bluuebunny/crossref_metadata_2025 huggingface dataset:
ثقافة الحوار في الروايات العراقية روايات عبد الخالق الركابي أنموذجًا
Authors: دعاء فاضل نايف م.د.
Published: July 2022

يعدّ الحوار طريقة من طرق التواصل، وتبادل الحديث بين طرفين، أو عدة أطراف. ويشكّل الحوار في الرواية قاعدة أساسية ورئيسية في الصّرح الروائي. فقد يحمل الرواية حتى النهاية والنجاح، وقد يكون أهم أسباب فشلها. ومن خلال الحوار يتدفق السرد، ويمنح جمالية لمشاهد الرواية.والروائيّ الجيد هو الذي يستطيع صنع حوار جيد يدفع الأحداث ويكثف الحبكة.كما يمثل الحوار وسيلة جيدة لإرسال نفحات من التشويق وتحضير لأحداث فجائية لاحقة، ومن خلاله يمكن لشخصيات العمل أن تنبأ بأحداث ستحدث عن طريق إضافة القليل من التلميحات التي تشجع القارئ على التساؤل، والتخيلات.إن كتّاب الرواية العراقية لم يغفلوا عن أهمية عنصر الحوار في العمل الروائيّ كونه يستدل عن وعي الشخصية وتفردها، ويساهم في تطوير الأحداث ، لذلك جعله الهدف البارز والحاد لإظهار ثقافة وتفكير وأساليب الشخصيات ، ، وشاعت في لغة الكتابة الروائية العراقية ، ضربان من المستويات: مستوى الحوار السرديّ، وتكون لغته فصيحة عالية، ومستوى الحوار بين الشخصيات، وتكون لغته عامية متدنية أحيانا. ، ثم بدأت الكثير من التوصيات من قبل النقاد أن تكون لغة السرد أو الحوار لغة فصحى، تتوفر فيها سمات الفن والجمال، والإيحاء والشعرية.أما سبب اختيار الدراسة الروائي عبد الخالق الركابيّ؛ لأنّه يعدّ أحد الاسماء المهمة في المشهد السردي العراقي والعربي، وأحد الذين اسهموا في تطور الرواية العراقية ، حيث تكرس حضوره القصصي وفيما بعد الروائي منذ أواخر ستينات القرن المنصرم ، كما أنه يشكل أحد أهم أقطاب التجديد، إذ سعى إلى اغناء أعماله بالجدة والابتكار غير العادي والمألوف في الكتابة الروائية, عبر استثمار المخطوط بمصادره التاريخية، فيمثل أحد الأقطاب المهمة في كتابة الرواية التاريخية.ووقعت خطة البحث اعتمادًا على عنوانه (ثقافة الحوار في الرواية العراقية روايات عبد الخالق الركابي أنموذجًا) في ثلاثة مطالب: الأول بعنوان تاريخ نشأة الرواية في العراق ، والمطلب الثاني تنوع الحوار في الرواية العراقية ، والمطلب الثالث الحوار الفصيح والعامي في روايات عبد الخالق الركابيّ.
لمحات اجتماعية من حياة الشيخ باقر شريف القرشي 1927-2012
Authors: حيدر علي خلف جودة العكيلي م. د.
Published: July 2022

يُعد الشيخ باقر شريف القرشي واحداً من مجموعة العلماء والمفكرين الإسلاميين الذين يأخذوا بعد موقعهم الرائد في وعي الجيل الحاضر، ولعل السبب في هذا الأمر عائدٌ إلى ما اعتادت عليه الذهنية الإسلامية أو العراقية –إذا صح التعبير- وهي عدم الاحتفاء بالأحياء حتى يموتوا! وربما عدم التركيز والاهتمام بهم إلى أن تمضي عقود مديدة على موتهم.لقد بدأ الشيخ باقر شريف القرشي حياته العلمية وعطاءه الفكري والثقافي في النصف الثاني من القرن العشرين، وترك بعد موته في عام 2012 العشرات من المؤلفات التي ألفت مكتبة متعددة الأبعاد في مختلف ضروب الثقافة الإسلامية، فيها الدراسات الفقهية والكلامية والفلسفية والتاريخية وتراجم أهل البيت (ع) فضلاً عن التحقيق والدراسات القرآنية.لذا نجد من المفيد هنا أن نسلط الضوء على حياة الشيخ باقر شريف القرشي وعرض بعض المواقف الاجتماعية في حياته التي قضى معظمها بين الدرس والمطالعة والكتابة.الكلمات المفتاحية: تاريخ اج
أثر التنوع الاجتماعي في بناء شكل النظام السياسي العراقي
Authors: أمل عطوي عباس د.
Published: July 2022

يستهدف البحث دراسة اشكالية التنوع الاجتماعي واثره في تحديد شكل النظام السياسي, والكشف عن مدى استجابة الدستور العراقي لعام 2005 في احتوائه التنوع والحفاظ على خصوصيات المكونات الاجتماعية العراقية, من حيث التعرف على ماهية التنوع الاجتماعي, ووصوره ومظاهر التنوع الاجتماعي في العراق, فضلا عن التوصل الى النتائج.وتوصلت الدراسة إلى أن نظام الحكم بعد عام 2003 اعطى صلاحيات كبيرة في ادارة الاقاليم الفيدرالية من حيث اختيار اللغة ونوع التعليم ومنح العطل الي تعد اعيادا لتلك المجموعات حتى انشاء قوات امنية لحمالية تلك المكونات، حسب الدستور العراقي, ووجدت الدراسة أن التنوع الاجتماعي في العراق قد تمثل في صورتين، تنوع ديني وتنوع قومي، والتنوع الديني يتفرع الى مذاهب وفرق، والتنوع القومي كان نتيجة الهجرات المتعاقبة على العراق، وكذلك يتميز النظام الاتحادي بمميزات عدة, وهو ما يجعله حلا لاشكاليات المجتمعات المتنوعة، اذ انه يجمع بين مبدئين متعارضين هما المشاركة والاستقلال، فمن خلال مبدأ المشاركة فهو يمكن الجماعات المختلفة من المشاركة في السلطات العامة في الدولة، ومن حيث مبدأ الاستقلال فهو يمنحها حقها في الحفاظ على خصوصيتها الذاتية وفق دستور مخلي خاص بها، وبذلك يكون حلا لاشكالية تنوع المجتمع العراقي دينيا ومذهبيا وقوميا ولغويا.
المناطق العشوائية والامن الانساني/ دراسة اجتماعية ميدانية في المناطق العشوائية في مدينة بغداد
Authors: نوران مهدي عباس السعيدي ا.م.د. , ميسم ياسين عبيد أ.م.د.
Published: July 2022

