bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of intranasal and nebulized dexmedetomidine for premedication in pediatric patients: A non-inferiority randomized controlled trial
Authors: Verma Shilpi , Bhatia Pradeep Kumar , Sharma Vandana , Mohammed Sadik , Saran Anita 
Published: December 2022

Background and Aims:
Dexmedetomidine is a highly selective α-2 adrenoreceptor agonist and has been found to be an effective premedication agent when administered via the intranasal route. We aimed to compare the efficacy of dexmedetomidine premedication administered via intranasal route and through nebulization in pediatric patients.

Material and Methods:
This non-inferiority randomized controlled trial was conducted after getting approval from institutes ethics committee and informed written parental consent. Sixty-four children aged 2-8 years scheduled for elective surgery under general anesthesia were enrolled and were divided into two groups. Group I (Intranasal, n = 33) received 2 mcg/kg dexmedetomidine via intranasal route and group N (Nebulized, n = 31) received 2 mcg/kg dexmedetomidine through nebulization. The primary outcome was number of patients with satisfactory sedation 30 minutes after premedication at separation from parent. The secondary outcome included ease of medication acceptance, anxiety at parental separation, acceptance of anesthesia mask, perioperative hemodynamics, emergence agitation during recovery and adverse effects. Data collected was analyzed using Chi-square test, Student “t” test and Mann-Whitney U test with the help of SPSS 22. A one tailed P value < 0.025 was considered significant.

Results:
Demographic profile was comparable between groups. On arrival in OR 27 (81.8%) patients in group I and 21 (67.7%) patients in group N had satisfactory sedation score (P = 0.19). The median (IQR) sedation score was comparable between group I and group N (P = 0.057). Patients in Group I showed significantly better medication and mask acceptance scores (P < 0.0001, P = 0.001 respectively), parental separation anxiety score (P < 0.0001) and emergence agitation score (P = 0.001). There were no significant differences in hemodynamic parameters and adverse effects between the groups.

Conclusion:
Although nebulized dexmedetomidine is non-inferior to intranasal dexmedetomidine in providing desired level of sedation but intranasal administration had better acceptance of medication and anesthesia mask with lesser anxiety at parental separation and postoperative emergence agitation.
Dual Mobility Cup in Total Hip Replacements
Authors: Kumar Santhosh , Kulshrestha Vikas , Sood Munish , Datta Barun , Mittal Gaurav 
Published: December 2022

Objective:
Prosthetic joint dislocation remains a significant cause of revision following total hip replacement (THR). To prevent this complication, emphasis has been on choosing the optimum surgical approach, accurate implant alignment, bigger femoral head size, and implementing postoperative hip precautions. In the last decade, a newer acetabular design concept; the “Dual Mobility cup” (DM cup) was introduced to reduce the prosthetic dislocation. Although the concept of the use of such a device is well accepted, there remains apprehension regarding its precise indications, the outcome in terms of wear and ability to decrease the incidence of prosthetic dislocation. We reviewed the early results of a particular DM cup design.

Materials and Methods:
This study shares a single center experience of using a monoblock DM cup (Captiv DM, Evolutis, Briennon, France) in THR. It is a prospective cohort study that looked at indications, handling issues, complications including prosthetic dislocations at 24 months follow-up.

Results:
We followed up results of uncemented and cemented DM cup used in 129 patients who underwent primary THR or revision THR (RTHR). There was one (1.6%) prosthetic dislocation amongst primary THR and 2 (3%) in the RTHR group. There were handling issues with monoblock uncemented DM cups of occasional improper seating and acetabular rim fracture. Three cases in which revision was performed, were due to component to component impingement and resulted due to inappropriate acetabular version.

Conclusion:
The use of DM cups while performing THR or RTHR significantly decreased the incidence of instability. While placing DM cups an attempt should be made to maintain the native version of the acetabular cup to decrease the risk of component impingement and instability.

