bluuebunny/crossref_metadata_2025 huggingface dataset:
Online Group Counseling with Mindfulness-Based Cognitive and Solution-Focused Approach for Enhancing Students’ Humility
Authors:   Universitas Negeri Semarang, Indonesia, Naini Rohmatus , Mulawarman Mulawarman , Wibowo Mungin Eddy
Published: September 2021

Character education is also an important thing to be developed by school counsellors. The humility is one of necessary character that based others virtue. The student’s problems who have low humility tend to have difficulty accepting criticism/information from others, arrogance, sadism, selfishness, and bullying behavior. During the Covid-19 pandemic, the learning system used the internet, including counselling services. This study aims to test an effective approach in increasing the character of humility between mindfulness-based cognitive or solution-focused approach. The group counseling design used is the synchronous for the counselling process and asynchronous to complete the worksheet. This experimental study involved 24 students in each group of 8 students aged 14-17 years. This participant of research is limited. The scale used to measure humility is Elliot's theory of adaptation which is designed using a Likert-scale. There are four aspects, namely openness, self-forgetfulness, accurate self-assessment, and focus on other things with a total of 32 items. The reliability humility scale is 0.901, and CAMM α = 0.790. These results indicate no significant difference in MBCT-SFBT in increasing humility, whereas MBCT-control & SFBT-control have a significant difference. That is, the mindfulness group had an increase in the mean between pretest-posttest and follow-up. This study found that character enhancement can use mindfulness-based cognitive and solution-focused approach. Both of them have the characteristics of character strengths and applicable by school counsellors. This study has few subjects so that the research subjects in further research are to increase the number of studies and make online and non-online comparisons.
Who uses Transport Network Companies?: Characterization of Demand and its Relationship with Public Transit in Medellín
Authors: Bedoya-Maya Felipe , Scholl Lynn , Sabogal-Cardona Orlando , Oviedo Daniel
Published: September 2021

Transport Network Companies (TNCs) have become a popular alternative for mobility due to their ability to provide on-demand flexible mobility services. By offering smartphone-based, ride-hailing services capable of satisfying specific travel needs, these modes have transformed urban mobility worldwide. However, to-date, few studies have examined the impacts in the Latin American context. This analysis is a critical first step in developing policies to promote efficient and sustainable transport systems in the Latin-American region. This research examines the factors affecting the adoption of on-demand ride services in Medellín, Colombia. It also explores whether these are substituting or competing with public transit. First, it provides a descriptive analysis in which we relate the usage of platform-based services with neighborhood characteristics, socioeconomic information of individuals and families, and trip-level details. Next, factors contributing to the election of platform-based services modeled using discrete choice models. The results show that wealthy and highly educated families with low vehicle availability are more likely to use TNCs compared to other groups in Medellín. Evidence also points at gender effects, with being female significantly increasing the probability of using a TNC service. Finally, we observe both transit complementary and substitution patterns of use, depending on the context and by whom the service is requested.
Canino primario biradicular. Hallazgo radiográfico en paciente con caries de infancia temprana. Reporte de caso.
Authors: Devetak Pizarro Michelle , Perez Granja Martha
Published: September 2021

Los hallazgos radiográficos se presentan con poca frecuencia en la práctica odontológica cotidiana, de igual manera los caninos biradiculares representan un pequeño porcentaje de las anomalías dentales que se presentan en la población pediátrica ya que la mayoría de los casos suelen ser subdiagnosticados al no presentar síntomas. El objetivo de esta investigación es presentar un reporte de caso de un paciente de sexo masculino de 6 años, acude a consulta odontológica en la clínica de posgrados de la Universidad San Francisco de Quito, presentando un diagnóstico de Caries de Infancia Temprana (CIT). El examen radiológico reveló una anatomía anormal del canino mandibular derecho (bifurcación).
Funciones entre dendroides (abanicos) que (no) preservan (no)contractibilidad
Authors: Anaya José G. , Capulín Félix , Sánchez Garrido Mónica
Published: September 2021

J. J. Charatonik formulated in 1991 the following problem: What are all mappings that preserve contractibility (noncontractibility) of den-droids? On the other hand, J. J. Charatonik, W. J. Charatonik, and S. Miklos asked in 1990 the following questions (among others related to con-tractibility): What kinds of confluent mappings preserve contractibility of fans? And what kinds of confluent mappings preserve non contractibility of fans? In this paper, we will show some partial answers to these questions. Addition-ally, we will consider these questions with other kinds of families of mappings.
Propiedades del soporte de soluciones de una clase de ecuaciones de evolución no lineales en dos dimensiones
Authors: Bustamante Eddye , Jiménez Urrea José
Published: September 2021

In this work we consider equations of the form ∂tu + P(D)u + u^{l}∂xu = 0, where P(D) is a two-dimensional differential operator, and l ∈ N. We prove that if u is a sufficiently smooth solution of the equation, such that suppu(0), suppu(T) ⊂ [−B, B] × [−B, B] for some B > 0, then there exists R0>0 such that suppu(t) ⊂ [-R_0,R_0]×[-R_0,R_0] for every t ∈ [0, T].
Leveraging Pre-Trained Contextualized Word Embeddings to Enhance Sentiment Classification of Drug Reviews
Authors: Karsi Redouane , Zaim Mounia , El Alami Jamila
Published: September 2021