تهدف الدراسة الى التعرف على الامن الإنساني المقدم للأفراد الساكنين في المناطق العشوائية وقد اجريت الدراسة في مدينة  بغداد في المجمعات السكنية العشوائية جانبي الكرخ والرصافة لغرض معرفة واقع الامن الإنساني والخدمات المتوافرة للساكنين في المناطق العشوائية واهم الاحتياجات والتحديات التي يواجهها الافراد ولتحقيق ذلك أتبعت الباحثة المنهج الوصفي التحليلي بتطبيق استبانة على عينة قصدية مكونة من 350 من الافراد الساكنين في المناطق العشوائية في مدينة بغداد بجانبيها الكرخ والرصافة، وباتباع منهج المسح الاجتماعي بطريقة العينة، فضلاً عن استخدام ادوات جمع البيانات، وهي الاستبانة، والملاحظة، والمقابلة، وأظهرت نتائج الدراسة انعدام الخدمات الصحية في المناطق العشوائية بنسبة (98,6%)،وان سبب سكن افراد عينة الدراسة في المناطق العشوائية هو ضعف الحالة الاقتصادية وبنسبة (38.6%)، و أن هناك احتياجات يفتقر اليها افراد عينة الدراسة داخل المناطق العشوائية وبنسبة (99,7%).
التفكير الإيجابي وأثره في الكفاء الذاتية المدركة لدى طلاب المرحلة المتوسطة
Authors: سجاد عبد المهدي جاسم اسماعيل الوائلي الباحث , علي سلمان منصور الباحث
Published: July 2022

يهدف البحث الحالي إلى معرفة أثر التفكير الإيجابي في الكفاءة الذاتية المدركة لدى طلاب المرحلة المتوسطة ، تكون مجتمع البحث من طلاب المرحلة المتوسطة في المدارس التابعة للمديرية العامة لتربية محافظة واسط، وتم اختيار عينة البحث بطريقة عشوائية حيث بلغت (82) طالباً، توزعت بالتساوي على مجموعتي البحث، التجريبية التي تخضع للتفكير الإيجابي، والضابطة التي لم تخضع ، وبعد تطبيق التجربة وأدوات البحث، ومعالجة البيانات إحصائيا أظهرت النتائج تفوق المجموعة التجريبية على زملائهم في المجموعة الضابطة ، في مقياس الكفاءة الذاتية المدركة، ووضع الباحثان عدد من التوصيات والمقترحات.
The impact of Research and Development (R&D) spending on firm value: Empirical evidence from SouthEast Asia
Authors: Le Thanh Tung
Published: July 2022

This paper aims to examine the effect of R&D spending on firm value in Vietnam, an emerging economy with a rapid economic growth rate. The study data includes 343 companies covering the period of 2010-2018. Different from previous studies, the firm value is represented by both Tobin’s Q and stock price variables. Two econometrics models are Pooled-OLS regression and quantile regression with fixed effect employed to investigate the effect of R&D spending on firm value in the study sample. First, the Pooled-OLS regression techniques provide robust evidence of R&D spending on firm value which is measured by Tobin’s Q and stock price. Second, the quantile regressions indicate that R&D spending shows a stronger effect with better-performance firms, however, the empirical evidence confirms that the impact of R&D spending on stock price is quite faint. This study contributes some new evidence to support the efficient management of companies in emerging countries.
Iklan, Gaya hidup dan Perilaku Konsumen
Authors: MSC Muh. Pangeran Aditya Pratama
Published: July 2022

Iklan merupakan sarana untuk mempromosikan suatu produk yang ditujukan kepada calon konsumen atau masyarakat. Iklan yang baik adalah iklan yang mampu mendorong konsumennya untuk membeli produk yang dipromosikan dan sekaligus berhasil membentuk persepsi merek yang kuat dalam bemak target konsumen
Hermeneutika dalam islam (al-Ghazali)
Authors: huda Mmiftahul
Published: July 2022

This article elaborates al-Ghazali ideas on the qur’anic hermeneutical concept. The author concludes that al-Ghazali’s qur’anic hermeneutical concept has similarities with the theory of philosophical hermeneutics initiated by Gadamer in practice. It can be understood from the various interpretations expressed in the book Nahwa Maud}ū’i Tafsir al-Qur’an li Suwar al-Karīm. But even so, one thing that is emphasized by Muhammad al-Ghazali in his interpretation of the Qur’an that the Quran is a unified whole that must be understood in the context of a whole.
三教 『ウィキペディア』
Authors: Cranier Louis
Published: July 2022

