bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of backpack load on nerve conduction velocity and risk of peripheral neuropathy in upper extremities of undergraduate medical students carrying backpack
Authors: Jagdish C Hundekari  , Rai Amisha , Wasnik Sanjay , Kot Lokendra
Published: December 2022

Background: Prolonged load carriage can potentially affect hand and upper limb use through compression of the nerves, reduction in blood flow, and muscle fatigue. Backpacks of undergraduate medical student are not much different from their syllabus. They carry heavy backpacks on regular basis and many times they wear it incorrectly.
Aims and Objectives: We aimed to see the effect of backpack load on motor nerve conduction velocity and hand grip strength in the upper extremities.
Materials and Methods: The present study included 31 undergraduate medical students between the age of 18 and 25 years. The procedure is conducted in three phases on different days. In each phase, participants were asked to walk for 5 min with load. In Phase 1, nerve conduction velocity and grip strength weere measured in unloaded condition and after carrying load <10% of body weight. To limit the effect of fatigue, participants are instructed to return to laboratory in next consecutive weeks to repeat the procedure for Phase 2 and 3 as in Phase 1 by increasing load to 10–20% and 20–30% of their body weight respectively.
Results: Values of median and ulnar motor nerve conduction velocity obtained without and with increasing % of backpack load after 5 min walk were decreased non-significantly as load increased. There was significant (P>0.001) difference in grip strength of medical students carrying backpack with increasing load after 5 min walk.
Conclusion: In this study, we aimed at quantifying the effects of load carriage on overall upper limb performance, with a focus on conduction velocity of motor nerves. This has implications for occupations such as soldiers, firefighters, paramedics, and others who may be required to operate machinery, equipment, tools, or systems that require precise motor control.
Leprosy in posteradication era – A clinicopathological correlation: How far we have achieved?
Authors: Deepti Gangwar  , Amitosh Mishra  , Sara Siddiqui  , Sangeeta Bohara  , Bushra Khanam
Published: December 2022

Background: Leprosy or “Hansen Disease” is chronic inflammatory disease caused by Mycobacterium leprae. This disease is the oldest disease known to mankind. Leprosy is also known as “Kushtaroga.”. Leprosy was considered as an eradicated disease in 2005 but still a large number of leprosy cases are being reported in India.
Aims and Objectives: The aim of the study was to demonstrate that leprosy even being eradicated continuous to be a major health concern with changing trends.
Materials and Methods: This study is a a hospital-based crossectional study; it involves all new patients of leprosy attending dermatology O.P.D HIMS, Safedabad, Barabanki, U.P. from 2015 to 2016. The cases were classified as per Ridley – jopling classification. Skin biopsies were taken from all clinically suspected cases of leprosy and these biopsies were studied using H&E stain.
Results: In our study, 53 leprosy cases were registered from April 2015 to April 2016. According to demographic details of leprosy cases, maximum number of cases were in the age group 31–40 years 38.9% and in individuals <20 years 10.5%. Majority of cases were males (11.3%). The family history of leprosy was present in 9.4% of patients. Hypopigmented lesion on skin was most common symptom (32.1%). TT was most common clinical diagnosis (26.4%). IL was common histopathological diagnosis (26.4%). Atrophy of epidermis was seen in 50.9% of patients. Paucibacillary was seen in 62.3% of patients. Most of the cases were from Safedabad.
Conclusion: Leprosy although reported to be eradicated still continues to be one of the common communicable disease in Uttar Pradesh, India. This necessitates to strengthen screening of cases, early detection, and revival of our knowledge regarding the disease.
Study of clinical profile and pattern of stroke in diabetic and non-diabetic patients in a hospital of Kumaon region
Authors: Deepali Joshi  , Mohd Maroof  , Subhash Chandra Joshi  , Vivekanand Satyawali
Published: December 2022

Background: Diabetes enhances the risk of stroke which is one of the leading causes of morbidity and mortality.
Aims and Objectives: The study was done to analyze the clinical profile and pattern of stroke in diabetic and non-diabetic patients.
Materials and Methods: This was a hospital-based cross-sectional study done in 130 stroke patients (with/without diabetes – 65 each) presenting to outpatient department\inpatient department general medicine department, Dr. Sushila Tiwari Hospital of Government Medical College, Haldwani during January 2020–September 2021. A detailed history, neurological examination along with assessment of risk factors, pattern, and subtype were done.
Results: The mean age was significantly higher among stroke patients with diabetes (66.38±11.99 years). The proportion of systemic hypertension was significantly higher in stroke patients without diabetes (89.2%). Abnormal ECG was significantly more reported in stroke patients without diabetes (73.8%). The mean hemoglobin and mean random blood sugar were significantly higher in stroke patients with diabetes (8.82±1.72 and 291.17±107.39, respectively). The mean high-density lipoprotein was significantly higher in stroke patients without diabetes (43.06±5.1), whereas mean low-density lipoprotein, mean triglycerides, and mean total cholesterol were significantly higher in stroke patients with diabetes (126.28±33.19; 186.97±45.91; and 229.31±39.83, respectively). The presenting complaints observed were altered consciousness (67.7%) right hemiparesis (55.4%), left hemiparesis (41.5%), abnormal body movement (28.5%), etc. Ischemic stroke was significantly higher in patients with diabetes (90.8%). Lacunar (34%), basal ganglia (27%), cortical (23%), etc., were stroke subtypes seen among study patients.
Conclusion: Significant difference was observed between stroke patients with/without diabetes in terms of age, several risk factors, presenting symptoms, pattern, and its subtype.
Assessment of Vitamin D3 level in patients of rheumatoid arthritis and its relationship with disease activity using DAS 28-CRP in tertiary care center of Bihar, India
Authors: Poonam Sinha  , Rekha Kumari  , Ritesh Runu  , Sudhir Kumar  , Ranjay Kumar Ranjan  , Ravi Shekhar  , Jiut Ram Keshari  , Sweta Kumari
Published: December 2022

