bluuebunny/crossref_metadata_2025 huggingface dataset:
Enhancing classification performance in imbalanced datasets: A comparative analysis of machine learning models
Authors: Dube Lindani , Verster Tanja
Published: October 2023

In the realm of machine learning, where data-driven insights guide decision-making, addressing the challenges posed by class imbalance in datasets has emerged as a crucial concern. The effectiveness of classification algorithms hinges not only on their intrinsic capabilities but also on their adaptability to uneven class distributions, a common issue encountered across diverse domains. This study delves into the intricate interplay between varying class imbalance levels and the performance of ten distinct classification models, unravelling the critical impact of this imbalance on the landscape of predictive analytics. Results showed that random forest (RF) and decision tree (DT) models outperformed others, exhibiting robustness to class imbalance. Logistic regression (LR), stochastic gradient descent classifier (SGDC) and naïve Bayes (NB) models struggled with imbalanced datasets. Adaptive boosting (ADA), gradient boosting (GB), extreme gradient boosting (XGB), light gradient boosting machine (LGBM), and k-nearest neighbour (kNN) models improved with balanced data. Adaptive synthetic sampling (ADASYN) yielded more reliable predictions than the under-sampling (UNDER) technique. This study provides insights for practitioners and researchers dealing with imbalanced datasets, guiding model selection and data balancing techniques. RF and DT models demonstrate superior performance, while LR, SGDC and NB models have limitations. By leveraging the strengths of RF and DT models and addressing class imbalance, classification performance in imbalanced datasets can be enhanced. This study enriches credit risk modelling literature by revealing how class imbalance impacts default probability estimation. The research deepens our understanding of class imbalance's critical role in predictive analytics. Serving as a roadmap for practitioners and researchers dealing with imbalanced data, the findings guide model selection and data balancing strategies, enhancing classification performance despite class imbalance.
Risk-seeking insider trading with partial observation in continuous time
Authors: Xiao Kai
Published: October 2023

In this paper, a continuous-time insider trading model is investigated in which an insider is risk-seeking and market makers may receive partial information on the value of a risky asset. With the help of filtering theory and dynamic programming principle, the uniqueness and existence of linear equilibrium is established. It shows that (ⅰ) as time goes by, the residual information decreases, but both the trading intensity and the market liquidity increases, and (ⅱ) with the partial observation accuracy decreasing, both the market liquidity and the residual information will increase while the trading intensity decreases. On the whole, the risk-seeking insider is eager to trade all the trading period, and for market development, it is necessary to increase the insider's risk-preference behavior appropriately.
Le pouvoir des mots dans « El hombre muerto » (1920) de Horacio Quiroga : sacralisation, incantation et conjuration
Authors: Roux Eva Le
Published: October 2023

Le présent article propose une nouvelle lecture du conte « El hombre muerto » (1920) de l’écrivain uruguayen Horacio Quiroga, en partant de l’analyse des effets de sacralisation, d’incantation et de conjuration du logos. Contrairement à ce qu’une grande partie de la critique souligne, l’absence de tension et la quasi‑absence de l’élément fantastique ne suffisent pas à appauvrir l’efficacité narrative de ce conte. Nous souhaitons montrer que l’adoption d’une perspective stylistique permet de considérer la répétition, la densité et l’étirement du temps du récit comme de véritables stratégies d’écriture.
Genre, mémoire et sororité dans le roman La sangre de la aurora (2013) de Claudia Salazar Jiménez
Authors: Barrios Tania Romero
Published: October 2023

L’article suivant1 porte sur le roman La sangre de la aurora (2013) de l’autrice péruvienne Claudia Salazar Jiménez. Il s’agira d’aborder l’écriture éthique et féministe de la violence politique dans ce roman portant sur l’histoire de trois femmes victimes de violence sexuelle pendant le conflit armé (1980‑2000). Pour ce faire, l’article analyse la construction et la confrontation aux « mémoires androhéroïques » du conflit armé, qui se fait depuis les masculinités et les voix féminines du roman.
Les photos de la marge : captations de l’espace vide chez Ramón Masats et Francisco Gómez
Authors: Cristini Corinne
Published: October 2023

Nous nous intéresserons, dans cette étude, à deux photographes espagnols : Ramón Masats (né à Caldes de Montbui, en Catalogne, en 1931) et Francisco Gómez (né à Pamplona, en 1918, et mort à Madrid, en 1998). Ils ont tous deux été membres de la Real sociedad fotográfica de Madrid et du groupe photographique AFAL (Agrupación Fotográfica de Almería), ont été cofondateurs de La Palangana, et ont participé activement au renouveau de la photographie espagnole des années 1950 et 1960 encore tout imprégnée du pictorialisme ambiant. Dans les deux œuvres en noir et blanc de cette période, qu’il s’agisse des photos documentaires de Masats ou des photos plus abstraites de Gómez, le rôle prégnant du vide sera interrogé, que celui‑ci soit le reflet d’une réalité socio‑économique dans cette Espagne archaïque du franquisme ou encore une construction esthétique de la vacuité qui tend vers une forme poétique et symbolique.
On Experiencing Sustainability
Authors: Korpelainen Noora-Helena
Published: October 2023

