bluuebunny/crossref_metadata_2025 huggingface dataset:
The Historical Seismicity of the Puebla-Tlaxcala Region (Trans-Mexican Volcanic Belt) during Early Novohispanic Times (A.D. 1542–1740) and the Structure of the Tlaxcala-Huamantla Half-Graben
Authors: Suter Max
Published: September 2021

This article documents earthquake intensity observations during early novohispanic times (A.D. 1542–1740) in the Puebla-Tlaxcala region (central Mexico), mostly based on Nahuatl-language historical annals and chronicles, and includes (as a supplement) a descriptive earthquake catalog for this period. Although it is difficult to assign intensities from fragmentary accounts, the largest shocks (A.D. 1582 and 1711) caused damage through the entire region. Earthquake ground shaking in the study area, located within the active volcanic arc crossing central Mexico, can result from intraslab normal faulting in the subducted Cocos plate, subduction interface thrust earthquakes, motion on the faults of the intra-arc Tlaxcala-Huamantla half-graben, as well as extension accommodated through magmatic injection. Most of the historical sources describe earthquakes felt only locally and sometimes report prolonged sequences of shocks, which is indicative of magmatic dike-induced earthquakes or else resulted from motion on the faults of the Tlaxcala-Huamantla half-graben. This structure, ∼70 km long and 15–20 km wide, is the only major tectonic depression in the eastern part of the trans-Mexican volcanic belt. It is filled by a volcano-sedimentary sequence, up to 400 m thick, of unknown but likely Pliocene age. The half-graben is bound in the north by an east–west-striking and south-dipping normal fault system, which is morphologically most pronounced near the town of Tlaxcala where the footwall uplift reaches a maximum of 350 m. The fault array is likely to be active; it vertically displaces Quaternary Totolqueme volcano.
Realidade Aumentada e a Cyberformação de uma Professora de Matemática: Pontos Críticos de Funções de Duas Variáveis
Authors: Schuster Paula Etiele Sarmento , Rosa Maurício
Published: September 2021

ResumoEssa pesquisa investiga como uma professora constitui conhecimento matemático quando está estudando pontos críticos com gráficos produzidos em Realidade Aumentada (RA). Esta é uma pesquisa qualitativa que possui seu foco no processo formativo experienciado pela professora/pesquisadora em termos de Cyberformação, pois ela é a sujeito de sua própria investigação. Assim, a autoanálise em termos metodológicos concentra-se em estudos individuais da professora/pesquisadora, em um movimento rigoroso de gravação de dados, afastamento desses e análise, compreendendo que a constituição de conhecimento se dá “Com-Holográficos”, pois se refere ao ato de ser-com-Tecnologias Digitais (TD) de RA, no qual a professora/pesquisadora ao estar no contexto de RA se pluga com essa tecnologia pela materialidade que a expressa, possibilitando uma mudança de perspectiva matemática, sustentando por meio da TD expressões de aspectos matemáticos não vistos anteriormente. Logo, indicamos que a constituição do conhecimento matemático de uma professora em Cyberformação com TD de RA se dá por meio de interações com o contexto de RA, de forma indissociável e como fluxos matemáticos, pedagógicos e tecnológicos que se entrecruzam. A pesquisa contribui para a compreensão do processo de constituição do conhecimento matemático da professora e isso permite, em termos de formação, que professores entendam-se no processo para projetar/planejar suas aulas de matemática com o recurso de RA.
Palavras-chave: Educação Matemática. Formação de Professores. Autoanálise. Gráficos. Holográficos.
AbstractThis research investigates how a teacher constitutes mathematical knowledge when she is studying critical points through graphics produced in an Augmented Reality (AR) environment. The research is qualitative, whose focus is on the formative process experienced by the teacher/researcher in terms of Cybereducation, because she is the subject of her own research. The production of data was stored through audiovisual recordings which, in this article, focus on individual studies by the teacher/researcher. Thus, we understand that the constitution of knowledge is “With-Holographics”, because it refers to the act of being-with-Digital Technologies (DT) of AR, in which the teacher/researcher being in the context created by the RA connects with this technology due to the materiality it expresses. Thus, allowing a change in teacher’s perspective and an alteration in her mathematical performance, supporting through DT expressions of mathematical aspects not previously seen. Therefore, this research indicates that the constitution of the mathematical knowledge of a teacher in Cybereducation with DT of AR occurs inseparably through interactions with the context and as mathematical, pedagogical and technological flows that intersect.
Keywords: Mathematics Education. Teachers’ training. Graphics. Holographics.
Modelagem Matemática e Aprendizagem Significativa: uma Relação Subjacente
Authors: Souza Jerson Sandro Santos de
Published: September 2021

