bluuebunny/crossref_metadata_2025_split huggingface dataset:
Polypragmasia and interdrug interactions as risk factors of falling in elderly patients
Authors: Ильина Е.С. , Шалыгин В.А. , Богова О.Т. , Потапов В.Н. , Болотокова А.В. , Савельева М.И. , Синицина И.И. , Доскина Е.В. , Сычев Д.А. 
Published: October 2022

В статье представлены результаты анализа данных у пациентов многопрофильного стационара старше 75 лет с сердечно-сосудистыми заболеваниями и коморбидными состояниями. Был проведен анализ фармакотерапии геронтологических пациентов, имеющих несколько факторов риска падения, с точки зрения наличия полипрагмазии и межлекарственных взаимодействий, опасных по риску падения. У группы пациентов, испытавших падение в стационаре, по сравнению с пациентами без падения, аудит листов назначений показал преобладание лекарственных средств и их комбинаций, скомпрометированных по повышенному риску этого серьёзного нежелательного явления. Аудит лекарственных назначений пациентам с повышенным риском падений как средство борьбы с полипрагмазией и выявления лекарственных средств, способных вызвать падение, можно проводить с использованием «Светофорной классификации лекарственных средств, повышающих риск падений» и drug-чекера (Drug Interactions Checker интернет-ресурса www.drugs.com) для выявления клинически значимых комбинаций. Использование этих клинико-фармакологических инструментов может способствовать повышению качества и безопасности оказания медицинской помощи в условиях стационара.
This article presents the results of the analysis of data from patients over 75 years of age from a multidisciplinary hospital with cardiovascular disease and comorbid conditions. Pharmacotherapy of gerontological patients with multiple risk factors for falls was analysed in terms of the presence of polypragmasy and drug-drug interactions hazardous to the risk of falls. In the group of patients who experienced a fall in hospital compared to patients without a fall, the prescription lists audit showed a predominance of medicines (drugs) and drug combinations compromised by an increased risk of this serious adverse event. An audit of prescriptions of patients at increased risk of falls as a means of combating polypharmacy and identifying drugs that may cause falls can be conducted using the «Traffic light classification of FRIDs» and drug checkers to identify clinically relevant combinations. The use of these clinical and pharmacological tools can improve the quality and safety of medical care in a hospital setting.
Formulation and Evaluation of Zolmitriptan Loaded Nano-Structured Lipid Carriers for Effective Treatment in Migraine
Authors: Prajapati Dr. Bhupendra , Varia Umang , Patel Aara 
Published: October 2022

Objective: Zolmitriptan is a BCS class II drug having low solubility and poor bioavailability by formulating Nanostructured lipid carriers that will sustain the release of the drug for a longer period which leads to reduced dose and frequency of dose.
Method: Zolmiptriptan-loaded Nanostructured lipid carriers were fabricated by a solvent diffusion evaporation method. The formulation parameters like the selection of solid (Precirol ATO 5) and liquid lipid (Miglyol 812), solid to liquid lipid ratio (3:1), drug: solid lipid ratio (1:4), the ratio of the organic phase (Acetone: Ethanol, 1:1), the concentration of surfactant (1.5% Tween 80) and temperature (70 °C) of secondary phase were optimized. NLC dispersion was finally lyophilized and converted into a tablet. A stability study of freeze-dried NLCs tablet was performed according to ICH Q1A (R2) guidelines.
Result: Optimized formulation contained Particle size 11.39 ± 0.85 nm, Zeta potential -38.30 and %EE 76.56 ± 0.12. Characterization was performed by TEM and FTIR analysis. The residual solvent test confirms the concentration of organic solvents was in the acceptable range as per ICH guidelines. In-vitro drug permeation study of NLCs shows 88.91±0.238 % drug release while pure drug suspension shows 58.9±0.578 % drug release after 12 hrs.
Conclusion: Zolmitriptan-loaded NLCs show better absorption as compared to pure drug suspension which indicates prolonged release of medicament which may reduce dose or dose frequency.
Penentuan Jalur Distribusi Gas LPG dengan Metode Savings Matrix dan Nearest Neighbor pada PT. XYZ
Authors: Emaputra Andrean , Maulana Kevin Akbar 
Published: October 2022

