bluuebunny/crossref_metadata_2025 huggingface dataset:
Prioritizing People and Progress: Moving Beyond Shortsighted Productivity to Foster Innovation and Resiliency
Authors: Westover Jonathan
Published: January 2025

This article explores why a sole focus on efficiency can lead to failure for leaders and organizations, despite efficiency being an important trait. It discusses how an overemphasis on efficiency can result in a lack of flexibility to adapt to changing circumstances, a neglect of human elements like employee well-being and engagement, and a shortsightedness that prioritizes immediate gains over long-term strategic planning. The article then outlines a more balanced leadership approach incorporating flexibility, human focus, strategic vision, and humility alongside efficiency. It provides examples of companies that avoided pitfalls by developing this multifaceted leadership model, underscoring how efficiency is a means to an end rather than the end itself for driving sustainable organizational success.
Some Prescriptions from Abulcasis for Epilepsy Treatment
Authors: Arvide Cambra Prof. Luisa Maria
Published: January 2025

The Kitab al-Tasrif (Book of medical arrangement) is the master piece of the well-known Cordovan physician Abulcasis Al-Zahrawi (c.936-c.1013). This author was also an eminent surgeon, the first of Medieval Islam, and his influence reached as far as Renaissance Europe. The 9th treatise of his work is an interesting medieval treatise of cardiology and neurology, including the correct treatment of some of their most common ailments and diseases. It contains recipes of a great value to the fields of pharmacology, cardiology and neuroloy. This paper is an approach to this treatise, and includes the translation to English from some of its fragments referring to recipes of remedies that are beneficial for epilepsy treatment, according to the 502nd Arabic manuscript of the Süleymaniye Umumi Kütüphanesi from Istanbul, and the 137th manuscript of the Tibb Taymur collection from the Egyptian National Library and Archives (Dar al-Kutub al-Misriyya) in Cairo.
Linguistic and Listening Dimensions of FACT as a Tool for Assessing Spiritual Needs in an Acute Care Setting
Authors: Schnell Jim
Published: January 2025

Our understanding of health care chaplaincy practices continue to evolve in matters having to do with spiritual screening, histories and assessments. FACT, an acronym titled spiritual assessment tool, has been designed for chaplaincy use in acute care settings. Within the aforenoted FACT dynamics there is room for emphasis on linguistic variables. Language frames thought and so the language we use serves to frame the thoughts we process. It is subtle but it is concretely vivid. It is helpful to consider this phenomenon within the context of the hospital setting. It is important for expressions of caring to be offered in language which is understood by the patient. That is, the chaplain needs to gauge the level of understanding which the patient is capable of and converse with the patient in a manner that is easily understood by the patient. The chaplain needs to consistently consider if his/her language level is appropriate for the receiver. The chaplain’s communicative role involves a ministry of dialogue. This makes language usage especially relevant. If the receiver is not familiar with the terminology used by the sender he/she has little to rely on regarding the interpretation of meaning, except contextual cues. The accuracy of these contextual cues may or may not be reliable. Thus, chaplain sensitivity with patient language norms is pivotal to his/her success in providing counsel.
Diseño de cuatro ciclones tipo Stairmand y su influencia en la captura de materialparticulado del polvo de madera
Authors: De La Cruz-Cruz Miguel Angel , Santos-Andahua Jorge Enrique
Published: January 2025

La presente investigación tuvo como objetivo determinar la eficiencia de captura a través de cuatro ciclones Stairmand. La metodología usada fue científica experimental con estrategia procedimental que empezó desde el diseño en SolidWorks de los cuatro ciclones, la construcción en acrílico de 5mm espesor, construcción de depósito e implementación de un sistema de ventilación que hará que el efluente (aire con polvo de madera) ingrese a los ciclones. Los resultados obtenidos muestran que las eficiencias del ciclón convencional es 80.1%, el ciclón cilíndrico de 76.1%, el ciclón cónico de 72.5% y el ciclón de entrada hélice con 72.5%. El consumo eléctrico esta relacionado a la frecuencia de consumo, donde el ciclón convencional es 50Hz, el ciclón cilíndrico de 55Hz, el ciclón cónico de 45Hz y el ciclón de entrada hélice con 50Hz. Se concluye que el ciclón convencional es el que posee mayor eficiencia por tener mayor volumen debido a su parte cilíndrica, pero el de menor consumo eléctrico es el ciclón de entrada hélice, aunque su construcción es complicada.
Impacto del ERP SAP en la Optimización de Pagos a Proveedores: Atlas Copco Perú.
Authors: Cobos-Gutiérrez Carlos Eduardo , Flores-Amaro Oscar Hermes
Published: January 2025

El presente estudio analiza el impacto del sistema ERP SAP en la optimización de los pagos a proveedores en Atlas Copco Perú S.A.C. durante el año 2024. Con un enfoque cuantitativo, diseño no experimental y alcance correlacional, se recopilaron datos de 83 empleados mediante cuestionarios estructurados. Los resultados muestran que el ERP SAP contribuyó significativamente a la reducción de errores, el aumento de la eficiencia y la mejora en la relación con proveedores. Además, se encontraron correlaciones positivas entre la eficiencia, la reducción de errores y la efectividad. Estos hallazgos destacan la importancia de la integración tecnológica para mejorar procesos financieros y fortalecer la competitividad organizacional.
Militarismi Suomessa
Authors: Kotilainen Noora , Vastapuu Leena
Published: January 2025

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Membumikan Teori Negara Kesejahteraan Dalam Penguatan Dana Desa Untuk Pengentasan Kemiskinan Menurut Keadilan Distributif
Authors: Arifin Muhammad Zainul , Nugraha Muslim , Yunithia Putri Taufani , Ramadhan Muhammad Syahri
Published: January 2025