ResumoO presente artigo propõe-se a apresentar algumas reflexões, embasadas em uma pesquisa bibliográfica, sobre a modelagem matemática como metodologia de ensino. Discutem-se os pressupostos, as características, as etapas e as possibilidades de organização curricular de atividades que são pautadas nessa alternativa metodológica. Destaca-se o papel da teoria da aprendizagem significativa na fundamentação e na defesa da modelagem matemática como proposta de ensino. Efetua-se um confronto das várias perspectivas oriundas dos textos científicos selecionados para estudo e análise, de modo a buscar convergências que evidenciem o potencial da modelagem matemática para: (1) favorecer a utilização pedagógica dos conhecimentos prévios dos aprendizes e (2) instigar o comprometimento deles com as situações de aprendizagem. Conclui-se o trabalho apresentando argumentos que caracterizam essa metodologia de ensino como favorecedora da aprendizagem significativa de conteúdos matemáticos, com o intuito de disponibilizar aos professores de matemática subsídios teóricos que os auxiliem na tomada de consciência do processo de interação cognitiva, entre as novas informações e os conhecimentos prévios do educando, subjacente às atividades de modelagem matemática.
Palavras-chave: Modelagem Matemática. Aprendizagem Significativa. Educação Matemática.
AbstractThis article presents some reflections based on a bibliographic research on mathematical modeling as a teaching methodology. The assumptions, characteristics, stages, and possibilities of curricular organization of activities based on this methodological alternative are discussed. The role of significant learning theory in the foundation and defense of mathematical modeling as a teaching proposal is highlighted. A comparison of the various perspectives from the scientific texts selected for study and analysis is made to find convergences that highlight the potential of mathematical modeling to: (1) favor the pedagogical use of the students' prior knowledge and (2) instigate their commitment to learning situations. The work is concluded with arguments that characterize this teaching methodology as fostering significant learning of mathematical content, to provide mathematics teachers with theoretical subsidies that help them to become aware of the cognitive interaction process, among the new information and the students' previous knowledge that underlies the mathematical modeling activities.
Keywords: Mathematical Modeling. Meaningful Learning. Mathematics Education.
Elongated Styloid Process in Panoramic Radiographs
Authors: Carvalho Pedro Luiz de , Valente Lorena Guimarães , Freitas Larissa Victória Barbosa , Medeiros João Marcelo Ferreira de , Lemos André Alencar de , Lobato Stephany Araujo da Silva
Published: September 2021

AbstractThe aim of this study is to evaluate the prevalence of the elongated styloid process in panoramic radiographic exams, in a subpopulation of northern Brazil in relation to age, sex and side. Panoramic radiographs were selected, and the apparent size of the styloid process was measured from the point where the styloid leaves the tympanic plate to the tip of the process. The data were analyzed using chi-square tests and variance analysis with a 5% significance level. Approximately 30% of the elongated styloid process was observed in patients between 18 to 35 years. Of the styloid processes that measured more than 30 mm (elongated), 764 styloid processes (81%) showed Type I elongation pattern, 97 styloid processes (10%) showed Type II calcification patterns, and 85 styloid processes (9%) showed Type III calcification patterns. The prevalence of the elongated styloid process was high, and no statistically significant correlation was found between the presence of the elongated styloid process and the variables studied.Keywords: Bone Lengthening. Osteogenesis. Radiography, Panoramic. ResumoO objetivo deste estudo é avaliar a prevalência do processo estilóide alongado em exames radiográficos panorâmicos, em uma subpopulação do norte do Brasil em relação à idade, sexo e lado. Radiografias panorâmicas foram selecionadas, e tamanho aparente do processo estilóide foi medido a partir do ponto em que o estilóide deixa a placa timpânica até a ponta do processo. Os dados foram analisados por meio de testes qui-quadrado e análise de variância com nível de significância de 5%. Aproximadamente 73% do processo estilóide alongado foi observado em pacientes entre 18 e 53 anos (p <0,05). Dos processos estilóides que mediram mais de 30 mm (alongados), 543 processos estiloide (82,9%) mostraram padrão de alongamento do Tipo I, 33 processos estiloide (5,03%) mostraram padrões de calcificação do Tipo II, e 79 processos estilóide (12,06%) mostraram padrões de calcificação do Tipo III. A prevalência do processo estilóide alongado foi alta e não foi encontrada correlação estatisticamente significante entre a presença do processo estilóide alongado e as variáveis estudadas.Palavras-chave: Alongamento Ósseo. Osteogênese. Radiografia Panorâmica.
Therapeutic Group of The Elderly: Knowledge About Diabetes Mellitus and Arterial Hypertension
Authors: Santos Thalita Araújo dos , Alves Murilo Silva , Campos Thais Silva Pereira , Nascimento Mônica Pinchemel
Published: September 2021