This essay aims at clarifying our understanding of human participation in sustainability transitions from the pragmatist aesthetics perspective. By sustainability transitions, I refer to processual changes that move towards enhanced environmental and/or social sustainability. At the risk of inappropriateness, I argue that the cultivation of aesthetic sensibility manifests in experiencing sustainability. To understand those ordinary experiences that convey vistas for sustainability transition management, I return to John Dewey’s Art as Experience (1934). I first show that Dewey’s conception of sensibility is two-sided, marking both adaptation and expression. Second, by building on the two sides of sensibility together with the contemporary pragmatist aesthetics discussion, I propose that aesthetic sensibility means a shared practice of attuning to transformation. My analysis suggests that acknowledging aesthetic sensibility in experiencing sustainability stands for a transition towards an enhanced conception of the human being as one whose ameliorative practices evolve in collaboration with other beings, living and non-living. For the fruition of sustainability transitions and subsequent expected transformations, aesthetic sensibility should then be acknowledged as a significant dimension of the sensory approach.
John Dewey and Psychiatry
Authors: Frank Jeff
Published: October 2023

This article looks at the rare instances in Dewey’s collected works where psychiatry is addressed. Interestingly, Dewey draws on psychiatry as a way of demonstrating the flaws of excessively student-centered approaches to education. I take this to be of interest because it both clarifies Dewey’s philosophy of education while also suggesting that Dewey does not shy away from confronting truths disclosed by psychoanalysis. In fact, learning from advances in any and every field of inquiry is central to his philosophy of education. While some readers of Dewey dismiss him as naïve or overly optimistic, this paper argues that Dewey invites the challenges offered by psychoanalytic work and that his understanding education for growth must be grounded in a psychoanalytically informed vision of the person.
Pragmatismus als Antiautoritarismus und die Idee der Solidarität
Authors: Schulenberg Ulf
Published: October 2023

Seit nunmehr vier Jahrzehnten beschäftigt die Renaissance des Pragmatismus Philosophen und Theoretikerinnen. In verschiedenen Fächern, von der Philosophie und den Literaturwissenschaften bis zur Soziologie und Jurisprudenz, haben die sich um den Pragmatismus zentrierenden Diskussionen zu interessanten neuen Einsichten geführt. Allerdings ist es bisher nicht gelungen zu erhellen, auf welch komplexe Art und Weise Pragmatismus, Humanismus, Antiautoritarismus und die Idee einer genuin post-metaphysischen Kultur zusammenhängen. Seine Version des Pragmatismus als Antiautoritarismus verstehend, sucht Richard Rorty den antiautoritären Gestus aus den praktischen Bereichen der Ethik und Politik auf die Epistemologie zu übertragen. Sein Antiautoritarismus besagt, dass es keine nicht-menschliche Autorität gibt, deren Befehlen Menschen zu gehorchen hätten; weder die Wahrheit oder der Wille Gottes noch die Vorstellung einer objektiven Realität oder die Idee des wirklich Realen können als Autoritäten wirken. Die Vorstellung, es gäbe so etwas wie menschliche Verantwortlichkeit gegenüber etwas Nicht-Menschlichem, gilt es zu verabschieden. Dieser Aufsatz gliedert sich in drei Teile. Der erste sucht dazulegen, inwiefern der Pragmatismus als Antiautoritarismus zu verstehen ist. Der zweite Teil diskutiert die folgende Frage: Wie lässt sich innerhalb eines antiautoritären Rahmens, der bestimmt ist von Kontingenz, Antiessentialismus und der Praxis einer radikalen Historisierung, die Idee der Solidarität denken? Es wird argumentiert, dass die Literatur, und insbesondere der Roman, eine wichtige Rolle bei der Beantwortung dieser Frage spielt. Dieser Teil konzentriert sich auf Rortys Position. Ein kurzer abschließender Teil beschäftigt sich mit der Frage von Antiautoritarismus und ästhetischer Form.
Radikale Solidarität!
Authors: Faets Simon
Published: October 2023

In der aktuellen philosophischen Solidaritätsdebatte wird Solidarität meist in der systematischen Gegenüberstellung von sozialer und politischer Solidarität verstanden. Gegen diese klassische Einteilung entwickelt der Beitrag ein Verständnis radikaler Solidarität – Solidarität ist entweder eine radikale politische Praxis oder sie ist gar keine Solidarität. Zu diesem Zweck wird im Anschluss an die Kritische Theorie Stephan Lessenichs und Christoph Menkes eine Kritik des Konzepts der sozialen Solidarität entfaltet: Der Begriff der sozialen Solidarität versteht unter Solidarität eine soziale Praxis unter Gleichen und Ähnlichen, in der bestehende soziale Herrschaftsstrukturen und Ausschlussmechanismen stabilisiert und verstärkt werden. Soziale Solidarität wird auf dieser Grundlage in ihrem widersprüchlichen und pathologischen Charakter herausgearbeitet. Darauf aufbauend wird dafür plädiert, Solidarität von Anfang an als radikale Praxis der Politisierung und Transformation der in modernen, kapitalistischen Gesellschaften herrschenden Machtformen und Gewaltdynamiken zu begreifen. Dies wird durch eine systematische Zusammenschau der Kritischen Theorie mit José Medinas Konzeption eines radikalen Pragmatismus geleistet, in deren Rahmen der Begriff der radikalen Solidarität vorgeschlagen wird. Im Zentrum der Idee radikaler Solidarität steht dabei die Überbrückung und gleichzeitige Bewahrung von gesellschaftlichen Differenzen: Solidarität kann als soziale Praxis stets nur zwischen Subjektpositionen radikaler Differenz verwirklicht werden. Ziel radikaler solidarischer Praktiken ist es, die Erfahrungen und Perspektiven der Ausgeschlossenen und Unterdrückten, die als radikal anders und different konstruiert werden, auf widerständige Weise hörbar und damit die radikale Pluralität gesellschaftlicher Standpunkte und Subjektivitäten sichtbar zu machen. Solidarität geht, so verstanden, notwendig von der Vulnerabilität der Subalternen und Marginalisierten aus und zielt auf die grundlegende Kritik und Veränderung des sozialen status quo.
George Herbert Mead and Psychoanalysis
Authors: Côté Jean-François
Published: October 2023

