bluuebunny/crossref_metadata_2025 huggingface dataset:
Kamu Hastanelerinde Analitik Ağ Süreci Yöntemi ile Finans Yöneticisi Seçimi
Authors: AKÇA Nesrin , SÖNMEZ Seda , GÜR Şeyda , YILMAZ Ali , EREN Tamer
Published: July 2018

Hastane işletmelerinin büyük çoğunluğunun kamu sahipliğinde bulunması ve yönetim teknolojilerinin kamu düzenlemeleriyle yönlendirilmesi, hastane işletmelerinin gerek genel yönetim gerekse finans yapısının profesyonel yönetim özelliklerine uymasını zorunlu kılmaktadır. Türkiye şartlarına bakıldığında; finans yöneticiliği gibi önemli bir pozisyonun çoğunlukla hekim yöneticilerce üstlenildiği görülmektedir. Kamu hastanelerinde, herhangi bir unvan ile finans yöneticisi pozisyonunda ya da bu departmanlarda çalışanların finans konusundaki yeterliliklerini ya da bilgi düzeylerini belirlerken hangi kriterlerin etkili olup olmadığının belirlenmesi amacıyla karar verme sürecinde yaşanabilecek zorlukların üstesinden gelmede yardımcı olan çok ölçütlü karar verme yöntemleri ön plana çıkmaktadır. Bu çalışmada kamu hastanelerinde finansal yönetici seçimini etkileyen faktörler belirlenerek çok ölçütlü karar verme yöntemlerinden Analitik Ağ Süreci (AAS) yöntemi ile ağırlıkları hesaplanmıştır. Kırıkkale’de bir kamu hastanesinde yapılan uygulama ile aday kişiler arasından seçim yapılmıştır. Çalışmadan elde edilen sonuçlara göre; en güçlü aday %53’lük önem derecesiyle mali hizmetler başkanı olurken, onu %22’lik önem derecesiyle döner sermaye saymanı izlemektedir.
Ortadoğu Ülkelerinde Ticaret Hacmi ve Terör İlişkisi
Authors: SEZGİN Şennur , SEZGİN Selami
Published: July 2018

Bu çalışmada, terörizmin
uluslararası ticarete olan etkisi Ortadoğu ve Kuzey Afrika ülkeleri ele
alınarak incelenmektedir. 1980 yılından başlayarak ve özellikle 1990’lardan
itibaren dünya ticareti hızla gelişmiştir. 1980-2016 yılları arasında
uluslararası ticaretin gelişmesi yolunda çok önemli siyasi ve bilimsel
gelişmeler olmakla beraber terör olaylarındaki hızlı artış uluslararası
ticarette belirli sınırlamalara neden olmuştur. Globalleşme olgusuyla birlikte
uluslararası ticaret olabildiğince genişlemeye başlamıştır. İnternet ve bilişim
teknolojilerindeki gelişimde ticaretin çok daha hızlı kolay yapılmasını
sağlamıştır. Özellikle ülkelerarası hizmet ticaretinde çok hızlı büyümeler
meydana gelmiştir. Bu olumlu gelişmelerle birlikte uluslararası terörizm dünya
ticareti üzerine olumsuz etkide bulunmaktadır. 1980-2016 yılları arasında terör
olaylarının artması ticari faaliyetlerde azalmaya yol açtığına dair önemli
ipuçları vardır.  Bu çalışma terörizmin
Ortadoğu ülkelerinin dış ticaretini etkileyip etkilemediğini analiz etmektedir.
Çalışmada 1980-2016 yılları arasında dış ticaretin teröre karşı duyarlılığı
esneklik kavramı ile ölçülmüş ve terörizmin uluslararası ticaret üzerindeki
birtakım etkilere sahip olduğu tespit edilmiştir.
La clase magistral en la educación: artes plásticas y musicales / Lecture-style clases in Art and Music Education
Authors: Vico Prieto Antonio Félix
Published: July 2018

Desde el comienzo del presente siglo, el sistema educativo está tratando de arrinconar la clase tradicional, que asume la idea de un profesor como único transmisor de conocimiento y un alumnado que atiende a las clases de forma pasiva, intentando sustituirla por otros métodos y estrategias educativas, que traten al alumnado como una parte activa en el proceso de aprendizaje. Las técnicas ligadas al juego o las clases invertidas aparecen como técnicas educativas novedosas y actuales, pero, en realidad, dichas formulas pedagógicas se basan en las aportaciones de pedagogos como Guy Brousseau o John Dewey. La diferencia, claro está, es que los estos métodos asumen como herramienta principal el uso de las nuevas tecnologías. Así, este trabajo propone una revisión crítica de las últimas tendencias educativas ligadas a las nuevas tecnologías, incidiendo de forma particular en cómo los educadores en arte pueden dar un paso adelante para mejorar la didáctica de las materias ligadas a la educción artística. Palabras clave: clase tradicional, nuevas tecnologías, arte, pedagogía, estrategias educativas
Re/sidir y re/sistir. Un ensayo sobre mis topofilias
Authors: Hernandez Ramírez Giselda E.
Published: July 2018