AbstractControl and the care are continuous challenges in the treatment of chronic diseases, and it is necessary to know the users’ realities in order to seek intervention alternatives. The study aimed to identify the participants’ knowledge in a therapeutic group of the elderly regarding diabetes mellitus and systemic arterial hypertension. Descriptive and exploratory study with a qualitative approach, conducted with 12 elderly in the therapeutic group. Semi-structured interviews were used as data collection technique. Data were transcribed and analyzed using the content analysis technique. In the results the category about the participants’ knowledge on the diseases emerged, namely: etiological factors; main signs, symptoms and complications; drug therapy; use of herbal medicines; food control; lifestyle and regular follow-up at the health unit. It was concluded that the participants have knowledge about the diseases; however, they cultivate habits that can trigger complications. Knowledge from experience should not be neglected, but should be directed towards achieving the goal of the therapeutic group, helping to improve the understanding of the elderly about their disease (s) and stimulating self-care.Keywords: Therapeutics. Health Education. Chronic Disease. Self-Care. ResumoO controle e o cuidado são desafios contínuos na terapêutica das doenças crônicas, sendo necessário conhecer as realidades dos usuários para buscar alternativas de intervenção. O estudo objetivou identificar o conhecimento dos participantes de um grupo terapêutico de idosos em relação ao diabetes mellitus e hipertensão arterial sistêmica. Estudo descritivo e exploratório, com abordagem qualitativa dos dados. A pesquisa foi realizada no munícipio de Itabuna na Bahia, na Unidade de Saúde da Família Simão Fitterman, no ano de 2014. Participaram do estudo 12 idosos do Sistema de Cadastramento e Acompanhamento de Hipertensos e Diabéticos (HIPERDIA), que participaram das reuniões do grupo terapêutico de idosos. A técnica utilizada para coleta de dados foi a entrevista com roteiro semiestruturado, realizadas nas reuniões do grupo terapêutico da unidade referida. O instrumento de coleta foi composto por dados sócio demográficos, conceitos e fatores desencadeantes das doenças estudadas, tratamento não farmacológico, complicações, prevenção e noções de autocuidado. Concluiu-se que os participantes possuem conhecimento sobre as doenças, entretanto cultivam hábitos que podem desencadear complicações. O conhecimento advindo da experiência, não deve ser negligenciado, mas direcionado ao alcance do objetivo do grupo terapêutico, contribuindo na melhoria do entendimento dos idosos sobre sua (s) doença (s), e estimulando o autocuidado.Palavras-chave: Terapêutica. Educação em Saúde. Doença Crônica. Autocuidado.
Os Reflexos do Novo Código de Processo Civil na Exceção de Pré-Executividade em Matéria Tributária
Authors: Alves Mickael Ferreira
Published: September 2021

ResumoCom a publicação no ano de 2015 do Novo Código de Processo Civil serão analisados ao longo deste trabalho acadêmico seus reflexos no instituto da exceção de pré-executividade em matéria tributária. Sabe-se que ela é um importante incidente processual de defesa que o ordenamento jurídico do Brasil permite que seja manuseada quando determinada pessoa está sendo executada em face de uma cobrança equivocada quando existe uma Certidão de Dívida Ativa. Também serão analisadas algumas questões pontuais da execução fiscal que sofreram impactos devido a nova legislação processual civil, uma vez que esta é fonte complementar ou até mesmo pode ser invocada como norma principal para os procedimentos administrativos tributários. E por último serão debatidos aspectos relacionados a diferenciação entre a exceção de pré-executividade e os embargos, em que em ambas as situações estão sendo discutidos créditos tributários, em virtude das inúmeras ações tributárias movidas diariamente, inclusive em sede de execuções fiscais conforme disposições na Lei nº 6.830/1980.

Palavras-chave: Novo Código de Processo Civil. Exceção de Pré-Executividade. Execução Fiscal. Embargos.

AbstractWith the publication in 2015 of the New Code of Civil Procedure, its reflexes in the institute of the exception of pre-execution in tax matters will be analyzed throughout this academic work. It is known that it is an important procedural defense incident that the Brazilian legal system allows it to be handled when a certain person is being executed in the face of a mistaken collection when there is an Active Debt Certificate. Some specific issues of tax enforcement that have been impacted by the new civil procedural legislation will also be analyzed, since this is a complementary source or may even be invoked as the main rule for administrative tax procedures. Finally, aspects related to the differentiation between the pre-execution exception and the embargoes will be discussed, in which in both situations tax credits are being discussed, due to the numerous tax lawsuits filed daily, including in the case of tax foreclosures as provided in the Law No. 6,830 / 1980.

Keywords: New Code of Civil Procedure. Pre-execution exception. Tax Enforcement. Embargoes.
EC 103 e a Violação de uma Conquista Social: a Inconstitucionalidade do Restabelecimento da Idade Mínima para Aposentadoria Especial
Authors: Gonçalves da Silva Marcelo
Published: September 2021

ResumoA Declaração Universal dos Direitos do Homem fundou as bases dos princípios de proteção à dignidade da pessoa humana. Dentre esses princípios gerais, está a ideia de proibição de instituição de normas ou políticas públicas que impliquem em retrocesso nas garantias fundamentais. A partir da premissa de que o Brasil é signatário da DUDH, o presente trabalho tenta responder ao seguinte questionamento: A Emenda Constitucional nº 103 ao modificar e reintroduzir no ordenamento jurídico a idade mínima como requisito de admissibilidade para a concessão de aposentadoria especial, implicou em retrocesso social no âmbito do direito previdenciário? Seria a Emenda inconstitucional?

Palavras-chave: Aposentadoria Especial. Reforma da Previdência. Proibição do Retrocesso Social.

AbstractThe Universal Declaration of Human Rights laid the foundations for the principles of protection of the dignity of the human person. Among these general principles, there is the idea of prohibiting the establishment of rules or public policies that imply a setback in fundamental guarantees. Based on the premise that Brazil is a signatory to UDHR, the present work tries to answer the following question: Constitutional Amendment 103, by modifying and reintroducing the minimum age as an admissibility requirement for the granting of special retirement, implied in social setback within the scope of social security law? Was the Amendment unconstitutional?