Background: Rheumatoid arthritis (RA) is most common type of inflammatory arthritis. It is chronic autoimmune disease that affects joints as well as extra-articular structures. The prevalence of this condition could be due to both genetic and non-genetic factors (e.g., environmental, viral, and hormonal).
Aims and Objectives: The aim of the study was to determine and correlate 25(OH) D level with disease severity in patients of RA.
Materials and Methods: The prospective observational study consists of 70 patients of RA and 70 healthy controls. Assessed level of 25(OH) D, C-reactive protein (CRP), anti-cyclic citrullinated peptide (CCP), erythrocyte sedimentation rate (ESR), and Disease Activity Score (DAS) 28-CRP score were compared in both cases and controls. Correlation of Vitamin D level with parameters such as CRP, Anti-CCP, and ESR was performed. Correlation between Vitamin D level deficiency and disease activity among the RA patients was assessed.
Results: The mean age of patients in the RA group was 37.77±13.31 years. The mean CRP in cases was 40.57±25.94 mg/L and in controls was 3.26±1.95 mg/L with significant intergroup difference (P<0.001). The mean anti-CCP in cases was 62.18±27.21 U/mL and in controls was 4.99±1.52 U/mL with significant intergroup difference (P<0.001). The mean 25(OH) D level in cases was 12.65±5.88 and in controls was 32.18±10.22. The 25(OH) D was significantly decreased in cases than controls (P<0.001). A significant inverse relationship between serum 25(OH) D levels and DAS28 was observed. Receiver operating characteristic (ROC) curves results showed that 25(OH) D<11.7 ng/mL indicates severe disease activity (Area under ROC curve=84%, Sensitivity 77.78%, and specificity 83.33%,). 25(OH) D between 11.7 ng/mL and 19.83 ng/mL indicates moderate disease activity. 25(OH) D˃19.83 ng/mL indicates low disease activity value below 4.13 is alarming situation.
Conclusion: The study reveals high prevalence of Vitamin D deficiency and insufficiency in RA patients. There is also significant inverse correlation exist between serum Vitamin D levels and RA disease activity. Vitamin D level is good disease activity predictor in patients of RA.
A study on incidence of stress hyperglycemia in acute ischemic stroke in non-diabetic patients and its prognostic significance
Authors: Habibur Rahaman  , Soumyasil Das  , Angan Karmakar  , Linkon Biswas  , Subrata Kumar Pal
Published: December 2022

Background: Hyperglycemia detected during acute illness-like ischemic stroke is associated with adverse outcomes more than in normoglycemic patients. However,very limited data regarding stress hyperglycemia and its prognostic value are available for our Indian population.
Aims and Objectives: This study was aimed at comparing the stress hyperglycemic and normoglycemic patients in terms of mortality and functional recovery during 28 days follow-up assessed by the Barthel index for Activities of Daily Living.
Materials and Methods: Adult non-diabetic patients with ischemic stroke were assessed for random venous blood glucose and HbA1c levels and divided into two groups: Patients with hyperglycemia and normoglycemia. The Barthel Index for Activities of Daily Living was used to compare mortality and functional recovery on the day of admission, day 3, and day 28 after stroke.
Results: Mortality over the 28 days follow-up was significantly higher in hyperglycemic patients (45% vs. 20%,P=0.02). The Barthel Index score on admission (day 0) was 8.75±7.41 among stress hyperglycemic patient whereas it was13.54±11.12 among normoglycemic patient, which was significantly different (P=0.028). Similarly, day 3 (18.89±6.08 vs. 23.26±13.05, P<0.05) and day 28 scores (83.24±7.49 vs. 84.55±12.84, P=0.039) were significantly better in normoglycemic patients.
Conclusion: The mortality rate was much higher and functional recovery was much poorer in stress hyperglycemic patients. Further studies should be directed toward determining complications in long-term follow-up related to stress hyperglycemia and the effects of management on patient outcome.
A study to determine the effectiveness of conjunctival autograft as an alternative to normal surgical procedures to reduce the recurrence of pterygium
Authors: Padala Venkateswara Prasad  , Bhanumurthy Gangalapuram  , Shyamprasad Bukkapatnam Ramachandra
Published: December 2022

Background: Pterygium is a chronic degenerative condition, in which a triangular fibrovascular growth of bulbar conjunctiva encroaches on the cornea. It is a cause of concern for both the patient due to its unsightly appearance and the surgeon due to its tendency to recur.
Aims and Objectives: The present study was undertaken to determine the effectiveness of conjunctival autograft as an alternative to normal surgical procedures to reduce the recurrence of pterygium.
Materials and Methods: A total of 30 patients with primary and recurrent pterygia who attended the ophthalmology, outpatient department were taken up for the study after obtaining informed consent. A standard surgical technique essentially similar to that described by Kenyon et al., was followed in all patients with a few minor modifications. All surgeries are performed using an operating microscope.
Results: The majority of patients belonged to the 3rd and 4th decades. In our study of 30 cases, we had a recurrence rate of 3.0%. The results and outcome of pterygium surgery in our series stress the importance of conjunctival autograft as the procedure of choice for the surgical management of primary and recurrent pterygium in Indian eyes. The success of conjunctival autograft may be related to the significant learning curve and different surgical techniques for these procedures.
Conclusion: Conjunctival autograft proves to be a simple safe and inexpensive technique with low recurrence rates for pterygium in young people. Although conjunctival autograft is a time-consuming procedure and has a significant learning curve, it is the procedure of choice for pterygium. Further detailed studies with a higher sample size are needed in this area.
A cross-sectional study on burden of disability among leprosy patients in a tertiary care center of West Bengal, India
Authors: Shibasish Banerjee  , Chinmay Nandi  , Soumitra Mondal  , Kaushik Mitra
Published: December 2022

