bluuebunny/crossref_metadata_2025 huggingface dataset:
SOCIALIZATION OF ANALYSIS OF TOTAL TERPENOIDS FROM MANILTOA GRANDIFLORA (A. GRAY) SCHEFF LEAVES USING TLC METHODS
Authors: Sinurat Jhon Patar , Br Karo Reh Malem , Berutu Rinaldo
Published: July 2021

Saputangan leaves  contained terpenoids which appeared reddish brown rings when tested using Liebermann Burchard, Salkowski and cerric sulfate. Saputangan leaves were macerated, then partitioned to obtain total terpenoids using a separatory funnel while checking filtrate partition with cerric sulfate. Extracts dissolved with methanol were partitioned with n-Hexane and then partitioned between aquadest and ethyl acetate in a ratio of 1: 1 to obtain 50 g of total terpenoids. TLC analyses was performed on total terpenoids using n-hexane: acetone (80:20 v/v) solvent. The total terpenoids were proved that terpenoids have 11 terpenoids as red stain based on their Rf. Based on the results of tests conducted on participants involved in socialization, it was stated that around 98% of participants had understood terpenoid compounds.
LATIHAN SENAM TERHADAP KADAR GULA DARAH PADA PENDERITA DIABETES MELLITUS DI DESA PALUH BAJI KECAMATAN PANTAI LABU KABUPATEN DELI SERDANG
Authors: Ginting Samuel , Harahap Chaidir Saputra , Damayanti Grace Erlyn , Ani Pitri , Wati Syatria , Simarmata Juni Mariati
Published: July 2021

Diabetes mellitus was more commonly known as diabetes was a disease or disorder that affects the ability of the body in amounts or concentrations of glucose or sugar in the blood than normal. Accorded to WHO (2009), the number of patients with Diabetes Mellitus as many as 7.0 million people, WHO estimates the number of patients with diabetes mellitus have increased in the year 2030 as many as 12.0 million people. This type of research was a quasi-experiment (quasi experiment) with a model of design time series design. This study aims to determine the effect of exercise on blood sugar levels in people with diabetes mellitus in the Desa Paluh Baji Kecamatan Pantai Labu Kabupaten Deli Serdang 2012. The population in this study were all patients with diabetes mellitus in the Desa Paluh Baji Kecamatan Pantai Labu Kabupaten Deli Serdang week as many as 54 people, with a sample of as many as 35 people. Sampled technique with a non probability purposive sampling technique approach. From the results obtained that all respondents have a blood sugar> 120 mg / dl before exercise and the majority of respondents had a blood glucose <120 mg / dl as many as 28 people (20.0%) performed after exercise. Based on the results of statistical tests obtained p-value = 0.012 (α = 0.05) we can conclude there was significant influence between blood sugar levels before and after exercise. It was recommended to patients with diabetes mellitus in order to apply the exercises in an effort to decrease blood sugar levels and to further research in order to further develop the material handling problems researchers about how blood sugar levels in people with diabetes mellitus.
PENGARUH PEMBERIAN KOMPRES HANGAT PADA LEHER UNTUK MENGURANGI NYERI DI KEPALA PADA PASIEN HIPERTENSI
Authors: Syara Arfah May , Siringoringo Tiurma , Halawa Afeus , Sitorus Kristina
Published: July 2021

Hypertension or high blood pressure is an abnormal increase in blood pressure in the arteries or an increase in systolic blood pressure of more than 140 mmHg and diastolic blood pressure of more than 90 mmHg in two measurements with an interval of five minutes in a fairly calm/resting state. Common signs and symptoms that arise from hypertension are sore neck (neck pain). Neck pain due to hypertension makes the comfort needs of hypertensive patients not met. One of the non-pharmacological measures to reduce or overcome neck pain is a warm compress. A warm compress is giving a feeling of warmth / heat in a certain area. neck pain scale in hypertensive patients before warm compress therapy, said moderate pain 4 respondents (28.6%), severe pain 10 respondents (71.4%) with a standard deviation of 0.469. The pain scale of hypertensive patients after warm compress therapy was said to be moderate for 12 respondents (85.7%), the weight of 2 respondents (14.3%) with a standard deviation of 0.426. Hypertensive patients who experienced severe neck pain decreased, before being given treatment as many as 10 people, after being given treatment as many as 2 people. The application of warm compresses to hypertensive patients continues to be carried out for non-pharmacological therapy that can be carried out by the community at home.
PENGARUH RENDAM KAKI MENGGUNAKAN AIR HANGAT TERHADAP KECEMASAN PADA PASIEN HIPERTENSI
Authors: Yanti Dian Anggri , Karo-karo Tati Murni , Purba Anita Sri Gandaria , Br Ginting Junita Ika Susanti , Octavariny Raisha , Williani Nurul Fernanda
Published: July 2021

Hypertension is a condition of a person who has an increase in blood pressure above normal. Anxiety is an emotional response to a subjective assessment with a state of anxiety, worry, fear and increased emotions. Soak the feet using warm water. for the body to oxygenate body tissues for anxiety. Aim; To find out the effect of foot baths using warm water on anxiety in hypertensive patients at the Grandmed Hospital in 2020. Method; This research is an experimental research that is pre experimental design using one group prepost by using a comparison group (control) with a sample of 42 respondents while the research instrument uses a questionnaire sheet and observation sheet, using an anxiety measurement tool (HARS). Data analysis used bivariate analysis namely Paired Sample T-Test. Results; Bivariate test results with Paired Sample T-Test Test prove that there is an effect of foot bath action using warm water to reduce anxiety before and after the action is carried out proven by the value of p = 0,000 <0.05. Conclusion; there is an effect of soaking the feet using warm water on anxiety in hypertensive patient.
PENGARUH LATIHAN AEROBIK TERHADAP KUALITAS HIDUP PASIEN PENYAKIT PARU OBSTRUKTIF KRONIK
Authors: Purba Anita Gandaria , Anggriyanti Dian , Pohan Nur Hamida
Published: July 2021