三教（さんきょう）とは、中国で最も信仰者数の多い仏教・道教・儒教を一括する言葉。ただし、儒教は事実上の宗教では無いことから、この概念については異論がある。
Tafsir Sufistik Jawi Kyai Sholeh Darat
Authors: Rizqi Muhamad Taufiq
Published: July 2022

Tulisan ini membahas mengenai tafsir yang bernuansa sufistik dan berbahasa Jawa yang ditulis oleh Kyai Sholeh Darat. Fokus pembahasannya yakni pada Tafsir Faid Al Rahman. Penafsiran Kyai Sholeh memiliki unsur unsur Isyari. Dalam tulisan, ada tiga rumusan masalah terkait tema ini yaitu pertama, bagaimana metode yang dipakai dalam kitab tafsir tersebut. Kedua, bagaimana aspek lokalitas di dalam tafsir tersebut. Ketiga, seperti apa contoh unsur unsur sufistik yang ada di dalam tafsir tersebut. Dalam tulisan ini disimpulkan bahwasannya tafsir Faid Al Rahman memiliki ciri bernuansa sufistik yang ditulis dengan menggunakan bahasa jawa pegon dengan menggunakan metode tahlili. Hal ini tidak terlepas dari kondisi sosial dan budaya yang melekat di masyarakat sekitar mufassir. Adapun contoh-contoh penafsirannya misalnya terkait dengan halal dan haramnya makanan. Yang mana penafsirannya memiliki makna dzahir dan batin
Correcting for sampling error in between-cluster effects: An empirical Bayes cluster-mean approach with finite population corrections
Authors: Lai Mark H. C. , Zhang Yichi , Ji Feng
Published: July 2022

With clustered data, such as where students are nested within schools or employees are nested within organizations, it is often of interest to estimate and compare associations among variables separately for each level. While researchers routinely estimate between-cluster effects using the sample cluster means of a predictor, previous research has shown that such practice leads to biased estimates of coefficients at the between level, and recent research has recommended the use of latent cluster means in the multilevel structural equation modeling framework. However, the latent cluster mean approach may not always be the best choice as it (a) relies on the assumption that the population cluster sizes are close to infinite, (b) requires a relatively large number of clusters, and (c) is currently only implemented in specialized software such as Mplus. In this paper, we show how using empirical Bayes estimates of the cluster means can also lead to consistent estimates of between-level coefficients, and illustrate how the empirical Bayes estimate can incorporate finite population corrections when information on population cluster sizes is available. Through a series of Monte Carlo simulation studies, we show that the empirical Bayes cluster-mean approach outperforms the latent cluster-mean approach in relatively small samples in terms of bias, efficiency, and coverage rates for the between-cluster coefficients. We also provide an R function that implements the empirical Bayes cluster-mean approach, and illustrate it using data from the classic High School and Beyond Study.
Unquiet Treatment: Handling Treatment Refusal in Bipolar Disorder
Authors: Persons Jacqueline , Gruber June
Published: July 2022

Individuals with bipolar disorder (BD) frequently refuse to accept an adequate treatment plan. We describe strategies to help people with BD overcome treatment refusal and accept adequate treatment. We describe several strategies aimed at helping the clinician increase the patient’s willingness to accept an adequate treatment plan. We also discuss strategies clinicians can use when negotiating a compromise treatment plan for patients who refuse to accept optimal treatment and for situations where the patient and clinician cannot negotiate a mutually agreeable treatment plan.
Modeling individual differences in children’s information integration during pragmatic word learning
Authors: Bohn Manuel , Schulze Cornelia , Schmidt Louisa S. , Frank Michael C. , Tessler Michael Henry
Published: July 2022

Pragmatics is foundational to language use and learning. Computational cognitive models have been successfully used to predict pragmatic phenomena in adults and children -- on an aggregate level. It is unclear if they can be used to predict behavior on an individual level. We address this question in children (N = 60, 3- to 5-year-olds), taking advantage of recent work on pragmatic cue integration. In Part 1, we use data from four independent tasks to estimate child-specific sensitivity parameters to three information sources: semantic knowledge, expectations about speaker informativeness, and sensitivity to common ground. In Part 2, we use these parameters to generate participant-specific trial-by-trial predictions for a new task that jointly manipulated all three information sources. The model accurately predicted children’s behavior in the majority of trials. This work advances a substantive theory of individual differences in which the primary locus of developmental variation is sensitivity to individual information sources.
A tutorial on the psycholinguistic analysis of word-final repetitions
Authors: Garbarino Julianne , Exton Erika Lynn , Ratner Nan Bernstein
Published: July 2022

Purpose: We aim to provide a tutorial describing how atypical disfluencies can be assessed from a psycholinguistic perspective. We specifically focus on word-final repetitions (WFRs), e.g., “school-ool”. Methods: We identify the type of data that can be used to assess whether WFRs arise from difficulty at each stage of the word production process. WFRs produced by an adolescent with autism spectrum disorder are used to assess difficulty at each of these stages. Results: WFRs tended to occur on content rather than function words, and the portion repeated seemed to be driven by the syllabic rather than morphological structure. The pause time between the end of a WFR-containing word and the beginning of the repetition (e.g., between “school” and “ool”) was at least 298 ms. In contrast, there was only an audible pause between the repetition and the next word 42% of the time; the other 58% of the time, the repetition led directly into the next word. WFRs also tended to occur in longer utterances and in utterance-medial and -final positions. Conclusion: Our analysis suggested that the best candidates for loci where the production process breaks down to cause WFRs are (a) external channel monitoring of WFR words, which is consistent with the long pauses that occurred between the WFR word and the repetition, or (b) syntactic planning, which is supported by the occurrence of WFRs away from utterance-initial words and in longer utterances. We discuss the limitations of data collected through language sampling and make suggestions for future research.
Pedestrian interactions with Automated Vehicles: does the presence of a zebra crossing affect how eHMIs and movement patterns are interpreted?
Authors: Madigan Ruth , Lee Yee Mun , Lyu Wei , Horn Stefanie , Garcia Jorge , Merat Natasha
Published: July 2022