This article examines G.H. Mead’s critique of psychoanalysis, in order to show how it reflects the parallels with his own conception of social psychology. In showing that both Freud and Mead address the same issues of the redefinition of the psyche based on experimental psychology in their own theoretical entreprise, the analysis makes clear that Freud’s two topics (Conscious, Preconscious, Unconscious; Superego, Ego, Id) and Mead’s theory of the Self (I, Me, Self) are closely related but nevertheless kept apart by fundamental oppositions. However, further explorations in Lacan’s reading of Freud help in seeing how close psychoanalysis and social psychology can be, by shifting attention to the distinction between unconscious and conscious communication. By addressing the issue of emotions in social life, a final look at the transformation of social norms shows how the confrontation between social psychology and psychoanalysis can be fruitful.
Vulnerabilität als Problem
Authors: Gajic Danilo
Published: October 2023

In gegenwärtigem sozialen Protest lässt sich, mit Eva von Redecker, eine „Revolution für das Leben“ ausmachen: eine neue Protestform, die sich durch einen Bezug auf bedrohtes Leben auszeichnet und die Vulnerabilität politisiert. Im vorliegenden Beitrag möchte ich mit John Dewey ein Verständnis von Politisierung durch sozialen Protest entwickeln und dieses in Bezug auf die „Revolution für das Leben“ erläutern. Dazu schlage ich vor, Politisierung als Problematisierung auf drei Ebenen zu begreifen. Sozialer Protest artikuliert, erstens, ausgehend von Erfahrungen, Sachverhalte als Probleme von öffentlicher Bedeutung, die einer Lösung bzw. Bearbeitung bedürfen. Zweitens thematisiert er diese zugleich als Probleme zweiter Ordnung, d.i. als Probleme sozialer Institutionen und gesellschaftlicher (Selbst-) Gestaltung. Und schließlich stellt sozialer Protest die Grenzen politischer Gemeinschaft zur Disposition, indem er zugleich Probleme dritter Ordnung, d.i. politischer Teilhabe adressiert. In diesem Sinne ist auch die „Revolution für das Leben“ zu verstehen: sie artikuliert Vulnerabilität nicht nur als sachliches Problem des Schutzes von akut bedrohten Leben, sondern auch als soziales Problem gestaltbarer Praktiken der Sorge um verletzliche Leben sowie als politisches Problem des Ausschlusses aus der Gemeinschaft derjenigen, deren Leben als der Sorge und des Schutzes wert und würdig anerkannt werden.
Between Anger and Hope
Authors: Gregoratto Federica
Published: October 2023

Discussions around progress, that have always been at the core of critical social and political philosophy, have lately become particularly thorny, exposing a sort of double bind: arguments in favour of progress are unable to avoid positions that undermine progress itself, but rejection of progress risks giving in to reactionary, cynic or melancholic positions.In this paper, I formulate the hypothesis that the double bind depends on a sort of unhealthy “obsession” with normative criteria of progress. As a corrective, I propose to think of moral, social and political changes in the terms of what I call troubled normativity – a normative reflection, namely, that embraces conflicts, ambivalences, uncertainty. I discuss in this regard two recent perspectives on progress, Rahel Jaeggi’s pragmatist and Amy Allen’s genealogical-psychoanalytical ones. I further articulate their insights by taking into consideration the affective dimension of social transformations. I concentrate in particular on two emotional constellations, anger and hope, by drawing upon María Lugones’ and Jonathan Lear’s work.
Restoring the Dreamer
Authors: Henning Bethany
Published: October 2023

The dubious relation of “subjective” experience to “objective” reality finds its correlate in the opposition we often suppose between culture and nature. Twentieth century theorists, most notably Freud, have claimed various methods for interpreting the illusions of one realm that hide the truths of the other. Ricœur has famously called the psychoanalytic method of dream interpretation a “hermeneutics of suspicion,” which he sees as a threat to the “mytho-poetic core of imagination.” John Dewey regarded the binary opposition between culture/nature as particularly dubious, preferring to see them as reciprocal phases of a continuous process; if cultural life is an interpretation of the biophysical environment, that environment surely has its say. However, in the century since Freud, the tactics of suspicion have proven themselves to be indispensable for developing of critiques that reveal the subtle operations of anti-democratic ideologies, perhaps at the expense of democratic faith. This paper considers if there are less suspicious, more Deweyan possibilities for the interpreting and sharing of dreams, not for the benefit of the psychic health of the individual dreamer, but for the sake of a recovery of democratic life.
L’appropriation territoriale des formes du relief : l’exemple d’Al-Aïn et du Jebel Hafit (ÉAU)
Authors: Giusti Christian , Fouache Eric , Beuzen-Waller Tara , Louchet André , Pavlopoulos Kosmas
Published: October 2023

Après la présentation du potentiel paysager du Jebel Hafit comme objet naturel (géologie, géomorphologie, karst) et l’évocation des usages traditionnels de la montagne en relation avec les réseaux d’irrigation (aflaj), l’article montre comment se sont développés plus récemment d’autres modes d’appropriation de l’espace, notamment sur le plan touristique (vestiges archéologiques, route paysagère, points de vue, commerce, hôtels de luxe, folklore, courses de chameaux).
Apnea Management During WATCHMAN Device Deployment with Apneic Oxygenation: A Case Report of Three Cases
Authors: Maeda Makishi , Yoshikawa Yusuke , Oura Shunsuke , Takahashi Kanako , Ohno Sho , Hirata Naoyuki , Yamakage Michiaki
Published: October 2023