Level of Evidence:
Level III, therapeutic study.
Evaluation of Functional Outcome Following Transportal Arthroscopic Anterior Cruciate Ligament Reconstruction using Quadrupled Hamstring Graft
Authors: Sakale Harshal Suhas , Agrawal Alok Chandra , Balakrishna Martha , Kar Bikram Keshari , Moti B Raj Kiran 
Published: December 2022

Introduction:
The anterior cruciate ligament (ACL) has an important role in preserving the function and stability of the knee joint, and it prevents anterior translation of the tibia. The ACL is the most commonly injured structure of the knee following posttraumatic and sports-related injuries. The treatment of modality for ACL insufficiency was arthroscopic ACL reconstruction. In this study, we followed the transportal approach for ACL reconstruction using a Quadrupled Hamstring graft, and we reported the functional outcome of ACL reconstruction at a minimum follow-up of 6 months.

Materials and Methods:
This was a prospective outcome study conducted on 32 patients who met the inclusion and exclusion criteria. All patients in this study underwent arthroscopic reconstruction of ACL using quadrupled hamstring tendon graft through transportal technique. The graft was fixed with an endobutton on the femoral side and an interference screw on the tibial side. Patients were assessed for the functional outcome for a minimum of 6 months using the Tegner-Lysholm knee scoring system.

Results:
The mean age of the patient was 27 years. The majority of involved patients were males. The left side (77.14%) was involved more than the right side (22.86%). The most common cause of ACL injury in this study was road traffic accidents. Preoperative Tegner-Lysholm scores were 20 (62.5%) patients had poor and 12 (37.5%) patients had fair scores. Post-operatively, at 6 months follow-up, 27 patients had excellent, four patients had good scores, and one patient had a fair score. There was a significant improvement in the Tenger-Lysholm scoring system after 6 months of follow-up when compared to preoperatively. Three patients had knee pain and thigh muscle wasting (2 – 3 cm) during follow-up.

Conclusions:
Transportal arthroscopic ACL reconstruction using Quadrupled Hamstring graft gives excellent functional outcome and knee kinematics.
An Innovative Three Stitch Technique in Tibia Interlocking Nailing a Retrospective Analysis
Authors: Butala Rajendraprasad Ramesh , Patil Maitreya Jagdish , Samant Prakash Datta , Parelkar Kedar Anil 
Published: December 2022

Introduction:
More recent advances are about the incision technique for intramedullary interlocking (IMIL) nailing, a 3 cm stab incision is sufficient for the procedure of IMIL nailing as compared to commonly used suprapatellar incision of 5–7 cm with splitting of patellar tendon which might result in chronic knee pain restricted range of movement, risk of infection, longer duration of postoperative rehabilitation, and poor wound healing.

Objective:
A retrospective study and analysis of three stitch technique in posttraumatic shaft tibia fractures to assess the range of motion.

Background:
Tibial shaft fractures have peaked in incidence in the past decade with sky rocketing amount of road traffic accidents. With the mainstay of making any patient of such traumatic incident being early mobilisation, IMIL nailing for tibia remains one of the finest treatment modalities among plating or external fixator applications. With the increased demands in the field of cosmetology and minimally invasive scar techniques, the 3-stitch technique would have a major impact not only on the early healing of surgical scar but also reduced chances of acquired infections along with advancements in weight-bearing exercises.

Materials and Methods:
A retrospective analysis of midshaft tibia fractures who were treated with IMIL nailing with 3-stitch technique with a sample size of post op 100 patients. A study was held at a tertiary care hospital and research center.

Results:
Sample size of postoperative 100 patients out of which 76 showed conclusive results and 24 were lost at follow-up.

Conclusion:
Good to excellent outcome with a small healed scar was observed in patients who underwent 3-stitch technique IMIL nailing for shaft tibia fractures.
Functional Outcome of Arthroscopic Bankart Repair With or Without Remplissage in Recurrent Anterior Shoulder Instability
Authors: Chodavarapu Lalithmohan , Kumar K K Kiran , Bitla Venkatesham , Patnala Chandrashekhar 
Published: December 2022

Background:
Arthroscopic Bankart repair is now the standard procedure for shoulder stabilization in patients with recurrent anterior shoulder instability with Bankart lesion with minimum glenoid bone loss.

Aims:
The aim of this study is to evaluate the postoperative shoulder motion and functional outcome following arthroscopic repair of Bankart lesion with suture anchors with or without remplissage.

Materials and Methods:
This is a prospective study done between May 2019 and April 2021. A total of 20 patients with recurrent anterior shoulder instability were stabilized arthroscopically by the same surgical team over time. All patients met the inclusion criteria and were assessed with the American Shoulder and Elbow Surgeons (ASES) and Rowe scoring systems. The range of motion, postoperative function, recurrence rate, and return to preinjury activities were evaluated.

