bluuebunny/crossref_metadata_2025_split huggingface dataset:
Relief for Long-standing Postchikungunya Viral Myalgic and Arthralgic Pains Effected by Neuromodulation of Ultrasound-Guided Dry Needling of Affected Muscles and Steroid-Based Interventions
Authors: Pai Renuka Shantharam , Janardana Ramya , Valiyaparambil Jerome Jose , Joy Manuel , Pai Parashuram 
Published: April 2024

Abstract
Chronic myalgias and arthralgias occur after Chikungunya virus infections (pCHIKV- M&A). We report details of treating a 6-years lasting CHIKV-M&A pains with a combination of medications and interventions. The patient had severe pain in bilateral shoulders and elbows; right thumb and back. Response to steroids, sulphasalazine and methotrexate was poor. Examination revealed M&A pains. Medications initiated included Pregabalin, Paracetamol, Tramadol and vitamin D. At two weeks, despite improvement, there were residual pains in bilateral shoulders and elbows. Four weekly sessions (two on each side), of ultrasound-guided dry needling (USGDN) of all muscles of the upper limb was done. Patient reassessment revealed moderate, residual pains at bilateral supraspinatus muscles, bicipital tendons and radio-humeral joints. These pains were addressed by USG guided steroid injection of bilateral- suprascapular nerves, bicipital tendons and radio-humeral joints. Medications reduced pains especially of back and thumb. USGDN of muscles further reduced it by 60%. The interventions at the nerves, entheses and joints gave 90%-100% relief. The pre-intervention Disability of Arm, Shoulder and Hand (DASH) score of 52.7 reduced to 5.4. At fifth month follow-up, the DASH was15.8, but patient reported satisfaction over pain relief, improvement in daily activities and quality-of-life. There are no evidence-based treatment guidelines or corroborative evidence for rheumatic pathology (most times) for persistent CHIKV-M&A pains. This case-report highlights the successful management of CHIKV-M&A pains by multi-modal approach. USGDN and steroids have neuro-modulatory effects. We have proposed that USGDN aids pain relief by an integrative role with the biologically inherent “chaos theory.”
Coronary Embolism in Patient with Prosthetic Aortic Valve: Looks Can Be Deceiving
Authors: Mauriello Alfredo , D’Arco Beatrice , Desiderio Alfonso , D’Andrea Antonello 
Published: April 2024

Abstract
Coronary embolism is a rare cause of acute coronary syndrome. We report the challenging case of a 68-year-old female with ST-elevation myocardial infarction caused by right main coronary artery embolism in the setting of bioprosthetic aortic valve and previous episode of atrial fibrillation. The management of coronary embolism depends on the patient clinical setting. In this case, the patient has received an implantable loop recorder before discharge to decide the following therapy.
Risk prediction of Type 2 diabetes mellitus and obesity among the medical students in a tertiary care hospital of Pondicherry by using IDRS
Authors: Jafrin Mani Mercy M. 
Published: April 2024

Introduction/Background:
Diabetes mellitus is a major clinical and public health problem. More than 50% of the diabetic subjects in India remain unaware of their diabetes status, which adds to the disease burden. A simplified Indian Diabetes Risk Score (IDRS) for screening of undiagnosed diabetic subjects is used to assess the diabetes risk and helps in prediction of metabolic syndrome and cardiovascular disease.

Aim:
To assess the risk of DM and obesity using the parameters of the IDRS among the students of a tertiary care hospital.

Materials and Methods:
The study was conducted among the undergraduate medical students of Sri Lakshmi Narayana Institute of Medical sciences, Pondicherry, using the parameters like age, abdominal circumference contributing to obesity, physical activity, and family history of diabetes which constituted the IDRS.

Results:
The results showed a distribution of about 14.28% in the age group of 18-20 years and 85.71% in the age group of 21-24 years. The gender distribution showed 64.28% in male category and 35.71% in female category. The family history of diabetes showed a varied presentation with 45.14% having no family history. An equal percentage of 41.14% with one parent as diabetic and 13.72% having both the parents as diabetics. About 41.72% showed a medium score in IDRS which is about 30-50.