WATCHMAN is a percutaneous left atrial appendage closure device that is implanted in patients who are unsuitable for anticoagulation therapy for atrial fibrillation. During WATCHMAN implantation, inducing apnea in the patient is preferable to allow stable deployment. We present three cases in which apneic oxygenation was employed to maintain oxygenation during apnea, and oxygen reserve index (ORi™) was measured to evaluate its safety and efficacy. Oxygen was administered continuously via the endotracheal tube during apnea. During all four apneic events in three patients (mean duration of 356 seconds), the ORi values maintained above 0.24, which is generally considered the threshold of partial pressure of arterial oxygen (PaO2) > 100 mmHg. Transcutaneous oxygen saturation and PaO2 remained above 99% and 300 mmHg, respectively. There were no respiratory or circulatory complications during or after the surgery.
Role of Transesophageal Echocardiography in Early Detection of Myocardial Ischemia before Electrocardiography Changes Post Arterial Switch Operation
Authors: Negi Sunder L. , Chakorvarthy Loganathan , Gowda Nischita , Kumar Rupesh
Published: October 2023

Myocardial ischemia after arterial switch operation is most commonly associated with imperfect translocation of coronary arteries to the neoaorta. Early post-operative myocardial ischemia is the main cause of morbidity and mortality in these patients. We present a rare case of intra-operative myocardial ischemia after ASO, detected with transesophageal echocardiography before electrocardiography changes.
Effects of a Forced-Air Warming System and Warmed Intravenous Fluids on Hemodynamic Parameters, Shivering, and Time to Awakening in Elderly Patients Undergoing Open Cardiac Surgery
Authors: Roshan Mohammad Bagher Akbarpour , Jafarpoor Hasanali , Shamsalinia Abbas , Fotokian Zahra , Hamidi Seyed Hossein
Published: October 2023

Background:

As one of the most common postoperative complications, hypothermia is the main cause of numerous problems during treatment, especially in elderly patients with decreased cardiac reserves.

Objectives:

The aim of the present study was to compare the effects of forced-air warming system (FAWS), warmed intravenous fluids (WIVFs) and routine method on hemodynamic parameters, arterial blood gases (ABGs), shivering, and time to awakening in elderly patients undergoing open cardiac surgery (OCS).

Methods:

This clinical randomized controlled trial was conducted on 94 elderly patients who underwent OCS at Ayatollah Rouhani Hospital, Babol, Iran. They were divided into three groups, namely FAWS (n=31), WIVFs (n=31) and routine rewarming method (RRWM, with a blanket) (n=32). The data were then recorded in a checklist. Descriptive and inferential statistics were performed using SPSS 26 at a significance level of less than 0.05.

Results:

The findings demonstrated that the degree of hypothermia had a significant decreasing trend in the groups receiving FAWS and WIVFs (P=0.002). Additionally, increased respiratory rate (P=0.013), higher bicarbonate (HCO3-) levels on arrival up to 4 hours after surgery (P=0.045), reduced lactate level (P=0.005), normal base excess (BE) and accelerated time to awakening (P=0.004) were observed in patients receiving FAWS. There was no significant difference in the study groups regarding shivering.

Conclusion:

The results revealed that FAWS could mitigate the degree of hypothermia, increase body temperature and decrease the postoperative serum lactate levels. Moreover, BE as one of the most important parameters for ABGs, could remain at a normal level. Besides, the use of FAWS could lead to early awakening, and thus facilitate weaning and extubation of these patients.
Effect of Intravenous Levosimendan or Milrinone on Left Atrial Pressure in Patients Undergoing Off-Pump Coronary Artery bypass Grafting—A Prospective Double-Blind, Randomized Controlled Trial
Authors: Mondal Abhinandan , Ghosh Kakali , Kar Sandeep Kumar , Dammalapati Pavan Kumar , Dasgupta Chaitali S.
Published: October 2023

Background:

Maintaining a low left atrial pressure (LAP) in off-pump coronary artery bypass grafting (OPCAB) is desirable. This study was done to compare the effects of intravenous levosimendan or milrinone on LAP at different stages of OPCAB.

Materials and Methods:

After institutional ethics committee clearance, this two-arm double-blind randomized control trial was done in 44 adult patients with triple vessel coronary artery disease undergoing OPCAB at cardiac OT of IPGME&R, Kolkata. The patients were randomly allocated into two groups receiving intraoperative either levosimendan or milrinone. Pulmonary capillary wedge pressure (PCWP) was compared as the primary outcome parameter, whereas other echocardiographic and hemodynamic parameters were also assessed during six stages of OPCAB, that is, after sternotomy, proximal(s), left anterior descending artery (LAD), obtuse marginal (OM), posterior descending artery (PDA) grafting, and before sternal closure. Numerical parameters were compared using Student’s unpaired two-tailed t-test.

Results:

PCWP was found to be significantly lower (P < 0.05) in the levosimendan group during proximal (P = 0.047), LAD (P = 0.018), OM (P < 0.0001), PDA grafting (P = 0.028), and before sternal closure (P = 0.015). Other parameters indicate LAP, that is, from mitral early diastolic inflow velocity to mitral annular early diastolic velocity ratio (E/e’), which indicated significantly lower LAP in levosimendan group during LAD, OM, and PDA grafting and before sternal closure.

