bluuebunny/crossref_metadata_2025_split huggingface dataset:
Physical Examination of Sexually Abused Children and Adolescents
Authors: Horowitz David A. 
Published: December 2021

Sexual abuse of children has come to the forefront of our national consciousness through continued exposure in newspapers, in magazines, and on television. Despite this media attention, many pediatricians have not been trained to evaluate cases of suspected sexual abuse. Because estimates of the prevalence of sexual abuse in the general population range into the millions,1 it is likely that the office-based pediatrician will encounter more and more cases. Although guidelines for evaluation of child abuse exist,2 professional journals are now beginning to address sexual abuse. A recent article by Krugman3 reviewed the role of the office-based pediatrician in sexual abuse cases. Some points that he discussed included maintaining a high index of suspicion for both direct and masked presentations of sexual abuse; interviewing skills needed for both the child and family; legal ramifications; and the need for a coordinated effort among the many groups of professionals involved in each case, in an effort to minimize separate, repetitive, and traumatic evaluations. This article is intended to supplement Krugman's by providing a detailed description of the vaginal examination of the prepubertal child and adolescent.
PHYSICAL EXAMINATION
The prerequisite of a thorough, sensitive examination is time. This is the one element most lacking in a busy office or emergency room. Preparing the child for the examination will take more time the examination itself; this preparation is the most important part of the examination process.
PHYSICAL EXAMINATION
The prerequisite of a thorough, sensitive examination is time. This is the one element most lacking in a busy office or emergency room. Preparing the child for the examination will take more time than the examination itself; this preparation is the most important part of the examination process.
Infectious Exanthems
Authors: Hartley A. Howland , Rasmussen James E. 
Published: December 2021

An exanthem is a generalized Cutaneous eruption associated with a systemic disease, usually of infectious cause. The actual mechanisms that produce exanthematous skin lesions are not known but certainly involve a number of different processes including direct damage to cells by pathogenic organisms, toxin production by these organisms, and the patient's immune response. Because the skin has a limited repertoire of responses to illness and injury, there is no single skin lesion whose morphology is pathognomonic for a particular infectious disease. Therefore, the exanthem cannot be considered as a separate entity but only as one component of the disease.
There is a great tendency in pediatrics to label every exanthem "an erythematous maculopapular rash." Although this term is often correct, by itself it is always incomplete. The distribution, configuration, and evolution of the rash are often critically important. Historical information regarding infectious exposure, general symptoms, and drug use help constitute a brief, initial evaluation. Although the importance of appropriate laboratory studies cannot be denied, they are often not diagnostic during the acute phase of an infectious exanthem. The initial diagnosis is based on history and clinical findings in the great majority of cases. Too often the physician feels pressured to make a diagnosis and initiate treatment immediately in the sick child with fever and rash. If careful initial evaluation of the child fails to yield a diagnosis, sequential observation of the course of illness throughout time is indicated.
The Pediatrician as Team Physician
Authors: Menna Vincent J. 
Published: December 2021

Sports have been an integral part of my life since early childhood. I participated competitively until the end of my sophomore year in college when I realized that there was not much demand for a 68-in 180-lb foot-ball guard. My interest in sports continued, and in my medical school senior yearbook I am pictured reading the sports page.
My dad, a family practitioner and sports enthusiast, was the physician for our local high school. I witnessed the joy and satisfaction he obtained from the job. After I married and left home, there were weekends he could not visit because he "had to" be at a game.
When the opportunity arose in our school district, I applied and obtained the job of school physician.
Sickle Cell Diseases: Diagnosis and Management in Infancy and Childhood
Authors: Pearson Howard A. 
Published: December 2021

From their basic genetic and molecular mechanisms to their clinical expression, the sickle cell hemoglobinopathies are among the best understood of human diseases. However, advances in clinical management have not progressed as rapidly: sickle cell anemia, as of 1987, is still largely incurable and its treatment is empiric and symptomatic. Despite this, today we have a better understanding of the natural history of the sickle hemoglobinopathies and many of their clinical complications. This has led to improved diagnostic, prophylactic, and therapeutic strategies which have reduced the considerable morbidity and mortality of these diseases.
The sickle cell disorders will be reviewed from genetic, biochemical, and clinical perspectives. Particular emphasis will be given to the rationale and strategies for neonatal testing and comprehensive clinical follow-up.
Although it is widely believed that the gene for Hb S is almost exclusively, African, it has, in fact, a much wider geographic distribution. There is a broad periequatorial sickle cell belt in Africa. From Africa, the sickle gene was introduced into the Western hemisphere by the 16th and 17th century slave trade. In the United States today, sickle cell disorders are particularly prevalent in the South and in the urban North, reflecting the demography of black America. In the Carribean and Latin America, relatively high frequencies are seen in Purto Rico, Cuba, Jamaica, Haiti, Panama, Guyana, and Brazil, but not in Mexico and most of South America.
Complications of Cardiac Surgery in Children
Authors: Engle Mary Allen , O'Loughlin John E. 
Published: December 2021