Conclusions:
The results showed obesity and deviated parameters with respect to IDRS in certain students. So, regular follow-up and health education is the need of the hour to prevent the development of complications in future.
To evaluate the efficacy of the Alvarado scoring system as a preoperative diagnostic tool in acute appendicitis in relation to operative and histopathological findings
Authors: Gudipati Pradeep , Kakarla Himabindu , Velagapudi Murali Krishna , Peddi Rama Rao , Madanapalli Likhitha , Chowdary Gadipudi Hamika , Devarakonda Lakshmi Narayana 
Published: April 2024

Background:
Appendicitis is expected to occur in about 6% of people during their lifetime. The most useful diagnostic techniques are still routine medical history and examination; Post surgery, after the specimen has been examined histopathologically, the final diagnosis is achievable. Systems of scoring are useful and valid for separating acute appendicitis from generalized abdominal pain and can help reduce unwanted surgery, particularly in remote areas.

Aims:
1. To evaluate the efficacy of the Alvarado scoring system as a preoperative diagnostic tool in acute appendicitis, in relation to operative and histopathological findings. 2. To determine the role of the Alvarado scoring system in cutting down the rate of negative appendicectomy without increasing morbidity and mortality. 3. To know the specificity and sensitivity of the Alvarado scoring system in the diagnosis of acute appendicitis.

Methods:
A prospective study of 50 patients who presented with symptoms and signs of acute appendicitis and suspected enough to warrant surgery for acute appendicitis admitted in DR. PSIMS & RF under various surgical units from November 2018 to October 2020 were selected.

Results:
In our study, migratory pain was noted in 80% of patients in this study. In this study, anorexia was noted in 60% of cases, rebound tenderness was found in 82% of cases, 37% of cases with a fever over 99°F had appendicitis, 80% of patients had leukocytosis, and leukocyte shift to the left was observed. Sensitivity, specificity, and positive predictive value (PPV) were 77.2%, 66.6%, and 94.4% in this study.

Conclusion:
This study concluded that the Alvarado score is a reliable, cheap, and reproducible tool for the diagnosis of acute appendicitis in the emergency room.
Effects of training nursing process using the concept map on caring self-efficacy of nursing students in pediatric departments
Authors: Alavi Azam , Okhovat Forogh 
Published: April 2024

BACKGROUND:
Self-efficacy is task-specific, and Professional self-efficacy has been introduced as a factor affecting providing quality nursing care. This study aimed to determine the effects of training the nursing process using the concept map on the caring self-efficacy of nursing students in pediatric departments.

MATERIAL AND METHODS:
This quasi-experimental study was conducted on 82 undergraduate nursing students in the second semester of 2021–2022 with a design of two groups before and after training. The samples were selected by census and divided into two experimental and control groups by simple random allocation. The data collection tool was Nursing Caring Self-Efficacy Scale in pediatric departments. The students of two groups in the pediatrics course were trained in the nursing process for nine sessions in three weeks using the concept map. Data were analyzed by descriptive statistics (frequency and percentage, mean and standard deviation) and inferential tests (Wilcoxon, Mann–Whitney, exact Fisher’s) using SPSS 23.

RESULTS:
The study results showed no statistical difference between the two groups of students regarding demographic information and pre-test scores. The concept map group’s post-test score of caring self-efficacy increased significantly compared to the pre-test (P < 0.001). The comparison of the post-test scores in the groups showed that the caring self-efficacy score in the intervention group of students was significantly higher than the control group (P = 0.014).

CONCLUSION:
According to the study results, it is suggested instructors use the concept map as a metacognitive intervention has increased the caring self-efficacy of nursing students in pediatric departments, which will lead to more accurate performance of nursing students in the future.
High Anxiety Levels before Elective Cesarean Section Can Negatively Affect the Mother and Fetus
Authors: Tosun F , Bülbül M , Yıldız CÇ , Özen Ö , Özerdem F 
Published: April 2024

ABSTRACT

Background:
Both pregnancy and surgery cause anxiety. This situation may negatively affect the health of the mother and baby.

Aim:
The effect of anxiety level before cesarean section (CS) on feto-maternal outcomes was investigated.

Methods:
The preoperative anxiety score was determined with the State-Trait Anxiety Inventory (STAI) in 224 pregnant women who were planned for elective CS.

Results:
Among patients, 33.5% were in the low anxiety group, 27.2% in the moderate, and 39.3% in the high anxiety group. The average birth weight in the low anxiety group was noticeably higher than that of the high anxiety group (P = 0.018). The mean heart rate at postop 1st and 24th hour in the high anxiety group was higher than the moderate anxiety group (P < 0.028). In addition, diastolic blood pressure (DBP) at the sixth hour in the low anxiety group was found to be lower than in the moderate anxiety group (P < 0.05).

