bluuebunny/crossref_metadata_2025 huggingface dataset:
PENGGUNAAN CONTAINER SEBAGAI PENGGANTI TERPAL UNTUK ANGKUT PUPUK PT GRESIK CIPTA SEJAHTERA
Authors: Aldi Abdillah Mohammad Haris , Indro Kirono
Published: December 2023

Transportasi di Indonesia sangat berperan penting bagi semua orang, karena dengan adanya transportasi kita bisa menghemat waktu serta bisa berperan sebagai pelayanan jasa yang baik. Banyak sekarang orang-orang sudah menggunakan jasa transportasi karena sudah dapat meningkatkan jasa nya, apalagi dalam hal transaksi sehingga untuk kebutuhan orang-orang bisa terpenuhi. Penelitian ini menggunakan metode penelitian kualitatif deskriptif yang dapat diamati untuk mendapatkan suatu informasi dari hasil observasi ke lapangan. Berdasarkan pengamatan penulis, dihasilkan suatu hasil fakta permasalahan yang ada yaitu adanya komplain pelanggan ketika barang sampai ditempat tujuan. Komplain yang dimaksud adalah barang yang rusak atau cacat pada saat perjalanan atau saat proses pengiriman. Kondisi barang rusak atau cacat tersebut yaitu pupuk basah yang disebabkan kondisi alam selama perjalanan dan pupuk bocor / tumpah dari kemasan karena tergencet tumpukan. Rusaknya barang tersebut dikarenakan masih menggunakan truk trailer dengan bak terbuka, maka usulan dalam permasalahan yang ada, proses penerpalan nantinya akan ditiadakan dan akan digantikan oleh container sehingga barang lebih safety dan tidak akan memakan waktu yang banyak pada saat proses pengiriman barang.
FORMULATION AND EVALUATION OF EFFERVESCENT GRANULE OF WHITE TEMU RHIZOME EXTRACT (Curcuma zedoaria (Christm.) Roscoe.) AS ANTIOXIDANT
Authors: Pratama Reza , Azhary Deny Puriyani , Muhsinin Soni , Khumairani Adinda
Published: December 2023

More than 9,606 plant species have medicinal properties, but only around 3-4% of these have been cultivated commercially and used in traditional medicine in Indonesia. One of the natural ingredients believed to have properties is the white temu rhizome. White Curcuma rhizomes are usually processed into food and drinks. White ginger rhizome has antioxidant activity. Antioxidants are secondary metabolites found in herbal plants and have pharmacological activities that can minimize free radicals. Several studies have shown that white ginger rhizomes have antioxidant activities that can remove free radicals. This research aims to formulate an effervescent granule preparation. for white temu rhizome extract (Curcuma zedoaria (Christm.) Roscoe) using the wet granulation method, which meets the requirements for the physical properties of granules and has antioxidant activity. Several formulae were selected from various combinations. Next, an evaluation was performed to determine the physical properties and activities of the formulated granules. The evaluation results showed that all formulations met the requirements of the physical properties of the granules. Qualitative antioxidant activity testing using TLC plates showed positive antioxidant results in the extract and effervescent granule preparation of white curcuma rhizome extract and in quantitative testing it was found that the IC50 value of white curcuma rhizome extract was in the strong category and in the effervescent granule preparation of white curcuma rhizome extract, the granules were found to be in the strong category.
Keywords: Effervescent Granule, Extracts, White Temu Rhizome (Curcuma zedoaria (Christm.) Roscoe), Antioxidants
ANALGETIC ACTIVITY DETERMINATION OF PAPAYA LEAVES (Carica papaya L.) AND BASIL LEAVES (Ocimum sanctum L.) EXTRACTED USING NATURAL DEEP EUTECTIC SOLVENT
Authors: Amelia Renny , Falya Yuniarty , Tomi  , Daryuti  , Barkah Eka Umi
Published: December 2023

Natural deep eutectic solvents (NaDES) are obtained from an adequate mixture of hydrogen bond acceptors (HBA) and donors (HBD), which can bond through the interaction of hydrogen bonds to form a eutectic with a low melting point. NADES has been implemented in several studies as an effective extraction method, but it is still not widely used. C. papaya leaves and O. sanctum leaves have been widely known to have various pharmacological activities. The aim of this study was to determine the best analgesic ability of the NADES extract of C. papaya and O. sanctum leaves. The extraction process used was Microwave-Assisted Extraction (MAE). The liquid extract was tested for antioxidant activity and analgesic activity using doses of 600 mg/kgBW, 800 mg/kgBW, and 1000 mg/kgBW. The results show that The IC50 values of the NADES extract of C. papaya and O. sanctum leaves were 920 ppm and 882 ppm, respectively. Both analgetic percentages are equivalent to the positive control starting from a concentration of 800 mg/kgBW, where the analgetic percentage of the NADES extract of papaya leaves and basil leaves is 59.80% and 54.57% respectively that included in weak category. It can be concluded that both NADES extracts of papaya and basil leaves have analgetic capabilities.
 Keywords: Natural Deep Eutectic Solvent (NADES), Carica papaya, Ocimum sanctum, analgetic activity.
ИЗУЧЕНИЕ БИОЛОГИЧЕСКОЙ И ПИЩЕВОЙ ЦЕННОСТИ СУХОФРУКТОВ ИЗ СОРТОВ ВИНОГРАДА, ПРОИЗРАСТАЮЩЕГО НА ЮГЕ КАЗАХСТАНА
Authors: Кантуреева Гульжан , Мурзабаев Болат , Раисов Болат
Published: December 2023