LEARNING CURVE OF CARDIAC SURGERY
The era of cardiac surgery to help children with congenital heart disease began in 1939 when Dr Robert Gross successfully tied off a patent ductus arteriosus. The next step, in 1944, by Drs Helen Taussig and Alfred Blalock to create an artificial ductus arteriosus for cyanotic children with deficient pulmonary blood flow, threw open the doors for the creation of diagnostic and surgical treatment teams for "blue" babies and others with simple anomalies. Coarctation of the aorta, vascular ring, and pure pulmonic stenosis were anomalies amenable to surgery by 1949. By the early 1950s, use of surface hypothermia and brief periods of circulatory arrest improved the results of pulmonary valvotomy for pulmonic stenosis by permitting incisions of fused commissures under direct vision. Hypothermic arrest also permitted closure of secundum atrial septal defects. Lillehei's pioneering of extra-corporeal circulation in the middle 1950s expanded the surgical horizons by permitting longer periods for repair under direct vision for patients with ventricular septal defect, tetralogy of Fallot, and ostium primum type of atrial septal defect. A decade later, the venous switch type of physiologic repair of complete transposition of the great arteries was developed and perfected. In the early 1970s, miniaturization of equipment brought the age for safe open heart surgery from 5 years or oler down too early infancy.
Nonimmune Hydrops Fetalis
Authors: McGillivray Barbara C. , Hall Judith G. 
Published: December 2021

Hydrops fetalis or fetal hydrops is defined as a generalized abnormal accumulation of serous fluid in the entire body including abnormal collection in tissues and body cavities. It is not a specific disease but the end result of many fetal conditions. Presentation may be prenatal with ultrasound diagnosis on at the time of delivery.
There are many causes of fetal hydrops including cardiac, pulmonary, chromosomal, hematologic, and metabolic. The mortality rate is high, with the best survival in those infants who have cardiac rhythm abnormalities.
Proper assessment of the infant with hydrops requires familiarity with the major causes and a stepwise protocol for investigation. Not only are the usual blood-grouping studies important, but also chromosomal analysis, metabolic screening, and carefully performed autopsy. The aim of the protocol that is suggested is to improve intrauterine detection and survival after birth and to ascertain the cause of the condition to aid in counseling and care in subsequent pregnancies.
İslam Öncesi Arap İnanç İkliminde Putçuluğun Toplumbilimselliği
Authors: DOĞAN Metin 
Published: December 2021