Conclusion:

Levosimendan may be used as a primary inotrope in terms of better reduction in left atrial pressure during different stages of OPCAB, translating to a decrease in left ventricular end-diastolic pressure, therefore maintaining optimum coronary perfusion pressure, which is the primary goal of the surgery.
Absent Right Superior Vena Cava and Persistent Left Superior Vena Cava: An Incidental Finding
Authors: Joshi Swati , Singh Ajmer
Published: October 2023

A patient with Marfan syndrome undergoing Bentall operation was found to have an absent right superior vena cava and persistent left superior vena cava. The dilation of coronary sinus raised the suspicion of persistent left superior vena cava. The diagnosis was confirmed by agitated saline contrast echocardiography and computed tomography of the chest.
Comparison of ultrasound-guided genicular nerve block and knee periarticular infiltration for postoperative pain and functional outcomes in knee arthroplasty – A randomised trial
Authors: Eid Gehan M. , El said Shaban Shiamaa , Mostafa Tarek A.
Published: October 2023

Background and Aims:

Optimal analgesia after total knee arthroplasty (TKA) enhances patients’ and surgical outcomes. The study investigated the ultrasound-guided genicular nerve block versus the periarticular infiltration in TKA.

Methods:

Eighty-eight patients aged above 50 years scheduled for unilateral TKA were randomised as: Group 1 received intraoperative periarticular infiltration (0.5 mL adrenaline [4.5 µg/mL], 20 mL bupivacaine 0.5% with 89.5 mL saline) and Group 2 received immediate postoperative genicular nerve block (15 mL bupivacaine 0.25% with 2.5 g/mL adrenaline). The postoperative morphine consumption was during the first two postoperative days the primary outcome. The secondary outcomes were time to rescue analgesia, pain scores and functional outcomes. The comparison between groups was performed using the Chi-square test, the Student’s t-test and the Mann–Whitney U test, as appropriate.

Results:

The postoperative morphine consumption during the first two postoperative days and pain scores at rest at 12 h postoperatively were less in Group 1 than in Group 2 (P < 0.001). Pain scores during movement on the first postoperative day were lower in the periarticular group than the genicular group at 6, 12 and 24 h (P < 0.001). At 18 h, pain scores were higher in the periarticular group than in the genicular group at rest and movement (P < 0.001). Quadriceps motor strength scores were comparable between groups (P > 0.05). The knee range of motion and time up and go test during both days showed a statistically significant difference in the periarticular group compared to the genicular group (P < 0.05).

Conclusion:

Periarticular infiltration and genicular nerve block yield effective postoperative analgesia and functional outcomes after TKA without motor affection.
Efficacy of intravenous nalbuphine for managing post-anaesthesia shivering: A systematic review and meta-analysis of randomised controlled trials with trial sequential analysis
Authors: Nair Abhijit , Dudhedia Ujjwalraj , Rangaiah Manamohan , Panchawagh Suhrud
Published: October 2023

Background and Aims:

Post-anaesthesia shivering is distressing and is observed after spinal and general anaesthesia. Nalbuphine, a partial mu-opioid receptor antagonist with kappa-opioid receptor agonist properties, has been successfully used to manage post-anaesthesia shivering.

Methods:

After registering the review with the International Prospective Register of Systematic Reviews (PROSPERO), we searched PubMed/Medline, Scopus, Ovid, Cochrane Library and clinicaltrials.gov with keywords for randomised controlled trials. The risk of bias-2 (RoB-2) scale was used to assess the quality of evidence. We also used Grading of Recommendations, Assessment, Development and Evaluations (GRADE) guidelines to evaluate the strength of evidence and trial sequential analysis to validate the conclusions.

Results:

Of the 240 articles, 10 were considered eligible for review (700 patients, 350- nalbuphine, 350- control or placebo). When compared to placebo, the success rate of nalbuphine controlling shivering was significantly better (risk ratio [RR]: 2.37, 95% confidence interval [CI]:1.91, 2.94; P = 0.04, I² = 94%), but comparable to the control group drugs (opioids, dexmedetomidine, ondansetron, pethidine). Compared to placebo, shivering recurrence was significantly less with nalbuphine than with placebo (RR: 0.47, 95% CI: 0.26, 0.83; P = 0.01, I² = 61%), but comparable with the control group. The incidence of postoperative nausea/vomiting (PONV) was significantly less with nalbuphine when compared to the control group (RR: 0.67, 95% CI: 0.47, 0.95; P = 0.02, I² = 37%), but PONV in the nalbuphine group was comparable to placebo (RR: 1.20, 95% CI: 0.68, 2.12; P = 0.54, I² = 0%). Other outcomes, like the grade of shivering and hypotension, were comparable between the nalbuphine and control groups.

Conclusion:

Nalbuphine successfully controls post-anaesthesia shivering and reduces the recurrence of shivering.
Non-opioid versus Opioid Peri-operative Analgesia In Neurosurgery (NOPAIN): Study protocol for a multi-centric randomised controlled trial
Authors: Sriganesh Kamath , Singh Georgene , Bidkar Prasanna Udupi , Sethuraman Manikandan , Moningi Srilata
Published: October 2023

Background and Aims:

Many patients suffer from post-operative pain after neurosurgery despite using intra-operative opioids. Opioid side effects are problematic in neurosurgical patients. Hence, non-opioid alternatives for the management of nociception and pain are needed. Previous studies comparing opioids with non-opioids in the neurosurgical population were few, from single centres, of small sample sizes and were equivocal in findings, which prevented change in clinical practice. To overcome these limitations, we are conducting a multi-centre trial with objectives to compare intra-operative rescue opioid requirements and post-operative pain scores (primary objectives), adverse events, quality of recovery from anaesthesia, quality of sleep and patient satisfaction during hospital stay, and persistent post-surgical pain and quality of life at 3 and 6 months (secondary objectives) in patients receiving opioid and non-opioid analgesia for brain tumour surgeries.