Patients with COPD experience a fundamental inability to breathe in the form of shortness of breath, chronic cough, chronic sputum production, and limited activity. Aerobic exercise for COPD sufferers aims to reduce symptoms, improve quality of life and increase daily activities. This study aims to determine the effect of aerobic exercise on the quality of life of COPD patients. This research is a quantitative study using a quasi-experimental design with a pretest-posttest research design, using the sampling technique is purposive sampling with 44 respondents. Retrieval of data using a quality of life questionnaire for COPD patients. The results of the paired t test showed a value of p <0.000, which means that p <0.05, this shows in general that aerobic exercise has an effect on the quality of life of COPD patients. COPD sufferers who routinely do aerobic exercise regularly will increase their perfusion so that tissue needs can be fulfilled and COPD symptoms, especially shortness of breath, will decrease.
PENYULUHAN TEKNIK RELAKSASI OTOT PROGRESIF UNTUK MENURUNKAN KADAR GULA DARAH PADA PASIEN DIABETES MELLITUS TIPE 2 DI RUMAH SAKIT GRANDMED
Authors: Sitepu Sari Desi Esta Ulina , Karo-karo Tati Murni , Simarmata Pratiwi Christa , Silalahi Amriani Eva Perawati , Hayati Kardina , Sipayung Selamat Tuahta
Published: July 2021

The prevalence of diabetes that occurred in 2015 was 9.3% and is expected to continue to increase every year. Type 2 diabetes mellitus occurs due to insulin resistance, namely glucose that fails to enter the body, usually occurs at the age of over 30 years. One form of therapy that can be done is progressive muscle relaxation. The purpose of this community service is to find out the benefits of progressive muscle relaxation techniques on reducing blood sugar levels in patients with type 2 diabetes mellitus at Grandmed Lubuk Pakam Hospital. The method used in this community service is a quasi-experimental using observation sheets. The application of muscle relaxation techniques was carried out on 10 patients with type 2 diabetes mellitus. The community service procedure started from an explanation of progressive muscle relaxation techniques and procedures, implementation and observations (observations), then the results were recorded in the observation sheet. The application of progressive muscle relaxation techniques in patients with type 2 diabetes mellitus accompanied by insulin injection has been shown to reduce blood sugar levels. The application of progressive muscle relaxation techniques can be used as an intervention in lowering blood sugar levels in patients with type 2 diabetes mellitus.
TINDAKAN KEMOTERAPI DENGAN TINGKAT KECEMASAN PADA KLIEN KANKER DI RUMAH SAKIT GRANDMED LUBUK PAKAM TAHUN 2021
Authors: Sitepu Kuat , Arianto Adi , Br Ginting Luci Riani , Damanik Henni Dawati
Published: July 2021

Chemotherapy is a treatment process that uses antineoplastic preparations with the aim of killing cancer cells and slowing the growth of cancer cells by disrupting cellular function and reproduction. Research objectives: To determine the relationship between chemotherapy and anxiety levels in cancer clients at Grandmed Lubuk Pakam Hospital in 2021. Research methods: This study used a quantitative research design with the type of analytical survey. This study used a cross-sectional design, which is a type of observational study that analyzes data from a population. the research results obtained p value = 0.00. It means that the p value <0.05, then there is a relationship between chemotherapy measures and anxiety levels in cancer clients at Grandmed Lubuk Pakam Hospital in 2021. Conclusion: chemotherapy will provide different levels of anxiety for each patient undergoing it, depending on their attitude to accept the disease. as well as the existing knowledge about cancer that will be treated by chemotherapy. Suggestion: For Research Sites: It is hoped that it can add insight to other nurses to further maximize the actions to be taken
EFEKTIVITAS EDUKASI GIZI DENGAN PENDAMPINGAN TERHADAP ASUPAN ZAT GIZI MAKRO, HbA1c, DAN PROFIL LIPID DARAH PADA PASIEN DM TIPE II
Authors: Ratnasari Indah , Ngadiarti Iskari , Ahmad Lilik Fauziyah
Published: July 2021