Birçok toplum tarihsel süreç içerisinde inanç anlamında farklı eğilimlere sahip olmuştur. Bu makalenin amacı, İslam öncesi kabile ve klan yapılanması içerisindeki Arapların da içinde bulunduğu toplum tiplerinin farklı şekillerde ve zaman dilimlerinde totemizm, fetişizm, natürizm ve animizm gibi sistemleri tecrübe etmiş olup olmadıklarına genel hatlarıyla bakmaktır. Aynı şekilde İslam öncesi Arapları, kendilerini diğer toplum tiplerinden ayıran özellikleri ve kadim zamanlardan beri yaşadıkları hem tek ilahlı dinleri hem de putperestliği irdelemektir. Araştırmamızda İslam’a kadar son temsilcisi “haniflik” olan tek ilahlı din algısının, İslam öncesi Arapların dini tecrübelerine yaşam biçimlerini derinden etkileyecek kadar sirayet etmiş olduğu ve dolayısıyla İslam öncesi Arapların putperestliği Haniflikte olduğu gibi, hiç bir zaman tek ilahlı dinin dejenerasyonundan bağımsız olmadığı sonucuna ulaşılmıştır. Aynı zamanda Hanif de kadim ilahi dinlerin kaderini paylaşmış, cemaatleşme olgusu gerçekleşemeden, yani Hanif dini tecrübesi inananları tarafından sosyal boyutuyla paylaşılamadan putperestliğin baskısıyla karşı karşıya kalmıştır.
Fakat gerek pagan tapınışların gerekse Hanifliğin dini tecrübesine ilişkin tarihsel verilerin sınırlı olması problematik bir konu olarak araştırmanın zorluklarındandır. Çalışmamızda sorguladığımız diğer bir konu, Putperest Arapların putçuluklarının salt puta tapınan, ona kulluk gösterisini simgeleyen farklı ibadet biçimleri olarak görülemeyeceğidir. Nitekim bu putlar, başta “yüce varlık Allah” olmak üzere, cinleri, melekleri ve diğer soyut varlıkları da içine alan bir tanrılar panteonunun yeryüzündeki sembolleri olarak somutlaştırılmıştır. Aynı zamanda tanrısal varlıklar olmaları nedeniyle de onlardan, bir tanrıdan istenecek her tür görevi yerine getirmeleri beklenmiştir. Bu anlamda putlar işlevseldirler ve onlara günlük rutin işlerin yürümesinden bireysel ve sosyal gereksinimlerin karşılanmasına, şifa kaynağı olmalarından yüce varlıkla irtibat aracı olma fonksiyonlarına kadar her açıdan sorumluluk yüklenmiştir.
STUDI EKSPERIMEN PENGARUH WICK PIPA KAPILER PADA MODEL LOOP HEAT PIPE
Authors: Asmara Dimas Panji , Hadi Kusuma Mukhsinun , Giarno Giarno , Rio Budi Syaka Darwin 
Published: December 2021

Kecelakaan yang terjadi pada Pembangkait Listrik Tenaga Nuklir Fukushhima Dai – Ichi memacu para periset di bidang keselamatan nuklir untuk menggunakan sistem pendingin pasif dalam rangka meningkatkan keselamatan termal isntalasi nuklir. Salah satu teknologi sistem pendingin pasif yang potensial untuk diterapkan adalah Loop Heat Pipe (LHP) karena memiliki kemampuan pembuangan kalor yang baik. Tujuan penelitian ini adalah untuk mengetahui pengaruh performa wick berupa pipa kapiler dalam rangka meningkatkan unjuk kerja termal dan distribusi suhu pada LHP. Metode eksperimen dilakukan dengan mengoperasikan LHP menggunakan wick. LHP dioperasikan dengan memvariasikan suhu air panas sebagai beban kalor di evaporator pada 35˚C, 45˚C, 55˚C dan 65˚C. Pendinginan pengambilan panas di bagian condenser dilakukan dengan mengaliri udara pada laju aliran udara 2 m/s. Sebelum dioperasikan, model LHP sebelum dioperasikan divakum hingga memiliki tekanan awal -74 cm Hg, dan diberikan fluida kerja air demineral dengan filliing ratio 200 %. Hasil eksperimen didapatkan suhu pada bagian adiabatic dengan wick lebih rendah dibandingkan pada bagian adiabatik tanpa wick. kesimpulan dari penelitian ini membuktikan bahwa penggunaan wick pada LHP dapat berfungsi dengan baik untuk menahan uap tidak naik ke bagian condenser dan sebagai jalur fluida hasil kondensasi untuk kembali ke evaporator.
Second Language Corner for Children’s House
Authors: Rosales Chavarria Romali 
Published: December 2021

This work reports, from a qualitative research perspective, the development of an English Corner project for a preschool Children’s House classroom in central Mexico over the course of a 3-year period. It shows the transition of a language specialist over six consecutive periods of work, from a traditional understanding and practice of teaching English as a second language to young learners into a more comprehensive one of the Montessori Method. The analysis of my own practice is used to recover insights through a reflective process with the intention to develop a second language (L2) Montessori program for 3- to 6-year-olds that aligns better with Montessori pedagogy. Variables such as instruction time, setting, group constitution, materials, and teaching and learning strategies allowed for certain aspects to arise as leading points of interest for the focus of the analysis and the methodological and pedagogical adaptations that followed each period. This paper is an attempt to fill the gap between the need to deliver a second language effectively in Montessori education and the lack of guidance for doing it the Montessori way; it is especially for practitioners who do not have a Montessori background but also for Montessori-trained teachers for whom more specific preparation would aid their practice. I also hope to stimulate further research in the field of second language acquisition and multilingualism in Montessori education at every level of education.
The clinical study of dermatophytosis in a tertiary care hospital of konkan region, Maharashtra
Authors: Raju U Ketan , Bobade Hanamant G , Mishra Anil 
Published: December 2021