Background: Leprosy, an infectious disease caused by Mycobacterium leprae, mainly affects skin, peripheral nerves, mucosa of the upper respiratory tract, and eyes. New goal of the WHO is to decrease the rate of disabilities in new cases among 10 lakhs population 35% with compare to base line 2010. Burden of disabilities continues to rise in society and they are in need of prevention and/or rehabilitation services. Prevention of disability consists of early detection and treatment of reactions and nerve damage.
Aims and Objectives: The objectives of the study were to find out the proportion of disability among leprosy cases and the factors associated with disability.
Materials and Methods: This observational, cross-sectional, and descriptive study was conducted at Dermatology, Venerology, and Leprosy Department of a tertiary hospital from May 2015 to January 2016. Data were collected from all the study population by interviewing the study subjects and clinical examination of patients with pre-designed and pre-tested schedule and disability assessment form available from National leprosy eradication program (NLEP). Skin examination was done as per NLEP guideline and palpation of all the nerve and function of the nerve by voluntary muscle testing (VMT) done as stated national guideline. Data were analyzed using R Studio.
Results: Among the study population, 87.9% of patients had disability and 61.7% of patients had Grade 2 disability. EHF score of most of the patients (59.8%) was ranged between 4 and 6. Among participants 33.6% had foot ulcer, 28% had ulnar claw hand, and 15.6% had lagophthalmos. Proportions of the upper limb digit loss, median claw hand, wrist drop, foot drop, and lower limb digit loss were 5.6%, 13.1%, 3.7%, 9.3%, and 12.1%, respectively.
Conclusion: The present study reflected that a large number of cases with leprosy have presented with complication and disability. There was significant association of disability with multibacillary cases, number of nerve thickening, and number of functionally impaired nerve as assessed by VMT, lepra reaction, presence of nodular skin lesion and patch in skin and delayed initiation of treatment since the onset of symptoms.
Labours’ Condemnations in Informal Employment: Cases of Handicrafts Industries in Kathmandu Valley
Authors: Adhikari Padma Kumar
Published: December 2022

This paper has attempted to explore labours’ complaints about who jobs informally the whole time and provisionally in some handicrafts industries in Kathmandu Valley. The technique of PCA method conducted to extract latent factors after loading 9 different observed issues at five-point Likert-scale variables. The outcome of the groups of 'change in the technology' rated best probably 3.25 out of a five-point Likert scale while groups of 'injury in work time' rated worst probably 3.17 out of a five-point Likert scale. Labours complained about the change in technology and facility work leave were strongly problems in the handicrafts society of labour in Kathmandu Valley.
Outcome of Surfactant replacement therapy for respiratory distress syndrome in preterm babies
Authors: Kansakar Prerana , Shrestha Narottam , Prajapati Alisha , Prasad Chalise Shiva , Kumar Mishra Santosh
Published: December 2022

Introduction: Surfactant is an important treatment modality in preterm babies with respiratory distress syndrome leading to decrease in mortality, morbidity and cost of treatment. Experiences on surfactant therapy in Nepal are scarce. This study was conceptualised to find the use and immediate outcome of surfactant therapy in preterm babies in a tertiary care hospital in Nepal.
Methods: A cross-sectional study was done in preterm babies who received surfactant over period of five years at neonatal / pediatric intensive care unit at Patan Hospital, Lalitpur, Nepal. After approval from Institutional review committee, information on gestational age, sex, birth weight, doses of dexamethasone, doses and time surfactant delivery, complications and immediate outcome was retrieved from the files. Comparison between early and late rescue group was done. Data was analysed using SPSS 16.
Results: Twelve babies (11.2%) needed a repeat dose of surfactant. Only 12 (11.2%) babies received early rescue surfactant. About 53 (49.5%) babies developed complications with hypotension being the most common seen in 38 (35.5%) babies. Complications were 75% and 46% in the early and late rescue group respectively (p - 0.22). The mortality was inversely proportional to the gestational age (p - 0.002) and birth weight (p < 0.05). Mortality was 16% in both the groups but the deaths related to complications of surfactant was all in the late rescue group.
Conclusions: Complications were more in early rescue group and mortality was similar in both the groups, but mortality related to complications of surfactant was all in the late rescue group. Complications of surfactant therapy and mortality were inversely proportional to the gestational age and birth weight.
Role of Sildenafil in Severe COVID-19 Pneumonia in Infancy - A Case Series
Authors: Muduli Jayant Kumar , Mitra Meenakshi , Banerjee Asish , Paul Arnab
Published: December 2022

