bluuebunny/crossref_metadata_2025_split huggingface dataset:
A prospective randomized clinical study to compare the efficacy of 0.25% bupivacaine with clonidine and 0.25% levobupivacaine with clonidine in supraclavicular brachial plexus block for upper limb surgeries
Authors: Abhishek R  , Aravind Arun , Shankaranarayana P  
Published: November 2021

:Bupivacaine is an amide local anesthetic, available as a racemic mixture of Dextro and Levorotatory Isomers. Due to its rapid onset and longer duration of anesthesia, It is routinely preferred in various regional anesthetic techniques. However, it is associated with serious cardiovascular and neurological toxicity. Its pure S- enantiomer, Levobupivacaine having similar pharmacological profile is known to have lesser cardiovascular and CNS toxicity. Combining adjuvants like clonidine, a centrally acting partial alpha-2-adrenergic agonist to improve quality of anesthesia is common practice. Hence, the aim of our study is to compare efficacy and safety of 0.25% Levobupivacaine and 0.25% Bupivacaine when combined with clonidine in supraclavicular brachial plexus block for upper limb surgeries.Eighty patients aged between 18 to 60 years with ASA physical status I-II, scheduled for elective upper limb surgeries under were randomized into two groups. Peripheral nerve stimulator guided Supraclavicular brachial plexus block was administered. Group BC received 30ml of 0.25% Bupivacaine plus 1µg/kg Clonidine and Group LC 30ml of 0.25% Levobupivacaine plus 1µg/kg Clonidine. The time of onset of sensory and motor block, duration of sensory and motor block, perioperative hemodynamic parameters, postoperative pain for 24hours and adverse effects were studies.Group LC had faster onset of sensory block (p= 0.014) as well as faster onset of motor block (p= 0.012) compared to group BC. However, durations of sensory block and motor block were statistically not significant in both the groups (p&#62;0.05). Perioperative hemodynamic parameters and assessment of pain during 24 hours of post operative period were comparable and statistically not significant.1mcg/kg of clonidine used as an adjuvant to 30ml of 0.25% Levobupivacaine produces faster onset of sensory and motor block compared to 0.25% Bupivacaine in supraclavicular brachial plexus block. However, similar anesthetic efficacy in terms of duration of sensory and motor block, hemodynamics and postoperative analgesia were observed.
Combined popliteal and saphenous nerve block vs NSAIDS for post operative analgesia in below knee surgery patients: A cross-sectional study
Authors: Gupta Amrita , Maheshwari Shanu , Saxena Avanish Kumar , Mishra Sukhdev , Pandey Aviral 
Published: November 2021

Peripheral nerve blocks are becoming increasingly popular to control postoperative pain in orthopaedic limb surgeries. An outstanding feature of nerve block is its lack of adverse effects, reduced requirement of analgesics and better patient satisfaction. To compare the efficacy of combined popliteal and saphenous nerve block with NSAIDS for postoperative pain relief in below knee surgery patients. We performed a prospective randomized study involving seventy patients. All patients underwent an elective orthopaedic procedure below knee under spinal anaesthesia. Thirty five patients had received a combined popliteal and saphenous nerve block and the rest thirty-five received intravenous NSAIDS at the end of surgical procedure. Post operative VAS Score, time for first rescue analgesia, total diclofenac requirement, total anti-emetic requirement and complications if any were noted.: The statistical power of sample was 80% and type I error (α) of 0.05. The distribution of the data was evaluated using the Shapiro-Wilk test. For data with a non-normal distribution, the Mann-Whitney U test was used in intergroup comparisons. The data were expressed as the median, minimum and maximum (min-max). For comparison of postoperative analgesic use, the chi-square test was used, and complication rates were compared using a cross-ratio test. P-values less than 0.05 were considered to be statistically significant in all the analyses.: Patients with a combined popliteal and saphenous nerve block had significantly less pain at six hours, twelve hours and twenty four hours (p value &#60;0.001) postoperatively. Time for request of rescue analgesia was prolonged. Total diclofenac and anti emetic requirement was also reduced. Also higher level of satisfaction was achieved among this group of patients. : A combined popliteal and saphenous nerve block provides significantly better postoperative pain relief than NSAIDS in patients who underwent below knee surgeries.
Perioperative effect of dexmedetomidine on quality of analgesia and hemodynamic parameters in vaginal hysterectomy: A tertiary centre experience
Authors: Sud Nishit , Sinha Sunil 
Published: November 2021