Distribusi merupakan suatu cara perusahaan agar dapat melakukan proses pengiriman dengan tepat. Oleh karena ini pengembangan sistem distribusi sangat dibutuhkan untuk pengembangan bagi perusahaan. PT. XYZ merupakan perusahaan yang bergerak dibidang pendistribusian Gas LPG dari gudang ke pelanggan yang berada di wilayah kabupaten Bantul Daerah Istimewa Yogyakarta. Permasalahan yang terjadi pada perusahaan PT. XYZ sendiri yaitu penentuan dalam rute distribusi yang belum berjalan baik, dikarenakan jarak pangkalan yang cukup jauh menyebabkan tingginya biaya distribusi. Untuk mengatasi masalah pada PT. XYZ, maka diperlukan penerapan metode Savings Matrix dan metode Nearest Neighbor yang digunakan untuk menentukan jalur dan jarak dari gudang ke pangkalan berdasarkan kapasitas alat angkut serta melakukan proses penghematan biaya distribusi untuk penekanan biaya. Tujuan dari penelitian kali ini untuk mendapatkan jalur atau rute distribusi yang tepat dan mendapatkan penghematan biaya distribusi dengan membandingkan setelah dilakukan perbaikan pada PT. XYZ. Dari hasil perhitungan dan analisis yang diperoleh setelah dilakukan perbaikan menunjukan bahwa jarak tempuh sejauh 4.945 kilometer dengan biaya distribusi Rp22.525.500. Penghematan jarak yang dihasilkan setelah dilakukan perbaikan adalah 24% atau 1.540 Kilometer, sedangkan penghematan biaya distribusi yang dihasilkan adalah 6% atau Rp1.315.950,-/bulan.
An Unusual middle ear foreign body in a welder; our experience
Authors: Sabih Nadeem Qamar  , Vandana Eswarappa  , Arunachalam Iyer Sabih Nadeem Qamar  , Vandana Eswarappa  , Arunachalam Iyer 
Published: October 2022

Introduction: Welding accidents commonly present as burns, electrocution, skin injuries and penetrating foreign body in the eyes, face and neck. Ears are usually uninvolved, but the possibility of foreign bodies in the external ear canal or even in the middle ear should always be considered in non-resolving ear infections in welders.
Case Presentation: A thirty-year old welder presented with ear discomfort and swollen ear canal and initially diagnosed and managed as otitis externa. But since it failed to resolve, he was extensively investigated and a metallic foreign body was identified in the middle ear, which was removed via endoscopic tympanotomy.
Conclusion: This case highlights the fact that small sharp foreign bodies can penetrate through the tympanic membrane and leave an almost invisible perforation which heals completely. But in suspicious or symptomatic cases further investigations such as an X-ray or Computed Tomography [CT] scan might be needed to confirm diagnosis.
Welcome Note
Authors: Faisal Masud Faisal Masud 
Published: October 2022

Good information is the best medicine.” – Dr. Michael E. DeBakey
With this quote in mind from a giant leader in medicine, I welcome all the readers to the inaugural edition of International JRMC. In today’s world of healthcare where there is an overload of information some good, some poor, and some false it is very encouraging that RMU has taken the bold step of launching JRMC International.<br> This is unique in nature for Pakistan as it is primarily focused on bridging the divide between good scientific research being done in Pakistan and that from outside of Pakistan. With contributions from local, national, and international researchers, doctors, and scientists, whether local projects or international this journal hopes to elevate the scholarly activity of learners in Pakistan.<br> Globalization of the world has brought new opportunities and new challenges. On the one hand, access to information and the opportunities to publish and collaborate have expanded. Still, on the other hand, clinicians have been forced to stay abreast with up-to-date information in their respective fields. Fast-changing paradigms of each sub-specialty of Medicine, the ever-increasing role of Artificial-Intelligence (AI), the importance of data mining, and complex misinformation (infodemic) call for a further refined approach to curriculum. Scholarly journals anchored and supported by esteemed and prestigious institutions like RMU play a vital role in this regard. Pakistan is lucky to have a glorious reputation for its medical colleges and physicians, many of whom are now at leading positions at international institutions. Bringing global experience to embed it in unique epidemiologic data and research outcomes of a country like Pakistan will go a long way in nurturing future scientists.<br> In this issue, you will hear about a variety of topics and varied authors from different parts of the world.
I encourage you to submit your original research so that this journal becomes a reference for a bigger audience.
Improving Medical Students’ Learning Experience of Pathology by Online Practical Sessions through Virtual Microscopy
Authors: Ahmed Safina , Habib Maryam , Naveed Hania , Mudassir Ghazala , Bhatti Mahwish Majid , Ahmad Rifat Nadeem 
Published: October 2022