Traditionally, pharmacovigilance data are collected during clinical trials on a small sample of patients and are therefore insufficient to adequately assess drugs. Nowadays, consumers use online drug forums to share their opinions and experiences about medication. These feedbacks, which are widely available on the web, are automatically analyzed to extract relevant information for decision-making. Currently, sentiment analysis methods are being put forward to leverage consumers' opinions and produce useful drug monitoring indicators. However, these methods' effectiveness depends on the quality of word representation, which presents a real challenge because the information contained in user reviews is noisy and very subjective. Over time, several sentiment classification problems use machine learning methods based on the traditional bag of words model, sometimes enhanced with lexical resources. In recent years, word embedding models have significantly improved classification performance due to their ability to capture words' syntactic and semantic properties. Unfortunately, these latter models are weak in sentiment classification tasks because they are unable to encode sentiment information in the word representation. Indeed, two words with opposite polarities can have close word embeddings as they appear together in the same context. To overcome this drawback, some studies have proposed refining pre-trained word embeddings with lexical resources or learning word embeddings using training data. However, these models depend on external resources and are complex to implement. This work proposes a deep contextual word embeddings model called ELMo that inherently captures the sentiment information by providing separate vectors for words with opposite polarities. Different variants of our proposed model are compared with a benchmark of pre-trained word embeddings models using SVM classifier trained on Drug Review Dataset. Experimental results show that ELMo embeddings improve classification performance in sentiment analysis tasks on the pharmaceutical domain.
Feature Extraction Model with Group-Based Classifier for Content Extraction from Video Data
Authors: Kalakoti Gowrisankar , G Prabakaran
Published: September 2021

In today's PC illustration, numerous object locations of videos are quite critical duties to accomplish. Swiftly and reliably recognising and distinguishing the multiple aspects of a video is a crucial attribute for collaborating with one's condition (object). The core issue is that in theory, to ensure that no significant aspect is missing; all aspects of a content in a video must be scanned for elements on various different scales. It requires some investment and effort anyway, to really arrange the substance of a given content region and both time and computational limits that an operator can spend on classification are constrained. Two presumption procedures for accelerating the standard identifier are performed by the proposed method and demonstrate their capability by performing both identification efficiency and velocity. The main enhancement of our group-based classifier focuses on accelerating the grouping of sub features by planning the problem as a selection procedure for consecutive features. The subsequent improvement gives better multiscale features to distinguish objects of all sizes without rescaling the information image from a video. Extracting contents from video is an assortment of successive images with a steady time interim. So video can give more data about contents in it when situations are changing regarding time. Along these lines, physically taking care of contents with features are very unimaginable. In the proposed work, it is suggested that a Group-based Video Content Extraction Classifier (GbCCE) extracts content from a video by extracting relevant features using a group-based classifier. The proposed method is distinct from conventional approaches and the findings indicate that better output is demonstrated by the proposed method.
Texture-Based Feature Extraction Using Gabor Filters to Detect Diseases of Tomato Leaves
Authors: Wiharto  , Nashrullah Fikri Hashfi , Suryani Esti , Salamah Umi , Prakisy Nurcahya Pradana Taufik , Setyawan Sigit
Published: September 2021

The disease in tomato plants, especially on tomato leaves will have an impact on the quality and quantity of tomatoes produced. Handling disease on tomato leaves that must be done is to detect the type of disease as early as possible, then determine the treatment that must be done. Detection of its types of tomato plant diseases requires sufficient knowledge and experience. The problem is that many beginner farmers in growing tomatoes do not have much knowledge, so they have failed in growing tomatoes. Based on these cases, this study proposes a model for the early detection of disease in tomato leaves based on image processing. The research method used is divided into 5 stages, namely preprocessing, segmentation, feature extraction, classification, and performance evaluation. The feature extraction stage used is texture-based with Gabor filters and color-based filters. The final decision is determined by the Support Vector Machine (SVM) classification algorithm with the Radial Basis Function (RBF) kernel. The test results of the tomato leaf disease detection system produced an average performance parameter of 98.83% specificity, 90.37% sensitivity, 90.34% F1-score, 90.37% accuracy, and 94.60% area under the curve (AUC). Referring to the resulting of the AUC performance, the tomato leaf disease detection system is in the very good category.
Identification of Network Traffic over IOT Platforms
Authors: Khedkar Shilpa P. , Ramalingam Aroul Canessane
Published: September 2021

The Internet of Things (IoT) is a rising infrastructure of 21st century. The classification of traffic over IoT networks is attained significance importance due to rapid growth of users and devices. It is need of the hour to isolate the normal traffic from the malicious traffic and to assign the normal traffic to the proper destination to suffice the QoS requirements of the IoT users. Detection of malicious traffic can be done by continuously monitoring traffic for suspicious links, files, connection created and received, unrecognised protocol/port numbers, and suspicious Destination/Source IP combinations. A proficient classification mechanism in IoT environment should be capable enough to classify the heavy traffic in a fast manner, to deflect the malevolent traffic on time and to transmit the benign traffic to the designated nodes for serving the needs of the users. In this work, adaboost and Xgboost machine learning algorithms and Deep Neural Networks approach are proposed to separate the IoT traffic which eventually enhances the throughput of IoT networks and reduces the congestion over IoT channels. The result of experiment indicates a deep learning algorithm achieves higher accuracy compared to machine learning algorithms.
Regional Innovation Systems of Medical Technology
Authors: Vadia Rucha , Blankart Katharina
Published: September 2021