Keywords: Special Retirement. Pension Reform. Prohibition of Social Setback
A Tutela Jurisdicional na Transmissão Post Mortem de Bens Digitais
Authors: Fazio Iracema , Gonçalves Michele
Published: September 2021

ResumoA era digital é uma verdadeira revolução no acesso à informação e toda essa transformação vem influenciando o modo como as pessoas estão se comunicando e interagindo entre elas. Devido a esse avanço tecnológico o acervo digital passa a ser relevante no âmbito jurídico sendo reconhecido como um bem de valor econômico e sentimental. A herança digital é uma realidade e o Direito precisa avançar lado a lado para alcançar as grandes mudanças trazidas no meio social, implicando em definir o que será feito com o acervo digital após a morte do titular de contas em plataformas digitais de comunicação e interação social. Logo, não se tem uma lei específica que trate desse assunto. Destarte, o presente trabalho teve o objetivo de analisar a destinação dos bens digitais quando o titular não declara em vida a sua vontade. Enfim, foi analisado o tradicional instituto sucessão, confrontando-se a sua adequação à transmissão de bens digitais após a morte quando não existir testamento, ensejando assim a sua total proteção.

Palavras-chave: Bens Digitais. Transmissão Mortis Causa. Legado Digital. Herança Digital.

AbstractThe digital age is a real revolution in the access to information and all this transformation has been influencing the way people are communicating and interacting with each other. Due to this technological advancement, the digital collection becomes relevant in the legal sphere, being recognized as a good of economic and sentimental value. The digital inheritance is a reality and the Law needs to advance side by side to achieve the great changes brought about in the social environment, implying in defining what will be done with the digital collection after the death of the account holder in digital communication and social interaction platforms . Therefore, there is no specific law dealing with this matter. Thus, the present study aimed to analyze the destination of digital goods when the holder does not declare his will alive. Finally, the traditional succession institute was analyzed, comparing its adequacy to the transmission of digital goods after death when there is no will, thus giving rise to its total protection.

Keywords: Digital Goods. Mortis Cause Transmission. Digital Legacy. Digital Inheritance.
COMPARATIVE STUDY OF FUNCTIONALLY GRADED MATERIAL MODELS FOR STRUCTURAL DESIGN OF THIN-WALLED BLADES
Authors: FARSADİ Touraj
Published: September 2021

In this work, three theories of Functionally Graded Material (FGM) are compared for structural dynamic and static performance of the thin-walled rotating blade. For this purpose, the pretwisted Thin Wall Rotating Beam (TWRB) with a fixed angular velocity is considered. The goal is to find the desirable FG model with improved free vibration, static deformation, and buckling behavior of the FGM blades. The Euler–Lagrange equations of motion of the energetic system are extracted utilizing Hamilton's principle. The Extended Galerkin`s Method (EGM) is used to solve the governing equation of motions. The effects of some parameters, such as the FGM models, angular velocity, and pretwist angle on the mechanical behavior of the FG beams are studied.
Generalized Lindley Family with application on Wind Speed Data
Authors: Cakmakyapan Selen , Ozel Gamze
Published: September 2021

In this study we introduce a new extended class of continuous distributions named generalized Lindley family of distributions. Some properties of the new generator, including ordinary moments, quantile, generating and entropy functions, which hold for any baseline model, are presented. The method of maximum likelihood is used for estimating the model parameters. The flexibility of the new family of distributions is shown via an application on the wind speed data set. The results shows that the proposed family is better than well-known distributions including log-logistic, Burr, Dagum, Frechet, Pearson, Dagum, Lindley, Weibull and exponential distributions.
Immunophenotyping of non-Hodgkin’s lymphoma by flowcytometry on fine needle aspiration
Authors: Kumar Sanjay , Verma Meena , Devi Pinki , Kataria Sant P. , Sen Rajeev
Published: September 2021

Background: Lymphoma represents one of the major health problems all over the world. Flow cytometry (FCM) can be used on fine-needle aspiration cytology (FNAC) from lymph node as an ancillary technique. Aim of the study was to assess the utility of flowcytometry (FCM) in diagnosis and differentiation of reactive hyperplasia and non-Hodgkin’s lymphoma (NHL) on FNAC.Methods: The study was carried out on 50 cases, 25 each of reactive hyperplasia and suspicious or confirmed NHL on FNAC. FCI was performed with a complete panel of antibodies on FACS Canto II FCM.Results: All 25 cases of reactive hyperplasia on FNAC were polyclonal on FCM. FCM could be performed in 22 cases (88%) out of 25 suspicious NHL and in three cases the material was inadequate on aspirate. Out of 22 cases of NHL on FNAC 17 cases (77.30%) were diagnosed as B-NHL on FCM. Light chain restriction was demonstrated in 15/17 cases. With the help of FCI, 6 cases were diagnosed as small cell lymphocytic lymphoma, one case as mantle cell lymphoma, one case as follicular lymphoma, and 9 cases as B-NHL-NOS. Histopathology diagnosis was available in nine cases and were in concordance to FCM. Sensitivity of combined FNAC and FCM in sub-classification was 77.30% (17/22). Four cases showed discordance between FNAC and FCM.Conclusion: We concluded that FCM enhances the diagnostic ability of FNAC, playing a crucial role in a rapid and accurate differential diagnosis between reactive hyperplasia, B-NHL and T-NHL.
Thyroid dysfunction in patients of depression and anxiety and response to therapy
Authors: . Harsha , . Amandeep , Jeenger Jitendra , Ahlawat R.S , Subberwal Manju
Published: September 2021