Soy una migrante y como tal he sufrido pérdidas de mi capital social y cultural, no obstante, he desarrollado una relación con la corresidencia donde se halla mi casa, mi lugar. Vivo en La Lisa un barrio periférico de la ciudad de la Habana,  Cuba, un lugar apartado y apuntalado de la geocultura capitalina, un municipio que ha creado su  propio  mundo sonoro contrapuntístico, donde se entretejen los cantos y toques de los negros cuando hacen sus fiestas de santos o simplemente  se relajan en un fluido guaguancó, con el más subterráneo reguetón facilitado por un músico no reconocido a los choferes de los flamantes Almendrones –coches de alquiler-, con los cantos de alabanzas de los protestantes  que proliferan en mi barrio. Sí, mi barrio ya lo hago mío aunque no cejo en este ir y venir de un lado a otro al margen de todo, en las intermediaciones, mi barrio canta, baila y llora porque ha desarrollado una gran resistencia cultural. El barrio como mi cuerpo que se resiste a envejecer, lucha y resiste los embates del tiempo. Este ensayo visual es el resultado de una deriva por Versalles el barrio donde habito, resido y resisto.
La fotografía como medio para la interpretación sonora
Authors: Guirado Isla Irene
Published: July 2018

El presente artículo busca responder al interrogante sobre si sería posible el uso de productos fotográficos para la interpretación sonora al piano. Para ello, realizo una investigación artística personal en la que pretendo encontrar las herramientas de observación en la imagen para traducirlas a una exposición auditiva. Como fuente de conocimiento para ello, parto de las partituras de grafismos musicales (Schröder, según citado en Buj, 2013) cuya forma sonora nace de la interpretación de los elementos visuales. De este modo, tomo dos fotografías tomadas en la costa malagueña para su posterior interpretación visual en función a un posible producto sonoro.
Cognição, condições socioeconômicas e estado nutricional de idosos cadastrados em uma unidade básica de saúde
Authors: Oliveira Juliana Maria , Marçal Danilo Franciso da Silva , Silva Eraldo Schunk , Cortez Lucia Elaine Ranieri , Bennemann Rose Mari
Published: July 2018

Introdução: estudos de avaliação cognitiva mostram queindivíduos idosos apresentam distúrbios cognitivos, que podemestar associadosàs condições socioeconômicas, ao estadonutricional, ao sexo e à idade. Objetivo: verificar a associaçãoentre capacidade cognitiva, condições socioeconômicas eestado nutricional de idosos cadastrados em uma unidadebásica de saúde. Casuística e Método: estudo transversal,quantitativo, com coleta de dados primários e secundários.Pesquisa foi realizada no domicílio dos idosos, que estavamcadastrados na Unidade Básica de Saúde, no período de18 de janeiro a 29 de fevereiro de 2016 na cidade de PortoRico – PR, localizada no noroeste do Paraná. Avaliou-se acapacidade cognitiva pelo mini exame do estado mental, ascondições socioeconômicas com auxílio de formulário e oestado nutricional, pelo índice de massa corporal. A associaçãoentre as variáveis foi medida utilizando o teste Qui-quadradoou teste exato de Fisher. Resultados: participaram do estudo180 idosos. Associação estatisticamente significativa foiobservada entre capacidade cognitiva e sexo e foi superiorno sexo feminino entre capacidade cognitiva e escolaridadeque foi entre 1 a 4 anos de estudo. Conclusão: grande parteda população estudada apresentou distúrbio cognitivo eexcesso de peso, sem associação entre essas variáveis. A pesardo resultado, podemos dizer que esses idosos necessitam deatendimentos especializados, afim de que problemas cognitivose nutricionais sejam identificados precocemente.
Fatores de risco associados ao desenvolvimento de alterações cervicouterinas em mulheres que realizam exame citopatológico
Authors: Da Silva José Irnaldo , Rodrigues Evelyn Gabryelle dos Anjos , Barros Jackson Matheus Rodrigues , Silva Ruan Carlos Gomes da , Peres Adrya Lúcia
Published: July 2018

problema de saúde pública em nosso país. Aparece em terceirolugar entre os tipos de câncer mais comum entre as mulheres.Vários são os fatores envolvidos na etiologia desse câncer esuas lesões precursoras. Objetivo: Verificar os principaiscofatores associados às alterações cervicouterinas. Casuísticae Métodos: Trata-se de um estudo analítico e documental,realizado em um laboratório do município de Surubim-PE,incluindo resultados de exames citopatológicos do períodode janeiro de 2014 a dezembro de 2015. Os dados foramavaliados pelo programa PRISM versão 7.0, por meio doteste Qui-quadrado, com intervalo de confiança 95% e razãode prevalência (RP). Resultados: Foram incluídos 1.200resultados de exames de mulheres na faixa etária entre 14 e 78anos. Quarenta e três por cento das mulheres pertenciam à faixaetária entre 31 e 47 anos e 86,6% haviam realizado seu últimoexame citopatológico a menos de três anos. A faixa etáriaentre 14 e 30 anos esteve associada a um maior risco para odesenvolvimento das anormalidades cervicais (p< 0,001 e OR2,9). Mulheres que realizaram o exame citopatológico a menosde três anos apresentaram uma maior associação com a presençade lesões intraepiteliais escamosas de baixo grau (LSIL) eatipias escamosas (p < 0,0001 e OR 11,3). A lesão intraepitelialescamosa de baixo grau foi a anormalidade cervical de maiorfrequência, correspondendo a 46,3%. Mulheres com presençade Gardnerella vaginalis e/ou Mobiluncus spp. apresentaramassociação com a presença de anormalidades cervicais (p<0,0001). Conclusão: Mulheres abaixo de 30 anos, querealizaram exame citopatológico a menos de três anos ouapresentam Gardnerella vaginalis e/ou Mobiluncus spp. devemser acompanhadas quanto aos possíveis riscos associados aodesenvolvimento de alterações cervicouterinas.
Curitibanas não cobertas pelo rastreio do câncer de colo de útero. Quem são elas?
Authors: Lima Dartel Ferrari , Lima Lohran Anguera
Published: July 2018