We investigated the role of external funding in cardiovascular device innovation across 31 countries in Europe. We rely on the knowledge production function (KPF) framework that establishes the knowledge output of a region as a function of innovatory effort and other characteristics of that region. In a cross-sectional analysis, we investigated regional variation in knowledge production by the number of publications in cardiovascular device research obtained from the bibliometric data of the world’s largest biomedical library, the US National Library of Medicine, 2014‒2017. We mapped these publications to product categories of medical devices approved for cardiovascular diseases by the US Food and Drug Administration. Considering spatial correlation across regions of Europe in our estimates of the KPF, we investigated the impact of two types of funding mechanisms: grants reported in the publications and the volume of European Union Horizon 2020 funding received by the innovating regions. We obtained 123,487 cardiovascular device-related publications distributed across 1,051 (75% of total) regions (NUTS-3 level). Receiving external funding strongly contributes to a region’s knowledge output. The estimated elasticities of innovatory effort range between 0.51 and 0.64. These estimates were consistently larger than the elasticities of other characteristics in the region measured by gross domestic product (0.14‒0.56). We also documented spillover effects from neighboring regions when the funding was measured by the grants reported in the publications, concluding that innovatory efforts in the form of external research investments are effective for promoting innovation in the medical device industry at the regional level.
Association of Myofascial Pain in Patients with Thoracolumbar Scoliosis, Kyphoscoliosis or Spinal Deformity Attending a Tertiary Care Hospital in Uttar Pradesh, India
Authors: Kumar Sanjay , Khuba Sandeep , Gautam Sujeet , Agarwal Anil , Vittobaraju Muralidharan , Aggarwal Aakanksha , Awal Shikha , Mishra Prabhaker
Published: September 2021

BACKGROUND Scoliotic spine puts undue strain on the back musculature which may lead to the production of myofascial pain syndrome (MPS). The purpose of this study was to find out the association of myofascial pain of iliopsoas and quadratus lumborum in scoliotic patients and to look for any correlation between the degree of deformity (Cobb’s angle) and severity of myofascial pain. METHODS A total of 60 patients of low back pain with spinal deformity were enrolled in the study. The severity of the spinal deformity and pain was calculated with Cobb’s angle and visual analogue scale (VAS) pain scale (0 - 100) respectively. Patients with iliopsoas and quadratus myofascial pain underwent trigger point therapy along with regimen of stretching exercises. VAS scores were recorded at 0 - hour, 2 - hour, 2 - weeks, 1 month and 3 months after the procedure. RESULTS Forty-four patients out of 60 had myofascial pain of iliopsoas or quadratus lumborum or both. 15, 31 and 12 patients had Cobb’s angle of 10 - 20, 21 - 30 and 31 - 40 degree, respectively. Trigger point injections were performed in 38 patients. The pre-procedure median VAS score was 70, at 0 hour 45, at 2 hour 40, at 2 weeks 30, at 1 month 30 and at 3 months 30. A significant reduction (P < 0.001) in VAS score was observed till 3 months. CONCLUSIONS The myofascial pain of iliopsoas and quadratus lumborum is an important source of low back pain in patients with scoliosis. There is no correlation between the degree of scoliosis and severity of low back pain. KEYWORDS Scoliosis, Kyphoscoliosis, Thoraco-Lumbar Spinal Deformity, Myofascial Pain, Iliopsoas, Psoas Major, Quadratus Lumborum, Low Back Pain
A Cross-Sectional Comparative Study of Mental Health among Geriatric Population Living in Care Homes and Those Living with Family in Hadoti Region, Rajasthan
Authors: Agrawal Swapnil , Khan Aftab Ahmed
Published: September 2021

BACKGROUND With recent advancement in health facility, both in urban and rural population, ratio of elderly people has increased and due to this apart from physical illness, mental health is also emerged as an important public health challenge. Psychiatric disorders such as depression, anxiety, cognitive disorders and substance use disorders were commonly found in elderly specially living alone and in care homes. The primary purpose of this study was to compare mental health of elderly people living in care homes with those living with family in Kota (Hadoti region, Rajasthan). METHODS This is a cross-sectional comparative study that was carried out in 50 elderly people living in care homes and 50 elderly people living with family. Both groups were screened for psychiatric disorders using general health questionnaire (GHQ – 12). Comparison was made under various headings between these groups including severity. Obtained data were analysed by using proportion, mean, standard deviation, chi-square, and Pearson correlation. RESULTS No statistically significant difference was found in having psychiatric disorders on screening with GHQ - 12. Difference in these groups for prevalence and severity was not statistically significant for depression and anxiety although significant higher mean of total geriatric depression score (GDS) score in control (10.74 ± 2.56) than in cases (9.38 ± 2.36) and total Hamilton’s anxiety rating scale (HAM – A) score was seen in case group (24.53 ± 3.50) than in controls (23.15 ± 2.34). CONCLUSIONS In this study, it was found out that psychiatry morbidity was higher among elderly population living in old age home when compared to elders living with family in community. Possible reason for higher psychiatric morbidity in old age home group in our study appears to be because of lack of family support, pain of being separated from their children whom they cared and nurtured for their whole life. In psychiatric morbidity we found that depression was the most common disorder in elderly population in both groups. KEYWORDS Old Age Home, Mental Disorders, Depression, Anxiety
Frequency of Ocular Symptoms and Signs in Cases of COVID-19 in Jhansi, Uttar Pradesh
Authors: Singh Vinod Kumar , Baranwal Vinod Kumar , Kumar Jitendra , Chandra Anil Kumar , Sharma Ravi Mohan , Sharma Jyoti , Sirohi Naveen , Dubey Mona
Published: September 2021