Prosperity and welfare have been ideals pursued by the founders of this nation and the current Indonesian government. These ideals are manifested in the preamble of the 1945 Constitution, which states: "The government shall protect the entire nation and all the blood spilled, promote general welfare, and educate the life of the nation." However, in reality, the issue of social inequality in Indonesia has become increasingly acute. According to data released by the Central Statistics Agency (BPS) in March 2024, the poverty line is defined as an income of Rp. 536,122 per person per month, with 25.22 million people recorded as living below this threshold. Meanwhile, the World Bank's poverty standard is defined as a minimum daily income of $2.15 or approximately Rp. 970,000 per month. There is a significant discrepancy between the standard set by the Indonesian government and that of the World Bank, which presents a serious issue that must be addressed. In 2014, Law No. 6 of 2014 concerning Villages provided a legal foundation and strategic framework for the development and empowerment of village communities. Through authority in village governance, development implementation, community guidance, and empowerment, it is hoped that villages will develop awareness and initiative. Subsequently, the central government initial village fund transfers through the state budget (APBN), allocating 10% of the total funds outside of regional transfers (on top), implemented gradually. The increase in budget allocation disbursed to villages aims to support village development to enhance community welfare and improve the quality of life while addressing poverty. This is achieved by fulfilling basic needs, constructing village infrastructure, developing local economic potential, and sustainably utilizing natural and environmental resources. Thus, the author formulates the following research problems: How can the concept of a welfare state be reformulated as a strategy for poverty alleviation through the utilization of village funds in Indonesia? What concrete measures can be taken to ensure effective and targeted use of village funds for poverty alleviation in Indonesia? This research employs a normative legal study approach supported by empirical data. The theoretical framework includes the theory of the welfare state, the theory of legal development, and Jeremy Bentham's theory of economic analysis of law
الضوابط المهنية لإصابات الطريق
Authors:   الجامعة الإسلامية في لبنان, العلي فادي باسم
Published: January 2025

قد يتعرض العامل لعدد من الحوادث خارج مكان العمل، سواء أثناء ذهابه للعمل، أو العودة منه، وهو ما يسمى بحادث الطريق، أو حادث المسافة، حيث يعد هذا الحادث الصورة الثانية لإصابة العمل، لاشتراكه مع حادث العمل بالشروط الأولية للحادث. وقد اتفق الفقه والقضاء في العديد من الدول على فرض وبسط الحماية القانونية على العاملين ضحايا هذا النوع من الحوادث، و من أجل معرفة المقصود بإصابة الطريق، وعلاقته بالعمل، والموانع التي تنفي الصفة المهنية عنه يقتضي تحديد معايير إصابات الطريق التي يحميها القانون، على اعتبار أن تشريعات قانون العمل في كل من سوريا ولبنان وفرنسا لم تتبن صراحة مثل هذا النوع من الإصابات رغم اتصالها وارتباطها بأسباب العمل، حيث لم تأت نصوص قانون طوارئ العمل بما يجيز اعتبار حادث الطريق على أنه إصابة عمل مما فتح الباب أمام الاجتهاد القضائي لتكييف إصابة الطريق على أنها حادث عمل نتج بسبب، أو بمناسبة تنفيذ العمل، مما يستوجب استحقاق المصاب أو أصحاب الحق من بعده التعويض، طالما ثبت تحقق معاييره القانونية أثناء المسافة التي قطعها العامل للذهاب إلى عمله أو الإياب منه، أيا كانت وسيلة التنقل المستعملة شريطة ألا يكون المسار قد انقطع أو انحرف مع الأخذ بعين الاعتبار ما يبرر توقف هذا المسار عند وجود حالة الاستعجال أو حالة الضرورة العارضة، أو أسباب قاهرة منعت استمراره .
Exploring the Principles of Judicial Review in Delegated Legislation
Authors: Hussain Shah Syed Zaheer , Azeem Hafiz Muhammad , Ayub Asif
Published: January 2025

The primary role of legislation rests with the legislature, but in order to meet public needs more efficiently, legislative powers are occasionally delegated to public functionaries under specified conditions. This the delegated legislation (DL); it has shown its profound impact on the everyday lives of citizens. However, when such delegation is unchecked or poorly structured, then it can lead to negative consequences. As a result, it becomes essential for other state organs, especially the judiciary, to oversee and regulate DL. Over time, internationally the judiciary has articulated well-established principles to guide and structure the DL. States for example India, the United States, and the United Kingdom have also formulated various doctrines to scrutinize DL. This study examines those judicial principles that have been developed in modern welfare states to ensure that DL remain within legitimate boundaries. Through comprehensive qualitative analysis, this study aims to clarify the scope and application of these principles in the context of administrative law. The research concludes that a thorough understanding of these principles is essential for the judiciary and public functionaries to interpret and exercise their powers effectively in DL, in order to serve the public interest.
Clinico-bacteriological profile of lower respiratory tract infections in a tertiary care hospital in Kolkata – A cross-sectional and observational study
Authors: Somnath Bhunia  , Surya Jyati Chaudhuri  , Bithika Ghosh  , Subhendu Sikdar  , Abhiparna Roy  , Ankita Das  , Prasenjit Jana
Published: January 2025