SARS-CoV-2 virus primarily affects the respiratory system, although other organ systems are also involved. Though pulmonary arterial hypertension (PAH) has been described in as a sequela of COVID pneumonia in adults, only a coincidental association between pre-existing PAH and SARS-CoV-2 infection in children has been reported. To our knowledge, severe COVID pneumoniacausing PAH in children, especially in infancy has not been reported yet. With the meteoric spread of the pandemic and rapid development of newer mutated variants, the timely discovery of new drugs is near impossible. The idea of repurposing existing drugs to treat COVID-19 is an attractive strategy, especially if they are already approved (for other indications) and have wellestablished safety profiles. Sildenafil specifically targets pulmonary vasodilation, endothelial function, and vascular remodelling. It hence has emerged as an effective first - line oral therapeutic agent for patients with symptomatic PAH in all age groups. We present a case series of four cases where Sildenafil has been repurposed for the treatment of PAH associated with severe COVID-19 pneumonia in infancy.
Anaemia In Preschool Children:its Correlation With Pica
Authors: Kaur Sukhdeep , Pal Singh Kunwar
Published: December 2022

Introduction: According to the third National Family Health Survey, 79% of Indian children are anaemic. Pica is characterized by the persistent ingestion of non-nutritive substances such as plaster, charcoal, chalk, and earth for at least one month in a manner that is inappropriate for their developmental level. We investigated the correlation between pica behaviour and anaemia in preschool children.
Methods: In total, 103 children of ages six to 48 months attending the OPD were randomly included in this study for six months; they presented with clinical features of anaemia. Complete blood count and peripheral blood film examination were carried out. The children were assessed clinically for signs and symptoms of anaemia. History of ingestion of clay, sand, chalk, wall paints etc was asked from the parents.
Results: Most of the children (90.3%) had microcytic hypochromic anaemia with a mean haemoglobin value of 8.82 g / dl. The mean age was 18 months, and boys slightly outnumbered girls. In total, 57.3% of children had a positive history of pica, and all of them were found to be anaemic. However, no significant statistical correlation was observed between anaemia and history of pica.
Conclusions: All children with history of pica were anaemic and the most common type of anaemia was microcytic hypochromic. Although no significant statistical correlation was observed between and history of pica, it is very important for the clinicians to be cautious of this common condition and evaluate for anaemia
Knowledge and Perception Regarding Adolescent Sexual and Reproductive Health Services among Adolescents attending a Tertiary Level Hospital
Authors: Singh Shreejana , Sharma Saraswati , Tandukar Bimala , Silwal Pratibha , Sharma Mohan Raj
Published: December 2022

Introduction: Adolescence is the transitional phase of growth and development between childhood and adulthood with ages ranging from 10 to 19 years. Adolescent sexual and reproductive health (ASRH) services are the centers where adolescents can get access to their queries regarding health of both physical as well as psychological aspect. The objective of the study was to find out the knowledge and perception regarding ASRH services among adolescents attending a tertiary level hospital.
Methods: A descriptive study was carried out among 112 adolescents attending adolescent clinic using a pretested structured interview schedule. Non probability purposive sampling technique was used. The data were analyzed using SPSS version 16 through descriptive statistical method and Inferential statistical methods.
Results: The study revealed majority (58.0%) of respondents had moderate level of knowledge regarding ASRH (Mean value 68.89 ± 14.59 S. D). Respondent’s had high perception towards programmatic domain. Almost all (97.3%) of the respondents had positive perception towards ASRH services. There was no statistical significance between the level of knowledge and perception, level of knowledge and sociodemographic variables at 95% confidence level.
Conclusions: The study concludes that adolescents have moderate level of knowledge regarding ASRH. Adolescents have an overall positive perception towards the ASRH services but they have negative perception towards the facility of ASRH services in comparison to programmatic domain.
CLASSIFICATION OF TYPES AND FORMS OF INTERNAL FINANCIAL CONTROL
Authors: Spiridonova Natal'ya
Published: December 2022

Introduction. Classification of types and forms is important for systematization of knowledge about control, substantiation of control provisions in an economic entity, development of ideas about its possible interpretation, which has a direct impact on practical implementation. Currently, the authors differ in their ideas about the classifi-cation of types and forms of internal financial control, and the insufficiency of its leg-islative regulation leads to an increase in research interest in the implementation of control activities. The purpose of the work is to study the problems of classification of types and forms of internal financial control, as well as to develop proposals that de-velop theoretical ideas about internal financial control. Methods. The research is based on methods of generalization, systematization, comparative analysis of research materials of domestic scientists and the content of normative legal acts, as well as methods of classification and grouping. Results. The authors systematized approaches to the classification of types and forms of control, including internal financial control. The relationship between the concepts of "type" and "form" is concretized on the basis of a philosophical interpretation. New classification features of forms of internal fi-nancial control are proposed, their content and directions of practical application in the implementation of control activities are disclosed. Conclusion. It is concluded that it is necessary to study the essence of the classified categories in the formation of a sci-entifically based classification of types and forms of internal financial control. The importance of substantiating the directions of practical use in the development of new classification features is noted.
Analisis Kebutuhan E-Module Berbasis Project Based Learning pada Materi Pokok Gelombang Bunyi Kelas XI SMA
Authors: Rahimah Rahimah , Yuliani Hadma , Syar Nur Inayah
Published: December 2022