BACKGROUND Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is a novel, enveloped, positive, single-stranded ribose nucleic acid (RNA) beta corona virus that causes coronavirus disease-2019 (COVID-19). During the COVID-19 outbreak, various ocular symptoms including conjunctivitis were reported as a manifestation of the disease and viral RNA was found in the patients’ tears. Eye specialists may be the first person to examine a patient suffering from COVID-19 in cases presenting with conjunctivitis. Conjunctivitis is a very common ocular presentation with varied causes. The purpose of this study is to evaluate the frequency of ocular signs and symptoms in cases of COVID-19. METHODS In this prospective observational study, we collected and analysed data from 522 laboratory-confirmed positive cases of Covid-19 from pure dedicated COVID-19 hospital from June 2020 to December 2020. All symptomatic patients were examined in detail and symptomatic treatment was provided taking appropriate self-protection. RESULTS Between June 2020 and December 2020, a total of 522 reverse transcription polymerase chain reaction (RT PCR) confirmed patients of Covid-19 presented to hospital were included in the study. Out of 522 patients, 421 were male and 101 were female. The mean age of the patients was 38.35 years. Out of these 522 patients, 4 patients (0.76 %) had ocular manifestations consistent with follicular conjunctivitis, 2 patients (0.38 %) had chemosis and epiphora, 6 patients (1.14 %) had lacrimation. No patients had loss of vision or other vision threatening events. No ocular symptoms were presented as first symptoms of COVID-19 in any of the 522 cases. CONCLUSIONS In our study, we found out that the overall prevalence of ocular events is low. Total 12 cases (2.29 %) amongst 522 COVID-19 cases had ocular manifestations. Ocular events other than conjunctivitis and lacrimation, like chemosis and epiphora were more common in severely ill patients. All symptomatic patients had presented in early course of disease, majority before the hospitalization. Presentation of ocular symptoms as initial COVID-19 symptoms was not seen in our study; no cases were presented as initial COVID-19 symptoms. KEYWORDS Covid-19; Ocular Symptoms, Corona Virus, Corona Virus Disease 2019 (Covid-19), Conjunctivitis
Diagnostic Accuracy of Diffusion-Weighted MR Imaging Versus CT Brain in Hyperacute Stroke – A Prospective Study, Rohtas, Bihar
Authors: Chaturvedi Ankit , Singh Dipu , Sinha Prashant , Prasad Rishav
Published: September 2021

BACKGROUND The purpose of imaging is multifaceted, ranging from selecting the most appropriate patients for treatment, to avoiding those who are unlikely to benefit. In the present situation, imaging methods basically include cross-sectional imaging by computed tomography (CT) or magnetic resonance imaging (MRI). The target of the assessment is the vessels that supply the brain parenchyma and its associated part at the same / distant perfusion level. In this study, we wanted to evaluate the diagnostic accuracy of diffusion-weighted MR imaging with nonenhanced CT in the diagnosis of hyperacute stroke. METHODS This prospective study was conducted in Radiology Department at Narayan Medical College Rohtas, Bihar. The study group includes a sample of 45 patients who had come to the Department of Radiology within 6 hours of onset of stroke symptoms. Non-enhanced computed tomography (NECT) and MRI were done in all the patients and the results were studied. Study subjects were recruited as following inclusion and exclusion criteria. Data was collected, entered and analysed using Microsoft Excel, Epi Info and statistical package for social sciences (SPSS) software. RESULTS The hyperintense ischemic lesions on diffusion-weighted imaging (DWI) were typically more visually distinct and easier to distinguish than the EIS on CT scans, resulting in better overall values. When the five regions were looked at separately, DWI had higher sensitivity than CT studies, which was close to the overall EIS ranking. The basal ganglia and the insular ribbon had the greatest sensitivity in both modalities. Eight of the 14 patients were classified in the consensus rating of CT and DW imaging, resulting in a sensitivity of 57 percent for both methods, with a bad value of 0.40 for CT and a good value of 0.68 for DW imaging. CONCLUSIONS DW imaging had a higher sensitivity and interrater agreement than CT imaging in detecting early infarction. KEYWORDS Stroke, Computed tomography, MRI, Ischaemia
Intraductal Papillary Mucinous Neoplasm of the Pancreas
Authors: Nethagani Jayalatha , Govula Priyanka , Chandu Revathi , T Pravin Raj
Published: September 2021