Background: Lower respiratory tract infection (LRTI) is the most common infection causing significant mortality with a 3–5% death rate in adults. The emerging nature of antimicrobial resistance to pathogens makes its treatment more challenging and complicated for physicians.
Aims and Objectives: The study was designed to obtain a comprehensive insight into the microbial profile and resistance patterns of the isolated pathogens in LRTI in a tertiary care hospital in Kolkata.
Materials and Methods: The cross-sectional observational study was carried out in the Microbiology Department of N.R.S Medical College from January to December 2021. Specimens collected from 782 clinically suspected LRTI cases were processed as per standard laboratory protocol following clinical and laboratory standard Institute guidelines.
Results: Out of 782 respiratory samples, 47.83% showed significant bacterial growth. The major risk factor was found to be type II diabetes mellitus (47.44%) followed by chronic obstructive pulmonary disease (36.57%) and smoking (21.35%). 85.56% growth was monomicrobial and Gram-negative organisms (88.50%) predominated. Klebsiella pneumoniae (36.90%) was the most predominant Gram-negative bacilli followed by Pseudomonas aeruginosa (17.11%) and Acinetobacter species (13.90%). Staphylococcus aureus was the predominant Gram-positive isolate (7.49%). Gram-negative organisms showed the highest resistance to penicillin and cephalosporins, whereas the lowest resistance in carbapenems. Piperacillin/tazobactam and levofloxacin showed good susceptibility. Linezolid was the most susceptible antimicrobial followed by vancomycin in the case of Gram-positive organisms. Extended-spectrum β-lactamase was detected as the mechanism of resistance in 31.12% of cases and carbapenemase was detected in 19.64% of cases.
Conclusion: Increasing antimicrobial resistance and varied bacterial etiology make it necessary to develop appropriate antibiotic policy and implement antimicrobial stewardship for effective and prompt therapy.
The clinical utility of pleural fluid cholesterol as a parameter in differentiating exudative from transudative pleural effusion when compared to light’s criteria
Authors: Neha Khillar  , Rohith George  , Sathiqali AS  , Basil Ibrahim
Published: January 2025

Background: Pleural effusions are classified as exudate or transudate to guide clinical management. While Light’s criteria have been the standard for this differentiation due to their high sensitivity, their lower specificity can lead to potential misclassification of transudates as exudates. This study evaluates the clinical utility of pleural fluid cholesterol compared to Light’s criteria.
Aims and Objectives: The aim of the study was to assess the clinical utility of pleural fluid cholesterol as a laboratory parameter in differentiating exudate from transudate pleural effusions.
Materials and Methods: This cross-sectional study included 100 participants with pleural effusion. After baseline data collection and clinical examination, blood tests and pleural fluid analyses were conducted. McNemar’s test compared the sensitivity, specificity, and diagnostic accuracy of pleural fluid cholesterol with Light’s criteria.
Results: Light’s criteria showed a sensitivity of 98.39%, specificity of 84.21%, positive predictive value (PPV) of 91.04%, negative predictive value (NPV) of 96.97%, and diagnostic accuracy of 93%. Pleural fluid cholesterol (threshold >45 mg/dL) demonstrated a sensitivity of 91.94%, specificity of 97.37%, PPV of 98.28%, NPV of 88.10%, and diagnostic accuracy of 94%. The difference in specificity was statistically significant (P<0.05), while the difference in sensitivity was not. The overall diagnostic accuracy of pleural fluid cholesterol was similar to that of Light’s criteria.
Conclusion: Pleural fluid cholesterol has a higher specificity and similar diagnostic accuracy compared to Light’s criteria. It effectively identifies transudates, reduces false positives for exudates, and can serve as a simple test to confirm the type of pleural, potentially minimizing invasive procedures.
Parkinsonism in a young adult after ventriculoperitoneal shunt procedure for tri ventricular obstructive hydrocephalus – A case report
Authors: SU Mahathy , CJ Selvakumar , JG Hempragadish
Published: January 2025

This case report centers on a 19-year-old male diagnosed with tri-ventricular obstructive hydrocephalus due to aqueductal stenosis. Following a right ventriculoperitoneal (VP) shunt procedure, the patient initially exhibited marked improvement but later developed Parkinsonian symptoms. Extensive investigations meticulously ruled out shunt malfunction and phenytoin toxicity. The suspicion of Parkinsonism secondary to VP shunt emerged, leading to the initiation of anti-Parkinsonian medications. The patient underwent a personalized treatment regimen with anti-Parkinsonian drugs, which yielded substantial clinical improvement. This case report underscores the importance of identifying unusual neurological presentations post-VP shunt. The critical role of early diagnosis and precise pharmacological intervention in the patient’s recovery cannot be overstated, and it emphasizes the potential for rare complications like post-shunt Parkinsonism.
Correlating Thompson score and cardiac dysfunction in neonates suffering from perinatal asphyxia – A prospective observational study
Authors: Anushka Nag  , Bhaswati Ghoshal  , Meghna Siddhanta
Published: January 2025

