bluuebunny/crossref_metadata_2025_split huggingface dataset:
Geographical Variation in Opioid Use in Elderly Patients with Dementia: A Nationwide Study
Authors: Jensen-Dahm Christina , Zakarias Johanne Købstrup , Gasse Christiane , Waldemar Gunhild 
Published: July 2019

Background: We recently reported frequent use of opioids among elderly with dementia. Discrepancies in clinical practice may in part explain the higher use of opioids in elderly with dementia, which geographical variation may be able to clarify. Objective: To investigate geographical variation in opioid use in elderly with dementia compared to elderly without dementia. Methods: Register-based cross-sectional study in the entire elderly (≥65 years) population of Denmark in 2015. Data included place of residence, prescriptions, and discharge diagnoses from hospital contacts. Prevalence of opioid use among elderly with ( n = 36,014) and without dementia ( n = 1,011,787) was compared nationwide across the five Danish regions using logistic regression analysis and for the 98 municipalities using age and sex standardization. Results: 32.5% of elderly with dementia and 16.9% without were treated with an opioid in 2015. For home-living elderly with dementia, there was a 4-fold difference in opioid use (9.4 to 36.8%) between municipalities compared to a 1.6-fold (12.7 to 20.2%) difference for elderly without. In nursing home residents there was a 2-fold difference (dementia: 26.5 to 55.2%; no dementia: 31.8 to 60.4%). Differences between the five regions were minor. Conclusion: Opioid use in elderly with dementia was frequent and almost twice as high compared to elderly without dementia, which may challenge patient safety. The pronounced geographical variations at municipality level, particularly among elderly with dementia, indicate differences in the approach to treatment of chronic pain in primary care. Our study suggests that more guidance on treatment of pain in elderly with dementia is needed.
INFLUENCE OF REVOLUTIONARY EVENTS IN THE SOCIETY ON VIOLENT DEATHS STRUCTURE
Authors: Mykhailychenko B.V. , Biliakov A.M. , Ergard N.M. , Yurchenko B.V. 
Published: July 2019

Relevance. The detector of the stability of the social system and its level of development is the frequency of violent deaths – murders, suicides and accidents. The level of murders correlates with the economic and social protection of the population. In a society reform, these indicators are changing. On the basis of the analysis of cases of violent death, on the basis of forensic medical expertise, it is possible to plan areas for preventive work of the police and health services to improve the assistance to the population.
Objective: to study the peculiarities of the violent death of Kyiv residents against the backdrop of the revolutionary events of 2013, in order to improve the preventive work of health authorities and law enforcement agencies in reducing the incidence of violent deaths among the population in the context of the reform of society.
Materials and methods. The material of the research was the acts of forensic research of 43138 corpses – residents of the city of Kyiv who died of violent death in 2001-2015 as a result of causing death wounds, gunshot injuries, height drop, mechanical asphyxiation, traffic accidents, poisoning, high and low temperature, and electrical trauma that were investigated in the Kyiv City Clinical Bureau for Forensic Medical Examination.
Results. In the course of active revolutionary events, 92% of deaths are death by force. The number of deaths among women is significantly reduced. The number of incidents of firearms is 21 times higher. The number of murders increases by 49%, and in the next it falls to the original level. The number of suicides remains at a constant level during revolutionary events, but increases by 25% after them. The level of accidents decreases by 3.7 times during the revolutionary events and increases after them to a level that was even higher than at the beginning of this period. The number of injuries in dull and sharp objects increased by 25%, followed by a fall to a level that was less than revolutionary events.
Conclusions. During active revolutionary events, the distribution of types of violent death changes.
SANITARY-HYGIENIC CHARACTERISTIC OF WORKING CONDITIONS AND STATE OF HEALTH OF TEACHERS
Authors: Savushina I.V. 
Published: July 2019