Сухофрукты, полученные из винограда, благодаря сочетанию высокой питательной ценности и приятного вкуса считаются полезным продуктом питания.Изучение биологической и пищевой ценности сушеного винограда из сортов, произрастающих на юге Казахстана, проводилось на базе НИЛ «Проблемы АПК и ЭР»ЮКУ им.M. Ауэзова. Экспериментальная сушка винограда проводилась на инфракрасной сушильной установке ШС-80 по экологической современной технологии без применения химических реагентов на  этапе предварительной обработки.В данной работе определены технологические параметры сушки (изменение массы сырья, время и продуктивность сушки)для четырех сортов винограда. В образцах сушеного виноградасодержится достаточное количествосахарозы(3,38 и 5,17),чтохарактерно для сортов винограда из южной области. По общему содержанию полифенолов образцы темных сортов винограда (Кишмиш, Мерседес, Тайфи розовый) показали хорошие значения в пределах 220,5-309,1мг ГК/100 г.Тогда как в белом сорте винограда было обнаружено наименьшее количество 110,0ГК/100 г.Также в опытных образцах отмечено высокое содержание калия (от 34% до 39%), кальция (в среднем 2,66-3,53%) и фосфора (2,92-3,88). Потребители и заинтересованные стороны могут получить выгоду от производства и реализации предлагаемых сушеных продуктов, какрегиональные бренды Казахстана или продукция с географическим указанием (ГУ).
Assessment of treatment outcomes for HIV Positives transitioned from Tenofovir/Lamivudine/Efavirenz to Tenofovir/Lamivudine/Dolutegravir in a Nigerian Tertiary Hospital
Authors: Ojo Omobola Yetunde , Ahmed AbdulMumin , Adeniran Adeyinka , Onigbogi Olarenwaju Olusola , Onigbogi Modupe Olajumoke , Alausa Kamil Olanipekun
Published: December 2023

Objective: Dolutegravir, an integrase inhibitor replaced nevirapine or efavirenz (both NRTIs) in a fixed dose combination with Tenofovir/Lamivudine, as the preferred first-line option for the prevention and treatment of HIV infection. This study aimed to assess the treatment outcomes of the new Tenofovir/Lamivudine/Dolutegravir (TLD) regimen at the Federal Medical Centre Abeokuta.
Methods: This retrospective study used data drawn from the treatment register of patients who transitioned from Tenofovir/Lamivudine/Efavirenz (TLE) to TLD. Data were analyzed using SPSS v23. Descriptive statistics were used to describe categorical and continuous variables. Statistically significant independent variables in univariate analyses were included in the multivariate model. The level of significance was set at p<0.05.
Results: The 358 cases reviewed showed a mean age of 44.29 ± 11.5 years. The majority (267; 74.6%) were females. Viral load suppression (≤1000 copies/ml) was achieved in 313 (87.4%) while on TLE but increased to 339 (94.7%) when transitioned to TLD. Also, 36.3% had a high CD4 count while on TLE, this increased to 67.3%. The mean CD4 counts (428.59±251.85) while using TLE increased exponentially when transitioned to TLD (634.89±244.72) (t-31.601; p-value- 0.001). Before the transition, 90.5% of respondents were at WHO stage 1 compared to 92.5% after the transition to TDF/3TC/DTG.
Conclusion: Treatment outcome was greatly improved in terms of virologic, immunologic and clinical parameters among patients who transitioned from TDF/3TC/EFV to TDF/3TC/DTG. The outcome of this work supports and encourages the use of TDF/3TC/DTG as the preferred first-line regimen in HIV treatment for the patient’s maximum clinical benefit.
Risk Analysis and Assessment Framework for Cyber Security in Management Systems
Authors: TARAKÇI Emin , GÖNÜL Anıl Mustafa
Published: December 2023

Organizations are depending more and more on interconnected digital ecosystems, therefore strengthening cyber security measures is essential. This paper offers a thorough framework for risk assessment and management that fits into the larger category of cyber security-focused management systems. The framework that has been suggest-ed combines state-of-the-art techniques from the fields of risk management and cyber security to build a resilient system that can deal with modern cyber threats.

The framework begins with a methodical inventory of resources—such as data centers, vital infrastructure, and network elements—that are necessary for the operation of the corporate cyber environment. A comprehensive risk assessment is then carried out, taking into account the possibility and consequences of any cyber attacks to the assets that have been identified.

Predictive modeling and scenario analysis are integrated into the framework to enable a proactive approach to risk mitigation. Consistent with well-known management system standards like ISO 27001 and DDO, the framework emphasizes an iterative and cyclical process. Regular risk reviews, performance reviews, and strategy updates for risk management lead to continuous progress. The synchronization of cyber security measures with changing organ-izational structures and developing threats is ensured by this adaptive approach.

In addition to strengthening an organization's cyber resilience, putting the suggested framework into practice ad-vances the more general objective of developing a strong and effective cyber security management system. This methodology offers a scalable and sustainable way to protect digital assets from the ever-changing pool of cyberat-tacks by smoothly integrating risk analysis and management into current organizational procedures.