Background: Perinatal asphyxia continues to be a leading cause of neonatal morbidity and mortality worldwide. It causes multiorgan failure with brain involvement as the major organ of concern (hypoxic-ischemic encephalopathy). Cardiac dysfunction is also a feature of perinatal asphyxia.
Aims and Objectives: The study and to correlate cardiac dysfunction detected by cardiac biomarkers and echocardiography with the severity of perinatal asphyxia as graded by the Thompson score.
Materials and Methods: In this prospective observational study, babies with Apgar score <7 at 1 min received in the sick newborn care unit of a tertiary care hospital in West Bengal, India, were enrolled over 6 months. Thompson’s score was assessed on the 1st day with the estimation of creatine phosphokinase MB (CPK-MB) and troponin (Trn) T within 24 h of birth. Thompson score assessment was continued twice daily till discharge or death. Transthoracic echocardiography was done at the earliest within the 1st week.
Results: Of the 81 neonates enrolled, 28 neonates had cardiac dysfunction detected by positive Trn T and raised CPK-MB. Echocardiography showed 15 neonates (18.5%) had systolic dysfunction whereas 13 (16.0%) had tricuspid regurgitation. There was a strong association between Thompson score and Trn T and CPK-MB (rpb=0.85, rho=0.97, respectively, P≤0.001). Thompson score was highly sensitive and specific in detecting the need for mechanical ventilation, and fluid restriction in inotrope-resistant cardiac dysfunction (sensitivity 90%, 78.4%, respectively; and specificity 95.8%, 97.7%, respectively), in predicting initiation of feeding and final outcome (sensitivity 82.9% and 100%, respectively, specificity 97.8%, 89%, respectively).
Conclusion: Clinical assessment by the Thompson score can predict the degree of cardiac dysfunction, mechanical ventilation requirement, feed initiation, and final outcome in perinatal asphyxia.
Poorly differentiated and undifferentiated (anaplastic) carcinoma of thyroid with diagnostic challenges: A case series
Authors: Arundhati Shit  , Soumita Ghosh Sengupta  , Abhishek Bandyopadhyay  , Gargi Raychaudhuri
Published: January 2025

Poorly differentiated thyroid carcinoma (PDTC) and anaplastic or undifferentiated thyroid carcinomas (ATC) are uncommon malignancies of the thyroid. Anaplastic thyroid cancers represent only 1–2% of all thyroid cancer diagnoses; however, they contribute to 14–50% of fatalities associated with thyroid cancer, with a median survival duration ranging from 3 to 5 months. The majority of patients diagnosed with this disease are aged 65 years or older. Most patients exhibit a rapidly enlarging neck mass, difficulties in swallowing, or alterations in their voice. The 2022 World Health Organization classification introduced PDTC as a subtype of high-grade follicular cell-derived thyroid carcinoma (HGFCTC), whereas also renaming ATC as anaplastic follicular cell-derived thyroid carcinoma. There are evidence which suggests stepwise molecular progression from well-differentiated carcinoma to HGFCTC to ATC manifested by alteration in the MAPK pathway especially BRAF and RAS mutations and gain of secondary aggressive molecular signatures. PDTCs and ATCs are difficult to diagnose due to their rarity and previous equivocal diagnostic criteria. The aim of this study is to present a series of rare and interesting cases of PDTC and undifferentiated/anaplastic thyroid carcinoma accompanied by a concise literature review.
The adequacy of tissue obtained by percutaneous needle autopsy in comparison to conventional autopsy for lung and liver tissues
Authors: Minnu Roy  , Lekshmidevi P  , Neetha Unnikrishnan  , Sankar S
Published: January 2025

Background: Autopsies are done since the olden days to study anatomy, to learn pathology, and to identify the cause of death. However, this procedure is not widely accepted due to lack of facilities, reluctancies by relatives, various religious and ethical issues, and fear of transmission of communicable diseases. Percutaneous needle autopsies have bridged these shortcomings and provide better results when done under radiological guidance.
Aims and Objectives: The aim of the study was to determine the adequacy of tissue obtained by percutaneous needle autopsy in comparison to conventional autopsy for lung and liver tissues.
Materials and Methods: Descriptive study, done in autopsies performed in the Department of Forensic Medicine and Department of Pathology, Government Medical College Kottayam. Percutaneous needle samples are obtained from lungs and liver using surface landmarks. Samples are also obtained after opening the deceased body. After microscopic examination, adequacy is observed and morphological findings are compared.
Results: In lungs, 164 samples met the adequacy criteria and 156 samples showed similar morphological findings by both methods; in the liver 159 samples met the adequacy criteria and 151 samples showed similar morphological findings by both methods. In lungs and liver, the most common histological finding was congestion.
Conclusion: Percutaneous needle autopsies and the tissue thus obtained are adequate and comparable when compared to conventional autopsies. The findings are more comparable in diffuse lesions rather than in localized lesions.
Omaya insertion followed by ventricular peritoneal shunt in case of epidermoid cyst of central nervous system: A case series
Authors: Harsh Deo Pandey  , Avdhesh Shukla  , Vivek Kankane  , Avinash Sharma  , Sridham Sutradhar
Published: January 2025

Intracranial epidermoid cyst originating from abnormal migration of neuroectodermal cells during embryogenesis. It is a slow-growing tumor commonly found in cerebellopontine angle, fourth ventricle, and sellar/parasellar region. This is a case series of five cases to know the effectiveness of Omaya in pre-operative and early post-operative period followed by ventriculoperitoneal shunt after 2 weeks. This is a prospective observational study done in premier institute of central India from April 2023 to April 2024. A total five cases of different age groups and clinical presentations are included. There is no ventriculoperitoneal shunt blockage when it was followed by early pre- and post-operative period large reservoir Omaya insertion.
A comparative study of efficacy of 0.5% intrathecal isobaric ropivacaine, ropivacaine heavy, and bupivacaine heavy for lower abdomen and lower limb surgeries
Authors: Archana Singh  , Ashish Mathur  , Umesh Prasad Yadav  , Preeti Goyal
Published: January 2025