Results:
In our study, all 20 patients were followed up for a minimum period of 1 year. All patients had a good range of motion. The two shoulder scores (ASES and Rowe) significantly improved after surgery (P < 0.05). There was only one recurrence (5%). Patients were able to return to their previous activities or physically demanding jobs.

Conclusions:
Arthroscopic Bankart repair for traumatic anterior shoulder instability is a good procedure with less postoperative morbidity and excellent functional outcome. It allows return of patients to previous activities without any restriction.
Posterior malleolus fracture fixation in ankle injuries
Authors: Dave Rutvik D. , Tank Parag M. , Patel Nimish B. , Shah Poojan V. 
Published: December 2022

Introduction:
Posterior Malleolar fractures are relatively rare and a part of complex ankle injuries. Trimalleolar fractures affect the stability of the weight-bearing ankle joint. Management of posterior malleolar fractures is a challenge.

Aims:
This study aimed to examine the radiological and clinical outcomes of the management of posterior malleolar fractures in adults.

Settings and Design:
This is an original research retrospective study

Materials and Methods:
Eleven patients underwent fixation of ankle fractures with fixation of posterior malleolus as needed using screws or plates. Surgical outcomes were examined in follow-up with an average follow-up of 21 months using the American Orthopedic Foot and Ankle Score (AOFAS) score and with radiological correlation at each follow-up.

Results:
In our series, 27% of patients had 44B type injury and 73% of patients had 44C type injury as per AO/OTA classification. The average AOFAS score was 90.45 for the series and the score for patients treated with direct reduction of the fragment was better than for those treated with indirect reduction. The average score for patients managed with screws was better than for those treated with plates in our series. 82% of patients showed excellent to good outcomes with one patient having an infection and one patient having moderate to severe pain.

Conclusion:
Anatomical reduction of posterior malleolar fragment leads to better long-term functional outcomes and a stable ankle joint with early mobilization.
Epidemiological study to assess the status of measles vaccination in under five children and factors associated, in a peri-urban area, Asudgaon village, in Raigad district, Maharashtra, India
Authors: Riswadkar Neha , Waingankar Prasad J. , Relwani Nisha Ram , Sanjeev Sunila 
Published: December 2022

Background:
Measles continues to be a major cause of childhood morbidity and mortality in India. Measles is considered one of the leading vaccine-preventable causes of child mortality worldwide. Major reasons for low vaccine coverage exist within the health care system itself, which creates barriers to obtaining immunization.

Materials and Methods:
A cross-sectional, descriptive, epidemiological study that aimed to examine the coverage of measles vaccination among under-five children of Asudgaon village. All under-five children residing in every 5th household of the village were included(n = 445). After obtaining consent from the mother, data was collected from her using a pre-designed and pre-tested questionnaire. The data was entered and analyzed in SPSS 23.

Results:
There was a total of 100 children eligible for the study. Overall, 41% of children were fully immunized against measles, 37% were partially immunized, 5% were immunized to date and 17% were not immunized. The most reasons for partial or non-immunization for measles were inadequate knowledge about immunization (19%), unawareness of days of vaccination(n = 14%), the child being ill at the time of vaccination, husband or mother-in-law against vaccination, fear of effects, and others. The Chi-square test indicates a significant association between mothers’ education and measles vaccination.

Conclusion:
Immunization status needs to be improved through education, increasing awareness, and counseling of parents regarding immunization and associated misconceptions as observed in the study.
Etiological profile, prescribing pattern of antibiotics and clinical outcomes of pneumonia patients in a tertiary care hospital in South India during 5-year period
Authors: Mathew Jerrin Reji , Noyal Shiyona , Biju Sijin T. , Joseph Siby , Jose Amit P. 
Published: December 2022

Background:
Pneumonia is one of the most important and serious lower respiratory tract infections, which requires implacable attention. This work aimed to document the causative organisms, antibiotics used, and outcome of pneumonia patients hospitalized in a tertiary care hospital.

Materials and Methods:
A retrospective study was conducted in the medical departments of a tertiary care teaching hospital for 5 years. Demographic details and clinical details including pertinent laboratory values of patients diagnosed with pneumonia were documented and analyzed using a specifically designed data collection form.