Methods:

This study protocol describes the methodology of a multi-centre randomised controlled trial. Ethics committee approval has been obtained from all five centres, the trial has been registered with the Clinical Trial Registry- India, and insurance has been obtained for this investigator-initiated funded study. In patients undergoing supra-tentorial brain tumour surgery (population), we will compare fentanyl (intervention) 1 µg/kg/h with dexmedetomidine (comparator) 0.5 µg/kg/h administered during surgery with regards to intra-operative rescue opioid requirement and post-operative pain (primary outcomes).

Results:

We describe the study protocol of the multi-centre trial (protocol version 2, dated 29/01/2022). The first patient was recruited on 19/10/2022, and we will complete recruitment before March 2024.

Conclusion:

We expect our study to establish dexmedetomidine as an effective non-opioid analgesic vis-à-vis opioids in the neurosurgical population.
Ultrasonographic assessment of brachial artery reactivity as a predictor of adverse outcome in patients undergoing emergency laparotomy for perforated peritonitis – Prospective observational study
Authors: Ravikumar Rajathadri Hosur , Maitra Souvik , Prasanna Mrudula , Anand Rahul K. , Bansal Virinder K. , Baidya Dalim K.
Published: October 2023

Background and Aims:

This study aimed to assess if pre- and postoperative parameters of brachial artery reactivity (BAR), like flow-mediated dilation (FMD) and hyperaemic velocity (HV), could predict in-hospital mortality in perforation peritonitis patients undergoing emergency laparotomy.

Methods:

In this prospective observational study, adult patients with perforation peritonitis undergoing emergency laparotomy were recruited. FMD and HV were measured preoperatively, postoperatively and at 24 and 48 h post-surgery. Adult patients undergoing elective laparotomy served as the control group. The primary outcome was in-hospital mortality. Baseline and BAR parameters were compared between survivors and non-survivors. Risk factors for mortality were identified by univariate analysis. Prognostic performances of BAR parameters were assessed by different models using logistic regression. All statistical analyses were performed on STATA version 13 for Mac OS.

Results:

Seventy-six emergency laparotomy patients were recruited, and 26 died during the hospital stay. FMD and HV were comparable at all time points between survivors and non-survivors, except that HV was higher in survivors at 48 h post-surgery (median [interquartile range] 1.28 [1.16–1.49] vs. 1.16 [0.86–1.35], P = 0.010]. HV at 48 h predicted mortality (adjusted odds ratio [OR] [95% confidence interval] 21.05 [1.04–422.43], P = 0.046), and a model consisting of age, Acute Physiology and Chronic Health Evaluation (APACHE) score and HV at 48 h was the best predictor of mortality (area under the receiver operating characteristic (AUROC) curve 0.82).

Conclusion:

HV, as measured by ultrasonography of the brachial artery at 48 h postoperatively, is a good predictor of mortality in patients undergoing emergency laparotomy for perforation peritonitis.
Monitored epidural catheter placement–ultrasound-guided neurostimulation-aided thoracic catheter placement via caudal route for perioperative analgesia in neonatal thoracotomies: A technical feasibility study
Authors: Diwan Sandeep , Sethi Divya , Jadhav Sudhakar , Patil Santosh
Published: October 2023

In this case series, we investigated the feasibility of combining ultrasound and neurostimulation for inserting a stimulating epidural catheter in the thoracic epidural space through the caudal route in neonates. Twelve neonates undergoing tracheo-oesophageal fistula repair under general anaesthesia were studied. The catheter was visible on ultrasound as a hyperechoic dot in the epidural space. Inadvertent high placement was identified in two neonates with neurostimulation, in whom the catheter was withdrawn to the thoracic epidural space, and the position was confirmed on ultrasound. A 0.5 ml/kg bolus dose of 0.125% bupivacaine injected through the epidural catheter was imaged in real-time in the epidural space. Block was effective in 10 neonates; two needed an additional local anaesthetic (LA) bolus. To conclude, ultrasound with neurostimulation facilitates accurate positioning of the caudally placed epidural catheter to the mid-thoracic level in neonates.
Extracorporeal membrane oxygenation in COVID-19– Associated acute respiratory distress syndrome – Outcome and experience in a tertiary care intensive care unit – A retrospective study
Authors: Murthy Pooja R. , C Narendraprasad , Karanth Sunil , Gupta Venkatesha K V , Kumar Ajith A K , Padyana Mahesha
Published: October 2023

Background:

Extracorporeal membrane oxygenation (ECMO) has been used in patients with severe acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19) who fail conventional treatment.

Methods:

A retrospective observational study was designed in patients who underwent ECMO for severe COVID-19 ARDS in a tertiary care centre from September 2020 to July 2021. The primary outcome was to assess factors influencing clinical outcomes and survival to hospital discharge. Secondary outcomes were to assess the clinical profile and pre-ECMO features, ECMO characteristics and complications. Collected data were entered in Excel software and analysed using R software version 4.0.2 (R foundation for statistical computing, Vienna, Austria).

Results:

A total of 19 patients underwent ECMO. Ten patients survived and discharge. Survivors had a longer median (interquartile range [IQR]) duration (days) on ECMO, that is, 25 (7–50), compared to non-survivors, that is, 12 (1–34) (P = 0.133). We also noted that patients who survived had a longer median (IQR) duration (days) of intensive care unit (ICU) stay, that is, 41.5 (30–70), compared to non-survivors, that is, 9 (2–40) (P = 0.001).