A 36-year-old non-smoker, chronic alcoholic female presented with recurrent episodes of epigastric pain and vomiting in the last 10 days. H/o similar episodes of pain 3 times, with last episode was noted 2 months back. She also had history of vomiting (3 episodes). Jaundice/melena/steatorrheas was not observed. Subsequently, contrast-enhanced computed tomography (CECT) of the patient was done and it showed well defined multiple cystic lesions with peripheral wall enhancement involving head and body of pancreas, largest measuring 24 X 22 X 22 mm in the head of the pancreas, the lesion was seen abutting antro-pyloric region anteriorly. Main pancreatic is mildly dilated measuring 4 mm in diameter. A well-defined heterogeneously hypodense (necrotic) para duodenal lesion, was noted inferior to uncinate process, m/s 22 X 20 X 20 mm, which is indicative of lymph nodal deposit. On magnetic resonance cholangiopancreatography (MRCP): few cystic lesions were seen scattered in the pancreatic parenchyma, with one of the cysts showing communication with main pancreatic duct (MPD) ab.
Cross-Sectional Study of Epidemiological Determinants of Substance Abuse among Male Substance Abusers Attending a De-Addiction Centre in Bangalore City
Authors: Parameshwaraiah Sumanth Tarikere , Gopalkrishna Vishnuvardhan , Malyam Vidhyavathi , Sannappa Asha Chandahalli , Bhaskara Amulya , Shanmugamurthi Subhashini , Riyaz Suha
Published: September 2021

BACKGROUND Substance abuse is a cause of deaths, global burden of disease and injury. Increasing trends of underage substance abuse have shown to be associated with future substance dependency. Understanding various factors associated with it will help mitigate the severity and extent of use. In this study, we wanted to find out the pattern of substance abuse in patients at a de-addiction centre in Bangalore. METHODS This cross-sectional study was conducted on 500 male patients admitted to a deaddiction centre in Bangalore. Information was collected using pre-tested and structured questionnaire forms and the collected data was analyzed using statistical package for social sciences (SPSS) v 16.0 software. RESULTS The majority of the participants abused alcohol (92.4 %) and nicotine (74.2 %). 40.5 % of the participants initiated alcohol abuse in age groups of 12 – 18 (Years). Peer pressure (40.4 %) and curiosity (19 %) were observed as the most common reason for substance abuse. The common reason to seek de-addiction services was family pressure (22.4 %), physical health problems (14.2 %), family responsibility (12.4 %) fear of being a social outcast in the community (12 %) and psychiatric problems (10.6 %). Among the participants, 39.4 % had a family history of substance abuse and 41 % had a history of psychiatric illness. 47.4 % reported a history of child abuse. CONCLUSIONS Most participants initiated abuse before age of 25 mainly due to peer pressure. Proper enforcement of rules concerning under-aged substance abuse, proper peer and familial support, addressing concerns of psychiatric comorbidity and child abuse can decrease the chances of future dependency and thus lessen the burden of the problem. KEYWORDS De-Addiction Centre, Under-Aged Substance Abuse, Family History, Psychiatric Illness
A Comparative Study on Serum Levels of Iron, Magnesium, Calcium and Phosphorus during First & Second Trimesters of Pregnancy at a Tertiary Referral Hospital in South India
Authors: M Pradeep Kumar , Brahmanandan Mayadevi , S.B Dini
Published: September 2021

BACKGROUND Multiple micronutrient deficiencies commonly coexist in pregnancy and may play a role in the pathogenesis of many high-risk events in pregnancy. Mineral estimation during the first and second trimester may help in the identification of high-risk pregnancies predisposed to pre-eclampsia, preterm birth or low birth weight. Body mass index (BMI) is an independent risk factor influencing the serum levels of micronutrients like iron, calcium, phosphorous and magnesium. The purpose of this study was to compare the serum levels of iron, magnesium, calcium and phosphorus during first & second trimesters of pregnancy and their correlation with body mass index and adverse pregnancy outcomes. METHODS This was a longitudinal descriptive study, done over a period of twelve months, from April 2017 to March 2018. 94 low risk pregnant women were selected in the first trimester, and they were followed up for the entire duration of pregnancy. 2 ml of blood is collected at first and second trimester and analysed for the serum levels of iron (µg/dl), magnesium (mg/dl), calcium (mg/dl) and inorganic phosphorus (mg/dl). Mean values of these elements were noted and BMI was measured. Patients were followed up to observe the pregnancy outcome, especially development of hypertension, preterm birth and low birth weight. The data were subjected to suitable statistical analyses. P value less than 0.05 is considered as statistically significant. RESULTS Mean values of Ca, Mg, inorganic P and Fe were 9.3 mg/dl ± 0.52, 1.79 mg/dl ± 0.28, 3.59 mg/dl ± 0.54 and 83.7 µg/dl ± 25.36 respectively in first trimester and 8.9 mg/dl ± 0.47, 1.62 mg/dl ± 0.16, 3.17 mg/dl ± 0.44 and 76.17 µg/dl ± 21. 69 respectively in the second trimester. Hypocalcaemia was noted in 12.7 % and 38.3 % in the first and second trimester respectively. Hypomagnesaemia was seen in 51.1 % and 80.9 % in the first and second trimester respectively. Hypophosphatemia was seen in 3.2 % and 14.8 % in the first and second trimester respectively. These findings were statistically significant. There was no significant change in the iron levels in the present study. 19.1 % were underweight. 56.4 % had normal BMI. 19.2 % were overweight. 5.3 % were obese. CONCLUSIONS There is no correlation between serum values of trace elements and the BMI of study subjects. Even though significant hypocalcaemia, hypophosphatemia and hypomagnesaemia was noted in second trimester compared to first, there was no predisposition to the development of adverse outcomes like pre-eclampsia, preterm birth or low birth weight. This may be the effect of dietary and pharmacological supplementation during pregnancy. KEYWORDS Micronutrients, Pregnancy Complications, Calcium, Phosphorus, Magnesium, Iron
Attenuation of Haemodynamic Response to Placement of Mayfield Skull Pin Head Holder - Comparison of Dexmedetomidine Versus Propofol Infusion - A Randomized Interventional Trial Done in a Tertiary Centre in Central Kerala
Authors: Unni Sruthy , Sebastian Ranju , Joseph Elizabeth , Kamalakshi Remani Kelan , Parambath Jamsheena Muthira
Published: September 2021