Background: Lower abdomen and lower limb surgeries can be performed under spinal anesthesia. Ropivacaine is a local anesthetic, belonging to the amino amide group. It is a pure S-enantiomer and is considered to have a better safety profile than bupivacaine.
Aims and Objectives: The aim of the study is to compare the efficacy of intrathecal isobaric ropivacaine (IR) 0.5%, ropivacaine heavy 0.75% and bupivacaine heavy 0.5% for lower abdomen and lower limb surgeries.
Materials and Methods: This prospective randomized study was conducted in 120 patients scheduled for lower abdomen and lower limb surgeries under spinal anesthesia belonging to ASA Grade I or II. Patients were randomized into three groups of 40 each. Group IR-received 3 mL of 0.5% IR, Group hyperbaric ropivacaine (HR)-received 3 mL of 0.75% heavy Ropivacaine and Group Hemoglobin received 3 mL of 0.5% heavy bupivacaine. The parameters studied were the onset and duration of sensory and motor block, duration of analgesia, hemodynamic parameters, and side effects.
Results: The onset of sensory and motor block was significantly faster in HR followed by hyperbaric bupivacaine (HB) followed by IR. The duration of sensory and motor block was significantly shorter in HR followed by IR followed by HB. Duration of analgesia was longest in HB.
Conclusion: HR produced a rapid onset of the sensory and motor block with a shorter duration. HB produced a longer duration of motor and sensory block.
Optimizing acromioclavicular joint management: A case series on minimally invasive TightRope with double endobutton fixation
Authors: Bharath Vadivel Kumar  , Prem Kumar Kothimbakkam  , Vijayashankar Murugesan
Published: January 2025

Acromioclavicular (AC) joint dislocation constitutes 40% of shoulder injuries, impacting patients across diverse activities. The Rockwood Staging System guides assessment, prompting exploration of the novel TightRope with double endobutton fixation technique to restore AC joint function. This study aims to evaluate the outcomes of the TightRope with double endobutton fixation technique in 20 cases of AC joint dislocation, emphasizing its potential advantages over conventional methods. A case series involving 20 AC joint dislocation cases underwent comprehensive evaluation, including follow-ups and radiological assessments. Surgical interventions were performed using the TightRope with double endobutton fixation technique. The average age was 44.5 years, with a notable prevalence of severe dislocations (Classes V and VI). Surgical interventions demonstrated efficiency, with a brief hospital stay. The innovative technique yielded excellent outcomes, with 90% achieving high Constant–Murley scores. TightRope with double endobutton fixation emerges as a promising, minimally invasive strategy for AC joint dislocation, exhibiting potential in minimizing post-operative complications and expediting recovery. The study advocates for individualized interventions and emphasizes the need for further exploration of long-term implications.
Comparative evaluation of Bailey manoeuvre of deep extubation with conventional awake extubation technique - A randomized clinical study
Authors: Rahul Tiwari  , Suman Gupta  , Youvaraj M
Published: January 2025

Background: Extubation is a critical procedure in anesthesia and critical care, often accompanied by complications, such as bucking, coughing, and hemodynamic instability, particularly after major surgeries. The Bailey manoeuvre, involving deep extubation with the i-gel laryngeal mask airway (LMA), may mitigate these issues. The study was planned to compare the hemodynamic effects and side effect profiles of conventional awake endotracheal extubation and exchange extubation with the i-gel LMA.
Aims and Objectives: The study was designed to compare hemodynamic stress response and respiratory complication between the conventional extubation group and the following exchange extubation group.
Materials and Methods: In a prospective, randomized, single-blinded controlled study, 60 patients undergoing surgery under general anesthesia were divided into two groups: Group T (awake extubation) and Group L (exchange extubation with the i-gel LMA). Hemodynamic parameters and side effects were recorded and analyzed.
Results: Group L exhibited significantly lower heart rates, systolic and diastolic blood pressures, and mean arterial pressures at various time points post-extubation compared to Group T. The incidence of hypertension was significantly higher in Group T (90%) versus Group L (50%). Bucking and coughing less in the i-gel LMA exchange group compared to the standard endotracheal tube extubation group.
Conclusion: Exchange extubation with the i-gel LMA offers better hemodynamic stability and a lower incidence of hypertension compared to conventional awake extubation. This technique may be particularly beneficial for high-risk patients and those undergoing complex surgeries.
Expression of isocitrate dehydrogenase 1 and tumor protein 53 in high-grade glioma and its correlation with the outcome – A prospective study at a tertiary care center in India
Authors: Kumar Vikas , Jaiswal Pooja , Jaiswal Somil , Tandon Pradeep , Ojha Bal Krishna
Published: January 2025

Background: Central nervous system tumors are the 10th most prevalent cause of mortality worldwide. The 2016 World Health Organization (WHO) classification of high grade gliomas (HGG) has identified Isocitrate dehydrogenase 1 (IDH 1) mutation as one of the primary molecular markers. Tumor protein 53 (p53) mutation is also closely associated with HGG.
Aims and Objectives: The current study intended to ascertain the expression of IDH1 and P53 in patients with HGG and correlate that expression with clinical prognosis.
Materials and Methods: The study included 34 patients with histopathological proven HGG. Relevant clinical information was recorded. The immunostaining results with anti-mouse monoclonal antibody for IDH 1 (R132H) and rabbit polyclonal antibody for p53 (RP 106-05) were statistically analyzed. Patients were followed up through telephone for a period of 1 year. Mortality within 1 year was regarded as a poor outcome.
Results: About 85.29% (29/34) of the patients had Grade IV glioma, while only 14.71% (5/34) had Grade III glioma. Most patients with Grade III (3/5) (60.00%) and Grade IV (21/29) (72.41%) gliomas had p53 positivity. The majority of the patients with grade-III glioma (3/5) (60.00%) had IDH1 positivity, while most of the patients (23/29) (79.31%) with Grade IV gliomas had IDH1 negativity (P=0.0658). Age, gender, WHO grade, and adjuvant therapy did not show significant association with the outcome except for the p53 expression (P=0.0011*) and IDH1 expression (P=0.0025*). Correlation analysis showed a significant positive correlation between p53 makers with poor outcome (r=0.4781) and glioma grade (r=0.4028). Further, a negative yet insignificant correlation was recorded between IDH1 with age (r=−0.2285), p53 expression (r=−0.2568), and grade (r=−0.2988), although it showed a significant correlation with poor outcome (P=0.0001).
Conclusion: p53-positive and IDH1-negative HGG had a significant correlation with the poor outcome. Thus, IDH1 and p53 are reliable markers for prognostication of HGG.
A study of non-invasive predictors of esophageal varices in patients with cirrhosis of liver – A cross-sectional study
Authors: Nauman Mujahid  , Kiran Aithal  , Dhananjaya M
Published: January 2025