Background: Depression and anxiety are the most common psychiatric presentation in thyroid dysfunction. Aim of the study was to determine the thyroid profile in patients with depressive and anxiety symptoms and to determine the change in symptoms with correction of thyroid profile.Methods: This longitudinal observational study was conducted in patients presented with depressive or anxiety symptoms who visited the psychiatry out patient department (OPD) first time. Two groups were made based on the serum thyroid profile. First group, (n=27) was patients with depression and anxiety with hypothyroidism (experimental group) and second was (n=123) without hypothyroidism (control group). Experimental group, (n=27) was then exposed to thyroxine, 15 patients came for first follow up and 11 patients came for second follow up.Results: The 63% of patients in the experimental group and 62.6% of patients in the control group were of female gender, 66.7% and 33.3% of patients in the experimental group had depressive disorder and anxiety disorder respectively. TSH level of 11 patients of experimental group had significantly less value in first follow up compared to entry point (p=0.002). Generalized anxiety disorder (GAD) 7 scores were significantly lower in first and second follow up than that of the entry point in 11 patients of experimental group (p=0.008, 0.016 respectively).Conclusions: Many patients of the clinical diagnosis of depression (17.6%) and clinical diagnosis of anxiety (18.75%) had hypothyroidism during the first visit to the psychiatry OPD. There was significant reduction in the hypothyroid patients of the serum thyroid stimulating hormone (TSH) value and anxiety scores during the follow up after treatment with levothyroxine.
Anatomical study on variable disposition of structures in the renal hilum
Authors: Dawani Pooja , Mehta Vandana , Kaur Amandeep
Published: September 2021

Background: The hilum is a deep vertical fissure present anteromedially in the kidney, and contains renal vessels and pelvis. Due to advancements in imaging techniques; nephron sparing surgeries like laparoscopic partial nephrectomy have become more common. In these procedures, only specific branch of renal artery, and tributary of renal vein are ligated in the renal hilum. This requires adequate skill of the surgeon as the structures are crowded in the renal hilum. The knowledge of arrangement of renal hilar structures is also important for radiologists to correctly interpret renal angiograms and other radiological scans.Methods: The present study was conducted in the department of anatomy, Vardhman Mahavir medical college, New Delhi on 64 kidneys derived from embalmed human cadavers. The renal hilum was dissected and the sequence of structures from anterior to posterior direction was noted.Results: The kidneys were classified in 6 patterns, with the classical pattern (renal vein, artery and pelvis from anterior to posterior) observed in 37.5% cases only. Remaining 62.5% cases exhibited variations, of which the pattern 2 (V-A1-P-A2) was seen in maximum cases (26.5%).Conclusions: The classical pattern described in anatomical textbooks is not the only pattern of arrangement of renal hilar structures. Instead, variant patterns are commonly encountered. The present study attempts to elucidate the variant anatomy of the renal hilar region to help radiologists and surgeons in proper diagnosis and treatment.
Histogenesis of developing human fetal stomach
Authors: Munawara Rafika , Kapoor Kanchan , Sharma Mahesh K. , Goel Poonam , Chaudhary Poonam
Published: September 2021

Background: Human stomach is a highly specialised organ with distinct types of glands and microscopic features for its physiological activity. This study aimed to assess the chronological order in the development of different layers and the cyto-differentiation of various glandular cells in 50 fetuses from 12 weeks of gestation till term.Methods: Tissue was taken from cardiac, body and pylorus to investigate with light and confocal microscopy.Results: The gastric gland formation began as an indentation of the surface epithelium, gastric pit and simultaneous development of glandular buds in the mucosa. The pyloric glands preceded the development of cardiac and gastric glands showing retro cranial sequence of development. In contrast, the muscularis externa showed the classical craniocaudal model of development with oblique layer in the cardiac region by 14 weeks and body region by 16 weeks of gestation. The parietal cells were well developed by 12 weeks and the chief cells by 16 weeks with prominent secretory granules. In addition, the pyloric sphincter was a clearly defined anatomical sphincter developed by whorling of the inner circular layer at the pyloric end of the stomach evident from 12 weeks of gestation.Conclusions: The results showed that the significant cellular morphogenesis occurred between 12-20 weeks of gestation. This aggregated data will serve as a catalyst in the understanding intricacy of embryogenesis, pathogenesis tracing of congenital anomalies and invention of new drugs.
Efficacy and safety of paclitaxel drug-eluting balloons in femoropopliteal artery disease: a prospective observational study
Authors: Hidayathulla Mohammed , . Nagesh
Published: September 2021