Introdução: O câncer do colo do útero é o terceiro tumor maisfrequente na população feminina e pode ser detectado na faseinicial de instalação por técnicas de rastreamento. Objetivo:Descrever as características sociodemográficas, econômicase comportamentais de mulheres não cobertas pelo rastreio docâncer do colo de útero residentes na cidade de Curitiba, Brasil.Casuística e Métodos: Trata-se de um estudo transversal dedados secundários do Ministério da Saúde obtidos pelo Sistemade Vigilância de Fatores de Risco e Proteção para DoençasCrônicas não Transmissíveis por Entrevista Telefônica para osanos de 2013 e 2014. Resultados: Participaram 2.164 mulheresadultas. Resultou em 10,2% (IC95%: 7,3 – 13,1) de mulheresnão cobertas por exame preventivo do câncer do colo do útero;4,6 pontos percentuais abaixo da média nacional (14,6%;IC95%: 11,8 – 17,1). A não cobertura foi maior nas mulherescom mais de 64 anos de idade (46,2%; IC95%: 39,7 – 52,2) ecom menos de 25 anos (18,7%: IC95%: 15,2 – 21,1), sendo que35% tinham idade que as incluíam na população de risco. Afalta de cobertura do rastreio foi maior em mulheres com baixaescolaridade (43,2%; IC95%: 40,5 – 46,0); 76,6% delas nãoconviviam com companheiros e 8% percebiam negativamente oseu estado de saúde; 46,6% (IC95%; 43,1 – 48,7) não realizarammamografia; 6,3% (IC95%: 5,2 – 7,3) eram fumantes; 3,4%(IC95%: 2,5 – 4,2) consumidoras abusivas de álcool; 38%(IC95%: 35,4 – 39,8) eram inativas no lazer e 33% (IC95%:30,6 – 36,1) eram hipertensas. Conclusão: O não engajamentono rastreio do câncer do colo do útero foi maior nas classessociais com menor poder econômico, sugerindo a necessidadede maior destinação de recursos financeiros e humanos para apopulação mais vulnerável no anseio de ampliar a coberturado programa de rastreio, sem prejuízo às demais camadas dapopulação.
Associação da função pulmonar e capacidade funcional com o tempo de ventilação mecânica invasiva após cirurgia de revascularização do miocárdio
Authors: Zanini Maurice , Martini Tamara Fenner , Santos Francielle Da Silva , Rovedder Paula Eidt , Stein Ricardo
Published: July 2018

Introdução: A cirurgia de revascularização do miocárdio(CRM) é realizada para diminuir os sintomas característicos dadoença arterial coronariana (DAC) e após esse procedimentoos pacientes necessitam de ventilação mecânica invasiva(VMI). Um tempo prolongado de VMI resulta no aumento decomplicações pulmonares, mortalidade e prolonga o tempo deinternação hospitalar. Objetivo: Verificar a associação entre afunção pulmonar e a capacidade funcional pré-operatória como tempo de VMI após CRM. Casuística e Métodos: Estudo decoorte prospectivo realizado entre 2011 e 2015 com inclusão de40 indivíduos. Foram avaliadas a capacidade funcional e funçãopulmonar no pré-operatório da CRM, além do tempo de VMIno momento após o procedimento cirúrgico. Resultados: Asvariáveis da função pulmonar apresentaram correlação inversacom o tempo de VMI pós CRM, capacidade vital forçada(CVF) (r = -0,51; p = 0,001); o volume expiratório forçadono 1º segundo (VEF1) (r = -0,49; p = 0,001), o pico de fluxoexpiratório (PFE) (r = -0,42; p = 0,008) e a capacidade vitalinspiratória (CVin) (r = -0,51; p = 0,001). A mesma correlaçãonão foi observada entre a capacidade funcional (r = -0,22; p =0,166) e o tempo de VMI pós CRM. Conclusão: Os pacientesque apresentaram melhor função pulmonar no pré-operatóriode CRM, necessitaram um menor tempo de VMI após essacirurgia. O mesmo não foi observado em relação a capacidadefuncional.
Estimation of Length and Body Weight of Children with Autism Spectrum Disorders
Authors: Bavykina I.A.
Published: July 2018

In the present study the physical development of 44 children with autism spectrum disorders aged 2.5 to
15 years was assessed in Voronezh region by the percentile tables (Federal and World Health Organization).
Results shows that every fourth child (25%) has a body mass index above the 50—85 corridor according to
the standards of the World Health Organization, i.e. exceeds the average for children of this age and sex. The
selectivity of appetite, which is reported by 72.8% of the interviewed parents of children-participants of the
study, may be a possible cause.
Year Round. Method of Speech Development and Correction
Authors: Pavlova Y.B. , Khotyleva T.Y.
Published: July 2018

This methodological manual is created based on analysis of many years of experience of teachers working with
children with developmental disorders. The manual is aimed at getting pre-school children or first graders with
speech and communication difficulties leading to academic failure ready for school.
About the Book «SPEECHLESS» by Rosemary Crossley
Authors: Zavarzina-Memmi E.G.
Published: July 2018

The technique of Facilitated Communication, created by the Australian teacher Rosemary Crossley, is described
in her book «SPEECHLESS». Present article is devoted to this book and the issue of facilitated communication,
which provides opportunities for communication to non-speaking people with severe multiple
developmental disorders, including autism.
Translation from English by E.G.Zavarzina-Memmi
Social and psychological aspects of terrorism ‘s counteraction in multicultural field
Authors: Yakhyaev M.Y. , Isaeva E.G. , Sutaeva A.R.
Published: July 2018