This study offers a methodical and comprehensive approach to risk analysis and management, which adds to the continuing conversation on cyber security. The framework that is provided here acts as a useful manual for com-panies that want to strengthen their cybersecurity while adhering to accepted management system standards.
Ectopic conundrum-A case series of unusual presentations of ruptured ectopic pregnancy in a low resource setting in northeast India
Authors: Chowdhury Pushpal
Published: December 2023

Ectopic pregnancy is a major contributor to maternal morbidity and mortality in the first trimester of pregnancy. The management of ruptured ectopic pregnancy accompanied by features of severe blood loss requires concurrent resuscitation and laparotomy to save precious life. Here we present a series of cases of ruptured ectopic pregnancy deviated from the expected intraoperative findings and the associated challenges in their management in a low-resource setting in a district hospital in North East India.
A rare case of Systemic Lupus Erythematosus presenting as acute myopericarditis with bilateral pleural effusions.
Authors: Wettasinghe Indika , Elanko Arjunar , Puthra Shiran , Ratnayake Asanka , Thambippillai Rajananthini , Ponnamperuma Chandrike , Sadeekin Aflah , Mendis Suresh
Published: December 2023

Acute myopericarditis is a rare presentation in clinical practice with multiple aetiologies. Eventhough cardiac manifestations are known to be present in up to 50% of Systemic Lupus Erythematosus (SLE) patients, acute myopericarditis is an uncommon presentation, occurring in up to 1% of patients. Here we report a patient who presented with fever and pleuritic type chest pain and was managed as acute myopericarditis with bilateral exudative pleural effusions and later diagnosed to have SLE. The patients were initially treated with nonsteroidal anti-inflammatory drugs and later with steroids and hydroxychloroquine. Early diagnosis of myopericarditis and identification of the aetiology is essential to halt the progression of disease. Pericarditis due to Tuberculosis need to be excluded before starting steroids in the Sri Lankan setting.
Neonatal presentation of Niemann-Pick disease type C2- A rare case report.
Authors: Singh Vinaya , Randad Kailas , Yadav Pushpa , Sawant Tejasi , Ansari Qudsiya
Published: December 2023

Niemann Pick type C [NP-C] disease is a rare neurodegenerative lysosomal storage disorder marked by an accumulation of unesterified cholesterol in the lysosomal system. It has autosomal recessive inheritance caused by mutations in NPC1 and NPC2 genes. The broad clinical spectrum ranges from a prenatal severe manifestation to an adult-onset chronic neurodegenerative disease. The manifestations in the perinatal period and infancy are predominantly visceral, with hepatosplenomegaly, jaundice, and pulmonary infiltrates (in some instances). Patients with NP-C usually do not show neurological manifestations during the neonatal period. Herein we present a case of neonatal cholestasis with hepatosplenomegaly and anaemia, which was diagnosed as Niemann Pick disease type C2. Thus, NP-C is an important differential diagnosis of neonatal cholestasis in the presence of visceromegaly.
Granulomatosis with polyangiitis presenting as acute ischemic stroke- A case of an unusual presentation
Authors: Maduranga Kasun , Karunarathne Wasantha , Sarathchandra Chamara , Senanayake Hemal
Published: December 2023

Ischemic stroke can be a rare atypical presentation of granulomatosis with polyangiitis (GPA). Awareness of this entity is vital when a clinician evaluates a patient for the aetiology of the ischemic stroke. We report a case of a 48-year-old female who presented with acute ischemic stroke and the etiology was found to be related to GPA. She was diagnosed according to the serological markers and MRI brain findings. Correct disease diagnosis is essential, as immunosuppressive therapy can improve the prognosis.
Severe rhabdomyolysis following a possible sea snake bite: A case report
Authors: Packiyarajah Pavithera , Maheshwaran Umakanth , Nusair M. S. M.
Published: December 2023

Rhabdomyolysis is a potentially life-threatening condition characterized by muscle necrosis and the release of muscle constituents into the circulation. Rhabdomyolysis has several causes, however many of them are complex or ambiguous. Rhabdomyolysis can lead to complications such as acute kidney injury AKI), electrolyte abnormalities, compartment syndrome, and disseminated intravascular coagulation (DIC). The main stray of management principle is the prevention of acute kidney injury by hydration, alkalization and diuresis, with correction of electrolyte imbalances and acidosis.In our case, a 38-year-old man presented with generalized body swelling, body pain and dark urine after a possible sea snake bite when he visited Mannar Gulf. Blood workup showed significantly elevated creatinine phosphokinase (CPK). With proper hydration and alkaline diuresis, the patient did not develop AKI or electrolyte imbalances and he was discharged after 2 weeks with a significant reduction in CPK and clinical improvement.
A Cross-Sectional Survey of Work-Related Musculoskeletal Disorders in Physiotherapists Using Orebro Musculoskeletal Pain Questionnaire (OMPQ)
Authors: Rahane Rohit Balasaheb , Kulkarni Nupoor Sanjiv , Khot Aditi Pramod
Published: December 2023

Background:

Physiotherapists in India are at a high risk of work-related musculoskeletal disorder (WRMSD). Faulty ergonomics and incorrect patient handling techniques are the common causes of WRMSDs. The disabilities caused due to musculoskeletal injuries are the frequent cause of absenteeism from work.

Aim and Method:

The aim of this cross-sectional survey is to investigate the occurrence of WRMSDs among physiotherapists in Maharashtra using Orebro Musculoskeletal Pain Questionnaire. Responses were obtained through Google forms and analyzed. Three hundred sixty physiotherapists who fulfilled the inclusion criteria were recruited for the study. All the participants responded to the questionnaire.

Result:

The prevalence of WRMSDs was found to be highest in age of 23-30 years (87.22%) and less in age of 41-50 years (2.22%). Most common affected area was neck (43.6%) and lower back (43.1%).