E-module merupakan bagian dari bahan ajar yang dapat diaplikasikan peserta didik dalam proses belajar. Penelitian ini bertujuan untuk 1) melihat bahan ajar yang digunakan peserta didik; 2) mengetahui kendala yang dihadapi peserta didik dalam proses belajar memahami materi fisika; 3) menganalisis kebutuhan peserta didik terhadap E-module berbasis Project Based Learning (PjBL) pada materi gelombang bunyi kelas XI SMA. Jenis penelitian ini menggunakan deskriptif kualitatif berupa hasil wawancara dan angket. Teknik pengumpulan data yaitu menyebarkan angket kebutuhan kepada peserta didik kelas XI SMA Muhammadiyah 1 Palangka Raya secara online berbentuk platform google form melalui WhatsApp. Hasil penelitian yang dilakukan menunjukkan bahwa 1) bahan ajar yang digunakan peserta didik yaitu 14,3% buku, 23,8% modul, 28,6% LKS, 14,3% PPT, 28,6% PDF, dan 9,5% video pembelajaran; 2) kendala yang dihadapi peserta didik dalam memahami materi fisika yaitu kurangnya pemahaman konsep materi sehingga peserta didik kesulitan dalam memahami rumus fisika serta mengaplikasikan dalam kehidupan sehari-hari; 3) peserta didik memerlukan bahan ajar seperti E-module berbasis PjBL sesuai data yang diperoleh yaitu sebanyak 81% peserta didik setuju adanya pengembangan E-module berbasis PjBL dalam memudahkan peserta didik memahami materi fisika serta mengaplikasikan dalam kehidupan sehari-hari khususnya pada materi gelombang bunyi.
PERBANDINGAN HASIL BELAJAR PESERTA DIDIK DENGAN MENERAPKAN MODEL PEMBELAJARAN FREE DISCOVERY DAN GUIDED DISCOVERY PADA MATERI HUKUM-HUKUM DASAR KIMIA KELAS X IPA
Authors: Suek Imelda A. , Komisia Faderina , Baunsele Anselmus B
Published: December 2022

Penelitian ini dilakukan untuk mengetahui hasil belajar dan ada tidaknya perbedaan hasil belajar peserta didik kelas X IPA 1 dan X IPA 2 pada materi hukum-hukum dasar kimia jika menggunakan model pembelajaran yang berbeda pada tiap kelas yaitu model pembelajaran Free Discovery dan Guided Discovery. Jenis penelitian ini adalah deskriptif dan komparatif. Sampel dalam penelitian ini adalah kelas X IPA 1 dan X IPA 2,Teknik pengumpulan data yakni observasi dan tes. Teknik analisis data yang digunakan yakni analisis deskriptif dan statistik, penelitian ini dilaksanakan di SMA Negeri 1 Rote Timur. Hasil analisis diperoleh: Hasil belajar peserta didik kelas X IPA 1 dengan menerapkan model pembelajaran Free Discovery tuntas dengan nilai akhir yang diperoleh yaitu 85,78, hasil belajar peserta didik kelas X IPA 2 dengan menerapkan model pembelajaran Guided Discovery tuntas dengan nilai akhir yang diperoleh yaitu 88,18, tidak terdapat perbedaan hasil belajar peserta didik dengan menerapkan model pembelajaran Free Discovery dan Guided Discovery pada materi hukum-hukum dasar kimia kelas X IPA dengan nilai thitung< ttabel (-3,109 < 2,024) atau sig > 0,05 (0,667 > 0,05).
OPTIMIZATION OF CROSCARMELLOSE AND SODIUM STARCH GLYCOLATE ON ORALLY DISINTEGRATING METOCLOPRAMIDE HCL TABLETS
Authors: Ikasari Endang Diyah , Cahyani Intan Martha , Collusy Deby Melinda
Published: December 2022

Dosage form of metoclopramide HCl which has high solubility but low permeability is Orally Disintegrating Tablet (ODT), because  can decrease first-pass-effect metabolism so that its bioavailability and effectiveness increase. Superdisintegrant is an excipient that has a major role in the formulation of ODT. The combination of croscarmellose and Sodium Starch Glycolate (SSG) can accelerate tablet disintegration time so that the resulting ODT is suitable for its intended use. The purpose of this study was to determine the effect of each and the interaction of the use of croscarmellose and SSG on the physical characteristics of ODT metoclopramide HCl, and to get the optimum formula of ODT metoclopramide HCl. Tablets were prepared by direct compression method. Optimization process by using simplex lattice design (design expert 10.0.1.R program) with eight formulas, including FI (5.25%A:1.75%B), FII (0%A:7%B), FIII (7%A:0%B), FIV (1,75%A:5,25%B), FV (7%A:0%B), FVI (3.5%A:3.5%B), FVII (3.5%A:3.5%B) and FVIII (0%A:7%B). Component A is the concentration of croscarmellose and component B is the concentration of SSG. Based on SLD equation could be seen the single-use croscarmellose and SSG components be increased flowability, hardness, moisture content, friability, water ratio absorption, weight uniformity, uniformity of content, accelerate disintegration time, wetting time, and dissolution. Interaction of the two components was increased flowability, moisture content, water ratio absorption and dissolution, decreased hardness, friability, uniformity of content, weight uniformity, accelerate disintegration time, and wetting time.  The optimum formula of ODT metoclopramide HCl  with proportion 5.145% croscarmellose and 1.855% SSG. Based on the one sample t-test between theoretical results and the experimental results could be seen that there were no significant differences between them
KESANTUNAN TUTURAN DALAM KOLOM KOMENTAR AKUN TWITTER FELIXSIAUW
Authors: Hayari Rima , - Fatmawati
Published: December 2022