Background: Current guidelines advise that patients diagnosed with liver cirrhosis undergo screening through upper gastrointestinal endoscopy to detect esophageal varices (EV). Prophylactic measures should be taken for those with large varices on diagnosis and during follow-up. However, this poses a dual challenge, both social and medical, as the number of cirrhotic patients rises while the availability of endoscopy units remains limited.
Aims and Objectives: In this study, we aim to evaluate the diagnostic accuracy of the non-invasive predictors such as spleen size, platelet count (PC), and PC/spleen diameter (PC/SD) ratio for the diagnosis of EV.
Materials and Methods: This hospital-based prospective observational study was done in the SDM College of Medical Sciences and Hospital, Dharwad, among 50 patients with cirrhosis of liver.
Results: Among the 50 patients studied males pre-dominated the study with 80%. Out of the study population, 70% of the patients had varices. For a cutoff point of PC/SD ratio 916, the sensitivity was 71.42% and specificity was 93.3%. For a cutoff value of PC of 1.32 lakhs, the sensitivity was 71.42%, and the specificity was 73.3%. For a cutoff value of the longest SD of 12.40 cm, the sensitivity was 94.30%, and specificity was 33.3%.
Conclusion: These non-invasive predictors can be useful screening tools for the diagnosis of EV. These can be effective for the initiation of prophylactic treatment when the endoscopy facility is not available.
The role of Thompson score of term newborns in predicting neuromotor outcome at 1 year of age
Authors: Subham Puhan  , Saugata Chaudhuri
Published: January 2025

Background: The mortality rate is approximately 20% and the frequency of neurodevelopmental sequelae in surviving newborns is approximately 30% in perinatal asphyxia; hypoxic-ischemic encephalopathy (HIE) is brain dysfunction due to lack of oxygen and blood supply to the brain.
Aims and Objectives: This study was conducted to predict the pattern of neuromotor outcome as early as 3 months using Hammersmith Infant Neurological Examination (HINE) in term hypoxic babies and its relation with the Thompson score (HIE score).
Materials and Methods: One-hundred twenty four term newborns with hypoxic babies were admitted to the neonatal care unit from January 2021 to August 2021. Thompson scoring was done on admission and subsequently reviewed. Discharged babies were followed up at 3 months, 6 months, and 1 year of age. A neurological examination (HINE) was done in this high-risk follow-up clinic. Maximum Thompson score was correlated with neurological score at various months. The earliest predictability of neurological examination was done at 3 months and was correlated with the neurological examination done at 12 months.
Results: The correlation between the Thompson score and the 3-month score is −0.65 indicating a strong negative association between the two measurements. The correlation between 3 months and 6 months and 1-year neurological scores was moderately associated with each other.
Conclusion: The maximum Thompson score was significantly higher in the mortality group compared to the discharged group. Thompson score has a significant correlation with the 3, 6, and 12-month neurological scores examined by HINE. The 3-month neurological outcome has a very significant correlation with the 1-year outcome.
Bacterial, fungal pathogens, and antimicrobial resistance patterns in ocular infections: Insights from a tertiary care hospital, North Karnataka
Authors: Aagalya A  , Vishalakshi B  , Krishna S
Published: January 2025

Background: Ocular infections, including conjunctivitis, keratitis, and endophthalmitis, significantly impact eye health, leading to morbidity, visual impairment, and blindness if not treated.
Aims and Objectives: This study focuses on reviewing and analyzing the prevalence of bacterial and fungal pathogens in ocular infections and assessing their antimicrobial susceptibility patterns at Vijayanagar Institute of Medical Sciences, Ballari.
Materials and Methods: A cross-sectional study was conducted by collecting ocular infection samples from January 01, 2022, to December 31, 2022. Samples, including corneal scrapings and conjunctival swabs, underwent initial procedures such as Gram staining and were inoculated on various agars. Antimicrobial susceptibility testing was performed using the Kirby–Bauer disk diffusion method.
Results: Out of 404 evaluated samples, corneal scrapings were predominant, with a significant incidence of fungal and bacterial growth. Aspergillus spp. and Pseudomonas spp. were the most common fungal and bacterial isolates, respectively. Antimicrobial susceptibility testing revealed that Gram-negative bacilli showed more susceptibility to gentamycin, ceftriaxone, and ciprofloxacin, whereas Gram-positive cocci were more susceptible to tetracycline and doxycycline.
Conclusion: The study highlights the cornea as the most common source of ocular infections, with Aspergillus and Pseudomonas spp. being the predominant fungal and bacterial pathogens, respectively. Identifying the prevalent species in this geographical area aids in early diagnosis and treatment, thereby preventing morbidity and improving patient outcomes. The antimicrobial susceptibility pattern observed suggests effective options for treatment, emphasizing the need for ongoing surveillance to adapt to resistance patterns.
Phenotypic detection of carbapenem-resistant Enterobacterales and carbapenem-resistant Pseudomonas aeruginosa by mCIM and eCIM and their ceftazidime-avibactam with aztreonam synergy profile in a tertiary care hospital in Eastern India
Authors: Payel Chanda  , Sharmila Gupta  , Saswati Chattopadhyay  , Soma Bose
Published: January 2025