Conclusion:

This study highlights the high incidence of WRMSDs among physiotherapists in Maharashtra.
Women Police Personnel’s Work-Family Conflict and Burnout from Individual’s Experience: The Moderating Effect of Stressful Working Environment
Authors: Bhuvaneswari D , Thirumoorthi P
Published: December 2023

Aim:

This study investigates the relationship between Work-Family Conflict (WFC) and the individual’s experience of burnout by considering the moderating role of a stressful working environment.

Material and Methods:

The questionnaire holds “Work-Family Conflict” and consists of eight questions adopted from Carlson and Perrewé (1999). “Burnout” consists of three subconstructs, namely “Emotional exhaustion”, which carries four questions, “Depersonalization”, which has four questions, and “Personal accomplishment”, holding three questions adopted from Maslach Burnout Inventory (Maslach and Jackson, 1981). And finally, “Stressful work environment” consists of 10 questions adopted from Gershon (1999). The research instrument was distributed among women police working in Chennai and Kanchipuram regions. The data from 427 women police personnel were collected through a questionnaire using a simple random sampling method.

Statistical Analysis Used:

First, exploratory factor analysis was performed to test the standardization and tested for reliability using Cronbach’s alpha test. It found that all loadings are between 0.649 and 0.866, which is satisfactory. Second, for demographic questionnaire items, descriptive statistics were performed. Finally, to find the moderating effects of stressful work environment on the relationship between WFC and the individual’s experience of burnout, multiple hierarchical regression analysis was computed.

Results:

The results show that WFC positively affects burnout and it has been found that a stressful working environment moderates the relationship. It also supports that individuals experience a high level of burnout when the working environment and WFC are intense.

Conclusion:

The result supports that individuals experience high burnout when the working environment and WFC are intense. The study initiated an attempt to explain the mechanism through which a stressful working environment influences burnout levels.
Measuring the Economic Burden of Health Conditions among White-Collar Employees: A Cross-Sectional Study from Delhi-NCR
Authors: Yadav Monika , Viji B
Published: December 2023

Background:

In the past few decades, there has been a significant increase in healthcare expenditure due to the prevalence of health issues across the globe. This is primarily seen among white-collar employees due to the sedentary nature of their jobs, which affects their current earnings (Purchasing Power) directly due to the reallocation of their real income towards healthcare expenditure (Economic Burden) and indirectly by impacting work productivity through sick leaves.

Aim:

To measure the economic burden of disease(s) among white-collar employees, and to study the same across different socio-demographic variables.

Methods:

A cross-sectional study has been conducted in the region of Delhi-NCR among 357 white-collar employees. A random sampling method was adopted using a structured questionnaire. The questionnaire collected information regarding the direct and indirect costs of health conditions with a recall period of one month. The cumulative score of these monthly costs was converted to annual data to estimate the economic burden of the health conditions among the employees over a year.

Results:

As compared to Communicable diseases (16.24%), Non-communicable diseases (27.17%) were more prevalent among the respondents. Compared to other diseases, the employees suffering from Heart diseases (INR 7,62,237.50), Spinal health issues (INR 1,73,625.00), and Diabetes (INR 1,64,535.71) incurred more economic burden. At a 5% significance level, no significant difference was observed in economic burden for Gender and BMI. However, the economic burden was significantly different across the categories of Age and Monthly income. A positive association can be observed in economic burden with the increasing categories of age and monthly income.

Conclusion:

With the nature of sedentary work (desk jobs), white-collar employees are at a greater risk of exposure to various NCDs than CDs and incur a significant amount of out-of-pocket expenditure to manage their health status.
Workplace Violence in Healthcare Settings: A Cross-Sectional Survey among Healthcare Workers of North India
Authors: Singh Amandeep , Ranjan Piyush , Agrawal Ramesh , Kaur Tanveer , Upadhyay Ashish D. , Nayer Jamshed , Chakrawarty Biswaroop , Sarkar Siddharth , Joshi Mohit , Kaur Tarang P. , Mohan Ajay , Chakrawarty Avinash , Kumar K. Raju
Published: December 2023

Background:

Workplace violence (WPV) is a significant problem in both developed and developing countries, especially among healthcare workers. It has widespread implications for their overall health and well-being.

Objective:

The study was conducted to assess the problem of violence among doctors and other healthcare workers in healthcare settings.

Material and Methods:

A cross-sectional survey was conducted using a validated questionnaire from August 21 to September 18, 2021, based on purposive and snowball-sampling techniques for data collection. Appropriate statistical methods were applied to study the association between sociodemographics and characteristics of violence.

Results:

A total of 601 responses were analyzed. The results showed that approximately 75% of the participants experienced violence in some form at their workplace. These episodes lead to a significant impact on the physical and mental health of these workers. Around one-third of the participants felt uncomfortable reporting these incidents. Some of the most common risk factors and mitigation strategies were also reported by the participants.

Conclusion:

The findings of this study can be used by the legislators, administrators, and policymakers to develop strategies that can help in mitigating these episodes of violence for the better functioning of the healthcare system.
Risk of Silico-Tuberculosis in Miners: A Systematic Review and Meta-Analysis
Authors: Sinha Ratnesh , Priya Angelin , Ahmad Absar
Published: December 2023

Context:

Tuberculosis (TB) and Silicosis are public health problems with high morbidity and mortality. They also exist as comorbidities and are highly prevalent among mine workers.

Aims:

This study aims to estimate the risk of TB in miners with silicosis than in miners not having silicosis.