Previous research has shown that the use of an eHMI can lead pedestrians to make earlier, and more, crossing decisions in front of an AV. However, there has been little exploration of the impact of crossing infrastructure or AV approach direction on pedestrian behaviour. This CAVE-based pedestrian simulator study investigated the individual, and combined, effects of a pedestrian crossing, automated vehicle (AV) approach direction, AV yielding behaviour, and a novel external Human Machine Interface (eHMI) on pedestrian crossing decisions at a four-way crossroads. Thirty eight participants took part in a multi-method study consisting of a pedestrian simulator experiment, an online interview, and a short questionnaire. The main independent variables were: (1) presence or absence of a zebra crossing; (2) the direction from which the AV approached (oncoming/right); (3) the AV’s yielding behaviour (yielding/not yielding); and (4) the presence or absence of a light-based eHMI. The AV’s yielding behaviour was the most important source of information for pedestrians, followed by the crossing infrastructure. Participants showed a greater willingness to cross in front of yielding than non-yielding vehicles, and were more likely to cross in the presence of a zebra crossing. The eHMI had the most impact in the absence of a zebra crossing, promoting earlier crossings, and encouraging more participants to cross while the approaching AV was still moving. The results of this study show the importance of eHMIs for situations associated with uncertainty about right-of-way between an AV and other road users, and highlights the interaction between formal traffic infrastructure and explicit forms of communication for future AVs. This knowledge increases our knowledge of when and where explicit communication from AVs can reduce the likelihood of pedestrian misunderstanding of AV intentions, thus reducing the likelihood of accidents occurring around these vehicles.
On religious practices as multiscale active inference: Certainties emerging from recurrent interactions within and across individuals and groups
Authors: Hipólito Inês , Hesp Casper
Published: July 2022

This chapter takes inspiration from Wittgenstein’s thinking to formulate a non-reductive toolbox associated with generative modelling, specifically as applied in complex adaptive systems theory. It converges on a communal perspective on religion as multiscale active inference that contrasts starkly with common “straw person” perspectives on religion that aim to reduce it to “erroneous” metaphysical theorising motivated by spiritual experiences “generated by the brain”. In contrast, religious practices both enable and require the emergence of implicit (or “ineffable”) meanings that are experienced both individually (i.e., one’s personal faith) and collectively (“the faith”), with only partial commensurability cast under Wittgenstein’s notions of ‘rule-following’ and ‘language games’. We show how the collective and perspectival aspects of religion in enculturation with morals, doctrines, rituals, and expressions can be formalised in terms of deep active inference in multi-agent systems. This approach describes how religions are incommensurable with the scientific method due to the epistemic separation between the different kinds of language games of religious and scientific practices. Touchpoints between these different kinds of language games tend to give rise to perpetual confusion and unproductive discussions. As a particularly impactful example, we discuss ethical considerations in policy-making, which demonstrates how our account can help shed light on complex societal challenges that have emerged at the touchpoints between religion and science.
Microbial profile with their antimicrobial susceptibility pattern in ear discharge of Chronic suppurative otitis media patients at a tertiary care hospital in Durgapur
Authors: Robert Priscilla  , Aditya Tiwari  , Jiwesh Kumar Thakur  , Pinki Kumari
Published: July 2022

Background: Chronic suppurative otitis media (CSOM) is a persistent middle ear disease with high risk of irreversible complications in absence of timely management. It is a massive health problem in India having the highest prevalence rate (>4%) requiring urgent attention.
Aims and Objectives: The aim of the study was to find out risk factors, microbiological profile, with their susceptibility pattern, and of ear discharge in CSOM patients to provide guidelines for the empirical treatment.
Materials and Methods: Ear discharge samples from 135 clinically diagnosed CSOM patients were collected and processed. Microbial isolates were identified and drug susceptibility testing was conducted using Kirby-Bauer disc diffusion method.
Results: Pseudomonas species (59/135, 43.70%) was the predominant isolate followed by Staphylococcus species (37/135, 27.40%) while Aspergillus species (10/12, 83.33%) was the predominant fungus isolated. No anaerobic bacteria were isolated on culture. Gram-negative bacilli were most susceptible to Meropenem (100%) and Amikacin (100%) while Pseudomonas species was to Imipenem (98.35%). Gram-positive cocci showed 100% susceptibility to Vancomycin, Linezolid, and Doxycycline.
Conclusion: A continuous and periodic evaluation of microbiological pattern of CSOM and antimicrobial sensitivity of isolates is necessary for forming the basis of empirical treatment which shall aid in decreasing the potential risk of complications. Further, accurate and timely identification, knowledge of the pathogens, and judicious use of antibiotics are the need of the hour.
Usefulness of post-bronchoscopic sputum cytology with respect to bronchoalveolar lavage and brush cytology using fiber-optic bronchoscopy in suspected cases of lung cancer
Authors: Abhishek Bandyopadhyay  , Mallika Pal  , Saugata Kumar Bhattacharya  , Ruplekha Mitra Mustaphi
Published: July 2022

