delineamento experimental utilizado foi em blocos casualizados com 4 tratamentos (10, 25, 40 e 55 t ha-1 doses de adubos de flor-de-seda) e 5 repetições. Para as características de peso de 100 grãos, número de grãos por vagens, peso dos grãos frescos e das vagens frescas de caupi-hortaliça consorciada com beterraba, obtiveram altos índices quando adicionaram-se 53 t ha-1 de flor-de-seda; 46,49 t ha-1 de flor-de-seda; 46,89 t ha-1 de flor-de-seda e 46,98 t ha-1 de flor-de-seda, respectivamente. Na beterraba, foram encontradas respostas crescentes para altura de plantas, número de folhas, produtividade comercial e total, e produtividade classificada, nas quantidades de 55 t ha-1; 44,21 t ha-1; 18,59 t ha-1; 22,23 t ha-1 e 55 t ha-1, respectivamente. Para os indicadores econômicos, renda bruta, renda líquida, taxa de retorno e índice de lucratividade, foram obtidos: R$ 31.784,46; R$ 10.732,57; 1,54 e 35,28%, respectivamente. O consórcio entre a beterraba e o caupi-hortaliça mostrou-se eficiente e os melhores desempenhos agronômicos foram obtidos na incorporação de 55 t ha-1 e 47 t ha-1 de flor-de-seda.
Amérique Latine: good-bye industrie, hello stagnation
Authors: Salama Pierre
Published: April 2019

Les 7 plaies de l’Amérique latine : des pays profondément inégalitaires, une informalité, une pauvreté importantes qui tend à croitre de nouveau et un déclassement des classes moyennes en augmentation, une tendance à la stagnation du PIB par tête sur longue période, une dépendance accrue vis-à-vis de l’exportation de matières premières ou des « remessas », un mépris de l’environnement et une remise en cause des droits nouveaux obtenus par les populations indiennes, une intégration dans les chaînes internationales de valeurs faible, enfin une désindustrialisation précoce. Qu’elles soient relativement  fermées commercialement  (et ouvertes financièrement) ou davantage ouvertes, ces économies subissent certains des effets délétères de la globalisation. Cet article privilégie l’étude de l’industrie et de la reprimarisation et ses effets sur l’emploi et la distribution des revenus et analyse les conditions pour que ces pays cessent de passer à coté de la révolution industrielle en cours.
Correlation of Body Mass Index and Spread of Spinal block in Herniorrhaphy Patients Under Spinal Anesthesia
Authors: Hosseinzadeh Hamzeh , Aghamohammadi Dawood , Marahem Marzieh , Magsumi Negin , Hosseinzadeh Parisa
Published: April 2019

Background: The level and time block in patients undergoing spinal anesthesia are affected by a variety of demographic factors (e.g., age, gender, height, weight, body mass index [BMI] and the amount of cerebrospinal fluid). Although the influence of BMI in spinal anesthesia is still a matter of controversy, the aim of this study was to determine the relationship between BMI and time of spinal block anesthesia in herniorrhaphy patients.
Methods: One hundred and eighty patients, who had undergone an inguinal herniorrhaphy operation, were divided into two groups—obese (BMI ≥30kg/m2) and non-obese (BMI<30kg/m2). Demographic characteristics, operation time, anesthesia time, time sensory and motor block and changes in hemodynamics were compared between the two groups. The evaluation of spinal block height was recorded with the help of a pin-prick test and Bromage Scale after the administration of bupivacaine.
Results: Body weight, height and BMI showed significant differences in the two groups and the time to reach sensory block T10 was significantly shorter in the group of obese patients. The time for recovery of sensory and motor block was longer in the obese group than in the non-obese group. Moreover, there were differences in the pattern of blood pressure of the two groups during surgery.
Conclusion: The results of this study showed a correlation between BMI and the time of spinal block anesthesia. Furthermore, the maximum motor and sensory block specified in obese patients happens faster and the analgesic duration could be prolonged in patients with a higher BMI.
The Evaluation of Factors Affecting on Patient Admission from Operating Room to Intensive Care Unit in University Teaching Hospital
Authors: Parish Masoud , Mahmoodpoor Ata , Abolhasani Kamelia , Aslanshirzadeh Firooz , Abedini Naghi , Farzin Haleh
Published: April 2019