Background: The femoropopliteal artery is most frequently involved artery in peripheral artery disease. To treat femoropopliteal artery disease (FPAD), various revascularization approaches have been available such as simple balloon angioplasty, debulking techniques, stent implantation, and recently the drug-eluting balloon (DEBs). Nowadays, the paclitaxel DEBs have been emerged to treat FPAD with promising outcomes. We therefore evaluate the efficacy and safety of paclitaxel DEBs in patients with lower limb FPAD.Methods: In total, 25 patients with FPAD were enrolled in the study. All patients underwent peripheral angioplasty using paclitaxel DEBs via antegrade femoral approach or contralateral femoral artery using crossover sheath. Demographics, risk factors, clinical characteristics, and pre- and post-procedure VascuQol-6 score were noted.Results: Out of 25 patients, the majority of patients (52%) were in the 6th decades of life. The incidence of FPAD was most common in patients with an O +ve blood group. The common risk factors of FPAD, include smoking (88%), diabetes (68%), dyslipidemia (68%), and hypertension (64%). Rest pain (64%) and ulcer (32%) were the most frequent clinical symptoms of FPAD. The percent stenosis was 100% in 17 patients, and 70-99% in 32 patients. A statistically significant difference was found in VascuQol-6 score between pre and post peripheral angioplasty (p<0.001).Conclusions: We have concluded that the paclitaxel DEBs are safe and efficacious in treating FPAD. Authors recommend that clinician should educate FPAD patients pertaining to modification of controllable risk factors such as cessation of smoking, unhealthy diet, sedentary lifestyle, high blood pressure, and high blood sugar.
Clinicopathological features of uterine fibroid in a tertiary care teaching hospital
Authors: Singh Priyanka , Mirza Sadaf , Trivedi Pawan , Singh Tanya
Published: September 2021

Background: Uterine fibroids are one of the common benign tumours of uterus seen in women of reproductive age group. These constitute 5-10% of all these tumours.Methods: Total of 56 patients above 21 years of age reporting to OPD or emergency of gynaecology department of the Mayo Institute and found to be suffering from leiomyoma of the uterus were included in the study.Results: Clinical manifestations seen in cases with uterine fibroid. Menstrual irregularities were seen in 69.64% of cases. 39.28% suffered from abdominal pain and infertility was seen in 10.71% cases. Endometrial changes during the histopathological examination. In 71.42% of cases, proliferative endometrium was found. Secretory endometrium was seen in 14.28% and atrophic in 8.92%.  Conclusions: Leiomyoma is the most well-known uterine tumor seen in gynecological practice. Feminine aggravations are the commonest manifestation of which menorrhagia is the most well-known show. The vast majority of these tumors are intramural in area. The most widely recognized example of endometrium noticed is proliferative. Hyaline degeneration, myxoid degeneration and cystic degeneration are the normal auxiliary changes found in fibroid uterus.
Awareness, knowledge, and barriers to low vision services among eye care practitioners in Maharashtra
Authors: Dilkash Mantasha , Banerjee Susmita , Dubey Gaurav , Kumari Vibha , Kumari Ragni , Gupta Deepak
Published: September 2021

Background: Visual impairment is an important global health issue. 90% of the world's blind people reside in underdeveloped countries. According to population-based statistics, India has the most visually impaired persons (about 9 million). The world health organization (WHO) estimates that 285 million people worldwide are blind or have impaired eyesight. Hence it is necessary to have information about knowledge and awareness of low vision services among eye care practitioners to improve the low vision care in the world.Methods: A prospective cross-sectional survey was done at Dr. D. Y. Patil medical college and research centre (Ophthalmology department) between eye care practitioners practicing in Maharashtra, India, through a pre-tested standardized questionnaire.Results: In this study, retinal problems (76.1%) and glaucoma (11.1%) were reported as two major causes of low vision. Provision of best spectacle correction, rehabilitation, and referral to other hospitals/specialized centers was considered by 31.7%, 4.7%, and 23.8% practitioners, respectively. Magnifiers were found to be the most commonly prescribed low vision device (73%).Conclusions: Low eyesight is a big health issue all over the world. Low vision services assist patients in improving and maintain their functional vision. It also enhances the quality of life and everyday living skills. There are many barriers and a lack of understanding about low vision services. They assess eye care providers' awareness, knowledge, and challenges to poor vision services in Maharashtra. This study results showed a lack of awareness (33.3%) and training (33.3%) among the practitioners were the significant barriers restricting low vision services.
Male breast carcinoma: study from a tertiary care centre in North India
Authors: Kataria Sant Prakash , Devi Pinki , Kumar Sanjay , Singh Gajender , Chhabra Sonia , Jain Promil , Singh Sunita
Published: September 2021

Male breast cancer is a rare malignancy. In recent years a rise in the number of male breast cancer cases has been seen. Due to rarity of the disease the reporting of such cases is important to support the present status of this aggressive malignancy. Fine needle aspiration method for breast FNA is an invasive procedure but can provide a diagnosis without causing much morbidity to the patient. Hence, objective of the present work was to report and study the clinico-pathological behaviour of male breast cancer at a tertiary care centre in North India using fine needle aspiration-based diagnosis. Present study includes cytologically diagnosed male breast carcinoma cases over a period of 4 years. Eleven cases of male breast cancer were identified. Median age of presentation was 57years. All the eleven patients presented with main complaint of swelling in breast (100%), nine (81.8%) patients presenting in left breast and two (18.2%) in right breast. Four cases presented with nipple retraction. Also, axillary lymphadenopathy was evident in four (34.4%) patients. Male breast cancer an aggressive disease having distinct clinical presentation, can be cytologically diagnosed easily as other benign conditions are rare in male breast.
Double plate fixation technique for prolonged non-weight baring induced severe disuse atrophy in hypertrophic non-union of left femur: a case report
Authors: Dharmayuda Cokorda Gde Oka , Pemayun Cokorda Krishna Dalem , Trisaputra I. Ketut Wahyu , Afandi Richard , Mahadhana Sri , Putra Made Winatra Satya , Wiguna I. Gusti Ngurah Indra
Published: September 2021