Conclusion:

In our study, 52.3% of patients survived and discharge, and with ECMO outcomes for COVID-19 ARDS were at par with ECMO outcomes for non-COVID-19 ARDS despite requiring ECMO for longer duration and increased ICU length of stay.
Health-related quality of life and its association with the symptom score and the thyroid function status of patients with primary hypothyroidism on replacement therapy
Authors: Martin Merina , Subramaniyan Rani , Naik Dhukhabandu , Ramamoorthy Lakshmi , Lalthanthuami Hmar T.
Published: October 2023

BACKGROUND:

A number of patients with primary hypothyroidism have reduced health-related quality of life (HR-QoL), even with optimum thyroid hormone replacement therapy. This study aimed to assess the HR-QoL of patients with hypothyroidism under replacement therapy and identify its relationship with the symptom score and thyroid function status.

MATERIALS AND METHODS:

Using a cross-sectional study design, 175 hypothyroid patients under replacement therapy who visited the Endocrinology Outpatient Department of a tertiary care center were selected by convenient sampling technique. Data was collected using a structured data collection tool comprising, HR-QoL Short Form-36 questionnaire, and Zulewski’s clinical score. Inferential statistical analyses were performed using Mann–Whitney U, Kruskal–Wallis, and Karl–Pearson Correlation tests.

RESULTS:

The overall mean quality of life score was 44.22 ± 12.14, with a substantial decline in role functioning because of physical health. A significant negative correlation (P < 0.05) was found between HR-QoL and hypothyroidism symptom score. A significant association was observed between participants’ HR-QoL and their dosage of thyroxine supplement (P < 0.05,) but no association was found with thyroid function status.

CONCLUSION:

There was a substantial reduction in the quality of life of the patients despite being on thyroid replacement therapy and achieving euthyroid status. This underlines the importance of symptom reduction and hormone optimization to enhance the quality of life.
Impact of sodium-glucose cotransporter-2 inhibitors on kidney outcomes in type 2 diabetes: A tertiary center experience
Authors: Tawhari Mohammed H. , Aldahash Raed A. , Almutairi Faisal M. , Albogami Mahdi S. , Rokon Ahmad E. , Alsomali Faisal A. , Alanazi Khaled H. , Alshehri Abdulrahman A. , Almutairi Talal H. , Alharbi Abdulrahman D. , Alghamdi Rayan M. , Tawhari Ibrahim H. , Salih Salih A. Bin
Published: October 2023

BACKGROUND:

Diabetic nephropathy (DN) is a complication of chronic hyperglycemia associated with diabetes mellitus (DM). Several studies have demonstrated the positive impact of sodium-glucose cotransporter-2 (SGLT2) inhibitors on kidney outcomes. The objective of the study was to evaluate the effects of dapagliflozin, an SGLT2 inhibitor, on kidney outcomes in Saudi patients with type 2 DM.

MATERIALS AND METHODS:

Study included all Saudi patients with type 2 DM who visited our center from August 1, 2021, to July 31, 2022, and had been on dapagliflozin for at least 3 months. Data was abstracted through chart review for all patients included in the study. Paired t-test or Wilcoxon signed-rank test were used to compare the results before and after treatment for continuous variables and the McNemar test was used to compare the results for categorical data.

RESULTS:

Study included 184 Saudi patients with type 2 diabetes with a mean age of 61.32 years (SD=9.37). Dapagliflozin 10 mg/day significantly reduced hemoglobin A1C (HbA1C) from a mean (SD) of 9.00 to 8.40 (P < 0.001). Among a subgroup of patients with significant proteinuria (n = 83), dapagliflozin significantly reduced ACR from a median of 93.1 to 64.9 mg/g (P = 0.001). Following treatment, the estimated glomerular filtration rate improved from a mean of 69.83 to 71.68 mL/min and the mean arterial pressure (MAP) fell from 90.03 to 89.06 mmHg, both were not statistically significant. Despite a statistically insignificant increase in the episodes of urinary tract infections (UTIs), the hospitalization rate declined. No episodes of amputations or ketoacidosis occurred during the study period.

CONCLUSION:

SGLT2 inhibitors had beneficial effects among Saudi patients with type 2 diabetes by improving diabetic control and lowering proteinuria. Dapagliflozin did not result in significant harm, including UTIs, amputations, and ketoacidosis.
Spinal cord compression secondary to intraspinal extramedullary hematopoiesis
Authors: AlShamrani Foziah J. , AlMohish Noor M. , AlDawsari Fahad A. , AlObaid Jaafer J. , AlGhanimi Ibrahim A. , AlNahdi Abdullah A.
Published: October 2023

Extramedullary hematopoiesis (EMH) is a rare cause of spinal cord compression (SCC) occurring in various hematological illnesses such as myeloproliferative disorders, thalassemias, and various types of anemia. EMH represents the growth of blood cells outside the bone marrow. Common EMH locations include the spleen, liver, lymph nodes, and paravertebral regions. When this occurs in the spinal cord, the mass effect can compress the spinal cord and cause different neurological symptoms depending on the area of the spinal cord affected. This report describes a 27-year-old female with a known case of beta-thalassemia major, who presented with mid-thoracic back pain, weakness, and paresthesia at the T10 level. In addition, this report illustrates the importance of considering EMH in the differential diagnosis of SCC in patients with thalassemia.
Frequency and risk factors for headache disability: A population-based cross-sectional study in Egypt
Authors: Elsary Asmaa Y. , El-Sherbiny Naglaa A. , Eldessouki Randa
Published: October 2023

BACKGROUND:

A headache is a very common condition that can have a significant impact on one’s quality of life. It is one of the leading causes of years lived with disability worldwide. The objective of the study was to determine the prevalence of primary headache disability, its characteristics, risk factors and its impact on daily life.

MATERIALS AND METHODS:

A cross-sectional study was conducted in Fayoum governorate. The sample size was 1909 participants. A multistage random sample technique was used to select adults aged above 18 years. A self-structured questionnaire solicited information on sociodemographic characteristics, headache characteristics, and the headache disability index. SPSS v 22.0 was used for data analysis.