Medical nutritional therapy is an important part of the comprehensive management of type II DM. Good glycemic control can control blood lipid profile levels so that it can reduce the risk of complications of heart disease in people with type II diabetes. This study aims to determine whether education with assistance for 6 months affects macronutrient intake, HbA1c, and lipid profiles in patients with Type II diabetes. This study used a Quasi-Experimental design with experimental design The Pretest-Postest design without a control group. The sample used the purposive sampling method according to the inclusion and exclusion criteria with 30 samples. The research data were obtained from secondary data from the Endocrine Metabolic Poly and Nutritional Poly RSCM Research in 2017. The results showed that there was a significant effect (p <0.05) of education with assistance for 6 months on the value of HbA1c, while with the intake of macronutrients (carbohydrates and fats), LDL and triglycerides had no significant effect (p> 0.05). HBA1c levels in this study were significantly related to blood triglyceride levels. Therefore, it is necessary to carry out more research using nutrition education methods with assistance to working groups of young adults and the need to pay attention to compliance with medication consumption or the use of insulin therapy. ABSTRAKTerapi gizi medik merupakan bagian penting dalam pengelolaan DM tipe II secara komprehensif. Kontrol glikemik yang baik dapat mengendalikan kadar profil lipid darah sehingga dapat menurunkan risiko komplikasi penyakit jantung pada penderita DM tipe II. Penelitian bertujuan mengetahui apakah edukasi dengan pendampingan selama 6 bulan mempengaruhi asupan zat gizi makro,  nilai HbA1c dan profil lipid pada pasien DM Tipe II. Penelitian ini menggunakan desain Quasi Eksperimental dengan desain eksperiment The Pretest- Postest design tanpa grup kontrol. Sampel menggunakan metode Purposive sampling sesuai dengan kriteria inklusi dan eksklusi dengan jumlah 30 orang. Data penelitian didapatkan dari data sekunder penelitian Poli Metabolik Endokrin dan Poli Gizi RSCM tahun 2017. Hasil penelitian menunjukkan ada pengaruh yang bermakna (p<0.05) edukasi dengan pendampingan selama 6 bulan terhadap nilai HbA1c, sedangkan dengan asupan zat gizi makro (karbohidrat dan lemak, LDL dan  trigliserida tidak ada pengaruh yang signifikan (p>0.05). Kadar HBA1c dalam penelitian ini berhubungan nyata dengan kadar tigliserida darah. Kesimpulan edukasi gizi dengan pendampingan selama 6 bulan  kurang efektif mengendalikan perilaku makan dan kontrol lipid darah. Oleh karena itu perlu dilakukan penelitian lagi menggunakan metode edukasi gizi dengan pendampingan pada kelompok usia dewasa muda yang bekerja serta perlu diperhatian kepatuhan konsumsi obat-obatan atau penggunaan terapi insulin. Kata kunci: asupan zat gizi makro, HbA1c, profil lipid, DM tipe II, pendampingan
PENGARUH KONSELING PADA PENGETAHUAN DAN ASUPAN IBU DI WILAYAH KERJA PUSKESMAS KEBAYORAN BARU JAKARTA
Authors: Ngadiarti Iskari , Soekatri Moesijanti Yudiarti Endang , Srimiati Mia , Fayasari Adhila , Agestika Lina
Published: July 2021

Providing counseling is one of the factors that increase the knowledge and actions of mothers in meeting adequate nutritional consumption. This study aimed to identify the lactation and nutrition counseling towards mother's knowledge and intake in Puskesmas Kebayoran Lama Jakarta. This research was a quasi-experimental study pre-post with a control group design. Sample collection technique used consecutive sampling with 30 respondents in each group (intervention group and control group). Counseling was given 3 times, after giving birth, a child at age 7-14 days and age 35 days. Knowledge and food intake were collected before and after the intervention. The bivariate analysis used an independent t-test and paired t-test with a significance level of p<0.05. There was a significant difference in mother's knowledge about breastfeeding between the intervention group and control group after they were given lactation counseling (p<0.05). However, there was no significant difference in the mother's nutrient intake between the intervention and control group after counseled (p>0.05). Lactation counseling can positively affect the mother's knowledge about breastfeeding, but not for the mother's action in consuming enough nutrient intake. ABSTRAKPemberian konseling menjadi salah satu faktor yang meningkatkan pengetahuan dan tindakan ibu dalam memenuhi konsumsi gizi yang adekuat. Penelitian ini bertujuan untuk mengetahui pengaruh konseling menyusui dan konsumsi gizi terhadap pengetahuan dan asupan ibu di Puskesmas Kebayoran Lama, Jakarta. Penelitian ini merupakan penelitian eksperimental semu dengan desain pre-post dengan control group. Teknik pengambilan sampel menggunakan consecutive sampling dengan jumlah sampel 30 responden pada masing-masing kelompok (kelompok intervensi dan kelompok kontrol). Konseling diberikan sebanyak 3 kali, yaitu pada saat setelah melahirkan, bayi berusia 7-14 hari dan 35 hari. Data pengetahuan dan asupan diambil sebelum dan sesudah intervensi. Analisis bivariat menggunakan independent t-test dan paired t-test. Ada perbedaan yang bermakna pada pengetahuan ibu menyusui antara kelompok intervensi dan kelompok kontrol setelah diberikan penyuluhan laktasi (p <0,05). Tidak ada perbedaan bermakna pada asupan gizi ibu antara kelompok intervensi dan kontrol setelah konseling (p>0,05). Konseling laktasi berpengaruh positif terhadap pengetahuan ibu tentang menyusui, tetapi tidak untuk perilaku ibu dalam asupan gizinya.Kata kunci: konseling, laktasi, menyusui
Classification of Remote Sensing Image Scenes Using Double Feature Extraction Hybrid Deep Learning Approach
Authors: Sungheetha Akey , Sharma R Rajesh
Published: July 2021

Over the last decade, remote sensing technology has advanced dramatically, resulting in significant improvements on image quality, data volume, and application usage. These images have essential applications since they can help with quick and easy interpretation. Many standard detection algorithms fail to accurately categorize a scene from a remote sensing image recorded from the earth. A method that uses bilinear convolution neural networks to produce a lessweighted set of models those results in better visual recognition in remote sensing images using fine-grained techniques. This proposed hybrid method is utilized to extract scene feature information in two times from remote sensing images for improved recognition. In layman's terms, these features are defined as raw, and only have a single defined frame, so they will allow basic recognition from remote sensing images. This research work has proposed a double feature extraction hybrid deep learning approach to classify remotely sensed image scenes based on feature abstraction techniques. Also, the proposed algorithm is applied to feature values in order to convert them to feature vectors that have pure black and white values after many product operations. The next stage is pooling and normalization, which occurs after the CNN feature extraction process has changed. This research work has developed a novel hybrid framework method that has a better level of accuracy and recognition rate than any prior model.
Role of LASER Stapedotomy in clinical improvement in subjective tinnitus among patients with Otosclerosis- a retrospective analysis
Authors: Suneha Swati
Published: July 2021