Hypertrophic non-union differs from other forms of non-union due to its the biological capacity for union, in which it results from mechanical instability, namely the implant being unable to provide long lasting stability. Non-weight bearing state will cause bone resorption and further bone-mass loss with worsened prognosis. A 64-year-old female patient presented with inability to walk normally resulting from prolonged non-weight bearing-induced severe disuse atrophy in hypertrophic non-union of the left femur. Implant revision and osteoclasis were performed, followed by an urgent implant revision a few days later using double plating technique by placing the second plate on the anterior part of the femur. Post-operative X-ray showed satisfactory two implants placement and physiological alignment was achieved. Inappropriate initial treatment on the acute phase has led to prolonged non weight bearing state, resulting in disuse atrophy of the bone. This should have been predicted during the first implant revision on drilling both cortices, since even the slightest distraction resulted in severe consequences. Double plating system leads to absolute stability so acceptable union can be achieved. Initial treatment on acute setting of fracture should maximize every effort to restore proper functional state and should promote early mobilization. Any maltreatment will result in prolonged morbidity and will require more reconstruction effort with less than normal end result. Robust fixation and alignment can be achieved with double plating system; however, prolonged immobilization should be anticipated.
Sister Mary Joseph nodule due to carcinosarcoma
Authors: Salgado Adame Israel
Published: September 2021

The Sister Mary Joseph Nodule is an eponymous term which describes a palpable umbilical nodule occurring as a result of metastasis of an intra-abdominal or pelvic malignancy. In approximately 50% of cases, this sign is associated with gastrointestinal malignancies. These include gastric, colonic and pancreatic (mainly body and tail) carcinoma. Gastrointestinal malignancy is found in 52% of the metastatic cases and gynecologic and genitourinary origin in 28%, with gastric and ovarian cancers being the most common. The next report is about a 62 year-old woman whose was referred to the surgery department due a painful mass on the abdominal wall that has appeared 3 months before as a fast-growing, with suspicious diagnosis of strangulated umbilical hernia.
Anaesthesia management in a patient of interstitial lung disease with pulmonary hypertension for emergency laparotomy
Authors: Parekh Hardik A. , Latkar Prajakta D. , Nalavade Ameya G. , Mehta Hemant H.
Published: September 2021

We report the anesthaetic management of a patient with known case of interstitial lung disease (ILD) with profound fibrotic changes and bullae with severe pulmonary hypertension (PH) posted for exploratory laparotomy for cecal volvulus. Emergency exploratory laparotomy was done under combined spinal-epidural anaesthesia to avoid intra-operative and post-operative pulmonary complications associated with general anaesthesia and mechanical ventilation.
The study of role of mammography and fine needle aspiration cytology in the diagnosis of early breast carcinoma
Authors: Stephen Biju , V. V. Manoj
Published: September 2021

Background: Epidemiologically breast cancer is the most common form of cancer among women. Prevalence rate of breast cancer is higher in urban women of middle age group. Early diagnosis of breast carcinoma is required for effective treatment else it may lead to mortality if advanced to stage 3 or 4. At present, there are different diagnosis modalities for early stage breast carcinoma. Currently triple diagnostic assessment including clinical, radiological and pathological examinations with 99% sensitivity is used in diagnosing all palpable breast lumps. The aim of the study was to determine the sensitivity and specificity of mammogram and Fine needle aspiration cytology (FNAC) in diagnosing breast cancer.Methods: A cross sectional study was conducted on total 80 female patients above 30 years of age with a palpable breast lump. Patients were sent for mammography, fine needle aspiration cytology and histopathological examinations. Results of mammography, FNAC and HPR were compared and statistically correlated.Results: Sensitivity of mammogram diagnosis was observed to be 92.857%, specificity as 86.842%, positive and negative predictive values to be 88.636% and 91.667% respectively. Therefore, current study findings revealed accuracy of mammogram to be 90.000%. Sensitivity of FNAC diagnosis was observed to be 92.857% and specificity to be 100%, positive and negative predictive values were observed to be 100% and 92.683% respectively. The study results revealed that FNAC diagnosis exhibited accuracy of 96.250%.Conclusions: Current investigation findings revealed that FNAC has more accuracy in predicting breast cancer than mammogram. Also, it was concluded that there is a significant association between FNAC and mammogram diagnosis.
Hybrid digitally guided hemorrhoidal artery ligation with laser hemorrhoidoplasty: our experience with a new approach to hemorrhoidal disease
Authors: De Anushtup , Roy Prabal
Published: September 2021