RESULTS:

Headaches caused complete disability in 19.5% of the study group, and 76.8% developed severe disability. Participants who reported that they had a headache more than once a week were; 44.5% had moderate pain and 40.2% had more intense pain. About 55% complained of attacks rather than continuous headache and were more likely to have a degree of complete disability, (P = 0.001). A statistically significant association was found between living in urban areas, working in professional occupations, complaining of severe headache in the form of an attack and seeking medical advice, with high scores of headache disability.

CONCLUSION:

Headache is a condition that affects the entire population in a way that causes high levels of disability. Good management is necessary for the reduction of the adverse effects of headaches on the health of the population. This should focus on raising public awareness by means of education and on the provision of basic healthcare.
Attention-deficit hyperactivity disorder in Egyptian medical students and how it relates to their academic performance
Authors: Shebl Eman M. , Abu Bakr Elsaid Noha M. , Hassan Hend A. , Kamal Doaa , Araby Eman
Published: October 2023

BACKGROUND:

The neurobehavioral disorder, known as attention-deficit hyperactivity disorder (ADHD), is characterized by impulsivity, hyperactivity, and a lack of focus. In addition, it is connected to poor academic performance. The purpose of this study was to determine the prevalence of ADHD and its effect on their academic performance among medical students.

MATERIALS AND METHODS:

This web-based cross-sectional study was conducted among medical students of four medical colleges during December 2021 and April 2022. Data was collected using a self-administered questionnaire comprising Wender Utah Rating Scale and adult ADHD Self-Report Scale [ASRS]. The link to Google Form survey was distributed to students through academic emails and WhatsApp. Data analyzed using SPSS; Chisquare test or Fisher’s exact test as appropriate, were used to determine statistical significance.

RESULTS:

A total of 990 students filled online questionnaire; 54.7% were females.. The estimated prevalence of ADHD in Egyptian medical students was 11%. Students who had childhood ADHD were significantly linked with the present ADHD (r = 0.54, P < 0.001). There was a negative correlation between the ASRS score for ADHD and students’ GPA (r = 0.2, P < 0.001). No statistically significant association was observed between ADHD and sex, type of university, and academic level. of the students.

CONCLUSION:

ADHD is prevalent among medical students. Since most of our students with adult ADHD also had preexisting childhood ADHD, it is crucial that the primary care services, especially school health services, have appropriate standards for the early identification and management of ADHD. Health authorities should conduct a comprehensive health education campaign to raise public awareness of ADHD and its risk factors, the clinical picture, and the burden.
NUTRIENT MANAGEMENT FOR RUBBER PLANTATION USING GOAL PROGRAMMING
Authors:   Universiti Teknologi MARA, BAHAROM NURIDAWATI , MOHD RAZALI NURUL AIN ,   Universiti Teknologi MARA
Published: October 2023

: Farm management must have proper planning on the resources such as fertiliser, labour, water and pesticide. Fertiliser provides healthy growth to the plant. It is one of the important resources the farm needs. Thus, the usage and allocation of fertilisers must be managed wisely to avoid wastage that incurs costs. This paper presents a case study which focuses on the nutrient management of rubber plantations. The main objective is to minimise the cost of chemical fertilisers used to plant rubber. Besides, the sub-objectives are to determine the best weight combination for fertilisers and calculate the mass per hectare of Nitrogen, Phosphorus, and Potassium needed for the rubber trees. The goal programming approach has been applied to solve the problem. In the model formulation, there are seven decision variables representing chemical fertilisers, while the constraints are the cost of chemical fertilisers and the requirement of the upper and the lower limit of nutrients in the chemical fertilisers. Results indicate that this method can meet all the goals expected. In conclusion, this study shows that goal programming is suitable for modelling plant input, cost and constraint of rubber farm management.
EFFECT OF LECTINS FROM SELECTED MALAYSIAN LOCAL FRUITS ON HUMAN BLOOD GROUP ANTIGENS
Authors:   Universiti Teknologi MARA, DZULKIPLI NUR AMIRA , HAIDA ZAINOL ,   Universiti Putra Malaysia, SHAHRUL ANUAR TENGKU ,   Universiti Teknologi MARA, KAMARUDIN EVANA ,   Universiti Teknologi MARA
Published: October 2023

Many individuals nowadays enjoy eating various types of local fruits without realising the impact of the fruits on blood group antigens. The fruit lectin can cause damage to the mucosal surface in the gut when the lectin is incompatible with blood group antigens. Therefore, the present study aims to determine the in vitro plant lectins reaction from the extraction of Artocarpus heterophyllus Lam. (Jackfruit), Artocarpus altilis (Parkinson ex F.A.Zorn), Fosberg (Breadfruit), Carica papaya (Papaya), Manilkara zapota (L.) P. Royen (Sapota) and Salacca zalacca (Gaertn.) Voss (Salak) with specific human blood group antigens. The local fruit extract was tested with human blood groups A and B for hemagglutination assay. The agglutination titer of the hemagglutination assay results was then evaluated. The total of 3+ reactions for jackfruit was 11%, salak (4%) and papaya(6%) for both blood groups. The breadfruit shows the highest titer reaction, 19% against A and 16% against B. In comparison, 19% was against A for sapota but only 4% towards group B. The highest titer value of erythrocytes by crude lectins of selected local fruits on blood groups A and B was given by extraction of sapota while for blood group B on papaya. This discovery proves that plant lectins from five varieties of local fruits react with blood group antigens and that comparable interactions may occur at the mucosal surface of the gut in susceptible individuals, causing significant inflammation, swelling, and ulceration. The mechanism and effect of fruit lectin on human blood types should be investigated further.