Methods and Material:

This systematic review was conducted by literature search using PubMed, and EMBASE for studies published from 1st Jan 2017 till 20th July 2022. From the data obtained using relevant keywords for the search, a total of 345 articles were selected for screening after applying our inclusion-exclusion criteria and removing duplicates. PRISMA guidelines were followed. items JBI critical appraisal checklist for cross-sectional studies was used for assessment of the risk of bias. The odds ratio was used to estimate the strength of the association.

Results:

After extensive screening, four studies have met our selection criteria. The meta-analysis of those studies revealed that the prevalence of TB in miners with silicosis is 27.11% while the prevalence of TB in miners with non-silicosis is 16.75%. The estimated pooled odds ratio (fixed effect model) is 1.34 (95% CI 1.01 – 1.76).

Conclusions:

The present study reveals that there is an increased risk of TB in miners with Silicosis. Newer initiatives must be taken to prevent TB in miners.
Ergonomic and Anthropometric Evaluation of Locally Manufactured Vehicle Seats
Authors: Kumar Vikas , Oumer Kindu , Merso Eshetu A. , Sharma Rohit , Hira Jaspreet , Haldar Barun
Published: December 2023

Background:

Most of the cars are imported as cargo vehicles and then converted into commercial passenger vehicles in Ethiopia. Seats are locally manufactured and installed as part of the conversion to passenger cars, with little regard permitted for the standard specifications required.

Objective:

A descriptive survey, an ergonomics assessment of passenger seats was conducted, and subjective evaluations of seat comfort were collected.

Methods and Materials:

For long journeys, there are problems of discomfort, back pain, and human fatigue. Anthropometric measurements of respondents and locally manufactured seats were used to conduct an objective evaluation of seat attributes.

Results:

The findings revealed that the passengers’ body proportions and the seat dimensions differ significantly and are not given any preference during design and fabrication of the seat.

Conclusion:

This study recommends the anthropometric dimensions of the Ethiopian passengers for the design and manufacturing of the vehicle seats.
Shift Work is Associated with an Elevated White Blood Cell Count: A Systematic Review and Meta-Analysis
Authors: Sooriyaarachchi Piumika , Jayawardena Ranil , Pavey Toby , King Neil A.
Published: December 2023

The white blood cell (WBC) count increases significantly in reaction to infections and certain chronic diseases. Shift employment increases the risk for chronic low-grade inflammation and the progression of several chronic diseases. The objective of this study was to systematically evaluate the evidence from studies on total and differential WBC counts in shift employees. A literature search was performed in PubMed®, Web of Science, and Scopus databases using keywords for research published before March 1, 2022. A meta-analysis was conducted for total and differential WBC counts using a random-effects approach. A total of 25 studies covering a sample of 37,708 day and shift employees were included in this review. The studies represented America, Europe, East Asia, and Middle East. A significant increase in the total counts (×109/L) of WBC [mean difference (MD) = 0.43; 95% confidence interval (CI): 0.34–0.52; P < 0.001], lymphocytes (MD = 0.16; 95% CI: 0.02–0.30; P = 0.02), monocytes (MD = 0.04; 95% CI: 0–0.07; P = 0.03), and eosinophils (MD = 0.01; 95% CI: 0–0.01; P = 0.03) was observed in shift workers compared to the day counterparts. However, neutrophils and basophils were not significantly different between the groups. Shift work significantly increases the total and differential blood counts in peripheral circulation. Therefore, total and differential WBC counts represent a relatively inexpensive biomarker for diagnostics and prognostics of diseases in shift workers.
External Auditory Canal Paraganglioma Causing Chronic Mastoiditis with Complications of Bezold and Luc’s Abscesses
Authors: Goh Siang Poon , Wong Danny Kit Chung , Tuang Geng Ju , Goh Bee See
Published: December 2023

Paragangliomas (PGs) are rare, benign neuroendocrine tumors that originate from neuroectodermal tissues. PGs arising from the ear canal are extremely rare, with only a few cases reported to date. The common symptoms of ear canal PGs include ear discharge, ear fullness, and hearing loss. This article describes unusual manifestations of ear canal PGs otitis media with Bezold and Luc’s abscesses, in an immunocompromised young adult. The pathogenesis of the disease is described. In addition, determining the origin of PG in this case was not straightforward compared to previously reported ear canal PGs. The derivation of the diagnosis is further discussed.
Surgical Management of Primary Inner Ear Schwannoma: A Rare Case Report and Review of Literature
Authors: Shukla Shambhavi , Goyal Sunil , Dwivedi Gunjan , Sengupta P.
Published: December 2023

We are reporting a rare case of primary inner ear schwannomas (PIES) with an interesting clinical presentation, its diagnostic challenge, surgical management, and follow-up. A case report and review of the literature concerning PIES is presented. Key role of otolaryngologist is symptomatic management and hearing preservation or rehabilitation. This was achieved in the present case by complete resolution of her symptoms and hearing rehabilitation with cochlear implantation. Early diagnosis and management of PIES carry a good prognosis. There are no guidelines for the management of this kind of tumor due to its rarity. This case mimicking labyrinthitis, however, raised suspicion of PIES on initial imaging. The patient underwent serial imaging which revealed similar findings which were confirmed intraoperatively on tumor identification and complete excision leading to successful diagnosis at an early stage.
A Comparative Study of Full Cuff Underlay and Over-underlay Tympanoplasty
Authors: Pandey Rajesh , Barnwal Abhishek Kumar , Yadav Anil Kumar
Published: December 2023

Background:

Various modifications in tympanomeatal flap elevation in tympanoplasty were described by otolaryngologist all over the world to achieve best surgical outcome. In this study, the surgical and audiological outcomes of circumferential (full cuffed) tympanomeatal flap elevation and over-under technique of flap elevation were compared in type 1 tympanoplasty.