There are presented the results of a study of the transformation of social processes in modern society connected with the formation and escalation of destructive manifestations of terrorism in the article. There is reflected the approach to understanding the essence of terrorism based on the authors’ concept of intrapersonal conflict. Initially, authors identify the psychological preconditions for manifestations of terrorism that were based on the results of a cross-cultural monitoring analysis with coverage of more than 1930 respondents. At the second stage, on the empirical sample of more than 300 subjects, authors distinguish a spectrum of qualities that ensure personal confrontation and stabilization in a multicultural field. Psychological security is defined as a condition for ensuring the prevention of terrorism and the formation of a multicultural identity. The issues of prevention and neutralization of terrorist tendencies are considered on the basis of actualization of such mechanisms of personal psychological security’s insurance as harmonization, emotional stability and protective strategies.
The relationship between the understanding of another person and the value of the ability to forgive in students
Authors: Yushchkova T.B.
Published: July 2018

The article is concerned with the problem of interrelation of system of values and understanding of each other. This article contains the findings of a study of the relationship between the values of the ability to forgive others with their ability to understand other people. An analysis of such ability was carried out by the author upon three criteria considered as components of the ability to understand other people: the accuracy of predicting the development of the situation of interpersonal interaction; understanding the state of another person by his non-verbal behavior; the subject’s assessment of his ability to understand other people. The methodological complex was used in the study including questionnaires and semi-projective methods. The sample group was 73 persons. Based on the data obtained it was concluded that the most part of students is distinguished by the average degree of importance of the ability to forgive and the low level of development of the ability to understand other people. It is established that the value of the ability for students to forgive can be combined with different indicators of success in understanding of other people.
Resilience as a characteristic of a social group of foster parents’ applicants
Authors: Makhnach A.V. , Tolstykh N.N.
Published: July 2018

Based on the research of the foster parents’ applicants sample from different regions of Russia (622 people, including 223 men, the average age is 39.6 years, and 399 women, the average age is 39.7 years), socio-demographic and psychological characteristics a large social group of potential Russian foster parents were studied. The phenomena of resilience of an adult and a family, the stages of their study and approaches to operationalization are analyzed. In the empirical study were used the following tests: “Resilience of an adult” (Makhnach, 2016), Symptom Check List-90-Revised (SCL-90-R) in the adaptation of N.V. Tarabrina and co-authors, “Family Resources” test (Makhnach, Postylyakova, 2013) as well as the “Scale of social desirability” of Marlowe-Crown. The received results testify high resilience of a social group of Russian foster parents’ applicants. Foster parents who already raised kin and / or adoptive children, have first marriage, are in the age range of 40—50 years have better results. Also women demonstrate more high resilience than men.
Adaptation of retired people to Internet environment
Authors: Alekseeva O.A. , Bestuzheva O.Y. , Vershinskaya O.N. , Skvortsova E.E.
Published: July 2018

The article presents the results of qualitative sociological research of information and communication technologies influence on social behavior and lifestyle of older Internet users conducted by a multidisciplinary group of the Laboratory of social and economic behavior of The Institute of Social and Economic Studies of Population, The Russian Academy of Sciences. The study involved Internet users of retirement age from 56 to 89 years. The survey was conducted by in-depth interview. The main changes in the life of the Internet users of the older generation were revealed and main characteristics of the new digital techno style of life were determined: use of new forms of textual, visual and audiovisual communication for interaction; obtaining cultural knowledge and necessary information; buying goods and services and paying bills from home; extensive use of state services online; the gradual move away from print media; using “smart” things. The analysis of respondents ‘ communication showed that older people can be divided into three groups: those for whom communication has become predominantly electronic; those who persistently prefer live communication, and those for whom electronic communication is additional to live communication.
Chest trauma in the older people: epidemiological profile and treatment outcome
Authors: Okonta Kelechi E. , Ocheli Emmanuel O.
Published: July 2018

Background: There has not been any documented account of chest trauma among the older persons in Nigeria. The aim is to determine the epidemiological profile of chest injury in the old population.Methods: A prospective study of all the patients with chest trauma in two Nigeria tertiary hospitals for 4 years period. The bio-data, cause and type of chest injury, time between injury and presentation in the hospital, number of rib fractures, associated injury, injury severity score (ISS), treatment and outcome were analyzed using range and mean.Results: A total of 38(15.8%) older persons of 241 patients with chest trauma were analysed. Twenty-two (57.9%) patients were male with most of the patients being farmers and unskilled workers. Twenty-four (63.2%) patients sustained chest injury from motor vehicular crash while 10(26.3%) patients were from falls,2(5.3%) patients from gunshot injury and 2(5.3%) patients from other causes. The time between injury and presentation to the hospital ranged from 30-minutes to 5-days. Twenty-seven patients (71.1%) had rib fracture. The associated injuries were limb bone injuries in 10 (26.3%) patients, blunt abdominal injuries in 2(5.3%) patients and neurological injuries in 4 (10.6%) patients. The treatment in 35 (92.1%) patients was at least by chest tube insertion. The 30-day hospital mortality was 3(7.9%) from patients with injury severity scores of 32, 41 and 48 respectively.Conclusions: Traumatic chest injury in the older persons is still not common. Trauma to the limb bones was the commonest associated injury, and rib fracture was the commonest thoracic injury encountered. However, expeditious management led to reduced mortality recorded in this study.
Surgical management of remaining cavity after open cystectomy for hepatic hydatidosis relative study of different methods
Authors: Humood Talib A. , Al Hilali Fouad J.
Published: July 2018