Penelitian ini dilatarbelakangi oleh bervariasinya kesantunan berbahasa yang dilakukan di akun media sosial twitter khususnya pada akun Felixsiauw. Tujuan yang terdapat dalam penelitian ini adalah untuk mengeksplorasi dan mengolaborasi skala kesantunan komentar pengguna twitter di akun twitter Felixsiauw. Sumber data dalam penelitian ini adalah kolom komentar akun twitter Felixsiauw pada tanggal 6 Mei 2020 dan 14 Januari 2021. Metode analisis isi. Teknik pengumpulan data adalah teknik dokumentasi, teknik simak, teknik catat. Hasil penelitian ini  ditemukan 120 data secara keseluruhan. Pada skala kerugian dan keuntungan terdapat 24 data, didominasi oleh tuturan yang santun. Pada skala pilihan terdapat 15 data, didominasi oleh tuturan yang santun. Pada skala ketidaklangsungan terdapat 56 data, didominasi oleh tuturan yang tidak santun. Pada skala keotoritasan terdapat 3 data, didominasi oleh tuturan yang santun. Pada skala jarak sosial terdapat 22 data, didominasi oleh tuturan yang santun. Tuturan yang banyak ditemukan pada skala ketidaklangsungan yang paling sedikit ditemukan pada skala keotoritasan. Pada penelitian ini, diperoleh temuan penelitian mengenai skala Leech. Untuk skala keotoritasan, terdapat kesulitan mengetahui apakah seseorang itu mempunyai peringkat sosial yang sama dengan Felixsiauw atau tidak. Untuk skala jarak sosial, terdapat kesulitan mengetahui seseorang itu mempunyai jarak sosial dekat atau tidak berdasarkan komentarnya.
KEMAMPUAN MENGIDENTIFIKASI MAKNA KATA DALAM PUISI ‘REMUK DAN HANYUTNYA AKHLAQ BANGSA’ KARYA TAUFIK ISMAIL
Authors: Afifah Nur , Sari Hasibuan Nikmah
Published: December 2022

Kata adalah makna atau maksud, kata-kata lain digabungkan dengan kata dalam kamus, konotasi kata, peristiwa yang diharapkan.  Penelitian ini bertujuan untuk mengetahui kemampuan mengidentifikasi makna kata dalam puisi "Remuk dan Hanyutnya Akhlaq Bangsa" karya Taufik Ismail dengan model think pair share (berpikir berpasangan) oleh siswa kelas X SMA Negeri 1 Kotanopan. Metode penelitian yang digunakan adalah metode deskriptif dengan pendekatan kuantitatif. Populasi dalam penelitian ini adalah 310 siswa dengan sampel 34 siswa. Dalam penelitian ini rumus yang digunakan adalah rumus korelasi "r" momen produk. Dari perhitungan dilakukan melalui rumus korelasi product moment, dengan nilai rxy 0,590, sehingga jika dibandingkan dengan nilai r tabel (0,590> 0,34) pada taraf signifikan 5% dan (0,590> 0,44) pada taraf signifikan 1% maka hipotesis dalam penelitian ini diterima. Dengan demikian hipotesis menyatakan adanya pengaruh yang signifikan antara kemampuan mengidentifikasi makna kata dalam puisi "Remuk dan Hanyutnya Akhlaq Bangsa" oleh Taufik Ismail dengan model think pair share (berfikir berpasangan) oleh siswa kelas X SMA Negeri 1 Kotanopan.
KESANTUNAN TUTURAN PENOLAKAN PADA BUDAYA MASYARAKAT BATAK DI DESA AIR JAMBAN KECAMATAN MANDAU
Authors: Mariana Susi , - Fatmawati
Published: December 2022

Penolakan pada dasarnya memberikan kesan atau perasaan kecewa pada lawan tutur, karena sesuatu yang diharapkan tidak sesuai harapan. Namun penolakan tidak akan memberikan kesan mengecewakan jika penolakan tersebut dituturkan dengan bahasa yang sopan dan santun. Penelitian ini bertujuan untuk mengeksplorasi dan mengelaborasi data mengenai bentuk tuturan penolakan dan skala kesantunan penolakan. Teori yang digunakan dalam penelitian ini adalah Kartomihardjo dalam Nadar, F X. (2009), dan Leech dalam Rahardi (2005). Metode yang digunakan dalam penelitian adalah metode konten analisis. Penelitian ini menggunakan pendekatan kualitatif (qualitative approach). Sumber data dalam penelitian ini adalah tuturan masyarakat batak di desa air jamban, kecamatan mandau, kabupaten bengkalis. Jenis penelitian ini adalah penelitian lapangan. Teknik pengumpulan data dalam penelitian ini menggunakan tekni domentasi, simak libat cakap, sadap, pancing, rekam dan catat. Hasil penelitian menunjukkan bahwa masyarakat Batak lebih dominan menggunakan penolakan dengan komentar. Hal ini menunjukkan bahwa pemberian komentar saat menolak tawaran, ajakan, perintah, dan himbauan akan dianggap lebih tepat dan tidak merugikan lawan bicara. Skala kesantunan yang paling berkaitan adalah skala ketidaklangsungan. Selanjutnya, masyarakat Batak lebih dominan menggunakan skala ketidaklangsungan saat melakukan tuturan penolakan. Hal ini menunjukkan bahwa tuturan penolakan yang diungkapkan oleh masyarakat Batak tergolong santun.
A simple surgical technique for sellar closure after transsphenoidal resection of pituitary adenomas in the context of risk factors for cerebrospinal fluid leaks and meningitis
Authors: Ueberschaer Moritz , Katzendobler Sophie , Biczok Annamaria , Schmutzer Michael , Greve Tobias , Tonn Joerg-Christian , Thorsteinsdottir Jun , Rachinger Walter
Published: December 2022

OBJECTIVE

The transsphenoidal approach is the standard for most pituitary tumors. Despite low morbidity, postoperative CSF fistulas and meningitis are specific complications. Various surgical closure techniques for intraoperative CSF (iCSF) leak and sellar reconstruction have been described. For many years the authors have applied synthetic materials for iCSF leak repair and sellar closure in a standardized fashion in their department. Here they analyze the surgical outcome as well as risk factors for iCSF leak and meningitis.