Results:
The study was conducted on 190 patients. The average age of the study population was 56.7 ± 22.6 years and there was a male preponderance of 111(58.4%) patients. Klebsiella pneumonia was found to be the most frequently isolated pathogen in 12.5% of the sputum culture, followed by Acinetobacter baumannii in 10.22% and Pseudomonas aeruginosa in 9.09%. The most commonly prescribed empirical antibiotics were beta-lactam antibiotics mostly in combination with macrolides for synergy irrespective of Pneumonia Severity Index (PSI) classes. Definitive therapy was classified based on World Health Organization (WHO) Access, Watch, and Reserve (AWaRe) classification of antibiotics, watch category antibiotics were prescribed according to culture report and reserve antibiotics were prescribed only in those cases where watch category antibiotics were resistant. On analyzing PSI of community-acquired pneumonia (176 patients), most of the patients in the study belong to class 4: 61 patients (34.7%) and class 5: 44 patients (25%). For the high-risk patients (PSI class 4 and 5), mortality was approximately 3.8% (4 of 105) and for low-risk patients, there was zero mortality reported within 30 days.

Conclusion:
Gram-negative bacteria were the major pathogens causing Pneumonia in the study site contradictory to the data from developed countries. Identifications of pathogens and appropriate antibiotic therapy based on PSI score can bring down the duration of hospital stay and mortality of patients with pneumonia.
Primary assessment of patients admitted to the emergency ward using arterial blood gas
Authors: Mulay Sanjay , Ursekar Rajesh , Mathew Jerry , Pinto Krista 
Published: December 2022

Background:
Arterial blood gas study (ABG) is a point-of-care testing (POCT) diagnostic tool that can furnish metabolic and respiratory aberrations. This study was conducted systematically, to assess the metabolic and respiratory aberrations quickly and the scope for corrective treatment so that metabolic and respiratory abnormalities get corrected.

Materials and Methods:
A prospective cross-sectional study was done among 150 cases admitted to the Department of Emergency Medicine during a three-month period where the study on ABG was done. Data was collected in the prescribed format and a stepwise interpretation of the ABG was done. The four primary disorders taken into consideration are metabolic acidosis, metabolic alkalosis, respiratory alkalosis, and respiratory acidosis

Results:
Out of 150 cases 82 had respiratory alkalosis, 51 had metabolic acidosis, ten had respiratory acidosis, and seven had metabolic alkalosis as a primary disorder.

Conclusion:
ABG analysis is a POCT diagnostic tool for analyzing various metabolic and respiratory aberrations and can also guide us in the scope for correction of the disorder.
A comparative assessment of the level of stockouts of modern family planning services in private and public health facilities in Nigeria
Authors: Onoja Ali J. , Sanni Felix O. , Onoja Sheila I. , Abu Aisha 
Published: December 2022

Background:
The use of family planning (FP) methods and stockouts of contraceptives are major challenges to the FP program in Sub-Saharan Africa. This study assessed the level of stockouts of contraceptives in Nigerian health facilities. This survey was carried out in 767 health facilities offering FP services across all six geopolitical zones of Nigeria.

Materials and Methods:
This was a cross-sectional study involving a quantitative technique. Data were collected from 116 private and 651 public health facilities in Nigeria. A structured questionnaire was used to collect data from the facilities, and a physical inventory was taken. Data were analyzed using IBM-SPSS, version 25.0.

Results:
The stockout rate in the last 3 months was 63.8% in private and 47.5% in public health facilities (P = 0.001), whereas stockouts on the visit day were 63.8% in private and 51.0% in public facilities (P = 0.011). On the day of the visit, the stockout rate in private health facilities ranged from 9.3% to 26.5%, whereas it ranged from 5.3% to 24.2% in public health facilities. The main causes of stockouts of some contraceptives are low/no demand and a lack of supply.