Objective: To determine the prevalence and severity of subjective tinnitus in patients undergoing LASER stapedotomy at the Department of Otorhinolaryngology, AIIMS Patna. To evaluate the efficacy of LASER stapedotomy in clinically significant improvement in tinnitus in these patients
Materials and methods: A retrospective study was conducted on 40 patients who underwent LASER stapedotomy from February 2018 to December 2019 at the Department of Otorhinolaryngology, AIIMS Patna. Pre- and post-operative audiological and tinnitus assessment was done. Hospital records were analyzed and otosclerotic patients with subjective tinnitus were included in the study. Prevalence and severity of tinnitus and accompanying degree of hearing loss across both genders were noted. Improvement in tinnitus postoperatively was evaluated. Results were analyzed using IBM SPSS Statistics software Version 20. Mean values were calculated and paired t-tests were applied to assess the role of LASER stapedotomy on tinnitus improvement.
Results: Out of a total of 40 stapedotomy patients, 29 (72.50%) had tinnitus at presentation. The mean age of these patients was 29.59±9.3 years. The mean gain in air conduction threshold (ACT) and air-bone gap (ABG) closure was 19.68 dB and 12.14 dB respectively. Unilateral tinnitus was seen in 55.17% and bilateral in 44.83% of patients. High-frequency hearing loss was found in 65.51% of patients. Postoperatively, 44.83% of patients experienced a complete resolution in tinnitus, while all of them had an improvement in tinnitus severity. This result was similar in both males and females.
Conclusion: Tinnitus is a frequent complaint of patients suffering from otosclerosis, which often takes a backseat in the treatment goals of a surgeon. It varies in severity and duration and is associated with a progressive worsening of hearing thresholds. LASER stapedotomy is an effective treatment modality, which not only improves post-operative hearing but also alleviates tinnitus to a great extent.
Study design: A retrospective observational study
Keywords: Otosclerosis. Tinnitus, LASER stapedotomy, Air Bone Gap (ABG)
A RARE CASE OF NEUROFIBROMATOSIS WITH SQUAMOUS CELL CARCINOMA OF EPIGLOTTIS
Authors: Jayendiran S
Published: July 2021

INTRODUCTION: The neurofibroma is a nonmalignant new growth of neuroectodermal origin. neurofibromas appear at the end of a nerve, often in the skin, producing small nonencapsulated nodules which may have pigmentation in the overlying skin. Neurofibromatosis with laryngeal involvement presents with dyspnea, followed by hoarseness, stridor, dysphagia, and voice change. most common sites involved in the larynx are the arytenoids and the aryepiglottic folds.
CASE REPORT: 65-year-old female with previously diagnosed of neurofibromatosis since 10 years of age manifested by multiple cutaneous nodules The patient had symptoms of dysphagia, hoarseness of voice for past 2 months. Direct laryngeal examination using flexible endoscope showed a edematousulceroproliferative growth in the laryngeal surface of epiglottis and fullness in the left pyriform fossa. Hisopathological examination revealed squamous cell carcinoma from epiglottis and fibromatosis changes from pyriform fossa.
CONCLUSION: All neurofibromatosis patient and their family members should under go regular oral and laryngeal examination to rule out complications at the earliest.
A STUDY ON CORRELATION OF SIZE AND SITE OF TYMPANIC MEMBRANE PERFORATION WITH DEGREE OF CONDUCTIVE HEARING LOSS IN CHRONIC OTITIS MEDIA
Authors: Lavanya M
Published: July 2021

Background: Tympanic membrane perforations are common cause of hearing loss. This study was designed to analyze the relation between tympanic membrane perforation and conductive hearing loss.

Materials and Methods: In this prospective study, patients with dry tympanic membrane perforations of safe type were included. The patients were divided into groups in according to size, site and duration of perforation. Based on the inclusion and exclusion criteria a total of 100 patients were included in this study. All the patients clinical data was analyzed statistically using paired t-test.

Results:Hearing loss increased as the size of perforation increased. Posterior quadrant perforations were associated with more hearing loss as compared to anterior quadrant perforations. Also duration of disease was in linear relation with mean hearingloss.

Conclusions: The degree of conductive hearing loss as a result of tympanic membrane perforation would be expected with the size, site and duration of perforation.

Keywords: Tympanic membrane, Conductive hearing loss, Perforation, hearing loss, posterior quadrant, ear.
Rhino Orbito-Cerebral Mucormycosis
Prevention and Treatment guidelines in Covid-19 Pandemic- an E.N.T. Perspective
Authors: Keshri Amit
Published: July 2021

Mucormycosis (sometimes called zygomycosis) is a serious fungal infection caused by a group of moulds called mucormycetes. These fungi live throughout the environment, particularly in soil and in decaying organic matter, such as leaves, compost piles, or rotten wood. People get mucormycosis by coming in contact with the fungal spores in the environment. For example, the lung or sinus forms of the infection can occur after someone breathes in spores.
AN INTRIGUING CASE OF LARYNGEAL FIBROLIPOMA - CASE REPORT AND REVIEW OF LITERATURE
Authors: Dhivya N
Published: July 2021

Although fibrolipomas are common benign mesenchymal tumors and are frequently found in trunk and limbs, their occurrence in head and neck is rare and still rarer is their endolaryngeal presence.
They may cause clinical dilemma due to their rarity and varied clinical presentations from progressive dysphagia to acute airway obstruction. We present a case of laryngeal fibrolipoma in an adult Indian male who presented with progressive obstructive sleep apnea and sudden appearance of a mass in oral cavity which was removed via transoral endoscopic approach.
Keywords– Fibrolipoma larynx, lipoma, obstructive sleep apnea, transoral excision
GIANT BENIGN SCHWANNOMA OF THE ANTERIOR BASE OF THE SKULL WITH SINONASAL AND PHARYNGEAL EXTENSION
Authors: Winga Foma
Published: July 2021