Objective:

The aim of this study is to compare surgical outcomes of two techniques of tympanomeatal flap elevation in tympanoplasty.

Materials and Methods:

This prospective randomized study included 200 patients. Patients were randomly allocated in 2 groups. Patients were followed for 3 months and compared surgical and audiological outcomes in 2 groups.

Results:

In full-cuffed underlay (Group A) techniques, the overall success (97.3%) and anterior blunting (9.1%) were more, whereas residual perforation (2.7%), granulation formation (2.7%), and lateralization (0.0%) were less common as compared to over-underlay technique (Group B). In over-underlay technique (Group B), success, residual perforation, lateralization, and anterior blunting were seen in 82.2%, 17.8%, 4.4%, and 2.2%, respectively.

Conclusion:

Both full-cuffed underlay and over-underlay techniques of tympanoplasty are effective surgical technique with satisfactory outcome.
Temporal Auditory Processing, Speech Recognition, and P300 in Adults with Opioid Use Disorders Attributed to Tramadol
Authors: Elnabtity Nadia Mohamed , Ibraheem Ola Abdallah , Galhom Dalia Helal
Published: December 2023

Background:

Tramadol is a centrally acting opioid with an analgesic effect. Prolonged chronic pain management with tramadol and tramadol misuse may cause opioid use disorder attributed to tramadol (OUD-T). Evidence from pathophysiologic mechanisms of OUD-T raised the probability for central auditory processing abnormalities.

Objectives:

To our knowledge, no available studies evaluate the underlying pathology. Consequently, this study was designed to evaluate speech recognition, auditory temporal processing, auditory neurocognitive function in these patients.

Materials and Methods:

This work comprised a study group of 19 males with OUD-T and a control group of 19 participants, both with an age range of 20-40 years. All participants were subjected to (1) basic audiological evaluation, (2) psychoacoustic central auditory tests to assess auditory figure ground (speech intelligibility in noise) and temporal processing (Gaps-In-Noise and pitch pattern sequence), and (3) P300 neurocognitive potential.

Results:

OUD-T showed statistical significant depressed scores of speech in noise and pitch pattern sequence tests in comparison to the control group. In addition a statistically significant elevated GIN test approximate threshold and depressed total score was present in OUD-T. As regards P300, there was statistically significant difference between the control and the study group in latency and amplitude.

Conclusion:

These findings emphasize the importance of speech in noise, temporal processing, and neurocognitive evaluation in adults with opioid use disorder attributed to tramadol.
Comparison of Tympanoplasty Done with Removal of Posterior Canal Wall Skin versus Tympanoplasty Done with Preservation of Canal Wall Skin
Authors: Sayani Ruta K. , Oza Meshwa , Vadiya Sohil
Published: December 2023

Aims and Objectives:

The aim of this study is to compare the outcomes of type 1 tympanoplasty in terms of graft uptake, hearing improvement, operative time, and healing time in patients operated with posterior canal skin preservation or without it.

Materials and Methods:

This is a prospective study of 100 patients operated for type 1 tympanoplasty surgery at a tertiary care hospital from August 2021 to June 2023 and operated by a single surgeon. Patients were divided into two groups and were randomly allocated (one with posterior canal skin preservation and other without it). Inclusion criteria were all patients operated for tympanoplasty between 12 and 50 years of age. Exclusion criteria were patients with mixed hearing loss or sensorineural hearing loss and patients who had to undergo ossicular chain reconstruction and revision cases were also excluded from the study. The outcomes were evaluated on follow-up by otoendoscopy and pure-tone audiometry.

Observation and Discussion:

In terms of graft uptake at 3-month postoperative period, no significant difference was found between both the groups. In terms of hearing improvement and healing time, P > 0.1 was noted, and hence the difference was not significant. However, the operative time was significantly lower for the group with posterior canal wall skin removal.

Conclusion:

Removal of skin from posterior surface of external auditory canal improves visualization during tympanoplasty. It reduces operative time and provides same success rates in terms of graft uptake and hearing improvement. It has almost the same healing time, and granulations or other canal-related complications are minimal. Graft medialization or lateralization is also minimal when anterior tucking and lateral tucking of graft is done.
The Epley Maneuver versus Betahistine in Treatment of Benign Paroxysmal Positional Vertigo
Authors: Dawood Mohammed Radef
Published: December 2023

Background:

Benign paroxysmal positional vertigo (BPPV) is considered the most common cause of vertigo. The necessity for early and effective management resulted in the improvement of the patient’s life quality. The objective was to compare the efficacy between Epley’s maneuver and betahistine dihydrochloride in BPPV treatment.

Patients and Methods:

A prospective follow-up comparative study on 60 patients with BPPV, who diagnosed with a positive Dix–Hallpike test, were divided equally and randomly into two groups; Group “A” treated with Epley’s maneuver and Group “B” treated with betahistine dihydrochloride. The efficacy of each modality was assessed, regarding the sense of vertigo and its associated symptoms, data of vertigo scales as the Visual Analog Scale (VAS), and Dizziness Handicap Inventory (DHI).