Vaginal hysterectomy Surgery with long acting local anaesthetic like bupivacaine still requires higher doses of analgesics in the post-operative period. Dexmedetomidine is highly selective αadrenoreceptor agonist and sympatholytic drug is a useful adjunct drug in patients undergoing vaginal hysterectomy under continuous spinal epidural block (CSE). We sought to study duration of perioperative analgesia, observe the intra-operative and post-operative hemodynamic changes and post-operative sedation effect of dexmedetomidine.: The study groups were divided as Group D (study group) administered 1 µg/kg Dexmedetomidine and Group C (control group) administered 0.9% saline drip at the rate of 1ml/kg. Dexmedetomidine group had prolonged duration of sensory blockade, duration for 2 dermatomal regression of sensory blockade and the duration for motor block regression to Modified Bromage scale 0. This group had prolonged duration of Time to first request for rescue analgesic.14% patients required mephentermine for management of hypotension.Intraoperative diastolic blood pressure (DBP) was lower in study group while Intraoperative Systolic blood pressure (SBP) was comparable in both the groups. Intravenous dexmedetomidine significantly decreases the heart rate and is associated with higher incidence of bradycardia. It is effective in providing postoperative analgesia and in preventing postoperative shivering with reduced incidence of postoperative nausea and vomiting.
Effectiveness and safety of cuff inflation technique over conventional method of Magill forceps for Nasotracheal intubation under direct laryngoscopy: Randomized controlled trial
Authors: Bhayani Ami , Patwa Apeksha 
Published: November 2021

The aim of the study is to compare the effectiveness and safety of cuff inflation technique over conventional method of Magill forceps for Nasotracheal intubation NTI under direct laryngoscopy.After taking permission from institutional ethical committee, patients of 18-60 years of either sex of ASA grade I and ll were divided into groups of 40 each. In group C, cuff inflation technique and in group M, Magill forceps technique was used for navigating the endotracheal tube from oropharynx to glottic opening to achieve intubation. Parameters observed were time required for intubation, attempts of intubation, injury occurring to oropharyngeal structures during intubation and hemodynamic parameters. Cuff of endotracheal tube was assessed postoperatively for any leaksAnalysis of the data for the various parameters was done using paired t-test for intra-group comparison and student t-test for intergroup comparison and chi-square test was used for qualitative (non parametric) data.There was no significant difference in demographic parameters, time required for intubation, number of attempts for intubation and hemodynamic parameters, but trauma to oropharyngeal structures was more in group M (8/40) compared to group C (0/40). (p≤0.05) Trauma to cuff of endotracheal tube was seen in group M (1/40) while none in group C (0/40) which was statistically not significant (p≤0.05).Thus, Cuff inflation technique can be used as an effective alternative to Magill forceps for oropharyngeal navigation of endotracheal tube under direct laryngoscopy guided nasotracheal intubation in patients with normal airways.
Nalbuphine versus dexmedetomidine for attenuation of haemodynamic response to laryngoscopy and intubation: A randomised double blind comparative study
Authors: Rathore Akanksha , Chaudhary Sujata , Kumar Mahendra , Salhotra Rashmi 
Published: November 2021