Introduction: Schwannomas are tumors developed from Schwann cells present in the peripheral nerve sheaths. Their development both extra and intracranial is extremely rare.
Observation: We report the case of a 36-year-old man who consulted for sinonasal syndrome evolving over the past ten years in which explorations found a large benign schwannoma of the anterior base of the skull with sinonasal and pharyngeal extension. The excision was performed externally by Moure and Sébileau with ENT and neurosurgery collaboration. The suites were simple.
Discussion: The present observation again raises the question of the exact origin of developing sinonasal and endocranial schwannomas. The origin of the lesion and our management conditions were discussed.
Conclusion: as for other authors, schwannoma should be considered in the diagnosis of skull base tumors. External surgery for extensive forms and ENT and neurosurgery collaboration help to minimize the risk of complications.
Keywords: schwannoma; sinonasal schwannoma; skull base tumor.
MAXILLARY MUCOCOELE A RARE ENTITY
Authors: Anand Abhay
Published: July 2021

Abstract
Mucoceles are accumulations of trapped mucus, forming cystic expansile lesions. Maxillary sinus mucoceles are rare amongst paranasal sinus mucoceles, usually being a late sequel of Caldwell-Luc surgery. We present a case of a maxillary sinus mucocele due to a molar root canal treatment in a middle aged patient, reported to highlight its unusual etiology.
Keywords Mucocele
“Central Giant Cell Granuloma of Maxilla-
A Case Report”
Authors: Talukdar Dhiraj Kr.
Published: July 2021

Central giant Cell granuloma (CGCG) formerly called giant cell reparative granuloma is a benign bony lesion and etiology is unclear. It occurs most commonly in mandible and also occur in maxilla. 1%-7% of all benign lesions of jaws are central giant cell granuloma. It affects children and adults. it is usually a slow growing lesion, fast growing lesions also reported. The fast growing CGCG has an aggressive behavior mimicking a malignant lesion through it has the innocent histological appearance. CGCG sometimes resemble a wide variety of conditions that led to a misdiagnosis both on clinical and radiographic examination. Histological examination confirms as CGCG. The case described here involved maxilla which was treated with surgical curettage. The patient has been followed up for 11/2 years with no post operative complications and no recurrence.

Keywords: Central giant cell granuloma, maxilla, benign, jaw
Pragmatic Competence: Difficulties faced by Pakistani EFL Learners
Authors: Dr. Sikander Ali  , Muhammad Ashraf
Published: July 2021

The study investigates the pragmatic knowledge; pragmatic competence level as well as speech act strategies used by Pakistani EFL learners. It reveals that Master level English language learners are unable to produce and comprehend the intended meanings in the target language. As a result, pragmatic failure and misunderstanding occurred. Pragmatic comprehension and production is essential for effective communication especially for EFL learners in this modern age where people have to communicate cross-culturally as English is being used as lingua franca internationally. The study explores the problems faced by EFL learners in comprehending and producing the correct speech acts in English. The study used two data collection tools: a WDCT in which speech acts of refusal and apology are used to find out pragmatic competence level and difficulties faced by Pakistani EFL learners. A Likert Scale questionnaire is used to know about the views and suggestions of the Pakistani EFL learners about the teaching and learning environment regarding the pragmatics. The data of speech acts of refusal is analyzed qualitatively according to the taxonomy of Beebe, keeping in view frequency, shift and content of semantic formulas. While the data of speech acts of apology is analyzed according to the speech act strategies of Cohen. Data collected through the Likert scale questionnaire is analyzed quantitatively. The study finds out that pragmatic competence level of Pakistani EFL learners is very low as well as they have to face many difficulties which result in pragmatic failure.  Findings of the study show that Pakistani EFL learners lack knowledge of pragmatics in the target language. EFL learners acknowledged that pragmatic knowledge is very important for effective communication and it should be an integral part of syllabus and classroom activities.
HUBUNGAN PENGETAHUAN IBU TENTANG INISIASI MENYUSU DINI DENGAN PARTISIPASI IBU MELAKUKAN IMD TAHUN 2018
Authors: Fauziah Harahap Ica , Siregar Sonja Elisna Dewi
Published: July 2021

Inisiasi menyusu dalam jam pertama  paska lahir menurunkan 22% resiko kematian  bayi-bayi usia 0-28 hari. Sebaliknya penundaan inisiasi meningkatkan resiko kematian hingga 2,4 kali. World Health Organization (WHO) menyebutkan tingkat Inisiasi Menyusu Dini di dunia pada tahun 2010 hanya sebesar 43% dari angka kelahiran bayi. Tujuan penelitian ini untuk mengetahui hubungan pengetahuan ibu tentang inisiasi menyusu dini dengan partisipasi ibu melakukan IMD di desa Sigama Kecamatan Padang Bolak Kabupaten Padang Lawas Utara tahun 2018. Penelitian ini menggunakan desain penelitian observasional analitik dengan pendekatan cross sectional . Populasi dalam penelitian ini adalah seluruh  ibu bersalin normal dengan bayi sehat di desa Sigama Kecamatan Padang Bolak Kabupaten Padang Lawas Utara yang berjumlah 43 orang. Pengambilan Sampel dalam penelitian menggunakan tekhnik total sampling dengan jumlah sampel sebanyak 43 orang. Berdasarkan hasil penelitian ini menunjukkan terdapat hubungan antara pengetahuan dengan partisipasi ibu dalam melakukan inisiasi menyusu dini (IMD) nilai probabilitas p=0,011 (p<0,05). Diharapkan bidan dapat memberikan bimbingan pada ibu bersalin untuk meningkatkan pengetahuan tentang inisiasi menyusu dini karena pengetahuan inisiasi menyusu dini akan meningkatkan pelaksanaan praktek IMD.
FAKTOR-FAKTOR YANG BERHUBUNGAN DENGAN PENYAKIT REMATIK PADA LANSIA DI DESA TIAL KECAMATAN SALAHUTU KABUPATEN MALUKU TENGAH
Authors: Pangandaheng Tommy , Wenno Frans , Rolobessy Nurvita Sara
Published: July 2021