Background: Bronchogenic cancer is the most common cause of cancer-related mortality in both sexes all over the world, especially across urban population. However, early diagnosis and timely intervention may minimize the mortality rate to a certain extent and increase the 5-year survival rate to 70–80%. Among the diagnostic modalities available, bronchoscopic biopsy, though gold standard, is less feasible in peripheral centers where we depend more on cytological techniques such as bronchoalveolar lavage (BAL) fluid and sputum cytology for quick diagnosis.
Aims and Objectives: This study was conducted at a tertiary care center for studying usefulness of post-bronchoscopic sputum cytology and also to correlate sputum cytology with brushing and washing cytology taking biopsy as the gold standard in the diagnosis of lung cancer.
Materials and Methods: A cross-sectional observational study was done in Nil Ratan Sircar Medical College, Kolkata, over a period of 18 months in clinically and radiologically suspected patients of bronchogenic carcinoma. Bronchoscopic samples using a fiber-optic bronchoscope were collected from 50 such patients. In every case, following sequence of events was performed: Pre-biopsy washing (BAL fluid), brushing, biopsy, post-biopsy washing (BAL), and post-bronchoscopy sputum. Cytological examination done and compared with bronchoscopic biopsy specimens of the same.
Results: All the available information were meticulously documented in tables and charts along with other variables such as age, sex, morphological types, and cytological and histological diagnosis. SPSS software was used to calculate the efficacy and statistical significance, if any, of these different diagnostic tools and its correlation with the final histological diagnosis.
Conclusion: We found that BAL cytology had higher sensitivity and positive predictive value in early and accurate diagnosis of lung malignancy. However, post-bronchoscopy sputum cytology had no additional benefit with respect to BAL and brush cytology (in addition to bronchial biopsy) in diagnosing the same.
PANC-3 score in predicting the severity of acute pancreatitis
Authors: Anandaravi BN  , Manjunath RD  , Shetty Darshan
Published: July 2022

Background: Acute pancreatitis (AP) presents as acute abdomen, Inflammatory process of pancreas associated with local and systemic complications. Many scores (such as Ranson’s, APACHE II, and Bedside index for severity in AP) that help us in predicting severity at the time of admission, but these are time consuming and require complex calculation and are not economically cheap. Our aim here is to analyze the simplified stratification system of PANC3 SCORE and its assessment in predicting severity of AP as decided by Modified Marshall Score.
Aims and Objectives: PANC-3 score in predicting the severity of acute pancreatitis.
Materials and Methods: PANC3 Scoring system is simple, easy to access readily available and economic, as it involves these criteria (hematocrit, body mass index, and pleural effusion). It is a prospective study in which 100 patients were evaluated with PANC3 Scoring, who were diagnosed with AP and admitted to the department of general surgery, Mysore Medical College and Research Institute.
Results: The results showed that PANC3 score had a 96.25% specificity, 70% sensitivity, 82.35% positive predictive value, and 92.77% negative predictive value.
Conclusion: PANC3 SCORE is cost effective, can be determined at the time of admission, thus early prediction of disease severity and early referral to higher center.
Clinicopathological spectrum of xanthogranulomatous pyelonephritis; a single-center experience over 7 years
Authors: Jain Manish , Khan Faiz Ahmed , Patel Shailendra , Pal Ravinder , Abhishek Shukla
Published: July 2022

Background: Xanthogranulomatous pyelonephritis (XGP) is chronic pyelonephritis subtype where in renal parenchymal destruction occurs and therefore results in progressive loss of kidney functions. Although middle age group is the predominant age group affected but it can be seen at any age. There is accumulation of macrophages (lipid-laden) leading to renal parenchymal destruction and fibrosis. In this study, we present our data of 15 patients who had undergone nephrectomy and were biopsy proven XGP.
Aims and Objectives: The aim of the study was to describe the clinical and radiological features of XGP in adults.
Materials and Methods: XGP constituted 4.31% of the 348 nephrectomies done for infective causes over a period of 7 years. All our patients had undergone unilateral total nephrectomy. Demographic and clinical records were analyzed after consent from all the patients.
Results: The age range in our study was 18–65 years with mean 42.93±15.66 years. Nine of our patients, that is, 60% were females. Diabetes was present in 53.3% of our patients. Three patients had imaging suggestive of pyonephrosis, three patients had perinephric collection and 9 patients (60%) had concomitant nephrolithiasis. All the kidneys were grossly enlarged and were non-functional on renal scintigraphy.
Conclusion: XGP is a form of chronic pyelonephritis which although being less common but is devastating given the destruction of renal parenchyma it does and associated morbidity. Clinicoradiologic correlation cannot be overemphasized. The definitive diagnosis is established after histopathologic examination.
A prospective cohort study to assess the clinical profile of acute appendicitis and evaluate the combined use of modified Alvarado score and ultrasonography in a tertiary care center in India
Authors: Yadav GD  , Nishant Saxena  , Anju Yadav  , Shraddha Verma  , Mohd Arshad
Published: July 2022

Background: Acute appendicitis is one of the most common causes of acute abdomen presentation to the hospital. If not treated in time, it may lead to perforation. Alvarado score is a clinical scoring system used in the diagnosis of acute appendicitis. The score is based on laboratory findings, clinical symptoms, and signs. We stipulate that ultrasonography and modified Alvarado score (MAS) can be synchronously and concomitantly be used to reach a trustable diagnosis of acute appendicitis.
Aims and Objectives: The aims of this study were to assess the clinical profile of acute appendicitis and evaluate the combined use of MAS and ultrasonography (USG) in a tertiary care center in India.
Materials and Methods: This is a prospective observational study, in which a cohort of patients presenting with acute abdomen due to acute appendicitis to the department of general surgery (Out Patient Department and Emergency) of L.L.R. Hospital attached to G.S.V.M. Medical College, Kanpur and meeting specific inclusion criteria were sampled between October 2021 and January 2022.
Results: Our study re-enforces and supports demographic findings of prevalence as well as clinical findings reported in the previous studies on acute appendicitis.
Conclusion: CECT of the abdomen can prove to be financially straining for people seeking treatment at public health care centers in developing or underdeveloped countries. Our study suggests that USG can be concomitantly and synchronously be used with MAS to reach a trustable diagnosis without the need for a CECT of the abdomen.
Comparison of efficacy of butorphanol and nalbuphine as premedicant in patients undergoing elective craniotomy using propofol and desflurane anesthesia – A randomized clinical study
Authors: Pal Tanaya , Biswas Chaitali , Bhar Kundu Sudeshna
Published: July 2022