Results:

There were 23 males (38.33%), and 37 females (61.66%), with mean age (54 ± 7.521) years. The total vertigo improvement was (78.33%); being (93.33%) in group “A” and (63.33%) in group “B”, nausea and vomiting symptoms improvement was (76.66%) in group “A”, and (70%) in group “B”. The baseline VAS score in Group “A” (7.69 ± 1.235 SD) and in Group “B” (6.35 ± 3.267 SD) after treatment improved to 0.56 ± 0.731 SD and 1.86 ± 1.375 SD, respectively, as well as the baseline DHI value in Group “A” (51.86 ± 23.583 SD) and in Group “B” (49.37 ± 18.152 SD) then improved to 2.31 ± 3.986 and 7.98 ± 9.512 SD, respectively.

Conclusions:

The Epley maneuver was more effective and “statistically significant” in relieving vertigo, and both the VAS and DHI scales compared to betahistine, while regarding associated nausea and vomiting symptoms, it shows no statically significant difference.
Takotsubo Cardiomyopathy Due to Electric Shock by Home Appliance; An Unusual Finding in Day-to-day Life
Authors: Manuja Nishtha , Saboo Keyur , Daiya Varun , Kumar Jayanth , Kumar Sunil , Acharya Sourya
Published: December 2023

Takotsubo cardiomyopathy or stress cardiomyopathy is a sudden transient cardiac syndrome that shows left ventricular apical akinesis and mimics acute coronary syndrome. Coronary flow is normal. We describe the case of a 28-year-old male who encountered an electric shock at home, and after that, developed acute chest pain and palpitations. His cardiac markers were raised, and his electrocardiogram revealed myocardial ischemia. The epicardial flow was found to be normal after coronary angiography. Takotsubo cardiomyopathy was identified as the cause.
Understanding the Position of Beta-blockers in the Management of Hypertension among Patients with Different Clinical Comorbidities: An Expert Opinion of Cardiologists from India
Authors: Kumar Arram Sreenivas , Jadhav Uday , Solanki Dharmesh , Hazra Prakash K. , Alexander Thomas , Biswas Kaushik , Revankar Santosh , Ghatge Shweta , Kumar Neeraj
Published: December 2023

Background:

Elevated blood pressure (BP) increases the risk of cardiovascular mortality, underscoring the vital importance of effective management in individuals with hypertension (HTN) and cardiovascular disease. However, lack of clear guidance on the utilization of the new beta-blockers has caused hesitation among doctors in using them effectively. The objective of this expert opinion was to understand the role and current position of beta-blockers in the management of patients with HTN and different clinical comorbidities.

Methods:

A collective of 828 cardiologists throughout India were invited to participate in an online survey and virtual meetings. Their clinical insights were gathered on approaches in managing these patients and their understanding of the role of beta-blockers.

Results:

The panel of experts recommended that in patients with HTN and angina, the BP target should be 130/80 mmHg (40.70%), and the use of a combination of telmisartan and cardio-selective beta-blockers should be used to lower BP (63.29%). A combination of telmisartan and a beta-1 blocker was recommended for effective BP control and structural regression of left ventricular hypertrophy (52.78%). For intensive BP control, combination therapy of telmisartan and beta-blockers should be used in patients with HTN and atrial fibrillation (59.18%). The panel of experts opined (60.02%) that different BP targets should be considered for different stroke subtypes. Telmisartan (44.44%) and selective beta-1 blockers (29.35%) are recommended to manage BP variability in patients with HTN and recurrent stroke.

Conclusion:

In patients with HTN and cardiovascular disease, individualized decision-making is necessary for beta-blocker use in HTN management. Selective beta-blockers should be considered first-line therapy or combined with telmisartan when indicated.
A Study of the Role of Prognostic Laboratory Parameters among COVID-19 Patients: A Retrospective Cohort Study
Authors: Parikh Nirav , Patel Hasmukh , Chauhan Ankit
Published: December 2023

Background:

The emergence and spread of the coronavirus disease 2019 (COVID-19) pandemic presents an immense challenge to public health and has resulted in a dramatic loss of human life worldwide. Thus, diagnosis and identification of clinical laboratory parameters associated with the disease become crucial in critical cases, requiring intensive care management.

Aim:

To investigate clinical laboratory parameters that may be associated with severe or critical COVID-19 disease patients, particularly those requiring intensive care management.

Materials and Methods:

A retrospective cohort study was conducted at the U. N. Mehta Institute of Cardiology and Research Institute, Ahmedabad, Gujarat. A total of 1460 COVID-19-positive patients (aged 18 years and older) requiring admission to the intensive care unit were selected from April 3 to May 23, 2021, were enrolled, and were diagnostically monitored. Patients were evaluated based on their demographics. A Welsch t-test was used to calculate the progression in the mean difference among inflammatory and/or thromboembolic markers.

Results:

We analyzed and examined certain laboratory parameters across the timeline and compared survival (Group 1) and nonsurvival (Group 2). All the factors were higher in Group 2 compared to Group 1, except for C-reactive protein-Q (CRP-Q), which decreased in both groups, but in Group 1, there was a further decrease in CRP-Q value as compared to Group 2 on retest day.

Conclusion:

The results of the current study provide clinical value for prognostic factors associated with COVID-19 and establish the role of laboratory parameters in evaluating disease severity and complications.
Impact of comorbidities and inflammatory markers on mortality of COVID-19 patients
Authors: Karim Azmat , Shameem Mohammad , Talwar Anjana , Talwar Deepak
Published: December 2023

Background:

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus that causes coronavirus disease 2019 (COVID-19) is a serious global health concern. The severity of the disease can be determined by serologic indicators such as C-reactive protein, lactate dehydrogenase, D-dimer, ferritin, and interleukin-6. (IL-6). Patients with preexisting conditions such as respiratory, cardiovascular, and pulmonary disease could be at risk of adverse outcomes. It is crucial to provide adequate medical care to manage these patients and increase their chances of survival.