Background: Handling the residual cavity of liver hydatid cyst after surgical management, is one of the most common surgical arguments in the managing of the liver hydatid disease. The aim of this prospective study was to report our experience at Al-Nu' man Teaching Hospital, Baghdad, Iraq. To achieves a comparative study with other techniques to illuminate the appropriate acquire practice of treating the residual cavity of the hydatid disease.Methods: A prospective study that achieved on 60 patients who have liver hydatid disease. The patients were treated in Al-Nu' man Teaching Hospital, Baghdad, Iraq between March 2010 and April 2016. The residual hepatic cavity after open cystectomy was managed by one surgical method; Simple Cyst Closure, Unroofing (Partial Cysto-Pericystectomy), Omentoplasty, Capitonnage, or Drainage in order to compare and highlight the postoperative complications.Results: There were five groups according to the type of operative techniques and postoperative complication. Group I (Simple Cyst Closure). Group II (Unroofing). Group III (Omentoplasty). Group. IV (Capitonnage). Group V (Drainage). Simple cyst closure had minimum postoperative stay. Omentoplasty or Capitonnage were less postoperative stay and tiniest post-operative days of biliary or purulent discharge. Drainage group has the highest percentage of bile leakage and purulent discharge plus prolonged hospitalization.Conclusions: Uncomplicated cysts have lower complication rates and short hospital stay with each cavity management technique. Complicated cysts have higher complication rates and longer hospital stay regardless of the management technique.
A comparative study of closed versus open haemorrhoidectomy
Authors: Naik Sundeep A. , M. Neelima
Published: July 2018

Background: Haemorrhoids, commonly called piles, are small, round, fleshy bumps that contain enlarged blood vessels, and are found around your anus or in your anal canal. They are associated with an increased pressure in your blood vessels in and around your anus causing them to become inflamed and swollen. It is thought that irritable bowel syndrome (IBS) may contribute to haemorrhoids developing around the anus as it can cause constipation and diarrhoea that lead to unusual straining during bowel movements.Methods: In the present study 60 cases of 2nd and 3rd degree haemorrhoids were chosen with complaints of bleeding per rectum, pain during defecation, mass per rectum, discharge and irritation. A detailed history of each patient was taken, and the data entered in the proforma.Results: Present study given 86% of cases good healing after six weeks of treatment. Open haemorrhoidectomy showed healing in 43% of cases and closed haemorrhoidectomy showed healing in 73 % cases after 3 weeks of treatment in present study.Conclusions: The results of the study concluded that post-operative pain was less in closed haemorrhoidectomy with early wound healing.
A prospective study of analyzing foot wear practice in patients with diabetic foot problems
Authors: Jain Amit Kumar C. , S. Rajagopalan
Published: July 2018

Background: The aim is to study usage and type of footwear practices in patients with diabetic foot and assess their socioeconomic status of these patients.Methods: A prospective descriptive study was carried out in the Department of Surgery of Rajarajeswari Medical College, Bangalore, India. The study period was for 6 months.Results: A total of 38 patients were included in this study. There were 30 males (78.9%) and 8 females (21.1%). Majority of patients (47.4%) were illiterate and around 31.6% of the patient’s education was less than 10th standard. Only 2.6% of them had completed their degree. Majority of patients had type 1 diabetic foot complication accounting for 50 % of patients. Only 5.3% of patients were on therapeutic foot wear with 94.7% using inappropriate footwear. 81.6 % of patients walked barefoot outside house and 94.7% walked barefoot inside the house with only 5.3% of patients use some footwear even in house. Only 15.8% of patients with diabetic foot had received advice on footwear by their doctors.Conclusions: Diabetic foot is often neglected by patients and health care professionals. Except for 5.3% who used therapeutic footwear, 94.7% of the patients with diabetic foot were on inappropriate footwear. 81.6 % of patients walked barefoot outside house and 94.7% walked barefoot inside the house. Only 10.5% of patients change their footwear every year. None of the patients after surgery received any foot wear advice.
A clinicopathological study on cervical lymphadenopathy: an institutional experience
Authors: Gorle Vamshi Krishna , Inamdar Padmanabh
Published: July 2018

Background: Despite advances in modern technology accurate diagnosis of cause of cervical lymphadenopathy remains a challenge. It leads to substantial morbidity to patients and sometimes even mortality. Uncertainty in diagnosis can lead to wrong diagnosis and increases cost of treatment. The objective of the study was to conduct a detailed evaluation of cervical lymphadenopathy in tertiary care set up and to enumerate the causes so that appropriate and adequate treatment can be initiated to reduce the morbidity.Methods: A prospective study was carried out on 100 patients of cervical lymphadenopathy and were evaluated clinically. Detailed history was taken of every patient followed by physical examination and appropriate investigations. This was followed by disease specific treatment and surgical intervention wherever necessary. Patient data was collected and evaluated to draw conclusions.Results: Most patients were young (between 12-40 years). Most common cause for cervical lymphadenopathy is due to non-neoplastic (82%) and less commonly from neoplastic (18 %). In non-neoplastic causes most, common cause is due to tuberculosis (51 %). In neoplastic causes, most common cause is due to lymphoma (10 %).  In tubercular lymphadenitis the posterior triangle group was the most commonly involved group of cervical lymph nodes (31.3%), followed by upper jugular group (21.5%). FNAC by virtue of it being inexpensive, quick in getting the results and easy to perform, is one of the important and essential diagnostic procedure.  Surgery should be to diagnostic biopsy, for treatment of abscess/sinuses and for a lymph node that do not resolve with chemotherapy and as an adjuvant to chemotherapy.Conclusions: Cervical lymphadenopathy can have varied manifestation from non-neoplastic to neoplastic condition. Proper history examination and relevant investigations and disease specific treatment can only cure the patient and improve the prognosis.
Assessment of postoperative analgesia after intraperitoneal instillation of lornoxicam in laparoscopic appendectomy: a randomized study
Authors: Kumar Anil , Kumari Rekha , Kumar Sushil , Raj Pragati
Published: July 2018