Dermatophytes are aerobic fungi that produce proteases that digest keratin and allows colonization, invasion and infection of the stratum corneum of the skin, the hair shaft, and the nail. This study was an attempt on the part of the author to find out the incidence and various clinico-epidemiological characteristics of Dermatophytosis in skin OPD of Tertiary care Hospital, B.K.L.W.R.M.C., Dervan. The study was carried on 2444 patients of Dermatophytosis attending the OPD, out of which 49.79% of the cases were Tinea Cruris (TC). The age group of 11-20 years showed maximum prevalence of Dermatophytosis (22.17%). 58% of the patients had diffuse lesions. Body involvement was seen in 87% of cases. Itching was the most common condition associated with Dermatophytosis. 35% of the patients reported with family history of Tinea Cruris.Circumscribed variety of TC was found to be most common variant mostly observed in 2and 4 decade, with a male preponderance. Groin was the most common site with multiple lesions. Nail changes was most commonly associated with TC.
Assessment of clinical and etiological factors in nail dyschromias
Authors: S Shwetha , C Lalitha , G S Asha 
Published: December 2021

Healthy nails appear smooth and have consistent coloring. Nail dyschromias have a wide variety of presentation. There are numerous causes of discoloration of the nail affecting the nail plate, nail attachments, or the substance of the nail. Different pattern of nail dyschromias can point out certain dermatological or systemic diseases. To evaluate the causes of nail dyschromias in our clinical setting. Cross sectional observational study. 200 patients presenting with nail dyschromias were included in the study from April 2015 to July 2015. Detailed history was taken and cause for nail dyschromias was evaluated. 115(57.5%) were males and 85(42.05%) were females. The most seen nail dyschromia in this study was melanonychia (86.5%) followed by leukonychia (5%), blue chromonychia (5%), brown chromonychia (2%) yellow chromonychia (1.5%). The cause of nail dyschromias were:60 cases(33.33%) were due to antiretroviral drugs, 25(12.5%) due to HIV, 30(15%) physiological melanonychia, 7(3.5% of onychomycosis, 8(4%) of lichen planus, 7(3.5%) of eczema, 15(7.5%) vitamin B12 deficiency, 10(5%) chemotherapy induced blue chromonychia, 3(1.5%) haematoma, 10(5%) leukonychia, 3(1.5%) jaundice 2(1%) Addison’s disease induced, 3(1.5%) cosmetic induced and 17(7.5%) due to other dermatological and systemic conditions. Examination of nail should always be a part of routine cutaneous examination and presentation with nail dyschromias should be worked up with the help of a good history and examination. Careful examination of the nail may help in identifying the root cause and many a times unravels some underlying systemic disorder
Association of metabolic syndrome in patients of vitiligo
Authors: Jat Yashdeep , Varma Krishnendra , Kumar Ujjwal , Mahadik Aishwarya 
Published: December 2021

The metabolic syndrome is the term used to describe a constellations of metabolic derangements that includes insulin resistance, hypertension, Dyslipidemia, central or visceral obesity, type 2 DM & accelerated cardiovascular disease. An oxidative imbalance is responsible for the development of both metabolic syndrome & vitiligo. In the present study we have evaluated the association of metabolic syndrome with Vitiligo.In this observational cross-sectional study we selected 40 subjects attending skin OPD with age matched 40 controls and assessed the waist circumference, blood pressure, serum triglyceride level, cholesterol and high-density cholesterol along with Fasting blood glucose level at tertiary care Hospital. A detailed history including age, gender, diabetes mellitus, hypertension, smoking and onset of vitiligo was taken. The MetS criteria were defined by National Cholesterol Education Program Adult Treatment Panel III 2005 (ATP III) guidelines.We identified metabolic syndrome in 15 subjects with vitiligo and 6 subjects without vitiligo. The P value came 0.022 which is statistically significant. Active vitiligo, segmental vitiligo and increased duration of vitiligo were determined to be independent predictors of metabolic syndrome.The risk of developing metabolic syndrome is increased in patients of vitiligo. Screening and the close follow up of the patients of vitiligo with clinical feature such as in unstable, segmental vitiligo with increased duration is necessary for the early diagnosis of the metabolic syndrome to reduce the morbidity & mortality of the patients
Different patterns of cutaneous manifestation of diabetes mellitus type-2 observed in tertiary care centre of South West Rajasthan
Authors: Gupta Kalpana , Bareth Anurag , Agrawal Charul 
Published: December 2021