Background: Worldwide, the emergence of carbapenem-resistant enterobacterales (CRE) and carbapenem-resistant Pseudomonas aeruginosa (CRPA) is a global concern to public health as they are responsible for several serious infections that lead to elevated treatment expenses, prolonged hospitalization, and a higher mortality rate.
Aims and Objectives: To detect Carbapenem resistance in Enterobacterales and Pseudomonas aeruginosa by phenotypic methods such as mCIM and eCIM. To determine synergism between Ceftazidime-Avibactum and Aztreonum in metallobetalactamase producing isolates.
Materials and Methods: Total 217 isolates including enterobacterales and Pseudomonas aeruginosa from patient’s samples such as urine, pus, blood, wound swab, sputum, and ET tube were processed as per standard protocol during the study period from July 2023 to January 2024 at Calcutta National Medical College, Kolkata.
Results: Resistance to carbapenem was observed in 110/217 (50.69%) isolates. Phenotypically, 99/110 (90%) produced metallo-β-lactamase and 11/110 (10%) produced serine carbapenemase by mCIM with eCIM test. MBLs producing organisms were most commonly isolated from blood culture samples. On an average, 76% of the MBL producing isolates shows positive synergy result to the combination of CZA+AT by disk elution method.
Conclusion: eCIM and mCIM test was performed for identification of carbapenemase producing CRE and CRPA, which causes serious infection in patients with no definitive treatment. The combination of CZA-AT is a potential treatment option to manage CRE and CRPA-associated infections.
Status of sexual health of married male traumatic paraplegics in Indian Population
Authors: Yesh Veer Singh  , Anirudh Chirania  , Vipin Kumar  , Afroz Ahmed Khan  , Abhishek Pandey  , Abhinav Kumar Srivastava
Published: January 2025

Background: About 1.5 million individuals with spinal cord injuries (SCIs) reside in India. Sixty to seventy percent of the 20,000 new cases of SCI that is added each year are from impoverished, illiterate people. SCI leads to life-altering experiences, encompassing physical, physiological, psychological, and social changes. The sexual orientation of an individual with SCI may directly impact their self-assurance and vice versa.
Aims and Objectives: Patients with SCI may have physical, physiological, psychological, and social changes, including changes in their sexuality. After a SCI, individuals’ sexual health is a crucial topic that is rarely addressed. The purpose of this study was to learn about the patients’ experiences and feelings regarding sexual activity after a SCI.
Materials and Methods: Patients with SCI were given a questionnaire. This study covered all male SCI patients between the ages of 18 and 50 who were married at the time of the injury and were followed up until December 2023. The purpose of this study was to talk about different facets of sexual activity and the issues that came with it. Second, these data will support SCI sufferer’s sexual rehabilitation.
Results: Of the 231 patients, 72.3% had erections but only 32% had ejaculations. 55.8% of patients experienced difficulties with sexual function as a result of other SCI sequelae, such as flexor spasm, bladder, and bowel dysfunction, among others. In response, almost 90% of patients said that they had never received sexual rehabilitation or advice on their sexuality.
Conclusion: Health-care providers and clinicians do not frequently bring up sexuality with patients who have SCI. Patients who frequently inquire about sexual activity following SCI yet are seldom helped. Since there is stigma associated with the topic, every SCI clinic needs to have a specialized sexual rehabilitation staff.
A comparative study of the outcome of unilateral versus bilateral internal anal sphincterotomy in treatment of chronic anal fissure
Authors: Partha Pratim Mandal  , Shivaji Mandal  , Debayan Chowdhury
Published: January 2025

Background: Gold standard treatment for chronic anal fissure is lateral internal sphincterotomy. Bilateral internal sphincterotomy (BIS) as a treatment option for chronic anal fissure has not been evaluated.
Aims and Objectives: The aims and objectives of the study are to compare the efficacy of unilateral versus bilateral internal anal sphincterotomy in treatment of chronic anal fissure.
Materials and Methods: Study design: A prospective randomized comparative study. Study area: Patients coming to General Surgery outpatient department at College of Medicine and Sagore Dutta Hospital with chronic anal fissure. Study period: July 2022 to December 2023 (18 months). Sample Size: 100 patients. Study Group: Group A=Patients who had undergone unilateral internal sphincterotomy (UIS)=50 patients and Group B=Patients who had undergone BIS=50 patients.
Results: 2 (4%) patients in Group A and 3 (6%) patients in Group B developed incontinence for flatus postoperatively. No patients in either group developed incontinence for stools. The Mean Fissure Healing Time (Mean±SD) (Weeks) post-sphincterotomy was 4.32±0.91339 in Group A and 2.66±0.65807 in Group B. There were 6 cases of recurrence in the unilateral sphincterotomy group. Second surgery was needed in 4 patients who underwent unilateral sphincterotomy.
Conclusion: As compared to UIS, BIS results in a faster healing of chronic anal fissure, with no increase in incontinence, decreased pain score, and less recurrence rates.
Variations of musculocutaneous nerve – A cadaveric study
Authors: Anju George  , Maheswary Thampi S  , Aswathy VA  , Geetha Jayachandran
Published: January 2025