Rheumatism is a disease that attacks the joints and bones or supporting tissues around the joints. This disease class is an autoimmune disease that affects many elderly people aged 50 years and over. Based on the prevalence of arthritis pain in Indonesia alone, it reaches 23.3% - 31.6% of the total population of Indonesia. This figure shows that pain due to rheumatism has greatly disturbed the activities of Indonesian society. The research objective was to determine the factors associated with rheumatic disease in the elderly in Tial Village, Salahutu District, Central Maluku Regency. The research design used in this study is a type of analytical research with a cross-sectional study approach. The number of population studied in this study was 69 people, so the researchers made all populations into the research sample (total sampling). The statistical test used in this study is the Fhiser's test. Based on the value of Fisher's test, the p value is obtained: 0.000 which means less than ?. Thus it can be said that there is a significant relationship between work and rheumatic disease in the elderly in Tial Village and that there is a significant relationship between types of food and rheumatic disease in the elderly in Tial Village.
PENGARUH TRADISI PEMBERIAN NASI PAPAH TERHADAP BOUNDING ATTACHMENT DAN KESEHATAN PADA BAYI USIA 6-12 BULAN DI DESA SAMBORI KECAMATAN LAMBITU
Authors: Supriadin Supriadin , Wahidah Wahidah
Published: July 2021

Introduction: Nasi Papah or in Bima language "Oha ra mama" which is food that has been spilled or crushed with the mother's mouth which is then given to the baby. Purpose: to know the influence of rice papah tradition on bounding attachment and health in infants aged 6-12 months in Sambori Village Lambitu District Bima Regency. Method: The design of this study uses a qualitative approach to phenomenological studies against 9 participants based on triangulation techniques.  Result: This study produced 4 themes namely: 1) strong body endurance 2) strong wthstand hunger 3) fast satiety 4) not fussy. Conclusion: the administration of MP breast milk in infants aged 6-12 months such as rice porridge containing carbohydrates can be given, as long as it remains concerned about hygienes and the number of portions of food given according to the growth of the baby.
Karakteristik Menstruasi , Kadar Kolesterol Dan Lemak Visceral Pada Remaja Obesitas
Authors: Zuraidah Zuraidah
Published: July 2021

Obesity is a crucial health issue for women of reproductive age that resulted in worse effects. This condition associate with irregular menstrual cycles. This study aimed to determine the characteristics of menstruation (cycle and duration), cholesterol, and visceral fat levels of obese adolescents in SMAN 6 Kota Pematangsiantar. This research was descriptive, conducted on 52 adolescent girls who have experienced menstruation for more than one year since their first menstruation with obesity condition. Held in May - November 2017, all data presented in the form of descriptive analysis. Measurement of obesity and visceral fat levels were measured using the Karada Scan HBF-375, menstrual data obtained using a questionnaire, cholesterol levels using Easy touch GCU. The length of menstruation less than three days was 53.8%, irregular menstrual cycles were 61.5%, normal cholesterol levels were 51.9%, normal visceral fat levels were 50%. Counseling adolescents about obesity prevention for reproductive health and further research on the relationship between cholesterol and visceral fat levels with the menstrual cycle diet on levels is needed.
GLUCOSE LEVELS AND MENSTRUAL CYCLE ASSOCIATED WITH ADOLESCENT OBESITY
Authors: Sukaisi Sukaisi
Published: July 2021

One of the factors causing menstrual cycle disorders was obesity. The incidence of obesity in children has increased significantly in the last three decades. Obesity in women was associated with menstrual disorders and decreased fertility in adolescence and reproductive years. Irregular menstrual cycles indicated a metabolic disorder characterized by glucose levels exceeding normal. The purpose of this study was to determine the relationship between glucose levels and the menstrual cycle in obese adolescents. This study was an analytical study with a chi-square approach, conducted on 52 obese adolescents with a BMI> 30 in 12th grade of SMAN 6, aged 17-18 years, who were healthy and have no history of disease and drug consumption. Sampling of fasting glucose levels used a digital tool called Easy Touch, measuring the menstrual cycle using a questionnaire, regular menstruation when the interval is 22-35 days, irregular <22 and> 35 days. Statistical test with the Fisher Test. Obese adolescents obtained normal glucose levels of 88.5%, menstrual cycles were generally not normal (61.5%) and found a significant relationship between glucose levels and the menstrual cycle with a value of p <0.026. Obesity was associated with glucose levels and menstrual cycle irregularities. It was necessary to monitor glucose levels and menstrual cycles as early as possible regarding future adolescent reproduction.
GAMBARAN FAKTOR-FAKTOR YANG BERHUBUNGAN DENGAN AUTISME ANAK DI SLB NEGERI AUTIS SUMATERA UTARA
Authors: Tinambunan Dohartha Juniati , Hastuty Yulina Dwi
Published: July 2021