ABSTRACT:
Objective: To assess the impact of interactive virtual pathology slides on students’ understanding of pathological disease processes.
Materials & Methods: The study was conducted at Shifa College of medicine, Islamabad. Class of 3rd year MBBS, comprising of 111 students, was divided into two groups during two teaching modules. All students received online lectures prior to practical sessions. In the first module, one group was taught virtual slides through online interactive sessions, whereas the second group was taught same set of slides, using light microscopy and glass slides. Both groups were assessed at the end of the module by online test and their scores were compared. Similar exercise was repeated in the second module in which the control group became the test group to remove the selection bias. Questionnaire feedback was taken from students to get their perceptions. The results were compared by applying t-test and p-value was calculated.
Results: The mean score of test group (group-1) in first module was 14.90 whereas mean score of control group (group-2) was 10.99. The t test was applied, and p-value calculated was significant (p=0.04). In the second module the groups were flipped. The mean score of test group (group-2) was 14.29 whereas control group (group-1) was 10.09. The p value was calculated which was again significant (p=0.04). The students gave their feedback through questionnaire.
Conclusion: Overall, we believe that the use of virtual microscopy significantly improves student’s understanding of pathological lesions.
Keywords: Education, medical, pathology, undergraduate, virtual microscopy.
Non-Operative Management of Acute Uncomplicated Appendicitis in Children
Authors: Napar Nabibux , Shaikh Noor Ahmed , Baloch Imamuddin , Shah Azhar Ali , Mahtam Ishrat , Memon Inayatullah 
Published: October 2022

Objective: To compare the efficacy of non-surgical conservative management with surgical management in cases of uncomplicated acute appendicitis in children.
Study design: Prospective comparative study.
Settings: Pediatric surgery Department, Ghulam Muhammad Mahar Medical College Sukkur.
Study duration: 1st February 2020 to 31st May 2021.
Materials and Methods: Ninety patients of either gender with age range from 5-12 years, diagnosed as uncomplicated acute appendicitis, were divided in two groups. Group C patients were managed conservatively with antibiotics (ceftriaxone 100 mg/kg/day, amikacin 10mg/kg/day and metronidazole 22.5 mg/kg/day) and maintenance fluids were started. Patients were observed for improvement or any signs of deterioration. Those who deteriorated within 24 hours were managed with surgical management immediately. Follow-ups were carried out after discharge on the 7th day, 1 month, and six months. Patients reporting a recurrence of symptoms were managed with appendicectomy. Group S patients were managed with appendicectomy with the open technique. Patients were observed for post-operative complications.
Results: Demographic data of both groups was comparable. In group C, 34 (75.56%) patients were successfully treated with conservative management, whereas in group S, 39 (86.67%) were successfully treated with surgical management. The difference was insignificant with a p-value of 0.114. In group C, 5 (11.11%) patients did not respond to conservative management and they were managed with appendicectomy and recurrence of symptoms was seen in 6 (13.33%) patients in group C, they were also managed with appendicectomy. In group S, 6 (13.33%) patients suffered post-operative complications. Mean length of stay in hospital was 4.31±1.20 and 4.09±1.12 days in group C and S respectively. This difference was statistically insignificant with a p-value of 0.368.
Conclusion: It is concluded in our study that uncomplicated acute appendicitis in children can be successfully managed with non-surgical conservative management.
Linear and Nonlinear Kelvin–Helmholtz Instability and Magnetohydrodynamic Wave Emission in Sheared Astrophysical Plasma Flows
Authors: Turkakin Hava , Mann Ian R. , Rankin Robert 
Published: October 2022