Background: Musculocutaneous nerve (MCN) is a mixed nerve arising from the lateral cord of brachial plexus having root values C5, 6, and 7. It supplies the muscles of the flexor compartment of the arm namely; coracobrachialis, most part of brachialis and both heads of biceps brachii. It is cutaneous to the lower lateral part of forearm. Variations in the origin, course, branching pattern, termination, and connections of MCN are very common. Knowledge about these variations is important while evaluating unusual presentations of peripheral nerve injuries, during surgical procedures such as arthroscopy of shoulder joint, corrections of fracture humerus, brachial plexus block, and so on.
Aims and Objectives: The study was conducted to find out any variations in the origin, course, branching pattern of the MCN. The secondary objective was to understand about the communication of the MCN with any other nerve.
Materials and Methods: A descriptive study was conducted in 60 upper limb specimens dissected from 10% formalin embalmed 30 cadavers (adult) in the Department of Anatomy, Government Medical College, Kottayam. All limbs were carefully dissected and studied about the origin, course, termination, and variations of MCN.
Results: Out of 60 specimens studied, in 46 specimens MCN Originate from lateral cord, eight from medial cord, and in six from the lateral root of the median nerve (MN). In 52 specimens, MCN supplies coracobrachialis but only in 34 it pierces this muscle. In four specimens, there is a communication between MCN and MN was seen.
Conclusion: The MCN has significant variations and knowledge of these variations is clinically important in diagnosis and management of peripheral nerve injuries as well as surgical interventions in the arm.
A comparative study of low-dose intrathecal bupivacaine 0.5% (heavy), levobupivacaine 0.5% (plain), and levobupivacaine 0.5% (heavy) with fentanyl as an adjuvant in transurethral resection of prostate surgery: A prospective randomized study
Authors: Sanyukta Paul  , Seema Shende  , Neelima Tandon  , Deepak R
Published: January 2025

Background: Spinal anesthesia is the technique of choice for transurethral resection of the prostate (TURP) surgeries. Levobupivacaine, an S-enantiomer of bupivacaine, is less cardiotoxic than bupivacaine; therefore, a low dose of local anesthetic with fentanyl as an adjuvant has been used to decrease toxicity and increase efficacy.
Aims and Objectives: The aim of this study was to compare and evaluate the efficacy of hyperbaric bupivacaine 0.5%, isobaric levobupivacaine 0.5%, and hyperbaric levobupivacaine 0.5% with fentanyl as an adjuvant.
Materials and Methods: One hundred and five patients scheduled for elective TURP surgeries were randomly divided into three groups. Group BH (n=35) received 1.5 mL of 0.5% hyperbaric bupivacaine with 25 μg of fentanyl, Group LH (n=35) received 1.5 mL of 0.5% hyperbaric levobupivacaine with 25 μg of fentanyl, and Group LP (n=35) received 1.5 mL of 0.5% isobaric levobupivacaine with 25 μg of fentanyl intrathecally.
Results: The onset of sensory and motor block was earlier and the duration of analgesia and motor block were longer in the BH group (P<0.001) as compared to LH and LP groups. The demographic data, duration of surgery, heart rate, SpO2, pruritus, and shivering were comparable between the groups (P>0.05). The visual analog scale score was higher in the LP group. Hypotension, nausea, and vomiting were seen in the BH group.
Conclusion: Hyperbaric is better than isobaric group due to quicker onset and longer duration. Levobupivacaine is better than bupivacaine in terms of the early mobilization and a lesser incidence of side effects, making hyperbaric levobupivacaine a better alternative to isobaric levobupivacaine and hyperbaric bupivacaine.
Effect of neoadjuvant chemotherapy on the expression of hormone receptors and Ki-67 in patients with locally advanced breast cancer
Authors: Aanchal Gupta  , Renuka Verma  , Nisha Marwah  , Sanjeev Parshad  , Priyanka Verma  , Sunita Singh
Published: January 2025

Background: Neoadjuvant chemotherapy (NACT) affects the tumor protein marker’s expression and status. Changes in the expression of biomarkers during NACT may influence the clinical decision of adjuvant molecular and hormonal therapy. Hence, re-evaluation of receptor status has to be done after NACT to give a specific adjuvant therapy for patient benefit.
Aims and Objectives: The aim of this study was to study the status of hormone receptors (HRs) – estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor (Her-2/Neu), and Ki-67 in patients with locally advanced breast cancer (LABC) in both core needle biopsies and post-mastectomy specimens after administering neoadjuvant chemotherapy.
Materials and Methods: The present study was conducted in the Department of Pathology in collaboration with the Department of Surgery, Pt B D Sharma PGIMS, Rohtak, for a period of 1 year. The study comprised 52 patients with LABC who received neoadjuvant chemotherapy and 20 control cases who did not receive neoadjuvant chemotherapy. Each case comprised two specimens: Trucut biopsy and a mastectomy specimen.
Results: ER changed from positive to negative in 15.4% of the cases and from negative to positive in 1.9% of the cases. The overall change in ER was statistically significant (P=0.020). For PR, 9.6% of the cases changed from positive to negative while none of the cases showed change from negative to positive. The overall change in PR was statistically significant (P=0.025). For HER2/Neu, 19.2% of the cases changed from positive to negative, and 11.5% of the cases changed from negative to positive. The overall change in HER2/Neu was not statistically significant (P=0.317). For Ki-67, 30% of patients changed from positive to negative while 11.5% of patients changed from negative to positive. The overall change in Ki-67 was statistically significant (P=0.024).
Conclusion: There was discordance in the HR status and proliferation marker after NACT in patients with breast cancer. The administration of NACT might be the main reason for the change in receptor status thus understanding the chemotherapy-induced biological conversion in the tumor cell behavior is strategically important in planning adjuvant endocrine therapy and for disease follow-up.