Background: Long duration neurosurgical procedures require the use a relatively longer acting analgesic which will give equianalgesia like a short-acting opioid without needing repeated administration or an infusion.
Aims and Objectives: In this study, we investigated and compared the intraoperative analgesic efficacy and post-operative recovery outcome of intravenous (IV) butorphanol and IV nalbuphine in non-emergency craniotomy patients.
Materials and Methods: A prospective, randomized, and double-blind study was conducted involving 60 patients of age 18–50 years, randomly assigned into two equal groups receiving either 1 mg butorphanol IV (Group B) or 10 mg nalbuphine IV (Group N) 10 min before induction of general anesthesia. Patients were monitored for changes in blood pressure, heart rate (HR) perioperatively and duration of analgesia, and Ramsay Sedation Score (RSS) postoperatively. The results were recorded and analyzed statistically using Pearson’s Chi-square test for Independence of Attributes/Fisher’s Exact Test and Student’s t-test for continuous variables.
Results: Statistically significant fall in HR and mean blood pressure was seen in both groups during intraoperative period, though fall was more in the nalbuphine group. Duration of analgesia was statistically significant in Group B than Group N (249.27±18.33 vs. 240.13±15.70, P=0.043). Sedation was more with nalbuphine as time to achieve RSS 2 was less with butorphanol.
Conclusion: Inj. butorphanol and inj nalbuphine both showed satisfactory result in maintaining hemodynamic stability and long duration of analgesia. When compared, butorphanol provided longer duration of analgesia and less post-operative sedation.
The comparative effects of desflurane and isoflurane on intraoperative cerebral hemodynamics, cardiovascular changes, and post-operative recovery in patients undergoing craniotomy for supratentorial tumors
Authors: Titas Mandal  , Maitreyee Mukherjee  , Amita Acharjee  , Soumya Chakrabarti
Published: July 2022

Background: Preserving hemodynamic stability, providing a slack brain, and enabling early recovery are the main criteria of neuroanesthesia. The most commonly used volatile anesthetic for neurosurgeries is isoflurane due to its favorable effects on cerebral blood flow and intracranial pressure. On the other hand, desflurane, having lower blood gas partition coefficient, favors rapid recovery from anesthesia.
Aims and Objectives: This study was conducted for comparing the effects of desflurane and isoflurane on intraoperative cerebral and cardiovascular hemodynamics and post-operative recovery among patients with supratentorial neoplasms posted for craniotomy.
Materials and Methods: A total of 52 patients aged 20–60, ASA I and II, scheduled for craniotomy under general anesthesia, were randomized into Group I (isoflurane) and Group D (desflurane). All patients received standardized anesthetic protocol and anesthesia was maintained either with isoflurane or desflurane (≤1 MAC). Lumbar cerebrospinal fluid pressure (LCSFP) and cerebral perfusion pressure (CPP) were monitored every 5 min till dura was opened and the degree of dural tension and brain swelling were assessed by neurosurgeons, blinded to the study, at the time of dural opening. Perioperative heart rate, mean arterial pressure, and post-operative recovery time were also noted.
Results: No statistically significant changes were observed among two groups regarding change in LCSFP, CPP, dural tension, brain swelling, and cardiovascular changes. Post-operative recovery time was significantly shorter in desflurane group (P<0.001) than isoflurane group.
Conclusion: Desflurane and isoflurane both can be used safely in maintaining neuroanesthesia. However, due to a significantly faster recovery which facilitates early post-operative neurological assessment, desflurane may be considered a better alternative to isoflurane.
Perinatal outcome of babies born to mothers with antepartum eclampsia: A study from tertiary care hospital of Central India
Authors: Sahu Priyanka , Goyal Prachi , Mehta Nirbhay , Bhattacharjee Somen
Published: July 2022

Background: Eclampsia is a major cause of perinatal mortality. There is a need for studies that will correlate maternal factors and perinatal outcome, which will provide potential strategies to improve fetal outcomes in pregnancies complicated by eclampsia.
Aims and Objectives: This study aims to study perinatal outcome of babies born to mothers with antepartum eclampsia and to correlate outcomes with convulsion delivery interval.
Materials and Methods: A study included 200 patients diagnosed and managed as antepartum eclampsia in the Department of Obstetrics and Gynaecology in MGM Medical College, Indore. A detailed pro forma was prepared and was filled with patient’s information, investigations, treatment, and birth details. The final outcome of both, the mother and her newborn, including stillbirths and early neonatal deaths was included in the study and the perinatal outcome was correlated with convulsion delivery interval.
Results: Incidence of antepartum eclampsia in our study was 2.1%. About 86.4% of women lack regular antenatal care at health care center. Only 7% of women delivered within 6 h of onset of convulsion. Case fatality rate was found to be 13%. There were 59.5% premature deliveries. Perinatal mortality (stillbirth and early neonatal deaths) was 42.5%. Significant association was found between convulsion delivery interval and perinatal outcome (P<0.05). Furthermore, association between use of multiple antiepileptic agents and perinatal outcomes was statistically significant.
Conclusion: Eclampsia being a major cause of perinatal mortality need early diagnosis, prompt referral from peripheral health centers, and timely intervention for improvising both perinatal and maternal outcomes.
Comparison of perineural administration of dexmedetomidine and fentanyl as an adjuvant to 0.5% bupivacaine to enhance the quality of supraclavicular brachial plexus nerve block in upper limb surgeries - A prospective, triple-blind, randomized study
Authors: Patra Sayak , Chanda Ranabir , Biswas Chaitali
Published: July 2022