Background: The laparoscopic surgeries though results in less postoperative pain it is not a pain-free procedure and early postoperative pain is the most dominant complaint which requires strong analgesia. This study assessed post-operative analgesia after intraperitoneal instillation of lornoxicam in laparoscopic appendicectomy.Methods: This single blind randomized controlled trial was done in a tertiary care Centre of Patna from January 2016 to December 2016. A total of 60 patients scheduled for laparoscopic appenticectomy were randomly assigned into two groups of 30 each (Group A and B) using computer generated random numbers. Patients in group A received intraperitoneal instillation of 8 mg lornoxicam (Diluted in 100 ml of normal saline) and in group B patients received 100 ml of intraperitoneal normal saline. During the post-operative period pain and requirement of analgesia were assessed.Results: The demographic characteristics, clinical presentation and preoperative evaluation for vitals was comparable in group A and B. The mean VAS score was significantly low in group A compared to group B at fourth, sixth, eight and twelfth hour interval (p<0.050). In patients with group B, the requirement of analgesia was high (53.33%) compared to group A (33.33%) (p=0.118).Conclusions: The intraperitoneal instillation of lornoxicam is simple analgesic technique that reduces the pain without adverse effects compared to normal saline.
Comparison of “medicated seton versus fistulectomy” in the management of fistula-in-ano in tertiary care hospital
Authors: Madankar Swapnil P. , Jatkar Girish L. , Bhusari Bhagwat
Published: July 2018

Background: Fistula-in-ano is defined as communication between anal canal or rectum to external surface.  The main objectives of the study are to compare management of fistula-in-ano by “Medicated seton Vs Fistulectomy” and its outcome in term of complications and the recurrences if any.Methods: This study is a randomized controlled trial. Total 46 consecutive patients presenting to the Department of Surgery at SVNGMC Medical College Yavatmal with fistula-in-ano during the time of Sep-13 to Oct-15 were included in the study.  All the patients were studied as per the proforma and treated by either medicated seton or fistulectomy.Results: It was observed that operative time required (min) in medicated seton was significantly less than fistulectomy procedure. Hospital stay (days) required was significantly more in fistulectomy procedure as compared to medicated seton. Time required for complete healing (days) was significantly more in medicated seton as compared to fistulectomy.Conclusions: It is concluded that treatment of fistula-in-ano by medicated seton is simple, easy, and safe. Medicated seton treatment is an outpatient procedure and can be done in a minor operation theatre or even at Primary Health Care level. Procedure not left with a large perineal wound and its associated morbidity.
Clinico-pathological profile of patients with upper tract TCC: a single centre experience
Authors: Patel Bhavin , Batra Ravi , Utaal Maneshwar Singh , Batra Pooja
Published: July 2018

Background: Urothelial carcinomas are rare tumors and this rarity have made these tumors greatly significant. Urothelial Carcinoma of Upper Urinary Tract (UC-UUT) are still rarer and occur in elderly population. Much of the literature concerning urothelial neoplasms has focused on the urinary bladder, which is understandable given that the majority of these tumors occur in the bladder. Most common UC-UUT are the renal pelvic tumors followed by distal ureteric tumors. There is paucity of literature of UC-UUT in the Indian context hence this study assumes importance.Methods: 16 cases of UC-UUT were included in the study. A complete preoperative evaluation was done. Radical Nephroureterectomy (RNU) with bladder cuff excision was undertaken and histopathology of resected specimen was noted. Adjuvant therapy was given wherever necessary. A systematic follow-up was done, and recurrences were noted and treated. Data was then analyzed.Results: Male to female ratio was 3:1. Most patients presented with hematuria. Most lesions were left sided. Renal pelvis was the most affected site.73% tumors were of high grade and 47% were in pT3 stage. There was a single case of systemic metastasis in present study.15 out of 16 cases underwent radical nephroureterectomy with bladder cuff excision. In follow up, recurrence free survival was 66.67% and cancer free survival was 86.6% after surgery.Conclusions: Upper urinary tract urothelial tumor is a rare disease In Indian context, majority of patients presented late and were having high stage and grade at the time of diagnosis. Invasive disease was more common. Radical nephroureterectomy in still the gold standard treatment. Conservative treatment should be considered in specific cases. Recurrences in bladder are common and should be treated early.
Is regional anesthesia a safe technique for patients with severe ankylosing spondylitis undergoing total hip replacement surgery?
Authors: Copuroglu Elif , Sagiroglu Gonul
Published: July 2018