Aim:

The study examined the impact of comorbidity and inflammatory markers on the severity and mortality of hospitalised COVID-19 patients.

Materials and Methods:

This retrospective study included 101 COVID-19 patients who had comorbidities and were hospitalised from April 2021 to April 2022.

Results:

Patients with a severe COVID-19 infection could be anticipated to have higher levels of inflammatory markers in their blood. Patients with chronic kidney and coronary artery disease have a worse prognosis than those with other comorbidities (P value <0.001). However, tuberculosis had no statistically significant effect on mortality and showed a minimal chance of death (P value = 0.303). In addition, tocilizumab performed poorly and was ineffective against the COVID-19 treatment. However, ivermectin exhibited a statistically significant probability of survival in COVID-19 patients.

Conclusion:

The inflammatory markers D-dimer, ferritin, and IL-6 were identified as valuable indicators of disease severity. Further, chronic kidney disease and coronary artery disease were identified as risk factors for mortality, while tuberculosis showed potential protective effects. The study showed that higher neutrophil levels were linked to mortality in tocilizumab-treated patients, while ivermectin showed promise in increasing survival rates.
Co-existing pulmonary hydatid cyst with aspergillosis
Authors: Agrawal Mousmi , Ziekhrii Catherine T. , Gaind Saurabh , Hussain Nighat
Published: December 2023

Pulmonary hydatid cyst is known to occur, but incidental detection of Aspergillus colonisation in an unruptured cyst wall, especially in immunocompetent patients, is very rare. Presentation can be hemoptysis or asymptomatic, depending upon immune status. Colonisation of the cyst wall may be due to immune dysregulation, structural abnormalities, invasion of fungal organisms through channels between airways and cyst and other mechanisms. Here, we report a rare case of Aspergillus colonisation in the hydatid cyst wall in a young immunocompetent patient and also try to describe the pathogenetic mechanism for the same.
Gauging the knowledge, attitude and practice of interns and dentists about obstructive sleep apnoea—A cross-sectional study
Authors: Chauhan Megha , Chauhan Manish R. , Agrawal Ananya , Chawla Ashokkumar R.
Published: December 2023

Context:

Obstructive sleep apnoea is less known and lesser practised in dentistry. Dentists often struggle to educate, diagnose or offer treatment to the patient. Hence, the disorder of the patient and the opportunity for the dentist both go unnoticed.

Aim:

To assess the knowledge, attitude and practice regarding aspects of obstructive sleep apnoea among dental practitioners, faculty and interns in India.

Methods and Material:

A self-constructed validated questionnaire was prepared and circulated online among dental interns and professionals in India. Responses received from 237 participants were evaluated and statistically analysed.

Results:

Only questions about diagnosis and symptoms of OSA were correctly answered by more than 50% of the participants. In all other questions, the knowledge was poor. Only 11.4% of respondents felt that they are well equipped to diagnose OSA. The general attitude of the participants was favourable but with poor practice. Only 5.1% of participants were ever involved in the treatment of OSA.

Conclusions:

Given the high prevalence of OSA among the population, along with widespread ignorance among dentists for the same as found in our study, there is an urgent need to spotlight OSA in the dental curriculum at an undergraduate level. To complement this, extensive training and motivation must also be provided so that dental graduates can identify, refer and participate in the treatment of OSA.
Acute kidney injury in birth asphyxiated patients: A cross sectional study at Bahawal Victoria Hospital
Authors: Tounsa Akhtar , Hussain Arif , Hussain Irshad , Tariq Rabia , Saqlain Muhammad , Shaikh Saba A. , Mumtaz Hassan
Published: December 2023

Background:

The presence of perinatal asphyxia and its severity appear to correlate with increasing incidence of Acute kidney injury (AKI). The objective of this study is to determine the frequency of AKI and its outcome in birth asphyxia.

Methods:

This cross-sectional study was carried out in the Department of Pediatric Medicine from March 2019 to September 2019. A total of 111 newborns with birth asphyxia of gestational age 37–41 weeks were included. Neonates born to mothers having hypertension and diabetes mellitus, patients with congenital kidney anomalies like polycystic kidney disease and renal agenesis, and mothers taking nephrotoxic drugs or any other known cause of AKI like hypovolemic shock were excluded. Urine output (UOP) and final outcome of the patient were also noted. AKI was noted.

Results:

The mean gestational age was 38.29 ± 1.07 weeks. The mean weight of neonates was 3.08 ± 0.31 kg. The frequency of AKI in birth asphyxia was 20 (18.02%) neonates. Complete recovery in AKI patients was seen in 07 (35.0%) and death in 13 (65.0%) patients.

Conclusion:

This study has shown that the frequency of AKI in birth asphyxia was found in 18.02% neonates with complete recovery seen in 35.0% and death in 65.0% patients.
Masqueraders of pneumonia in children: A case series
Authors: Kaur Hardeep , Bhat Vivek , Mukund Bal , Mahajan Gaurav
Published: December 2023

Pneumonia remains the top most killer of under-five Indian children. Pneumonia in children is usually caused by viral or bacterial infections. However, there are some unusual causes of pneumonia that merit consideration when pneumonia is recurrent or persistent.