Laryngoscopy and intubation are noxious stimuli which result in marked sympathetic response. However, literature search did not reveal any study comparing nalbuphine and dexmedetomidine for attenuation of haemodynamic response to laryngoscopy and intubation.After Institutional Ethical Committee approval and written informed consent, 80 ASA I and II patients were randomised in two groups of 40 each. Group N received 0.2 mg/kg of nalbuphine; group D received 1 µg/kg dexmedetomidine over a period of 10 min. Anaesthesia was induced as per standard general anaesthesia practice. Haemodynamic parameters [Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), & Mean Arterial Pressure (MAP)] were recorded at baseline, 0, 1, 3, 5, 10, and 15 min following intubation. Patients were also observed for any side effects of the study drugs.There was a significant decrease (p&#60;0.001) in mean HR in group D compared to group N, after administration of drug and 1 min after intubation. Both group N and group D showed no significant increase in mean HR at any time point compared to baseline values. There was no significant increase in mean SBP at any time interval in both the groups when compared to baseline. There was a significant increase (p&#60;0.001) in mean DBP and MAP at the time of intubation in group N whereas no significant increase in mean DBP, and MAP was observed in group D at any time point.Dexmedetomidine was found to be more effective in attenuating haemodynamic response to laryngoscopy and intubation as compared to nalbuphine.
Analgesic efficacy of intercostal nerve block in percutaneous nephrolithotomy: systematic review and meta-analysis
Authors: Sharma Gopal , Prasad Seema , Singh Saket , Thummala Yashasvi , Kumar Santosh 
Published: November 2021

Pain is important morbidity following percutaneous nephrolithotomy (PNL). Various adjunctive procedures such as intercostals nerve block (ICNB) have been described to reduce post-operative pain. The aim of this review was to determine the analgesic efficacy of ICNB in PNL patients. Systematic literature search was conducted to identify relevant publications. We followed preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines while conducting this review. In this review, five randomized studies with 319 patients were included. The analgesic requirement was statistically similar in ICNB and control group (Standard mean difference (SMD) -0.48 confidence interval (CI)[-1.4, 0.44] p=0.31) whereas analgesic requirement was lower for peritubal infiltration group (PTI) as compared to ICNB (SMD 0.85 CI[0.25,1.44] p=0.005). Also, time to first analgesic requirement was similar between ICNB and PTI (SMD 0.86 CI[-9.3,11.0]), p=0.87). Pain according to VAS (visual analog scale) and Dynamic VAS (DVAS) at 24 hours was lower in ICNB group as compared to the control group; however, only DVAS at 24 hours was statistically significant. DVAS and VAS at 24 hours were similar for both ICNB and PTI. Intercostal nerve block in terms of analgesic requirement appears to be inferior to peritubal block and no better than control group. Also, mean pain scores for ICNB were similar to control group and peritubal block.
Anaesthesia management of a difficult airway patient with severe aortic stenosis for major oncosurgery
Authors: Chodankar Ninad , Kapadia Disha , Mehta Hemant 
Published: November 2021

Over the past few decades, oncosurgical procedures are increasing in number, require considerable expertise and training for anaesthetising such patients. Aortic Stenosis itself poses great challenge, causes significant increase in morbidity and mortality in the perioperative period. Head, neck oncosurgical procedures with difficult airway requiring awake fiberoptic intubation in such patients adds to the challenge.We describe once such case of previously operated Carcinoma of oral cavity with new growth involving mandible for excision of tumour with neck dissection and mandibular reconstruction with a free Fibula flap. This patient now presented with anticipated difficult airway with restricted mouth opening and a recent diagnosis of severe Aortic stenosis with mean gradient across aortic valve of 52mmHg and valve area 0.8 cm2.Such patient requires multidisciplinary team approach by cardiologist, anaesthesiologist, surgeon and intensivist to prevent perioperative morbidity and facilitate early recovery.
Anaesthesia management of a case of huge neck mass due to cervical spine chondrosarcoma with distorted anatomy
Authors: Bhojane Utkarsha P , Deshpande Jyoti P , Salunke Akshay M , Singh Noopur D 
Published: November 2021