Background: Supraclavicular approach of brachial plexus block (BPB) has been in popular choice in recent years for surgical, diagnostic, and therapeutic management of injury and pathology related to upper limb.
Aims and Objectives: In this study, we investigated the effect of dexmedetomidine and fentanyl as an adjuvant to bupivacaine on quality of block and post-operative analgesia in perineural supraclavicular BPB.
Materials and Methods: A prospective, randomized, and triple-blind study was done involving 70 patients of age 18–60 years, randomly allocated into two equal groups [group BD- bupivacaine (0.5%) 29 ml with 100 μg (1 ml) of dexmedetomidine and group BF - bupivacaine (0.5%) 29 ml with 50 μg (1 ml) of fentanyl]. The scores of modified Gormley and Hill scale, modified Bromage scale, Ramsay sedation scale, and rescue analgesic requirement were recorded along with hemodynamic parameters. Pearson’s Chi-square test and Mann–Whitney U test were used for statistical analysis.
Results: The onset time of sensory and motor blockade was shortened and the duration of the block was significantly prolonged in the BD Group than BF Group (P<0.001). The duration of post-operative analgesia was also longer in the BD Group compared with the BF Group (549.43±10.56 vs. 403.69±10.84) P<0.001. BF Group had more requirements of analgesic postoperatively.
Conclusion: Addition of dexmedetomidine to bupivacaine prolonged the duration of perineural supraclavicular BPB and improvement of post-operative analgesia than fentanyl without significant side effects in patients undergoing upper limb surgeries.
A clinical study of outcome of two different methods of meatoplasty following modified radical mastoidectomy
Authors: Surbhi  , Shaheen Zafar  , Rohit Kumar
Published: July 2022

Background: Meatoplasty usually is the final step of a canal wall down mastoidectomy. It provides sufficient enlargement of the external auditory meatus which leaves the patient with a smaller mastoid recess that could readily be cleaned and examined without anatomical restriction.
Aims and Objectives: The aims of this study were to study the outcome of two different methods of meatoplasty following modified radical mastoidectomy.
Materials and Methods: This is a prospective study done for 2 years from January 2020 to December 2021 on 50 patients of chronic otitis media unsafe type, where modified radical mastoidectomy was done followed by meatoplasty.
Results: The result in both the groups is comparable up until the meatus remains wide and large which could facilitate cavity examination, aeration, debridement, and drainage.
Conclusion: Outcome was favorable in both the groups and complications related to the meatoplasty technique was also comparable.
A study on assessment of disability associated with common mental disorders in the slum population of Indore
Authors: Ritesh Upadhyay  , Ruchi Soni  , Apurv Thakur  , Dandotiya Dileep
Published: July 2022

Background: Changing life styles have increase chance of common mental disorders (CMD) which may lead to disability.
Aims and Objectives: The aim of the study was (1) to assess CMD in urban slum community and (2) to gain attention of policy makers toward the mental health and its need of the community to address unmet care.
Materials and Methods: A crosssectional study was conducted in which 423 people were screened with the help of a pretestedquestionnaire by Self Reporting Questionnaire (SRQ-20). All the subjects who scored 7 and more in SRQ-20 were further evaluated using Sheehan disability scale.
Results: Out of 423 subject, 76.12% reported typical response within 7 in SRQ-20 scoring. Common mental disorder was found in 16.07% with SRQ-20 scoring between 7 and 13. Severe distress was found in 7.80% of the population with SRQ-20 score >14. Among psychological distress group, females scored higher with 10.63%. In the severe distress group, again females scored higher with 4.96%, although this was not statistically significant. A total of 101 subjects were found to have CMD after screening the population and its prevalence come to 238.77 per thousand. Mild disability was found in 59.41% of the people with CMD and 34.65% moderate disability and 5.94% reported severely disability, which was not statistically significant.
Conclusion: On the basis of our study findings, we conclude that their mental health requires attention, which is an essential part of an individual’s health. It is essential to design intervention that aim at allaying their distress which can improve their mental health, however, being of a descriptive nature and the study population coming from only one slum the above mentioned finding cannot be generalized.
The correlation between iodine nutrition and autoimmunity among hyperthyroid goiter patients in tertiary care hospital of Tamil Nadu
Authors: Suresh Pichandi  , Sivakumar J  , Ganesh V  , Janakiraman P  , Ramadevi K
Published: July 2022

Background: Iodine is a trace element that is essential for the formation of thyroid hormones. It is essential for the human life’s growth and development. The thyroid gland size and functions affected by deficient or excessive intake of iodine. Iodine excess intake was found to associating with iodine-induced hyperthyroidism (IIH) and autoimmune thyroiditis.
Aims and Objectives: The present study was to find the hyperthyroid goiter patient nutritional status by urinary iodine excretion (UIE) measurement and correlate them with thyroid hormone and thyroid autoantibodies.
Materials and Methods: In this study, 100 adult hyperthyroid goiter ssubjects and 100 apparently normal adult subjects were conveniently recruited in this study.Urinary iodine estimation and serum TSH, fT4, fT3, AMA, and ATG were estimated,which were estimated for case and control groups.
Results: The hyperthyroid goiter patient mean UIE concentration was 278.98 μg/L and 68% of excess UIE which was found. There was significant difference in the UIE between the hyperthyroid goiter patient and control (P<0.001). The following types of goiter, based on palpation, were identified among the 100 hyperthyroid patients: Grade I – 4 %, Grade II – 63%, and Grade III – 33%. There were elevated serum AMA levelswith positive correlation of excess iodine for hyperthyroid goiter patient.
Conclusion: In this study, there were excess UIEs among patients; hence, these associated complications, namely, benign goiter (14%), thyroiditis (43%), cancer of thyroid (4%), and thyrotoxicosis (39%) were observed.
Clinical profile of patients with psoriatic arthritis in a tertiary healthcare center
Authors: Ilyas Baig  , Shraddha More  , Milind Nadkar  , Mulkalwar Alhad , Hunaid Haider
Published: July 2022