Background: Authors report two cases of regional anesthesia management whom were scheduled for total hip replacement surgery due to ankylosing spondylitis.Methods: Mouth opening, and cervical spine movements were limited. Cervical ostheophytes have been recognized to cause distortion of the airway and can lead to unexpected difficulties during intubation.Results: In present first case report we described continuous spinal anesthesia for a patient with severe ankylosing spondylitis. We achieved successful anesthesia using epidural catheter by insertion of spinal area. Awake epidural anesthesia management was described in second case of the study.Conclusions: Authors suggest that regional anesthesia can be safely and effectively used as an alternative to general anesthesia in patients with ankylosing spondylitis.
Case report of giant retroperitoneal liposarcoma in a young woman
Authors: Moreno Fernando Mendoza , Díez-Gago María del Rocío , García Javier Mínguez , Martinez Diego Enjuto , Iglesias Benjamín Tallón , Maoño Manuel Solana , Argüello-de-Andrés Jesús Manuel
Published: July 2018

Retroperitoneal liposarcoma is a rare malignant mesenchymal tumor with an annual incidence of approximately 2.5 cases per 100,000 inhabitants. It does not present specific symptoms, so its early diagnosis is difficult and in most cases it is performed when it has a large size. A 45-year-old patient with a history of increased abdominal perimeter and local discomfort was admitted in our center. After performing an abdominopelvic CT, she was diagnosed of a large, bulky tumor of lipomatous origin that significantly displaced the intestinal loops and the rest of neighboring organs. In view of the clinical suspicion of a liposarcoma, the patient underwent a resection of the lesion located in the retroperitoneum. The histopathological study determined a well differentiated retroperitoneal liposarcoma. The well-differentiated liposarcoma located in the lower limbs and the retroperitoneal space. Its age of presentation is between the fourth and sixth decade of life without finding differences between men and women. Its treatment is surgical and involves the resection of the tumor mass with non-affected surgical margins. Retroperitoneal liposarcoma is a malignant tumor whose treatment is fundamentally surgical. These tumors tend to be resistant to radiotherapy and / or chemotherapy. Among the most important prognostic factors related to survival is surgery with non-affected margins.
Acute acalculous cholecystitis as a presenting feature of neurotoxic snake bite: a case report and review of literature
Authors: Nayak Chitralekha A. , Naik Akshay S. , Gomes Edwin
Published: July 2018

Snakebite is classified by the WHO as a neglected tropical disease. Neurotoxic snake bites pose a great diagnostic challenge to the physicians in tropical and subtropical regions of the world. There is considerable variation between individual patients in the clinical manifestations following envenoming by neurotoxic snake bite. Here authors describe a rare case who presented to emergency department as acute acalculous cholecystitis following unknown neurotoxic snake bite. This acalculous cholecystitis resolved post administration of anti-snake venom. The possibility of this rare but potentially fatal complication needs to be considered in patients with snake bite and abdominal symptoms so that prompt management can prevent mortality in such patients.
Acupuncture treatment in menstrual disorder after oocyte donation
Authors: Zhu Jihe , Arsovska Blagica , Kozovska Kristina
Published: July 2018

Oocyte donation or egg donation is a process in which one woman donates eggs (oocytes) to another women in order to conceive. The process involves in vitro fertilization and it is seen as third party reproduction in the assisted reproductive technology. The oocytes from the donor are combined with the spermatozoa from the recipient to produce embryos. However, the treatment has some risk factors that afterwards need to be taken care of. One of the complications is delayed or stopped period and the acupuncture treatment can efficiently solve this problem. The treated patient is a 34 year old woman with 3 months delay in the period after receiving hormone therapy for egg donation. The patient was treated with normal needle acupuncture on the meridians of spleen, kidney, pericardium, stomach, liver, large intestine, bladder, ren mai and du mai. Treatments were made indoor, with duration of 35-40 minutes both sides of the body. In the treatment were used fine sterile disposable needles. After only one treatment the period was back and normalized. The patient has made 6 treatments. After the 6th treatment the second period was normal again. Acupuncture treatment as part of the 5000 years old Traditional Chinese Medicine, as in many other menstrual disorders, it is as well successful treatment in menstrual disorder after egg donation and gives very satisfying and positive results in a very short time.
Challenges in removal of congenital nasopharyngeal teratoma in a 5 day old neonate
Authors: Subramanian Nitya , Singh Satinder , Sharma Shalabh
Published: July 2018

Neonatal stridor is a serious condition which poses a challenge in diagnosis and requires immediate evaluation of the underlying etiology. Tumors of the head and neck region are among the more unusual causes of airway obstruction in the neonatal period. Amongst them, nasopharyngeal teratomas are rare entities accounting for less than 10% of all tumours. We present the rare case of a nasopharyngeal teratoma causing inspiratory stridor and critical airway obstruction in a newborn at birth. This tumour was removed successfully using novel coblation technique in a 5 day old neonate managed without even a tracheostomy. We present the challenges faced in diagnosis and surgical management of teratoma at a site with difficult access like nasopharynx in a 5 day old newborn which could be safely and successfully removed using coblation technology.

 

 
Thyroid dysfunction in region of excess iodine intake of eastern Nepal
Authors: Ma Zheng Feei , Zhang Hongxia
Published: July 2018

Iodine deficiency is one of most common micronutrient deficiencies worldwide, the consequences of excess iodine should not be ignored. Both chronic iodine excess and iodine deficiency can result in thyroid dysfunction in populations, especially children and pregnant women if not corrected. This is because children and pregnant women are very vulnerable to iodine deficiency and sensitive to iodine changes
Thyroid nodules: ultrasonographic stratification of malignant risk by TIRADS
Authors: Thomas George , S. Surumi , John Anulekha Mary
Published: July 2018

Background: Thyroid neoplasia is easily diagnosed with, noninvasive imaging modality like ultrasonography that is widely available. TIRADS scoring is a useful modality in establishing better stratification of cancer risk in thyroid nodules, particularly, papillary thyroid cancers (PTC) as well as papillary thyroid microcancers (PTMC).