METHODS

All patients with transsphenoidal resection of a pituitary adenoma performed by the same surgeon between January 2013 and December 2019 were screened retrospectively. A small amount of iCSF flow without a diaphragmatic defect was classified as a minor leak, and obvious CSF flow with or without a diaphragmatic defect was classified as a major leak. In case of iCSF leak, a fibrin- and thrombin-coated sponge was used to cover the diaphragmatic defect and another one was used for the sellar opening. A gelatin sponge was placed in the sphenoid sinus as an abutment. The primary and secondary outcomes were the number of postoperative CSF (pCSF) leaks and meningitis, respectively. Clinical, histological, and perioperative data from medical records were collected to identify risk factors for CSF leak and meningitis.

RESULTS

Of 417 transsphenoidal surgeries, 359 procedures in 348 patients with a median age of 54 years were included. There were 96 iCSF leaks (26.7%; 37.5% major, 62.5% minor). In 3 of 359 cases (0.8%) a pCSF fistula occurred, requiring revision surgery in 2 patients and a lumbar drain in 1 patient. Meningitis occurred in 3 of 359 cases (0.8%). All 3 patients recovered without sequelae after antibiotic therapy. According to univariate analysis, risk factors for iCSF leak were macroadenoma (p = 0.006) and recurrent adenoma (p = 0.032). An iCSF leak was found less often in functioning adenomas (p = 0.025). In multivariate analysis recurrent tumors remained as a risk factor (p = 0.021) for iCSF leak. Patients with iCSF leak were at increased risk for a pCSF leak (p = 0.005). A pCSF leak in turn represented the key risk factor for meningitis (p = 0.033).

CONCLUSIONS

Patients with macroadenomas and recurrent adenomas are especially at risk for iCSF leak. An iCSF leak in turn increases the risk for a pCSF leak, which carries the risk for meningitis. The authors’ surgical technique leads to a very low rate of pCSF leaks and meningitis without using autologous graft materials. Hence, this technique is safe and improves patient comfort by avoiding the disadvantages of autologous graft harvesting.
Role of CDKN2A deletion in grade 2/3 IDH-mutant astrocytomas: need for selective approach in resource-constrained settings
Authors: Suman Shalini , Sharma Ravi , Katiyar Varidh , Mahajan Swati , Suri Ashish , Sharma Mehar C. , Sarkar Chitra , Suri Vaishali
Published: December 2022

OBJECTIVE

The authors aimed to assess the frequency of homozygous CDKN2A deletion in isocitrate dehydrogenase (IDH)–mutant diffuse astrocytomas (grade 2/3) and to narrow down the clinicopathological indications in which the CDKN2A fluorescence in situ hybridization (FISH) assay is cost-effective in resource-constrained settings.

METHODS

IDH-mutant astrocytomas were analyzed for ATRX, p53, MIB1-LI, and p16 expression using immunohistochemistry. The FISH assay was used to evaluate CDKN2A deletion and 1p/19q codeletion. Survival outcomes were assessed according to the different molecular markers.

RESULTS

A total of 150 adult patients with IDH-mutant grade 2 (n = 95) and grade 3 (n = 55) astrocytomas (145 primary and 5 recurrent) were analyzed. Using a cutoff value of 30% for defining significant homozygous CDKN2A deletion, none of the grade 2 and 10.9% (6/55) of grade 3 astrocytomas showed this deletion (4 primary and 2 recurrent grade 3 tumors) and were reclassified as grade 4. This mutation was more frequent in recurrent (40%, 2/5) than primary (2.76%, 4/145) gliomas. Half (3/6, 50%) of the CDKN2A-deleted cases demonstrated poor outcomes; 2 of these cases experienced recurrence at 12 and 36 months after surgery, and 1 died at 5 months. The majority of CDKN2A-deleted cases showed marked cellularity (100%), pleomorphism (100%), brisk mitosis (83.3%), and tumor giant cell formation (83.4%). None of the cases with retained p16 expression harbored this deletion. Both overall survival (p = 0.039) and progression-free survival (p = 0.0045) were found to be worse in cases with p16 loss. Selectively performing CDKN2A FISH only in high-risk cases with histomorphological features of anaplasia, p16 loss, or recurrent tumors achieved a sensitivity and negative predictive value of 100%. This approach would have resulted in saving 41.1% of the original expenditure ($6900 US per 150 samples) and 27.6 person-minutes per sample without compromising the identification of deleted cases.