Conclusion:
According to these results, it was found that an increased anxiety score before CS is associated with low birth weight in the baby, higher heart rate, and DBP in the mother.
Primary Rectal Perineurioma: A Rare Incidental Finding
Authors: Abrari Andleeb , Hasan Naba , Akhtar Kafil 
Published: April 2024

Abstract
Perineurioma is a rare benign peripheral nerve sheath tumor which can occur intraneurally or uncommonly in the extraneural soft tissues. The majority of the perineuriomas of the gastrointestinal tract occur distal to the splenic flexure as polypoid pedunculated or sessile lesions. Lesions are often discovered incidentally during routine colonoscopy for cancer screening. Diagnosis is mainly histological with the majority of the cases showing mucosal/submucosal bland spindle cell proliferation with expression of perineurial markers. We report a rare case of rectal perineurioma in a 42-year-old female who presented with the complaint of intermittent episodes of painless rectal bleed associated with defecation. A pedunculated polypoid lesion in the rectum measuring 12 mm in greatest dimension was seen on colonoscopy. The patient underwent endoscopic mucosal resection of the mass. Microscopically, the lesion showed proliferation of spindle cells with oval-to-spindle nuclei, bland chromatin, and moderate amount of pale to eosinophilic cytoplasm with indistinct cell borders. Overlying mucosa showed hyperplastic crypt epithelium. Spindle cells were positive for epithelial membrane antigen and CD 34 and negative for S100, with low Ki-67 marked cycling cell population (<1.0%) and negative Progesterone receptor (PR) and CD 117, these features confirming the diagnosis of perineurioma.
Managing Infection Complications in the Setting of Chimeric Antigen Receptor T cell (CAR-T) Therapy
Authors: Ahmed Nausheen , Oluwole Olalekan , Mahmoudjafari Zahra , Suleman Nahid , McGuirk Joseph P 
Published: April 2024

Chimeric antigen receptor T-cell (CAR T-cell) therapy has changed the paradigm of management of non-Hodgkin’s lymphoma (NHL) and Multiple Myeloma. Infection complications have emerged as a concern that can arise in the setting of therapy and lead to morbidity and mortality. In this review, we classified infection complications into three categories, pre-infusion phase from the time pre- lymphodepletion (LD) up to day zero, early phase from day of infusion to day 30 post-infusion, and late phase after day 30 onwards. Infections arising in the pre-infusion phase are closely related to previous chemotherapy and bridging therapy. Infections arising in the early phase are more likely related to LD chemo and the expected brief period of grade 3-4 neutropenia. Infections arising in the late phase are particularly worrisome because they are associated with adverse risk features including prolonged neutropenia, dysregulation of humoral and adaptive immunity with lymphopenia, hypogammaglobinemia, and B cell aplasia. Bacterial, respiratory and other viral infections, protozoal and fungal infections can occur during this time . We recommend enhanced supportive care including prompt recognition and treatment of neutropenia with growth factor support, surveillance testing for specific viruses in the appropriate instance, management of hypogammaglobulinemia with repletion as appropriate and extended antimicrobial prophylaxis in those at higher risk (e.g. high dose steroid use and prolonged cytopenia). Finally, we recommend re-immunizing patients post CAR-T based on CDC and transplant guidelines.
Comparative characteristics of axial spondyloarthritis and psoriatic arthritis with axial involvement
Authors: Gubar Е. Е. , Korotaeva Т. V. , Dubinina Т. V. , Vorobyeva L. D. , Tremaskina Р. О. , Agafonova Е. М. , Korsakova Yu. L. , Loginova Е. Yu. , Sakharova К. V. , Sablina А. О. , Smirnov А. V. , Erdes S. F. , Urumova М. М. , Glukhova S. I. 
Published: April 2024