Relevance. The main causes, which cause voice disruption in teachers can be divided into biological, professional, everyday, psychological. Combinations of two or more factors are possible. Objective. To carry out an analysis of working conditions and the state of health of teachers of general educational institutions in the city of Krivoy Rog.Materials and methods. The analysis of working conditions is carried out sanitary-hygienic method. The state of health of teachers is investigated by a clinical method.
Results. The working conditions of teachers are characterized as tense and heavy, and in terms of labor intensity indicators belong to class 3.3, microclimate and equivalent noise level to class 3.1. Chronic catarrhal laryngitis is 131,00±15,07 cases, hypertrophic laryngitis – 190,20±22,61 cases. The critical work experience under the conditions of the impact of the voice load is 10-19 years, accounting for 60 % of cases of professional laryngitis.
Conclusions. Analysis of working conditions, the duration of the voice load and the levels of the pathology of the vocal apparatus open up prospects for determining the risk of developing professional laryngitis in teachers and developing modern methods of treatment and prevention.
MEDICAL RECORD KEEPING; AN UPDATE
Authors: Gupta Dr. Naveen , Choubey Dr. R. K. 
Published: July 2019

Now a day’s Medical Profession not only deals with Medical affairs it involves various aspects of Legal Profession as well. Hence it should be re- coined as Medico Legal Profession. While providing any medical services if any issue arises then Doctors has to face the legal consequences and brought under the court jurisdiction for prosecution like other criminals.
The only thing which helps in front of court is the documents produced by the treating doctor, so keeping the Medical Records in meticulous manner, maintaining it & keeping it safe is very important.
So one should be very particular while recording the details & vitals in OPD Card, Bed Head ticket, Consent Form, Admission & Discharge Ticket of the patients. Doctors should be well aware of the things to be recorded into Medical Records, as well more aware about how to keep the records & to produce them when demanded in a Legitimate manor.
Keywords: Medical Records, Record Keeping, Medico legal, Guidelines, Legetimate
A LOW GRADE TUMOR, EXTRA SKELETAL MYXOID CHONDROSARCOMA, WITH METASTATIC POTENTIAL: A CASE REPORT
Authors: Shukla Sushil Kumar , Kumar Viney , Chandra Smita 
Published: July 2019

Extraskeletal Myxoid Chondrosarcoma (EMC) is a rare soft tissue sarcoma of uncertain differentiation characterized by abundant myxoid matrix located in the soft tissues. It affects mainly the soft tissues of the proximal end of long bones. EMC has a male preference, and this occurs in soft tissue area in patients who are more than 40 years old. The present case was 63 year old female diagnosed as EMC on histopathological examination with immuno–histochemical confirmation and after eight months presented with pulmonary and inguinal metastasis. EMC is a rare tumor should be considered in the differential diagnosis of myxoid soft tissue neoplasm. Therefore, a multi-modal approach, having distinct clinical, cytological, histo-pathological, immunohistochemical features and cytogenetics analysis, must be necessary in establishing a more definitive diagnosis, which may finally lead to a more targeted and specific treatment for patients.
Keywords: Extraskeletal myxoid chondrosarcoma, Inguinal metastasis, low grade tumor, IHC
CHILD HOMICIDES IN ADANA, TURKEY
Authors: Kaya Kenan 
Published: July 2019

Violence is a common and important public health problem in our country like all over the world. Homicide is the last point of no return and solution. Nearly at all communities; homicide is being accepted as most serious crime and it is being punished with severe sanctions and also they are trying to develop prevention strategies.
At this study, 5159 cases were investigated retrospectively which were medico-legally autopsied at institute of Forensic Medicine Adana Group Authority Morgue Specialty office between the years of 2009-2011. Cases were investigated according to cases’ ages, genders, the objects (weapons) causing death, localization of wounds. Besides, toxicological analyzes of all cases were reviewed. It was seen that; 79 (66%) of total 120 child victims were male, youngest was 7 months old, eldest one was 18 years old, average age was 13,5. It was detected that when we group the children according to their ages; most cases [85(70,8%) ] were between the ages of 13-18. When we look at homicide methods, it was seen that; firearms is at first place with 73 (60,8%) of cases. It was detected that; head is at first place with 50 (41,7%) of the cases and it was following by rib cage area with 21 cases. When we look at shooting ranges at the cases which were killed by firearms, shooting was done from adjacent range at 40 cases.
Even if removing the violence isn’t possible; revealing its reasons and methods provides possibility of forming strategies.
Key Words: Child; homicide; death; method.
Efectos económicos de la aplicación de impuestos directos e indirectos a las PYMES en la provincia de Tungurahua periodo 2014 - 2017
Authors: Flores Guamán Jonny Jesús , Padilla Martínez Mario Patricio 
Published: July 2019