CONCLUSIONS

Homozygous CDKN2A deletion is conspicuously absent in grade 2 and rare in primary grade 3 IDH-mutant astrocytomas. The authors propose that restricting use of the FISH assay to cases showing histomorphological features of anaplasia, p16 loss, or recurrent tumors will help this platform to be utilized in the most cost-effective manner in resource-constrained settings.
Autoimmune Hepatitis Leading to Liver Cirrhosis: A Case Report
Authors: Shrestha Moon , Subedi Sudip Chandra , Shah Sangam , Acharya Jeny , Regmi Milan , Mehta Neha
Published: December 2022

Autoimmune hepatitis is a rare form of chronic liver inflammation that begins as acute hepatitis and progresses to chronic liver disease. It presents with varied clinical features from acute hepatitis to chronic liver diseases like chronic viral hepatitis and alcoholic liver disease, making it difficult to diagnose in the absence of a high index of suspicion and adequate laboratory support. Autoimmune hepatitis is divided into two categories autoimmune hepatitis-1 and autoimmune hepatitis-2 based on the antibodies involved. We discuss the case of a 37-year-old woman who developed autoimmune hepatitis-1, with swelling and epigastric pain. These symptoms later progressed to liver cirrhosis leading to the death of the patient. Autoimmune hepatitis is extremely sensitive to immunosuppressive medication, it is necessary to maintain a high suspicion index for the disease because a prompt diagnosis can be an integral step toward a better prognosis of the disease.
Stromal Keratitis among Herpes Simplex Keratitis Patients in a Tertiary Eye Hospital: A Descriptive Cross-sectional Study
Authors: Shrestha Poonam , Paudel Santosh
Published: December 2022

Introduction: The manifestations of herpes simplex virus keratitis range from epithelial keratitis to vision-threatening stromal keratitis. There are limited studies done on our part regarding stromal keratitis. The aim of the study was to find out the prevalence of stromal keratitis among herpes simples keratitis patients in a tertiary eye hospital.
Methods: This descriptive cross-sectional study was conducted among patients who presented with herpes simplex virus keratitis in a tertiary eye hospital between 1 January 2020 to 28 February 2022. Ethical clearance was taken from Ethical Review Board (Reference number: 1/2079/80). Data was collected from hospital records which was reviewed and visual acuity at presentation and at one-month follow-up, clinical details on examination were recorded and, diagnosis of the stage of disease given in the case record was noted. Convenience sampling was used. Point estimate and 95% Confidence Interval were calculated.
Results: Among 112 Herpes simplex keratitis patients, the prevalence of stromal keratitis was 38 (33.93%) (25.16-42.70, 95% Confidence Interval).
Conclusions: The prevalence of stromal keratitis among patients of herpes simplex keratitis was similar to studies conducted in similar settings.
Extragonadal Mixed Germ Cell Tumour of the Right Scapular Region: A Case Report
Authors: Gurung Sushma , Karim Sabina , Thapa Sagun , Gautam Shristi
Published: December 2022

Extragonadal germ cell tumours are rare; to the best of our knowledge, a location in the soft tissue of the right scapular region has never been previously reported in the literature. We report a case of a 9-years-old girl who presented with swelling over the right scapular region, treated by a combination of surgery and cisplatin-based chemotherapy. Immunohistochemistry and serum tumour markers concluded it to be an extragonadal mixed germ cell tumour. Our patient had a complete response up to 2 years of follow-up. This case is being reported here due to a very rare site of presentation with a diagnostic dilemma. A multidisciplinary, combining systemic chemotherapy and surgery is the most appropriate treatment strategy for extragonadal germ cell tumours, to ensure both local and systemic control.
Intracranial Calcification and Seizure with Down Syndrome: A Case Report
Authors: Rai Nilshan , Thapa Monika , Pokharel Merina , Acharya Jinee , Yadav Dhirendra
Published: December 2022

Down syndrome is a genetic disorder caused by an extra copy of chromosome number 21. New onset of seizure in adults with Down syndrome is rare. The exact pathogenesis of intracranial calcification and seizure in Down syndrome is unknown, however, a possible association between hypocalcemia and vitamin D deficiency in Down syndrome was reported. An 18-year-old girl with nasal bridge, mongoloid slants, clinodactyly and saddle gap of toes, and prominent Downs phenotypes was present with a low level of parathyroid hormone, calcium, and vitamin D. Due to a higher prevalence of intracranial calcification in people with Down syndrome, there is an increased possibility of hypocalcemia and vitamin D deficiency. Hence, serum levels of calcium and vitamin D should always be checked before starting treatment with anti-epileptic drugs.
Analisis Penempatan Iklan dan Logo Sponsor pada Acara Olahraga dengan Teknologi Eye Tracking
Authors: Kusumo Argo Hadi , Ronyastra I Made , Hartono Markus , Sofian Andrew
Published: December 2022

Iklan dapat dipromosikan dengan menggunakan media poster dan tayangan televisi pada acara olahraga. Namun demikian, belum ada penelitian yang mengukur tingkat efektivitasnya secara khusus pada level atensi. Penelitian ini bertujuan untuk mengukur tingkat atensi dalam penempatan iklan yang berbeda pada olahraga sepak bola dan MotoGP. Penempatan iklan pada poster dibagi menjadi dua yaitu inner dan outer area. Sedangkan penempatan iklan pada video dibagi menjadi tiga penempatan, yaitu penempatan di atas, di bawah, dan penempatan penuh. Delapan instrumen digunakan dalam penelitian ini yang terdiri dari delapan poster dan empat video. Indikator eye-tracking yang digunakan dalam penelitian ini untuk mengukur tingkat atensi yang diperoleh adalah Time Viewed (CFT), Time to 1st View (TFF), dan Number of Fixation (NF). Iklan dalam poster yang ditempatkan di area aksi (inner area) mendapat tingkat perhatian yang lebih tinggi dari pada iklan yang ditempatkan di area luar. Sedangkan pada video, penempatan iklan sepakbola terbaik adalah pada penempatan iklan penuh. Namun, penempatan iklan di posisi bawah juga dapat disarankan. Penempatan iklan pada MotoGP yang mendapat perhatian lebih adalah pada iklan penuh. Namun, saat adegan diperbesar, iklan bisa ditempatkan di posisi bawah.