Background: Psoriatic arthritis (PsA) is an inflammatory arthritis associated with psoriasis, usually seronegative for rheumatoid factor. While many patients with PsA do well, there is a group of patients who suffer from severe disease, with progression of articular damage and increased morbidity.
Aims and Objectives: This study was aimed at assessing the clinical profile of patients suffering from PsA in a tertiary care hospital.
Materials and Methods: A prospective observational study was carried out with due permission of the Institutional Ethics Committee. Demographic and clinical parameters were tabulated and DAPSA and PASI scores were noted. The comparison was done using Chi-square test and paired t-tests. Outcomes were noted and comparisons were made after 3 months of observation.
Results: A total of 43 patients were included in the study. Most of them belonged to the age group of 26–35 years (25.25%), followed by 36–45 years (23.26%). The mean age of the study subjects was 39.09±8.4 years and median age was 30 years, with roughly an equal number of male (55.81%) and female (44.19%) patients. We observed that along with small joint involvement, which is common in PsA, many patients also showed involvements of large joints. Low backache, dactylitis, and enthesitis were observed in few patients.
Conclusion: The study concludes that there was significant difference between mean DAPSA score at <1 year duration but not after 1 year and there is no correlation between the DAPSA score and PASI score.
A prospective comparison of the operative outcome of D1 and modified D2 gastrectomy in adenocarcinoma of the stomach
Authors: Tusar Kanti Saradar  , Jorge Pal  , Gautam Ghosh  , Bikash Chandra Ghosh
Published: July 2022

Background: Gastric adenocarcinoma is a leading cause of cancer and cancer related death among Asian countries. Although there is considerable improvement in chemoradiation, surgery still remains the primary curative modality with special emphasis on lymphadenectomy.
Aims and Objectives: The aim of the study was to assess and compare post-operative morbidity and mortality, anastomotic dehiscence, and length of hospital stay between D1 and modified D2 gastrectomy in adenocarcinoma of the stomach.
Materials and Methods: A prospective, open labeled, and comparative analysis was done in patients with adenocarcinoma of stomach at a tertiary care hospital in Eastern India for 15 months. Total (n=50) patients were divided into two groups and undergone D1(n=24) and modified D2 gastrectomy (n=26) operation, respectively. Post-operative assessment was done for 6 months following the operations.
Results: In the study, (n=35) patients presented with antral growth of which 18 (51.4%) patients underwent D1and 17 (48.6%) patients modified D2 gastrectomy. Most of the Stage III cases were dealt by modified D2 surgery (62.5%) whereas Stage I by D1 surgery (68.2%). Incidences of hematemesis noted around 9 (34.6%) in D1 group patients and lesser in modified D2 group 6 (25%) with P=0.545. However, the incidences of melena were observed that more 11 (45.8%) in modified D2 group in the study patients was compared to D1 group 6 (23.0%) which was statistically insignificant (P=0.130).Post-operative complication (mainly wound dehiscence) was more in D1 surgery group 12 (46.1%) as compared to modified D2 group 8 (33.3%) and the finding was statistically insignificant (P=0.399). There were 4 (33.3%) cases of mortality in modified D2 group as compared to 8 (66.7%) cases in D1 group.The duration of hospital stays,that is,>14days was observed longer in the modified D2 surgery cases as compared to the other group (<8 days)and this difference was statistically very significant (P<0.001).Conclusion: Outcome of modified D2 operation in adenocarcinoma of stomach is better than D1 gastrectomy with lesser post-operative morbidity and mortality with longer duration of hospital stays and possibly a better chance of survival.
A study on the evolving facet of anatomy education based on the learners’ perspective of medical students in Kolkata, India
Authors: Ray Ansuman , Mandal Lopamudra
Published: July 2022

Background: Anatomy education is dealing with tribulations and challenges, especially in the post-COVID period. Erosion of basic knowledge and time allocated to anatomy has caused great concern. As appraisal is an integral part of Medical Education, student evaluations can highlight divergent perspectives for the identification of existing lacunae and propose amendments.
Aims and Objectives: This study was undertaken to reorganize the academic schedule and frame relevant recommendations for the enhancement of teaching standards in anatomy based on the learner’s perspective.
Materials and Methods: A descriptive cross-sectional study was conducted among 876 MBBS students in Kolkata, India. A feedback response structured questionnaire was distributed to the students at the end of the 1st Professional MBBS for data collection. The template was generated in Microsoft Excel sheet and the results were analyzed to find out the possible solutions and actions required at regulatory levels including institutions, faculty, and medical students.
Results: Anatomy was paradoxically perceived as the most interesting yet the most difficult curriculum. Complicated anatomical terms as well as rationed study specimens were significant impediments to understand anatomy. Dissection and demonstration with 10–20 students were optimal, while histology and lectures were considered redundant. The study underlined the need of reforms in the course module and academic schedule toward an integrated syllabus extended for 18 months.
Conclusion: Conventional theoretical and experimental teaching should be blended with innovative inclusions based on scholar responses, in which the learner’s perspective is also emphasized, principally in the present online approach of education.