Las empresas son el motor de la economía del país a través de sus actividades económicas generan empleo y contribuyen al crecimiento económico, en especial las PYMES que están estructuradas por organizaciones con mayor capacidad para adaptarse a los cambios tecnológicos y generar fuentes de empleo, convirtiéndose en un factor importante de política de distribución de ingresos a los estratos sociales medio y bajo; son motores del desarrollo económico que aportan con el pago de impuestos los cuales actúan como instrumentos del Estado para promover el incremento económico, e influir en los niveles de distribución de la riqueza. Las PYMES al pagar sus impuestos, directos e indirectos dependiendo de la actividad económica que realice, el tamaño, el monto de sus ingresos y su capital carecen del conocimiento básico sobre los incentivos tributarios y el pago de impuestos, para conocer la realidad que se genera, se ha realizado una investigación sobre el impacto que genera los impuestos directos e indirectos en las PYMES en la provincia de Tungurahua en el periodo 2014 -2017, el objetivo para este estudio es determinar los efectos económicos que causan los impuestos directos e indirectos en las PYMES, mediante el análisis de fuentes teóricas, identificando la situación económica actual a través de metodologías adecuadas. Los fundamentos y elementos de discusión referentes a impuestos en las PYMES desde una perspectiva histórica, para analizar los resultados obtenidos con la encuesta aplicada conociendo la población finita de 3151, para saber sobre el tipo de actividad y la diversificación de las mismas en el sector económico primario, secundario y terciario de la provincia de Tungurahua como personas naturales o jurídicas obligadas y no obligadas a llevar contabilidad, los resultados indican que las PYMES en la provincia tienen un pago sobre impuestos en un rango entre 500 a 5000 USD, los impuestos más recaudados son el (IVA) con un porcentaje del 100%, el Impuesto y Anticipo a la Renta con un 100%, retención a la fuente con un 68%, retención al IVA con un porcentaje del 26% y la salida de divisas con un 2%; las recaudaciones de las municipalidades corresponden a: el Impuesto predial y Patentes Municipales con un porcentaje de recaudación del 100%, adicional las PYMES con categoría jurídica tienden a pagar tributos a la Superintendencia de Compañías que asciende a un 10%. Las políticas fiscales y tributarias han afectado a través del tiempo a las PYMES con factores negativos, ya que promueven la inflación como el aumento del precio de producción lo que refleja en el precio venta de los diferentes productos y servicios, ofreciendo poca competitividad en el mercado, cierre de las PYMES y como efecto el despido de los trabajadores.
Modelo de gobierno electrónico peruano: servicios para el ciudadano en los portales de los gobiernos regionales
Authors: Alvarado Aguirre Pablo Felipe , Cevallos Vásquez Paolo Israel , Moran Villamarin Edwin Daniel , Preciado Ortiz Lenin Feliz 
Published: July 2019

La investigación inicia con una parte introductoria de lo que se pretende realizar en el presente trabajo. En el segundo capítulo se incorpora la normativa relativa al servicio del ciudadano en la Administración Pública, los cuales permiten entender la legislación básica del proceso de Modernización de la Gestión del Estado, el Gobierno Electrónico, los Portales Web y los Gobiernos Regionales en el Perú. Se hace una breve contextualización de los antecedentes y avances de Gobierno Electrónico en el mundo y en el Perú. El cuarto capítulo se divide en dos partes, en el primero se realiza la selección de criterios y la metodología que permitirán evaluar de manera global el front office de los portales web de cada Gobierno Regional y en la segunda parte se exponen los resultados obtenidos, que a su vez: 1) muestra el estado actual de desarrollo de Gobierno Electrónico en los 25 gobiernos regionales del Perú, 2) detalla las características relacionadas a la interacción, información y medio digital y 3) describe el estado actual de algunos servicios para el ciudadano como el acceso a la información, los trámites en línea y la participación.
Use of Internet among Rural Teenagers: Pattern of Usages, Awareness and Associated Health Hazards
Authors: Jobayer Mohammad , Sultana Rabeya , Anwar Sk Serjina , Afroz Zeenat , Akter Nadira , Chowdhury Mahbuba , Rashed Asif , Farhana Nasreen , Islam Lohani Md Tazul , Hussain Dewan Azmal 
Published: July 2019