BACKGROUND Anaesthesia for neurosurgery requires special considerations. The brain is enclosed in a rigid cranium, so the rise in intracranial pressure (ICP) which impairs cerebral perfusion pressure (CPP), results in irrepairable damage to various vital areas in the brain. Stable head position is required in long neurosurgical procedures. This is obtained with the use of clamps which fix the head rigidly. This is done usually under general anaesthesia because it produces intense painful stimuli leading to stimulation of sympathetic nervous system which in turn causes release of vasoconstrictive agents. This can impair perfusion in all organ systems. The increase in blood pressure due to sympathetic nervous system causes increase in blood flow. This causes increases in intracranial pressure which result in reduction in cerebral perfusion pressure once the auto regulatory limits are exceeded. We compared the effects of dexmedetomidine 1 µgm/kg and propofol 100 µgm/kg given as infusion over a period of 10 minutes before the induction of anaesthesia and continued till 5 minutes after pinning to attenuate the stress response while cranial pinning. In this study, we wanted to compare the effects of dexmedetomidine and propofol as infusion to attenuate the stress response while cranial pinning in patients undergoing neurosurgical procedures. METHODS This is a randomized interventional trial. Patients were divided into 2 groups of 20 each. Group 1 receiving dexmedetomidine and group 2 receiving propofol, both drugs given as infusion. Haemodynamic variables were monitored before and after cranial pinning. Data was analysed using IBM statistical package for social sciences (SPSS) statistics. The parameters recorded were analysed with the help of a statistician. RESULTS The two groups were comparable in demographic data. Incidence of tachycardia between group 1 and 2 showed that tachycardia to pinning was better controlled with propofol than dexmedetomidine (P < 0.05) which is statistically significant. There is no statistically significant difference in blood pressure values between group 1 and 2 after pinning. CONCLUSIONS From our study, we came to a conclusion that propofol was superior to dexmedetomidine in attenuating the heart rate response to cranial pinning. The effect of propofol and dexmedetomidine was comparable in attenuating the blood pressure response to cranial pinning. KEYWORDS Cranial Pinning, Dexmedetomidine, Propofol
A Descriptive Study of Cytomorphological Grading of Hashimoto’s Thyroiditis and Its Association with Thyroid Hormone Profile in a Tertiary Care Center in Mandya, Karnataka
Authors: Bhat Yakkar Muralidhar , H.V Suma , Chettier Shivakumar Sundaram , C.M. Maithri
Published: September 2021

BACKGROUND Thyroid diseases are the most common endocrine disorders throughout the world. Hashimoto’s thyroiditis is an autoimmune thyroid disorder and it is the second most common thyroid lesion diagnosed on fine needle aspiration cytology (FNAC), only after goiter. FNAC is a quick, easy, safe, cost-effective and highly sensitive investigation for diagnosing Hashimoto’s thyroiditis. The cytomorphological grading of Hashimoto’s thyroiditis was 1st done by Bhatia et al. in 1912. The purpose of this study was to grade Hashimoto’s thyroiditis cytomorphologically according to lymphocytic infiltration and correlating it with thyroid hormone profile. METHODS This is a descriptive study of 87 cases which were diagnosed with Hashimoto’s thyroiditis from January 2019 to December 2019 at the Cytopathology, Department of Pathology, MIMS, Mandya. The slides were collected, reviewed and graded according to Bhatia et al.’s grading system. Thyroid hormone values were collected from the department of biochemistry. The association between cytological grades and thyroid hormone parameters such as T3, T4, TSH and antithyroid peroxidase (anti-TPO) antibody were evaluated. RESULTS In our study, female preponderance was noted. The age range in our study was 10 - 64 years and the majority of cases were in the age group of 21 - 40 years. Grade II was the most common cytological grade, followed by grade III. Based on thyroid function values, majority of the cases were hypothyroid, followed by euthyroid and remaining were hyperthyroid. Anti-TPO levels was raised in 80.6 %, most of them had hypothyroidism. CONCLUSIONS In our study, there was no statistical association between cytological grades and thyroid hormone status. KEYWORDS Hashimoto’s Thyroiditis, FNAC, Bhatia et al.’s Grading, Anti-TPO Antibodies, fT3, fT4, Immunoassay Analyzer
Study of Clinical Correlation between Diabetic Retinopathy and Diabetic Nephropathy - A Cross-Sectional Observational Study in Eastern India
Authors: Bala Bivas , Pratap Viswanath , Kanji Soumi
Published: September 2021