Objective – to compare clinical characteristics of patients with axial spondyloarthritis (axSpA)/ankylosing spondylitis (AS) and with axial psoriatic arthritis (axPsA).Subjects and methods. 100 patients were examined: 45 – with axSpA/AS (group 1), 55 – with axPsA (group 2). Patients of group 1 were included according to axSpA/AS criteria, patients of group 2 – according to CASPAR (ClASsification criteria for Psoriatic ARthritis) criteria, and having axial involvement (axPsA). Axial involvement was detected in case of radiologically significant sacroiliitis (bilateral grade ≥2 or unilateral grade ≥3) or active MRI sacroiliitis, or ≥1 syndesmophyte(s) of the cervical and/or lumbar spine. Patients were evaluated for presence of inflammatory back pain (IBP) by ASAS (Assessment of Spondyloarthritis International Society) criteria.Results and discussion. Patients of group 1 were younger (p<0.001), more often HLA-B27 positive (p<0.001), had more IBP (p=0.001). Patients of group 2 had older age (>40 years) at back pain onset (p<0.001), more often peripheral arthritis (p<0.001), dactylitis (p=0.004), and skin psoriasis (p<0.001). Nail psoriasis was found only in group 2 patients (p<0.001). Group 1 patients had more often heel enthesitis (p=0.005). Group 2 patients had worse axial disease activity scores: BASDAI (Bath Ankylosing Spondylitis Disease Activity Index; p=0.006) and ASDAS-СRP (Ankylosing Spondylitis Disease Activity Score with C-reactive protein level determination; р<0.001); and worse patient reported outcomes: BASFI (Bath Ankylosing Spondylitis Functional Index; p=0.004), patients’ pain (p=0.005) and patients’ global assessments (p=0.036). Patients of group 2 had more syndesmophytes of the lumbar (р=0.009) and cervical (р=0.007) spine. Only in group 2 patients, chunky “non-marginal” syndesmophytes were found (in 32.1%), as well as spinal lesions without sacroiliitis (in 20.0%). Patients of group 2 had more joint erosions (р=0.001), osteolysis (р=0.015), juxta-articular bone formation (р<0.001) and joint ankyloses (р=0.02). All patients of group 1 and only 80% of group 2 (р=0.003) met ASAS criteria for axSpA. AxSpA/AS and axPsA seem to be two different diseases. In our cohort of patients, axPsA patients had worse disease status compared to axSp and AS.
TAXALLUSLARNI O’RGANISHNING NAZARIY JIHATI
Authors: Avezova Dilovar 
Published: April 2024

Tishunoslikning, onomastik ko'lami hamda ular haqidagi bilimlar majmuining jahon va o'zbek onomastikasning. amaliy va uslubiy jihatlardan tadqiq etilishi, ya'ni ularni bir butun gizim sifatida o'rganilish tarixi bilan tanishish;Mazkur maqola adabiy taxalluslar bilan qiziquvchi talabalar, migistrantlar va tadqiqotchilarga mo’ljallangan.
STAND PAMERAN TEMA INDUSTRIAL DENGAN SISTEM KNOCKDOWN
Authors: DHAMAR WIHANG 
Published: April 2024

Salah satu bentuk apresiasi terhadap karya hasil rancangan mahasiswa/i adalah dengan mengadakan pameran. Pameran dapat memunculkan persaingan yang sehat, terarah, dan menjadi pendorong untuk meningkatkan kemampuan berkarya. Melalui kegiatan pameran mahasiswa/i dilatih untuk memberikan tanggapan dan penilaian secara lisan, tertulis, maupun perbuatan dan sikap. Keterbatasan perabotan di galeri/kampus Universitas Sahid Surakarta yang dapat digunakan untuk pameran mengakibatkan para mahasiswa menguras dana cukup besar untuk pengadaan biaya sewa perlengkapan pameran atau pengadaan biaya untuk memproduksi sendiri perlengkapan pameran. Hal-hal ini akan menguras waktu dan tenaga mahasiswa/i prodi Desain Interior Universitas Sahid Surakarta. Stand Pameran ini memberikan solusi dari permasalahan tersebut dengan konsep industrial bersistem knockdown. Konsep industrial yang diaplikasikan pada furniture memiliki kesan yang maskulin dan tegas, bahan yang serba logam dan kayu serta finishing yang simple atau mengandalkan keaslian bahan dasar membuat konsep ini mudah dicapai dalam segi kreatifitas pengolahan bentuk. Sistem knockdown dianggap paling tepat untuk sebuah stand pameran karena sistemnya yang bongkar pasang sehingga dapat memangkas waktu untuk me set-up serta clear-up sebuah stand pameran.
Kata kunci : Pameran, Stand Pameran, Industrial, Knockdown
2016 - 2019. DURLET
Authors: AgwA  
Published: April 2024