Gangguan autisme adalah gangguan pada masa anak-anak yang mempengaruhi aspek seperti komunikasi, sosial, dan perilaku repetitif. Gangguan autisme ini memiliki faktor resiko yang belum diketahui dan dianggap sebagai multifaktorial. Faktor yang mempengaruhi autisme dibagi menjadi 2 yaitu genetik dan lingkungan. Penelitian ini bertujuan untuk mengetahui faktor hubungan dari faktor kejadian seperti usia ayah, usia ibu, konsumsi obat, riwayat infeksi virus, riwayat perdarahan, riwayat berat bayi lahir, dan riwayat kejang  pada anak disekolah luar biasa negeri autis sumatera utara. Jenis penelitian adalah survey analitik. Jumlah sampel dalam penelitian ini adalah sebesar 56 orang, yang terdiri dari orang tua dengan anak autis disekolah luar biasa negeri autis sumatera utara. Cara pengambilan sampel adalah dengan total sampling. Hasil analisis bivariat penelitian ini didapatkan bahwa beberapa faktor telah di uji usia ibu, perdarahan,bayi berat lahir rendah, dan kejang pada anak berhubungan dengan kejadian autis.
PAPARAN ABU VULKANIK LETUSAN GUNUNG AGUNG DENGAN KEJADIAN ISPA
Authors: Susila I Made Dwie Pradnya , Sawitri I Gusti Ayu Mirah Dewi , Dewi Si Putu Agung Ayu Pertiwi
Published: July 2021

Volcanic ash occurs due to volcanic eruptions that can cause adverse health effects if inhaled. One of which is can cause respiratory problems in the form of respiratory tract irritation, increased phlegm secretion, irritation and inflammation of the throat, dry cough, chest pain, and difficulty breathing. This aimed at determining the correlation between volcanic ash exposure and ARI accident at Public Health Center Rendang Karangasem District Health Center. This study used a correlational research design with the approach used is cross-sectional. The sample in this study was 43 people affected by ARI in September 2017 in the area of Puskesmas Rendang Karangasem. Data analysis was using the Mann-Whitney test. The results of this study showed that no significant correlation from this study based on the Mann Whitney test value of 832.5 and the value of p = 0.138 (P> 0.05), meaning at alpha 5%. It is expected that people who suffer from ARI disease to use masks so as not to aggravate the condition of illness due to ARI and the health center to always provide counseling about healthy lifestyles and avoid ARI.
First-level Neurocognitive Screening Tests and Their Application
Authors: Salis Francesco
Published: July 2021

Finding an effective therapy able to slow Neurocognitive Disorder’s (NCD) progression represents an ambitious purpose of biomedical research.

In June 2021, the Food and Drug Administration approved Aducanumab for the treatment of Alzheimer’s disease – the most common cause of dementia worldwide [1]. This drug is a monoclonal antibody that would be cause amyloid-β plaques reduction in the brain [2]. Whether its effectiveness will be confirmed or not, the fact remains that the patients that will benefit the most from any treatment are the ones suffering from mild NCD. Mild NCD is a clinically insidious and difficult-to-diagnose disorder, and consequently, the development and the spread of screening methods are necessary to early intercept these subjects.
Hydroxyurea-induced Amyopathic Dermatomyositis
Authors: Abid Hatim
Published: July 2021

Background: Hydroxyurea-induced amyopathic dermatomyositis is a rare complication of prolonged therapy based on this antimetabolite. We report in the light of data literature a new case of this entity to remind this complication mainly observed in patient treated for chronic myeloid leukemia. Materials and methods: We report the case of a 49-year-old woman, followed for chronic myeloid leukemia, who was under Hydroxyurea for 3 years and which presented a dermatomyositis-like eruption with many other mucocutaneous side effects. Results: The skin examination revealed on the dorsum of the hands and the posterior aspect of the elbow joints Gottron’s papules. In addition, dry skin, oral and facial hyperpigmentation, bilateral ulcers on both heels with alopecia plaques of the scalp were noted. On the other hand, there were no clinical or para-clinical signs of proximal muscle weakness. Stopping the Hydroxyurea allowed around 5 months a clear improvement of the skin lesions. Conclusion: Hydroxyurea-induced amyopathic dermatomyositis is a rare entity that simulates from a cutaneous point of view a classic dermatomyositis without being accompanied by clinical or para-clinical manifestations of myositis.
Dermoscopy of Dermatofibrosarcoma Protuberans
Authors: Amraoui Nissrine
Published: July 2021

ermatofibrosarcoma protuberans (DFSP), also known as dermatofibrosarcoma of Darier and Ferrand, is a soft-tissue neoplasm of intermediate to low-grade malignancy, which accounts for 0.1–1% of all cutaneous malignant tumours [1]. The diagnosis of this entity is based on physical examination and a confirmative biopsy sample [2-5]. However, the lack of reliable clinical criteria suggestive of DFSP results in delayed diagnosis and poorer patient outcome.
The Gluteus Maximus V-Y Advancement Flap for Reconstruction of Latero-sacral Pressure Injury
Authors: Abid Hatim
Published: July 2021

Pressure Injuries (PIs) are described as “localized injury to the skin and/or underlying tissue, usually over a bony prominence, as a result of pressure or pressure in combination with shear [1]. The pathology remains frequent in hospital settings despite the progress made in prevention which represents the optimal management of this pathology [2]. Clinically, they can cause severe pain, serious physical and psychological discomfort often leading to prolonged hospitalization and poor quality of life in the daily clinical practice [3-6].
A Rare Association Between Neurofibromatosis Type 1 and Thigh Leiomyosarcoma
Authors: Amraoui Nissrine
Published: July 2021