Internet has become an essential tool for communication, information, and entertainment and use of internet is increasing among the teenage group. This cross sectional study was conducted among 385 teenagers from rural area of Narayanganj district in Bangladesh to evaluate the practice of internet use, their awareness about the beneficial and harmful effects and associated physical and psychological health hazards. The study reached its various findings from the view point of rural area of our country. The study population was chosen purposively; data were collected using a semi structured questionnaire regarding their knowledge and various practice of internet use relating to the objectives. Most of the respondents were students and came from lower middle class family. Majority of the study people recently started to use internet and they were mostly light or moderate user in terms of time spending. Mobile phone was used as device by 84.7% people for their internet browsing. Teenagers used internet mainly for entertainment (42.1%) and social networking (35.6%) purpose and not much for learning or education. They were aware about the beneficial and the harmful effects of internet use especially abuses. Commonly experienced physical health hazards by them were headache (11.7%), straining of eyes or blurring of vision (10.7%) and skipping meals or change in eating behavior (9.1%), and among the psychological hazards, restlessness or agitation (8%) and depression (5.2%) were stated. It may be concluded that use of internet among teenagers of rural area of our country is at modest level associated with a few health hazards but the merits of internet based networking is yet to be revealed by them.
Bangladesh Med J. 2017 Sep; 46 (3): 69-73
Surgical Outcome of Vesico-Vaginal Fistula (VVF) after Repair: Experience of 51 Cases in a Teaching Hospital of Dhaka City
Authors: Akter Shimul , Mujib Fouzia , Rahman Mohammed Masudur , Banu Dewan Shahida , Begum Taslima , Firdousi Tahmida , Mondal Dipika Rani 
Published: July 2019

Background: Surgical management of vesico-vaginal fistula is very crucial regarding the outcomes among the women.
Objectives: The purpose of the present study was to see the surgical outcomes of vesico-vaginal fistula.
Methodology: This cross-sectional study was carried out from July 2013 to December 2013 for a period of 6 months in the National Fistula Centre in the Department of Obstetrics & Gynaecology at Dhaka Medical College Hospital (DMCH), Dhaka, Bangladesh. All patients who underwent surgical repair for iatrogenic VVF in National Fistula Centre of the department of Obstetrics and Gynaecology of Dhaka Medical College Hospital were included in this study. Patients who got themselves admitted to Obstetrics & Gynaecology department of DMCH with the complaints of fistula. An interview usually lasted for an hour. The entire selected patients were interviewed for detailed history. Thorough physical examination was done. The surgical outcomes were recorded among the women.
Result: A total number of 51 cases of VVF were recruited for this study. The mean age was 46.02 (±SD 6.104) years. Regarding the causes of iatrogenic vesico-vaginal fistula most of the cases (88.2%) were abdominal hysterectomy. In 4(7.8%) patients lower segment caesarean section caused the situation. Vaginal hysterectomy was responsible for 3.9% (2/51) cases of iatrogenic VVF. In more than 90% cases (46/51) the surgical outcome was successful; while in 5 patients’ fistula recurred 5 to 7 days following surgery. They were treated by re-operation later on.
Conclusion: In conclusion abdominal hysterectomy is the most common cause of iatrogenic vesico-vaginal fistula with a very good surgical outcomes.
Journal of National Institute of Neurosciences Bangladesh, 2019;5(1): 29-32
Surgical versus Conservative Management of Granular Myringitis: A single-centre Randomized Control Trial
Authors: Ahsan Ali Imam , Jamal Nasimul , Ahmad Ashfaq , Ali Syed Farhan , Haque Momenul 
Published: July 2019