Background: Minimally invasive surgeries are currently advocated in hemorrhoidal disease for better patient satisfaction. The aim of our study is to assess the feasibility, efficacy and safety of a hybrid hemorrhoidal artery ligation under digital guidance with laser hemorrhoidoplasty (Hybrid HAL-LHP) in patients with grade II to III hemorrhoids.Methods: In a prospective clinical study, hybrid HAL-LHP was performed in 75 consecutive patients between May 2018 to February 2020 with grade II to III hemorrhoids. Hemorrhoidal artery ligation was done by digital palpation followed by laser hemorrhoidoplasty using a 1470 nm diode laser. Postoperative pain and bleeding, return to work, resolution of symptoms, recurrence and reoperation was assessed on a follow up upto 1 year.Results: Postoperative pain assessed on Visual analog score (VAS) was 2.82 on 3rd day, 1.28 on 7th day and till 14th day was extremely low. None of the patients had significant intraoperative or spontaneous postoperative bleeding. Most of the patients had some degree of post defecation bleeding till 7th to 14 days which resolved after 2 weeks. After a mean follow up of 16.6 months, we reported a suspected recurrence rate of 5.33%.Conclusions: Postoperative pain assessed on Visual analog score (VAS) was 2.82 on 3rd day, 1.28 on 7th day and till 14th day was extremely low. None of the patients had significant intraoperative or spontaneous postoperative bleeding. Most of the patients had some degree of post defecation bleeding till 7 to 14 days which resolved after 2 weeks. After a mean follow up of 16.6 months we reported a suspected recurrence rate of 5.33%.
Pandemic and medical education of surgical residents in a tertiary care hospital in India: a cross-sectional study
Authors: Sekar Raghul , Alexander Arun , Raja Kalaiarasi , Saxena Sunil Kumar
Published: September 2021

Background: COVID-19 pandemic has brought tremendous changes in the functioning of residency training. The impact was maximal on surgical residents whose hands-on training was affected. This study aimed to assess the effect of COVID-19 pandemic on medical education and training of surgical residents. Methods: A single institutional cross-sectional survey was conducted in a large tertiary care hospital in India. It included residents in various surgical specialties. The survey was divided into six sections to cover all the aspects of their residency.Results: Out of 106 residents who participated in the study, 95 (59.3%) had worked in the dedicated COVID-19 facility, and 97 (91.5%) feared transmitting the infection to their family members. There was a considerable reduction in both elective and emergency surgeries performed by residents (p<0.05).There was a significant reduction in the working hours per day, helping residents get more time for research work. Further Maslach burnout inventory score was 7.43±2.35 after the pandemic, which shows a statistically significant reduction (p<0.001) in residents' burnout.Conclusions: Surgical residents had to balance their residency training with caring for COVID-19 patients. There had been a decrease in their hands-on training, clinical exposure, and working hours. Both theoretical and practical training of surgical residents has been affected during this pandemic. This survey can be used as a tool to improve the lives of surgical residents in any pandemic situation or during further waves of COVID-19.
Clinical profile, management and surgical outcome of spinal cord tumors
Authors: Chhabra Shobhit , More Bhagirath , Ranade Deepak , Gotecha Sarang , Punia Prashant , Raghu Vybhav , Kashyap Dushyant
Published: September 2021

Background: Spinal cord tumors can result in dramatic neurological and functional disabilities in the patients. We aimed to know the incidence of different types of spinal tumors and correlation between clinical presentation and pathological findings and compare outcomes of these tumors postoperatively.Methods: A total of 50 patients were included in the study group. After a thorough clinical evaluation, patients were subjected to a magnetic resonance imaging (MRI) and then surgery. They were described on the basis of age, sex, location of the tumor, type of the tumor, symptoms, histopathological type, surgical resection and complications.Results: Study included 29 males and 21 females and their age ranged from 5 years to 70 years. Out of the 50 patients, 39 had intradural and 11 had extradural spinal tumors. Amongst the 39 intradural tumors, 27 were extramedullary and 12 were intramedullary in location. A predilection towards the thoracic region (44%) was seen followed by the cervical cord. The tumors were excised completely in 68% of the patients while subtotal resection was done in 18% and near total resection in 14% patients. There was significant drop in VAS score and improvement in McCormicks score at 3 months of follow up.Conclusions: Based on this study it could be suggested that surgical excision and decompression should be attempted in all patients of intradural spinal tumor fit to undergo the procedure, as it not only helps in reaching a definitive histopathological diagnosis but also achieves neurological improvement in most patients without causing significant morbidity and mortality.
Effects of silodosin, darifenacin, and combination therapy for the treatment of ureteral stent related discomforts
Authors: Benedict Aquinas , Rajenthiran Vinothkumar , Eswaramurthy Abhinaya
Published: September 2021

Background: To evaluate the effect of silodosin, darifenacin and combination therapy of two agents in improving the lower urinary tract symptoms of patients with indwelling double-J ureteral stents.Methods: A total of 150 patients underwent placement of a double-J ureteral stent after retrograde ureteroscopy for urinary stone disease. All patients received polyurethane double-J ureteral stents (4 Fr and length 26 cm), which were removed at a mean of around 14 days postoperatively. A total of 40 patients were given no medication (group 1), 39 patients were given silodosin 4 mg once daily (group 2), 40 patients were given darifenacin 7.5 mg once daily (group 3), and 31 patients were given a combination of two agents postoperatively (group 4). International prostate symptom score (IPSS) and visual analogue pain scale (VAPS) questionnaires were completed by each patient at 1st day postoperatively and on the day of stent removal.Results: In the total group of patients, the mean age was 50.24±12.90 years. There was a significant difference in the IPSS total score between group 1 and groups 3 and 4.  Group 4 also differed significantly from group 1 in the irritative subscore. The obstructive subscore differed between groups 2 and 4 and group 1. There was a statistically significant difference between group 1 and group 4 in the quality of life (QoL) score.Conclusions: Combination therapy with silodosin and darifenacin improved both irritative and obstructive symptoms more than in the other groups. Combination therapy should be strongly considered for patients who complain of stent-related symptoms.