BACKGROUND In diabetes mellitus microvascular damages at various end-organ frequently occurs and leads to development of diabetic nephropathy as well as diabetic retinopathy. Diabetic nephropathy ultimately causes end stage renal disease. Diabetic retinopathy even at its earlier stage is easily suspected by simple clinical examination in any ophthalmological clinic. We wanted to study the relationship between various stages of diabetic retinopathy with diabetic nephropathy. METHODS 1209 diagnosed patients of diabetic mellitus were screened for presence of diabetic retinopathy. First comprehensive ophthalmological examination including slit-lamp bimicroscopy and indirect ophthalmoscopy were done and then clinically typing of diabetic retinopathy according to ETDRS classification was done. Then all diagnosed case of diabetic retinopathy further examined for blood Glycosylated haemoglobin, blood urea and serum creatinine to detect diabetic nephropathy. RESULTS 273 patients were included in this study. Average age of patients was 64.6 years with mean duration of diabetes mellitus was 7.4 years. Patients suffering from severe NPDR and PDR had association with poor control of blood glycosylated haemoglobin. Patients with mild NPDR 31.1 %, Moderate NPDR 52.3 %, severe NPDR 67.4 % and in PDR 65.2 % patient had blood urea more than 40 mg / dl. In mild NPDR group 32.2 %, moderate NPDR 55.4 %, severe NPDR 67.4 % and in PDR group 63.9 % patients had serum creatinine more than 1.5 mg / dl. We have found statistically significant correlation between HbA1c level and severity of diabetic retinopathy. Prevalence of nephropathy increased with increments in the grade of retinopathy. CONCLUSIONS A significant number of patients with severe NPDR or PDR had increased blood urea and serum creatinine level. Clinical grading of diabetic retinopathy gives us a clue about the presence of diabetic nephropathy. As diagnosis of diabetic retinopathy is simple and straight forward clinical procedure and it can be done all ophthalmological se up, we recommend all patient with diabetic retinopathy must be screened for nephropathy. KEYWORDS Diabetic Retinopathy, Diabetic Nephropathy, Glycosylated Haemoglobin, Blood Urea, Serum Creatinine
Burden and Resilience among Care Givers of Patients with Chronic Kidney Disease - A Cross-Sectional Study at Government Medical College, Kottayam
Authors: Abdullah Shameena , P.G. Saji , Kaimal Ganga Gangadhara , K.P Jayakumar
Published: September 2021

BACKGROUND Chronic kidney disease (CKD) is a major health issue around the globe. The illness and its treatment affect both the patients and care givers life. Care giving can have varying effects on the caregiver’s life. It can disrupt the family routines, can contribute to occupational and financial problems and can affect the physical and psychological health of the carer. The purpose of this study was to assess the caregiver burden and resilience of the caregivers of patients undergoing maintenance haemodialysis. METHODS This is a cross-sectional study. The sample of the study consisted of caregivers of 180 patients with chronic kidney disease undergoing maintenance haemodialysis. Specially designed pro-forma, Burden Scale for Family Caregivers (BSFC), Brief Resilience Scale (BRS) are the tools used for the study. RESULTS The mean age of patients in bystanders with significant caregiver burden was 47.36 years and those with low burden was 48.12 years respectively. Among the 180 care givers, 8.9 % had low burden and 91.1 % had significant burden. Resilience was low in 27.2 % of caregivers, medium in 72.2 % and high in 0.6 % of caregivers. The mean BRS score was 3.81 + 0.473 in low burden group against a BRS score of 3.15 + 0.543 in significant burden group. There was a significant association between caregiver resilience and caregiver burden. CONCLUSIONS Chronic kidney disease, due to its long course and prolonged treatment, affects the physical, psychological and social spheres of patient and family. This may result in the feeling of burden among caregivers and affects the various aspects of carer’s life. Burden was high and resilience was low among the caregivers of patients with CKD. Attention should be given to the strategies to support the caregivers. KEYWORDS Care Giver Burden, Resilience, Chronic Kidney Disease
Difference between Sociodemographic Variables in Elderly Population Living in Care Homes and within Family Setup - A Comparative Study in Kota, Rajasthan
Authors: Agrawal Swapnil , Khan Aftab Ahmed
Published: September 2021