Background: By consideration of clinical predictors and true way for transfer of patient from the operating room (OR), it can be prevented of complications and thus mortality rate reduced. Thus, the study aimed to investigate clinical predictors of admitted cases from OR to ICU.
Methods: In this study250 patients were transferred to ICU. Data such as underlying diseases, prior reservation for transferring to ICU, unexpected decision for transferring, problems in OR, multi-trauma, and other effective causes of transferring were analyzed.
Results: Of 250 subjects, 144(57.6%) were male. The four major causes of admission to ICU follow as trauma (43.6%), respiratory problems (20.4%), bleeding (19.6%) and postoperative care (16.4%). The most common causes in traumatic patients included brain trauma (60 cases), multiple trauma (32 cases), and abdominal trauma (8 cases).
Conclusion: The viewpoint of an anesthesiologist for selection of patient who requires receiving critical care services is also necessary.
A Comparison of Labetalol and Nitroglycerin for The Management of Intraoperative Hypertension in Ambulatory Surgical Patients Who Underwent Cataract Surgery
Authors: Sanatkar Mehdi , Sadrossadat Hossein , Goudarzi Mehrdad , Espahbod Ebrahim , Zangeneh Masoumeh
Published: April 2019

Background: This is a prospective randomized blinded clinical trial comparing the efficacy and safety of labetalol and nitroglycerin for the management of intraoperative hypertension in ambulatory surgical patients who underwent cataract surgery.
Methods: A total of 80 hypertensive patients (systolic blood pressure> 200 mmHg or diastolic blood pressure>100 mmHg) who had increased blood pressure during cataract surgery under topical anesthesia were reviewed. Patients were randomized to receive nitroglycerin (group N, n=40) or labetalol (group L, n=40). The initial dose of nitroglycerin was a bolus of 2 µg/kg and repeat dose of 1ug/kg intravenously every 5 minutes. Labetalol was administered as a bolus of 5 mg followed by 5 mg intravenously as needed every five minutes up to maximum dose of 1 mg/kg.
Results: Systolic blood pressure decreased from 21.4±8.6 mm Hg (200 to 260 mm Hg) to 18.8±6.4 mm Hg with administration of nitroglycerin. Labetalol reduced systolic blood pressure from 21.4±6.7 mm Hg (201 to 258 mm Hg) to 17.6±11.6 (p=0.02). Nitroglycerin increased baseline heart rate from 68±8 beats/min to 82±6 beats/min (p=0.04), however, in the labetalol group heart rate reduced from control 72±6 to 64±9 beats/min (P<0.05). The hypotension episode was 18 (45%) cases in the nitroglycerin group and 2 (5%) cases in the labetalol group respectively (p<0.05). The mean of systolic blood pressure during their stay in the recovery room in nitroglycerin group was 20.7±9.6 mm Hg and in labetalol group was 18.5±10.2 mm Hg (p<0.05).
Conclusion: Nitroglycerin may produce reflex tachycardia and episode of hypotension especially in elderly patients intraoperatively. Labetalol is a safe and effective antihypertensive agent for management of increased blood pressure during cataract surgery with topical anesthesia.
Color Doppler Ultrasound-guided Axillary Brachial Plexus Block in Patient without Brachial Pulse: A Case Report
Authors: Ahmadi Abbas , Amini Saman Javad , Roshani Bahman
Published: April 2019

Color Doppler ultrasound-guided regional block like brachial plexus block lately changed other anesthesia and analgesia practice because of the accuracy and simplicity of practice to view the anatomy of blood vessels and nerves. With color Doppler ultrasound-guided regional block you can follow needle track to nerves and prevent any vessel puncture. It can be the standard for any regional block. The patient was a 64 years Iranian who had diabetes mellitus and hypertension and planned as an urgent right upper limb amputation surgery. Because of the acute exacerbation of COPD due to pneumonia we decided to use regional anesthesia for this patient. On the first physical examination there was no peripheral pulse in patient’s right hand. With ultra-sonographic color Doppler the pulselessness of right hand artery were monitored. With the anatomic and awareness of grey-scaled ultrasonography the nerves and vessels were found. Axillary brachial plexus block with guidance of grey-scaled ultrasonography were done and the surgery was successfully performed and patient transferred to ICU for post operation care after surgery.