Methods: All patients who presented with thyroid swelling and underwent surgery in the department of ENT were included in this study. All patients were evaluated with ultrasonographic examination of the neck. The decision of surgery was based on TIRADS scoring, size of swelling, or patient preference. Ultrasound features of the nodules, number of malignant features and TIRADS scoring were compared with final histopathology of the tumors.  

Results: A total of 58 thyroid surgeries were performed from January 2014 to December 2017. On statistical analysis, we found that more the number of radiological features favouring malignancy more were the likelihood of finding malignant histopathology.

Conclusions: Ultrasonographic features of malignancy along with TIRADS scoring are an extremely useful tool in diagnosing thyroid cancers and will help in standardising all sonographic reports.
Rosacea: an update on therapeutic options
Authors: Majid Imran , Bhat Shabir Ahmad
Published: July 2018

Rosacea is a common inflammatory skin disease affecting the face usually in middle-aged individuals. The disorder is associated with a lot of psychological impact on the quality of life of the affected patient. Treatment options for this skin disease range from topical treatment options to systemic agents and even lasers. This paper will review the current and some of the upcoming treatment options for this chronic skin disease.
Cutaneous manifestations of diabetes mellitus: a clinical study
Authors: Bhardwaj Nancy , Roy Samarjit , Jindal Rashmi , Ahmad Sohaib
Published: July 2018

Background: Diabetes mellitus is a leading cause of morbidity with adverse effects on various systems including skin. Cutaneous manifestations seen in diabetes aid in its diagnosis and some of them may also correlate with diabetic control, duration and other complications. This study was undertaken to estimate burden of skin disorders among diabetics in a tertiary care centre of Uttarakhand.

Methods: The study was conducted at Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India, over a period of one year from January 2016 to December 2016. Three hundred and seventy seven patients irrespective of age and sex were included in the study and those with gestational diabetes were excluded. Patients were examined for mucocutaneous manifestations and evaluated. Structured case reporting form was used to generate data.

Results: Out of 377 patients studies, 114 (30.2%) were in the age group of 51-60 years. Male to female ratio was 1.44:1. Mucocutaneous manifestations were present in 278/377 (73.7%) patients. Common cutaneous manifestations were cutaneous infections [fungal infections (n=106/377; 28.1%), bacterial infections (n=33/377; 8.8%)], pruritus (n=47/377; 12.5%), xerosis (n=39/377; 10.3%), diabetic dermopathy (n=36/377; 9.5%) and diabetic ulcers (n=24/377; 6.4%). Uncommon manifestations were necrobiosis lipoidica diabeticorum, alopecia areata, scleredema diabeticorum and granuloma annulare. Cutaneous reactions due to treatment of diabetes were noted in 4 (1%) patients.

Conclusions: As prevalence of cutaneous manifestations is high in diabetic patients, knowledge of these will help in a timely and comprehensive management of both diabetes and dermatoses.
Genetics of multiplex familial vitiligo as cases and controls: a preliminary report
Authors: Deo Kirti S. , Ganjre Samyak A.
Published: July 2018

Background: Studies on etiology of generalized vitiligo have established that it is a genetically determined, autoimmune, auto inflammatory diathesis. Polymorphism in myriad genes is associated with vitiligo and newer ones are being identified with advancement in research methods. This study enabled inheritance pattern recognition in multiplex familial cases of vitiligo and subject members to whole exome sequencing (WES) to find out the etiological gene defect in a particular family.

Methods: 7 multiplex families with at least two cases and two healthy counterparts, spread across generations were enrolled. Demographic data, clinical history and familial data were collected for pedigree analysis and blood samples were collected for extraction of genomic DNA.

Results: Multiple possible modes of Mendelian inheritance could be contemplated to cause disease expression in probands. Autosomal recessive pattern was observed to be the most likely amongst various possible modes, followed closely by autosomal dominant, with X-linked recessive, and X- linked dominant occurring less frequently. WES for one of the multiplex families is desirable and planned at an apex institute of genetic studies which will reveal the etiologic gene defect on conclusion of analysis.

Conclusions: In this study we have used to our advantage the familial occurrence of the disease to seek for genes which occurred with a greater frequency in affected members of a family than their healthy counterparts, assuming that the same mutated gene should be universally present in all affected members across generations in the same family, enabling a better understanding of genetic predisposition in familial vitiligo. 
Omalizumab in chronic spontaneous urticaria
Authors: A. Ramesh , V. Sampath , U. R. Dhanalakshmi , G. Vinitha Kumari
Published: July 2018

Background: Chronic spontaneous urticaria is a common skin disorder affecting 0.5 to 1% of people in the general population. There are a variety of treatment options available without much successful outcome. Omalizumab is a novel treatment option which can be used in the treatment of chronic spontaneous urticaria. The aim of our study is to assess the efficacy of omalizumab in chronic spontaneous urticaria.

Methods: A retrospective analysis of data of 10 patients with chronic spontaneous urticaria who were treated with three doses of omalizumab in our institution. Doses were given at monthly intervals for 3 months and they were followed for another 6 months. Response was assessed using urticaria activity score.

Results: 70% of patients had well controlled urticaria with 3 doses of omalizumab by the end of 9 months.
Conclusions:Omalizumab is a safe and effective treatment option in the management of chronic spontaneous urticaria. 
 