Chondrosarcoma is the tumor which affects bone and soft tissue with only 2% spinal involvement. Anesthetic management becomes challenging in patients with cervical chondrosarcoma. Here, we are presenting a case of huge neck mass due to cervical spine chondrosarcoma in 70 year old male hypertensive patient. The patient has distorted anatomy with mucosal edema with left tracheal deviation and compression from right side. Awake Nasal Fiberoptic intubation was done with cuffed ETT no 8. The neck mass was removed and Anterior Cervical Discectomy and Fusion (ACDF) with bone grafting. The case was managed with adequate analgesia, replacement of fluids and Blood and Blood products. Considering complex cervical spine surgery and airway edema the patient was shifted to Surgical Intensive Care Unit (ICU) for elective ventilation and advanced monitoring. After serial ABG and proper weaning the patient was extubated next morning smoothly. Extensive preoperative evaluation, planning, clinical judgement and skilled experienced personale are essential for proper execution of difficult airway cases.
Peri-operative anaesthesia challenges in large anterior mediastinal mass - A case report
Authors: Wadhwa Rachna , Sharma Varun , Ahluwalia Pallavi , Datt Vishnu 
Published: November 2021

Thymic mass is a rare tumor in the anterior mediastinum. They are usually of unknown etiology. About 50% of patients are diagnosed incidentally on chest radiographs. A 45 years, BMI-28, male patient presented to cardiac outpatient department with breathlessness and persistent cough for past three months. He also complained of generalized fatigue and nonspecific chest pain. On chest x-ray (PA view), there were diffuse opacities in middle and lower zone and no tracheal compression or deviation. Lateral neck X-ray also ruled out any airway compression. Computed tomography thorax revealed a huge mass occupying the prevascular compartment of mediastinum and insinuating the visceral compartment bilaterally with extension upto bilateral cardiophrenic and anterior costophrenic angles. CT-guided biopsy was consistent with thymolipoma which was surgically resected.Thymolipomas usually present with nonspecific symptoms. They pose a huge anaesthetic challenge during the peri-operative period in terms of difficult intubation, co-existing airway compression requiring reinforced tubes and fiberoptic guidance, the possibility of sudden airway collapse post-induction, risk of hypoxemia secondary to reduced functional residual capacity (FRC) and haemodynamic disturbances during and after removal of huge mass.
Associations between emotional scaffolding, classroom quality and dialectical thinking support in kindergarten
Authors: Veraksa Nikolay , Airapetyan Zlata , Krasheninnikov-Khait Evgenii , Gavrilova Margarita 
Published: November 2021

Emotional scaffolding by the teachers of kindergarten children facilitates children's emotional well-being and contributes to their achievements in school. Our aim was to analyze the association between emotional scaffolding, dialectical thinking support and classroom quality. We used the Early Childhood Environment Rating Scale (ECERS-R), Dialectical Thinking Support (DTS) scale and Emotion Socialization Observation Scale (ESOS). The study involved 22 kindergarten groups attended by 6-7-year-old children and their educators who have worked with these children for several years. The actions of teachers aimed at emotional expressiveness modeling and teaching about emotions are positively associated with high-classroom and dialectical thinking support. We revealed for the first time associations between dialectical thinking support and emotional scaffolding in children. This suggests that the discussion of opposites and contradictions in objects and situations in the classroom environment and the study of them in the process of change is positively associated with emotion socialization.

Keywords: dialectical thinking; teaching about emotions; emotional scaffolding; preschoolers; quality of educational environment
Assessing Distance- Education services for students with Learning difficulties during the Corona pandemic
Authors: Al-Ramamneh Abdallatif Khalaf Sliman 
Published: November 2021

This study aimed to assess the distance-education services provided to students with learning difficulties during the Coronavirus pandemic. To achieve the objectives of the study, the researcher built two scales to assess distance education services that are offered to students with learning difficulties; one is from the teachers’ viewpoint and the other is from the parent's perspective. The findings showed that the degree of assessment of distance education services for students with learning difficulties during the Corona pandemic was moderate at the overall level among teachers and low among parents. There were no statistically significant differences in the teachers’ responses attributed to the variables: gender, academic qualification, and years of experience. Moeover, there were no statistically significant differences in parents’ responses attributed to the variables: the child's gender, the educational qualification of the parents and the child's age.