Diabetes mellitus (DM) is a common endocrinal disorder caused by complex interaction of genetics and environmental factors. Various dermatological features are known to be cutaneous markers of diabetes mellitus like diabetic dermatopathy, acrochordons, acanthosis nigricans and bullous diabeticorum, etc.An observational cross-sectional study on a total of 400 patients of Diabetes Mellitus Type-2. A complete cutaneous examination was done in all cases to observe for the presence of any specific or nonspecific dermatosis. All the statistical tests were two sided and P-value &#60;0.05 was considered as significant level.This study showed that in specific cutaneous disorders, Acrochordon 138(34.5%) was the most common manifestation which was followed by, Bacterial Infections 93(23.5%), Dermatophytosis 77(19.2%), Candidiasis 76(19%), Acanthosis nigricans 50(12.5%) and Onychomycosis 33(8.25%) in decreasing order. Xerosis 259(64.7%) was the commonest manifestation in non-specific cutaneous disorders followed by, Generalized pruritus 200(50%), Seborrheic keratosis 35(8.75%) in decreasing order.Cutaneous manifestations are quite common in uncontrolled (HbA1c&#62;7gm) type 2 diabetes mellitus as compare to controlled group. Uncontrolled group is more prone to develop diabetic complication like hypertension, diabetic retinopathy and peripheral neuropathy etc. It is concluded that, Diabetes mellitus Type-2 involves the skin quite often and whenever patients present with multiple skin manifestation and then diabetic statusshould be checked and controlled.
A homokfásítás alkonya és az ártérfásítás hajnala
Authors: Tölgyesi Csaba , Bátori Zoltán , Deák Balázs , Erdős László , Hábenczyus Alida Anna , Kukla Luca Sára , Török Péter , Valkó Orsolya , Kelemen András 
Published: December 2021

A Duna-Tisza közi homokhátságon az 1970-es évektől jelentős szárazodás figyelhető meg, mely veszélyezteti a térség gazdasági termelékenységét és a vízigényes élőhelyek fennmaradását. Jelenleg nincs konszenzus a szárazodást kiváltó tényezők egymáshoz viszonyított szerepéről. A legellentmondásosabb a homokfásítás kérdése, mely a homoki erdőgazdálkodás nagy múltja miatt „tabunak” számít. Jelen munkánkban a homokhátság erdeinek hidrológiai hatásait tekintjük át, és levezetjük, hogy negatív vízmérleget generálnak, így szárító hatásuk megkérdőjelezhetetlen. Míg több, a szárazodásban közrejátszó tényező szerepe csökkenő tendenciát mutat, a homoki erdőké arányában növekszik, így új erdők telepítése nem ajánlott, sőt, az erdőborítás csökkentése indokolt a letermelésre kerülő faültetvények újratelepítésének mellőzésével. A fásítás súlypontját folyóink ártereibe érdemes áthelyezni, melynek együtt kellene járnia azok kibővítésével, azaz az árterek részleges restaurációjával.
A Natura 2000 területek természetvédelmi jelentősége az agrártájban: esettanulmány a lőkösházi Turai-gyep tájban betöltött szerepéről
Authors: Bozó László , Rozgonyi János , Csathó András István 
Published: December 2021

Békés megye déli részén az agrárterületek a teljes külterület közel 90%-át teszik ki, míg a természetvédelmileg értékes élőhelyek csak szigetszerűen, kis fragmentumokban maradtak fenn. Dolgozatunkban ebből a földrajzi régióból, a lőkösházi Turai-gyep Natura 2000 területről közlünk madártani és növénytani adatokat a 2010 és 2020 közötti időszakból. A terepi munka során összesen 170 madárfaj jelenlétét mutattuk ki a területről, amelyek közül 57 faj rendszeresen vagy alkalmilag fészkelt a gyepen. A fészkelők között több olyan védett és fokozottan védett faj is akad, amely a térség más részein nem költ. A botanikai adatgyűjtés során is előkerültek védett, a tájban egyébként igen ritka fajok, míg egy fokozottan védett rovarfaj (nagy szikibagoly – Gortyna borelii lunata) előfordulása szintén a terület fontosságát jelzi. Eredményeink egyértelműen jelzik, hogy a még megmaradt természetes élőhelyfoltok kulcsfontosságúak a térség biodiverzitásának fenntartásában, eltűnésük több faj lokális–regionális kipusztulását okozná.