Neurofibromatosis type 1 (NF1) is a rare genetic disorder sporadic or genetically transmitted in autosomal dominant mode with an estimated incidence of 1 :3000-4000 live births [1]. Clinical diagnostic criteria are well established. About that there are seven criteria for NF I according to the National Institutes of Health (Table 1) [2] and two or more of which must be met to make a diagnosis of the disease. During NF I, the susceptibility to neoplastic malignant transformation is the main feature of the disease with a probability from 3 to 4 times greater than the general population [3-5]. On the other hand, few cases of NF I associated with sarcoma including pleomorphic sarcoma [6], rhabdomyosarcoma [7], leiomyosarcoma [8] and Ewing sarcoma [9], have been reported.
Linear Morphea en Coup de Sabre, a Rare Subtype of Localized Scleroderma
Authors: Amraoui Nissrine
Published: July 2021

Scleroderma is a rare connective tissue disease that is manifested by cutaneous sclerosis and variable systemic involvement [1]. Two categories of scleroderma are known: systemic sclerosis (SSc), characterized by cutaneous sclerosis and visceral involvement, and localized scleroderma (LoS) or morphea which is confined to the skin and/or underlying tissues [1,2].
Usefulness of Osmolar Excretion Rate in the Diagnosis of Fluids and Electrolytes Overlap Syndromes
Authors: Aranalde Gabriel Ignacio
Published: July 2021

Clinical practice related to electrolytes and acid-base disorders is commonly approached as a single entity. Overlap syndromes are an uncommon clinical condition that must be considered as part of differential diagnosis when a patient is assessed. The coexistence of electrolytic disorders could make it difficult to interpret certain variables due to the influence of such disorders on the same variable, even in the opposite way.

In this context, there are some tools that are very useful in order to establish the correct diagnosis. Thus, osmole excretion rate, tonicity balance, and estimation of electrolyte-free water balance should be considered along with other biochemical variables in order to increase the possibility to make a correct interpretation.
Comparative Evaluation of Tear Film Parameters Following Cataract Surgery in Diabetic Patients.
Authors: Dash Sagarika
Published: July 2021

Purpose: To compare the propensity of manual small incision and phacoemulsification cataract surgery in causing tear film dysfunction and dry eye syndrome in diabetic patients.

Methods: Diabetic patients in group A underwent manual small Incision Cataract surgery whereas in group B underwent phacoemulsification with similar post-operative regimes. The primary outcome measures were the Ocular Surface Disease Index (OSDI), a Subjective questionnaire. The secondary outcome measures were the Subjective Dry Eye (DE) questionnaire, Corneal Fluorescein staining, Tear meniscus height, Schirmer’s II test, and Tear film break-up time. All parameters were measured pre and then postoperatively.

Result: 126 patients were divided into group A (undergoing small incision cataract surgery) and group B (undergoing phacoemulsification). The OSDI and subjective DE scores continued to be worse for Group A until the first month after which they became similar to group B with no statistically significant difference (p-value of 0.726 and 0.347 respectively). The OSDI and subjective DES at 3 months were better in both groups as compared to baseline (p <0.0001). The objective tear film parameters (Schirmer’s, TBUT, TMH, and fluorescein staining scores) showed statistically significant changes from the baseline in both groups but the scores remained in the normal range clinically. Schirmer’s test scores were different between the two groups at three months (p=0.007) in SICS group being higher.

Conclusion: Manual Small Incision Cataract Surgery (SICS) causes subjective dry eye symptoms more than phacoemulsification until 1 month of surgery in diabetic patients after which the subjective symptoms become similar to phacoemulsification at 3 months.
Ocular Disorder in Students with Intellectual Impairment and Other Neurological Disorders: A Case Series
Authors: Mandal Rajib
Published: July 2021

Purpose: Literature shows high prevalence of ocular disorder in children with mental retardation. This study aims to evaluate the ocular disorders in children with Intellectual impairment and other neurological disorders. Materials and methods: 36 school students (15 females, 24 males) aged between 5-18 years were included in this case series study. All children had undergone through a complete eye examination including a standard sensory and motor evaluation to assess binocular vision dysfunction. Results: Result shows 97.22% students have ocular problem. Refractive error (48.71%) and binocular vision disorder (35.80%) were the major ocular problems following by ocular disease (ex; keratoconus, glaucoma) (5%) seen in this study. Conclusion: Prevalence of refractive error and binocular vision dysfunction is high in the students with intellectual impairment and other neurological disorders. This study suggests that all children with these similar disabilities should undergo an annual eye checkup to prevent visual impairment for their future life.
Multidisciplinary Optimization in Helical Grooved Tubes for Heat Transfer Enhancement
Authors: Jamshed Shamoon
Published: July 2021

Optimization in engineering is a significant tool for selecting the best fit when several design variables are present. It helps in determining the optimum through a combination of a set of design variables with objective functions subject to certain constraints. In the design of heat exchangers too, where tremendous research is going on to optimize its effectiveness, certain efforts are being done to improve the quality of the inner tube, shell, or plate design. In this respect, surface enhancement has been actively researched in recent decades. This sort of augmentation is usually dominant on the tube side. It has been seen that the study is greatly conducted in the past experimentally, but numerical studies are limited to determine friction factor or Nusselt number. Only a few discussed an important factor called entropy generation minimization. In this paper, with the optimization in view, the design is based on multiple disciplines. That is, first a numerical study is performed on the helically grooved tubes to examine the thermal enhancement factor. Numerical results are initially validated with published experimental results. The optimized tube is then selected based on the D-optimal design for the thermal enhancement factor and finally, the entropy minimization study concerning the Reynolds number is conducted on the optimized tube. It is observed that the tube with the greatest number of grooves, the maximum depth, and the least pitch performs the best. However, the optimum Reynolds number is at the point where the tube has the least entropy generated as compared to the smooth tube.