Keywords: Corona pandemic, students with learning disabilities, distance education.
Digital literacy curriculum management in kindergarten
Authors: Munawar Muniroh , Fakhruddin Fakhruddin , Rodiyah Rodiyah , Prihatin Titi 
Published: November 2021

Education needs to formulate a curriculum that suits the digital era, especially in terms of digital literacy and cyber wellness. This research was conducted to get an overview of digital literacy curriculum management in kindergarten. A total of 122 kindergartens were purposely selected to take part in a survey of this study. Of the 122 kindergartens, 27 kindergartens have integrated digital literacy education in schools, while 95 kindergartens have no integrated digital literacy education in schools. Then, the 27 kindergartens joined a focus group discussion and the results showed that there were six valid and reliable indicators to evaluate the implementation of digital literacy curriculum management in kindergarten, they are: 1)availability of digital infrastructure; 2) competence of managers and teachers in digital literacy; 3) curriculum objectives related to mastery of basic digital literacy competencies in children; 4) digital literacy implementation in school (children’s learning experiences); 5) digital literacy teaching materials and strategies in schools and 6) parental involvement in curriculum development. In addition, there is a need for a technology integration development module in kindergarten classes that can become a guide for teachers and parents when using digital technology with children.

Keywords: Curriculum, management, digital, literacy, kindergarten.
Education politics: Learning model through Google Apps in office administration management of diploma students
Authors: Elyta Elyta , Darmawan Deni 
Published: November 2021

Digital natives are unlimited digital information sources to provide convenience in accessing of digital information sources. It’s developed in the Industrial Revolution 4.0, which were marked by the rapid advancement of information technology and which had an abundant impact on people accustomed to receiving high-speed information. The government in the Indonesian National Qualifications Framework policy under Presidential Decree No. 8 of 2012 has outlined the importance of fulfilling educational qualifications for each profile of its graduates to have the competencies needed in the world of work. There needs to be a careful and thorough evaluation step to see whether the campus authorities can meet the competency standards and this problem then motivates researchers to conduct little experiments on using Google Apps to manage office administration and non-conventional learning models by looking at the relationship between the required competency standards and the learning received by students.

Keywords: Digital, Educational Politics, Google Apps
The reality of using Moodle In a distance education program
Authors: Al Soub Tarik Faris , Amarin Nidal Zaki 
Published: November 2021

Using e-learning system (moodle) in distance education in time of the Covid-19 has become a reality, and the study was concerned with revealing the degree of faculty members ’benefit from the Moodle system, as well as the nature of the challenges they faced, in addition to their vision to develop the use of Moodle system in teaching. The study used the descriptive analysis method, and the results showed that faculty members have benefited from the Moodle system for a high degree, although they indicated that there are significant challenges. The faculty members suggested continuing training on using the Moodle system and updating the version of the system available at the university. Results also showed that there are statistically significant differences in the estimates of the study sample of the reality of employment in favor of female faculty members as well as faculty members with low teaching experience, in the youth group. Accordingly, the study recommends training the teaching staff to use educational platforms and face the challenges facing distance education through these platforms

Keywords: Distance education - Corona pandemic
Magnitude of Covid-19 on Rural Universities in the Eastern Cape Province: Lessons Learnt
Authors: Newlin Marongwe , Grasiab Chisango 
Published: November 2021

This research paper aims at assessing the impact of the Covid-19 pandemic on rural institutions of higher learning in South Africa. It further explores lessons learnt from the magnitude of the pandemic. Covid-19 does not discriminate – it spares no institution, no organisation, and no country but infects and affects everyone. Some institutions of learning, when hit by Covid-19 were better prepared to fight it because their alert levels were higher than that of African countries. This study adopted a desktop approach which relied on published data. The paper concludes that the impact of Covid-19 on institutions of higher learning was catastrophic. The magnitude of the Covid-19 pandemic on rural institutions of higher learning in South Africa was devastating because some universities had no strategy to counter the challenge. One of the lessons learnt was that the universities’ think-tanks should plan in advance, be proactive, and be ahead of any challenge.
Keywords: Covid-19; e-learning; higher learning; impact; lessons; pandemic
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