Conclusions:
This study found a high level of stockouts of FP services in private and public health facilities, but higher in private facilities. Both the poor supply and low demand for FP services in Nigeria require the attention of policymakers and health officials.
Sequential and distributive forcings without choice
Authors: Karagila Asaf , Schilhan Jonathan 
Published: December 2022

AbstractIn the Zermelo–Fraenkel set theory with the Axiom of Choice, a forcing notion is “
$\kappa $
-distributive” if and only if it is “
$\kappa $
-sequential.” We show that without the Axiom of Choice, this equivalence fails, even if we include a weak form of the Axiom of Choice, the Principle of Dependent Choice for
$\kappa $
. Still, the equivalence may still hold along with very strong failures of the Axiom of Choice, assuming the consistency of large cardinal axioms. We also prove that although a
$\kappa $
-distributive forcing notion may violate Dependent Choice, it must preserve the Axiom of Choice for families of size
$\kappa $
. On the other hand, a
$\kappa $
-sequential can violate the Axiom of Choice for countable families. We also provide a condition of “quasiproperness” which is sufficient for the preservation of Dependent Choice, and is also necessary if the forcing notion is sequential.
Long range‐based low‐power wireless sensor node
Authors: Devi Komal , Mahajan Rita , Bagai Deepak 
Published: December 2022

AbstractSensor nodes are the most significant part of a wireless sensor network that offers a powerful combination of sensing, processing, and communication. One major challenge while designing a sensor node is power consumption, as sensor nodes are generally battery‐operated. In this study, we proposed the design of a low‐power, long range‐based wireless sensor node with flexibility, a compact size, and energy efficiency. Furthermore, we improved power performance by adopting an efficient hardware design and proper component selection. The Nano Power Timer Integrated Circuit is used for power management, as it consumes nanoamps of current, resulting in improved battery life. The proposed design achieves an off‐time current of 38.17309 nA, which is tiny compared with the design discussed in the existing literature. Battery life is estimated for spreading factors (SFs), ranging from SF7 to SF12. The achieved battery life is 2.54 years for SF12 and 3.94 years for SF7. We present the analysis of current consumption and battery life. Sensor data, received signal strength indicator, and signal‐to‐noise ratio are visualized using the ThingSpeak network.
Optimum solar energy harvesting system using artificial intelligence
Authors: Sangsang Sasmowiyono Sunardi , Fadlil Abdul , Subrata Arsyad Cahya 
Published: December 2022

AbstractRenewable energy is promoted massively to overcome problems that fossil fuel power plants generate. One popular renewable energy type that offers easy installation is a photovoltaic (PV) system. However, the energy harvested through a PV system is not optimal because influenced by exposure to solar irradiance in the PV module, which is constantly changing caused by weather. The maximum power point tracking (MPPT) technique was developed to maximize the energy potential harvested from the PV system. This paper presents the MPPT technique, which is operated on a new high‐gain voltage DC/DC converter that has never been tested before for the MPPT technique in PV systems. Fuzzy logic (FL) was used to operate the MPPT technique on the converter. Conventional and adaptive perturb and observe (P&O) techniques based on variables step size were also used to operate the MPPT. The performance generated by the FL algorithm outperformed conventional and variable step‐size P&O. It is evident that the oscillation caused by the FL algorithm is more petite than variables step‐size and conventional P&O. Furthermore, FL's tracking speed algorithm for tracking MPP is twice as fast as conventional P&O.
Analisis Apokaliptik Pada Hermenuetika
Authors: Maranatha Christian Ade , Barus Ronaganta 
Published: December 2022

Pembahasan ini lebih membahas tentang kanon kristen pada jaman dulu. Hal ini menyebabkan nilai-nilai dan pesan moral sebagai substansi dasar dalam sastra cenderung dianggap dan sikapi sebagai acuan standart ideal perilaku manusia dalam kehidupannya sebagai makhluk individual dan sosial, bukan sebagai makhluk biologis, lebih-lebih sebagai makhluk ekologis. Wacana etika sering kali menjelaskan tujuan dari penglihatan bagi para pembaca. Simbolisme esoterik merupakan sifat yang paling tampak dari sastra apokalipsis. Pada pembahasan apokaliptik selalu melibatkan hermeneuetik. Oleh akrna itu hermeneuetik menjadi acuan dalam pembahasan analisis apokaliptik, dan tidak biasa di lepas dari situ. Oleh karna itu, hermeneuetik juga harus dipahami secara dasar. . Pada tulisan ini menggunakan metodologi kualitatif, dimana sumber-sumber dari pustaka menjadi acua. Kita juga tahu bahwa pmbelajaran apokaliptik ini sendiri sangat sulit di buat batasannya. Karena apokaliptik ini pada umumnya digunakan dalam kata benda. Jadi sering sekali analisi ini tidak digunakan dalam penganalisisan.