La ampliación de la escuela Durlet presenta un estudio de formas geométricas sencillas en medio de un complejo contexto urbano. Este proyecto navega de forma lúdica por la interacción entre volumetría y construcción. El lugar alberga un edificio de corte renacentista neoflamenco de finales del siglo XIX, acompañado de tres alas reformadas en los años 1960. La intención de la ciudad de añadir una cuarta ala, reflejando el diseño original, se complicó por la presencia de un bloque de apartamentos adyacente establecido en la década de 1970. Las regulaciones urbanas impusieron un enfoque volumétrico distinto al las estructuras existentes.
Illustration
Authors: Male Alan 
Published: April 2024

Alan Male’s Illustration is a classic in the field. Bringing together theory, context and issues around conceptual understanding, the book is a perfect companion for illustration students around the world.
Hundreds of images from a wide variety of contemporary illustrators explore how successful creators work with depth of knowledge and understanding of their subjects. By looking across examples from around the world, readers gain an understanding of:
- Visual metaphors
- Storytelling and narrative
- Truth and documentation
- Identity and persuasion
- Briefs and development
New for this edition is ‘The Illustrator as Author and Polymath’, a chapter which explores the mix of skills that illustrators need beyond a strong visual style – they must be problem-solvers, visual thinkers, researchers and communicators. It also reveals how image creators from the world of illustration, visual communication and fine art can illuminate and present exciting and original concepts and ideas related to everything that is current, in the past and in the future.
Minimizing the Effect of Integrating Wind Farms on Transmission Power Systems
Authors: Elhaffar Abdelsalam , Al-Badi Abdullah , AlBadi Naif , AlDarmaki Issa , AlSenani Ahmed 
Published: April 2024

Expanding the renewable energy sources usage in power systems will help the government meet its energy policy goals of lowering emissions, ensuring high power supply reliability, and promoting spot markets with high competitivity. However, due to the intermittent nature of these sources, this will necessitate the mitigation of network vulnerabilities. High wind energy penetration in the grid could have an impact on the system frequency, voltage, real and reactive power response, and power quality of the system. The main objective of this paper is to investigate how the integration of wind farms in the Jalan Bani Bu Ali (JBBA) area will affect Oman's main interconnected system (MIS). Results show that the effect is minor on voltage and frequency stability by all disturbances taken into account.
The Removal of Total Knee Arthroplasty From the Inpatient-Only List has Improved Patient Optimization
Authors: Cochrane Niall H. , Kim Billy I. , Jiranek William A. , Seyler Thorsten M. , Bolognesi Michael P. , Ryan Sean P. 
Published: April 2024

Introduction:
On January 1, 2018, the Centers for Medicare and Medicaid Services removed total knee arthroplasty (TKA) from the inpatient-only (IPO) list, expanding outpatient TKA (oTKA) to include patients with insurance coverage through their programs. These regulatory changes reinforced the need for preoperative optimization to ensure a safe and timely discharge after surgery. This study compared modifiable preoperative optimization metrics in patients who underwent oTKA pre-IPO and post-IPO removal. The authors hypothesized that patients post-IPO removal would demonstrate improvement in the selected categories.

Methods:
Outpatient TKA in a national database was identified and stratified by surgical year (2015 to 2017 versus 2018 to 2020). Preoperative optimization thresholds were established for the following modifiable risk factors: albumin, hematocrit, sodium, smoking, and body mass index. The percentage of patients who did not meet thresholds pre-IPO and post-IPO removal were compared.

Results:
In total, 2,074 patients underwent oTKA from 2015 to 2017 compared with 46,480 from 2018 to 2020. Patients undergoing oTKA after IPO removal were significantly older (67.0 versus 64.4 years; P < 0.01). A lower percentage of patients in the post-IPO cohort fell outside the threshold for all modifiable risk factors. Results were significant for preoperative sodium (10.7% versus 8.8%; P < 0.01), body mass index (12.4% versus 11.0% P = 0.05), and smoking history (9.9% versus 6.6%; P < 0.01).

Conclusion:
Outpatient TKA has increased considerably post-IPO removal. As this regulatory change has allowed older patients with increased comorbidities to undergo oTKA, the need for appropriate preoperative optimization has increased. The current data set demonstrates that surgeons have improved preoperative optimization efforts for select modifiable risk factors.