Background: Treatment of granular myringitis (GM) is diverse with no definitive management.
Objective: The aim of the present study was to see the effectiveness of different interventions for treating granular myringitis.
Methodology: This was a single centred, parallel, randomized control trial. This study was done at the Specialized ENT Hospital of SAHIC, Dhaka from July 2010 to June 2012. Patients presenting with granular myringitis of 18 years of age or more with both sexes were included. All patients were divided into two groups by simple random sampling method of which patients of group A were treated by surgical treatment and that of group B were treated by medical treatment. Medical treatment was given in the form of topical ear drops and surgical treatment was performed by surgical debridement of granulation tissue followed by chemical cauterization. Repeated follow up was performed up to 6 months in both groups of treated patients. The primary outcome was the resolution of granulation tissue. During follow-up the secondary outcome variables were recurrence, perforation of the TM and any other complications or complain from the patients.
Results: A total number of 60 patients were studied of which 30 patients were treated medically and 30 patients were treated surgically. The cure rate was higher in surgical treatment (80%) than conservative (16.7%) (p=0.011). The recurrence rate (17.24%) is also less in surgical group compared to medical treatment group (77.27%) (p=0.001).
Conclusion: Surgical treatment is a more successful treatment modality for granular myringitis.
Journal of National Institute of Neurosciences Bangladesh, 2019;5(1): 64-68
Association of HbA1c Level with Lipid Profiles among Type 2 Diabetic Patients attended at Medical University of Bangladesh
Authors: Majumder Moitreyee , Mollah Forhadul Hoque , Ferdous Shamim Ara 
Published: July 2019

Background: Type 2 diabetic patients are presented with dyslipidemia.
Objective: The objective of this study was to see the association between the HbA1c and lipid profiles among the diabetic subjects.
Methodology: The cross-sectional study was carried in the Department of Biochemistry at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh on type 2 diabetic individual attending the endocrine OPD of BSMMU. In this study estimation of HbA1c level and lipid profiles in diabetic subjects were performed and was compared the lipid profiles between the controlled (HbA1c <7%) and uncontrolled (HbA1c >7%) groups.
Result: A total number of 95 patients were recruited for this study. The mean age of the respondents was 42.63 ±5.56 years. Female (8.21± 1.88) had lower HbA1c than male (8.42±2.21) in the study. TC: HDL (6.07±1.02:1) and LDL: HDL (3.88±1.58:1) were also higher. Among the study population 30 had good (HbA1c<7 mg%) glycemic control and 14 of them were male and 16 were female. Those having good glycemic control had lower TG and HDL (176.72±88.83 vs 206.84±124.77mg/dl) and (32.84±7.78 vs 34.88±8.48 mg/dl); however, higher TC and LDL (201.56±34.73 vs 197.19 mg/dL) and (133.04±33.71 vs 124.30±35.97 mg/dL) than those having poor glycemic control. No statistically significant difference between these two groups were observed.
Conclusion: Thus there is no statistical significant difference between HbA1c and lipid profile among type 2 diabetes mellitus patients.
Journal of National Institute of Neurosciences Bangladesh, 2019;5(1): 72-75
Pattern of Periodontitis among Adult Patients Attending at Medical University of Bangladesh
Authors: Alam Md Rajaul , Abid Mohammad , Biswas Utpalendu , Islam Syed Shariful , Banik Rajib Kumar , Bithi Sonia Jahan 
Published: July 2019

Background: Periodontitis is one of the most common oral diseases and is one of the widest spread chronic diseases all over the world. If a person maintains a good oral hygiene, he/she can control periodontitis easily. Periodontitis is a preventable disease.
Objectives: This study was aimed to know the current pattern, the possible causes and the attitude towards periodontitis among adult patients attending at outdoor of dental faculty of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
Methodology: This cross-sectional study was carried out in the OPD of Dental faculty of BSMMU, Dhaka fromJanuary 2013 to December 2013 over a period of one year. One hundred twenty patients with any sort of dental problem were enrolled in this study.
Results: The current study depicted that 68.3% of the patients were from age group of 18 to 40 years and 59.2% were male while 40.8% were female. Most of the respondents (65.8%) lived in urban area. This study showed that 80.8% experienced bleeding from gums and 59.2% had knowledge about cleaning teeth before going to bed and after breakfast. It was found that 77.5%of the respondents used tooth brush and tooth paste for cleaning their teeth. Only 15.8% of the respondents visited dentist for oral and dental check-up regularly. According to life style related habit, 53(44.2%) respondents were smoker, 55 (45.8%) respondents chewed betel leaf and 30 (25%) of the respondents hewed betel leaf with Jarda or SadaPata. Majority 104 (86.7) had calculus, defective margins and restorations. Most of the respondents (95.0%) had bleeding on probing.
Conclusion: In this study a significant number of respondents have periodontitis who have attended outdoor of dental faculty. Older age, smoking, betel, jarda/sadapata, diabetes mellitus and presence of calculus and restorations are the risk factors for developing periodontitis.
Journal of National Institute of Neurosciences Bangladesh, 2019;5(1): 76-80