BACKGROUND Due to various factors, elderly population is growing rapidly worldwide and also in India. Changing socio-economic patterns, such as women becoming economically active and participating in the workforce, and increasing mobility are all leading to more nuclear households, altering social norms of elder care in the family. Old age homes which were not common are now growing rapidly to fulfil needs of these needy elderly people. It is important to understand socio demographic factors of persons living in care homes. The purpose of this study was to assess and compare socio demographic variables between elderly people living in old age home and within the family setup. METHODS A descriptive research design was adopted for the study. The study was conducted at two old age homes and various local areas of Kota, Rajasthan. The sample comprised of 100 participants who were further divided into 50 participants from old age homes and 50 participants from family. A tool such as socio-demographic data sheet was administered to obtain the data. RESULTS Significant difference was found between these groups in age wise, regarding marital status (case - 66 % widow or widower, control - 82 % married), literacy (case - illiterate 52 % middle 30 % secondary or higher 18 % while in control these figures are 34 %, 18 %, 34 %) employment (case - 86 % unemployed while in control it is 30 %), family type (case - 36 % joint family, control - 80 % joint family), socio-economic status (case – lower - 72 % control - upper 84 %) having own house (case - 14 % control - 86 %) attitude of family members (case - attitude of their family members perceived as bad 50 %, normal - 11 %, good - 39 % while in control group these figures are 85, 18 %, 74 %). CONCLUSIONS Socio-demographic factors like marital status, employment status, housing and attitude of family members play a major role in elderly population for which they had to stay in care homes. KEYWORDS Old Age Homes, Socio-demographic Variables, India
Bupivacaine Hydrochloride and Ketamine Hydrochloride with Dextrose Given Intrathecally for Inguinal Hernia Repair - A Randomized Controlled Study in a Tertiary Centre in South Kerala
Authors: Sebastian Ranju , Kamalakshi Remani Kelan , Parambath Jamsheena Muthira , Kuttiparambil Praseetha Vallomparambath
Published: September 2021

BACKGROUND Spinal Anaesthesia is the most commonly used form of anaesthesia for surgeries below the level of umbilicus. Bupivacaine is the drug of choice for subarachnoid block. Spinal anaesthesia with bupivacaine is associated with many side effects and complications especially in patients with multiple co-morbid conditions. In our study we compared the anaesthetic effectiveness of 3.5 ml hyperbaric bupivacaine with a mixture of 100 mg ketamine and 0.1 mg adrenaline, the solution is made hyperbaric by adding 1.4 ml of 5 % dextrose given intrathecally. The objective of our study was to compare the anaesthetic properties and clinical effectiveness of intrathecally administered ketamine with bupivacaine for inguinal hernia repair. METHODS This randomised control study was conducted on fifty American society of Anaesthesiologists (ASA) 1 and 2 patients in the age group of 25 – 60 years posted for elective inguinal hernia repair from December 2004 to December 2005. They were randomized in to two groups. Group 1 (Bupivacine group) and Group 2 (Ketamine group). Bupivacaine group (group 1) received 3.5 ml of bupivacaine heavy and ketamine group (group 2) received preservative free ketamine 100 mg with 0.1 mg adrenalin 1/1000 solution in 1.4 ml of 5 % dextrose to make it heavy. Anaesthetic properties, side effects and complications of both groups were compared intraoperatively. RESULTS The onset of action of ketamine (1.58 minutes) was faster than bupivacaine (3.31 minutes) which is statistically significant. Duration of blockade was longer in bupivacaine group (sensory 227.92 and motor 203.08) compared to ketamine group (sensory 143.40 and motor 109.46). Ketamine group showed a greater level of haemodynamic stability than bupivacaine group. CONCLUSIONS Intrathecal ketamine produces optimal anaesthetic conditions for surgeries like inguinal hernia repair. Haemodynamic stability provided by intrathecal ketamine is beneficial in patients with multiple comorbidities. KEYWORDS Hyperbaric Bupivacaine, Ketamine in Hyperbaric Solution, Intrathecal Block, Inguinal Hernia Repair
Cytogenetics and Y Chromosome Microdeletion in Azoospermic Males - A Retrospective Cohort Study from a Tertiary Care Hospital in Kerala
Authors: Sasidharan Sreejith Pongillyathundiyil , Balakrishnan Sheila , Govindan Krishna , K.R. Chandramohanan Nair
Published: September 2021

BACKGROUND Infertility is the inability to become a parent of a child even after one year of intercourse involving male and female partner without any contraceptives. There are many causes for infertility, Y chromosome microdeletion is one among that. Partial or complete deletion of the proximal Yq region, which contains azoospermic factor (AZF) locus, leads to infertility. Along with genetic and biochemical factors the ethno-geographical reasons also play an important role in infertility. The present study was done to identify the association of genetic and hormonal factors in the development of infertility in azoospermic males of southern Kerala. METHODS Retrospectively screened the medical records of 2100 infertile males of the Department of Reproductive Medicine of Sree Avittom Tirunal Hospital, Government Medical College, Thiruvananthapuram for a period from January 2017 to December 2019. Stringent inclusion criterias were taken to select patients for the molecular study and finally 46 were selected. Structural and numerical chromosome abnormalities were detected using karyotyping and microdeletion was identified using polymerase chain reaction. Electro-chemiluminescence immunoassay method was used for the quantification of reproductive hormones. Demographic data of selected patients were collected from the medical records. RESULTS The cytogenetic results showed that among the selected patients, 10.86 % had Klinefelter syndrome and one person had De la Chapelle syndrome. Partial microdeletion in AZFa, b or c regions have been observed in 13.63 % of the patients. The hormonal analysis showed significant change in concentration of reproductive hormones irrespective of genetic defects. Demographic data showed that the majority of participated patients are unskilled/skilled laborers, economically poor and are from urban areas. CONCLUSIONS The study concludes that among the selected patients, 24.49 % have clinically significant chromosomal abnormalities like Klinefelter syndrome, De la Chappelle syndrome and partial microdeletion on the AZF region. Irrespective of genetic defects, significant changes in the concentration of reproductive hormones are also observed. KEYWORDS Azoospermia, Infertility, Karyotyping, Y Chromosome Microdeletion