Abstract
The evolution of the Kelvin–Helmholtz instability (KHI) and magnetohydrodynamic (MHD) wave emission is investigated at shear-flow boundaries of magnetized plasmas. While MHD wave emission has been suggested to be only possible during the nonlinear stages, we find that there is also significant wave emission during the KHI’s linear stages. These emitted MHD waves may have stronger impacts than KHI surface waves since they can act to transport energy away from the local region of the shear flow. The removal of energy from the shear-flow region, instead of just the local redistribution considered in previous studies, and its propagation away from the interface could have major implications for the evolution of astrophysical objects characterized by fast plasma flow shears.
Red Supergiant Stars in IC 1613 and Metallicity-dependent Mixing Length in the Evolutionary Model
Authors: Chun Sang-Hyun , Yoon Sung-Chul , Oh Heeyoung , Park Byeong-Gon , Hwang Narae 
Published: October 2022

Abstract
We report a spectroscopic study on red supergiant stars (RSGs) in the irregular dwarf galaxy IC 1613 in the Local Group. We derive the effective temperatures (T
eff) and metallicities of 14 RSGs by synthetic spectral fitting to the spectra observed with the MMIRS instrument on the MMT telescope for a wavelength range from 1.16 to 1.23 μm. A weak bimodal distribution of the RSG metallicity centered on [Fe/H] = −0.65 is found, which is slightly lower than or comparable to that of the Small Magellanic Cloud (SMC). There is no evidence for spatial segregation between the metal-rich ([Fe/H] > −0.65) and -poor ([Fe/H] < −0.65) RSGs throughout the galaxy. The mean effective temperature of our RSG sample in IC 1613 is higher by about 250 K than that of the SMC. However, no correlation between T
eff and metallicity within our RSG sample is found. We calibrate the convective mixing length (α
MLT) by comparing stellar evolutionary tracks with the RSG positions on the H-R diagram, finding that models with α
MLT = 2.2–2.4H

P
can best reproduce the effective temperatures of the RSGs in IC 1613 for both Schwarzschild and Ledoux convection criteria. This result supports our previous finding that a metallicity-dependent mixing length is needed to explain the RSG temperatures observed in the Local Group, but we find that this dependence becomes relatively weak for RSGs having a metallicity equal to or less than the SMC metallicity.
Disks of Stars in the Galactic Center Triggered by Tidal Disruption Events
Authors: Perna Rosalba , Grishin Evgeni 
Published: October 2022

Abstract
In addition to a supermassive black hole (SMBH), the central parsec of the Milky Way hosts over 100 massive, high-velocity young stars whose existence, and organization of a subset of them in one, or possibly two, misaligned disks, is puzzling. Due to a combination of low medium density and strong tidal forces in the vicinity of Sgr A*, stars are not expected to form. Here we propose a novel scenario for their in situ formation: a jetted tidal disruption event (TDE) from an older wandering star triggers an episode of positive feedback of star formation in the plane perpendicular to the jet, as demonstrated via numerical simulations in the context of jet-induced feedback in galactic outflows. An overpressured cocoon surrounding the jet shock-compresses clumps to densities high enough to resist the SMBH tidal field. The TDE rate of 10−5–10−4 yr−1 per galaxy, out of which a few percent of events are jetted, implies a jetted TDE event per galaxy to occur every few million years. This timescale is interestingly of the same order of the age of the disk stars. The mass function predicted by our mechanism is top heavy. Additionally, since TDEs are isotropic, our model predicts a random orientation for the disk of stars with respect to the plane of the galaxy and, due to the relatively high TDE rate, can account for multiple disks of stars with uncorrelated orientations.
Fitting Rotational Frequency of Polytropes as a Function of their Oblateness
Authors: Yoshida Shin’ichirou 
Published: October 2022

Abstract
Giving a simple functional relationship between the rotational frequency and the centrifugal deformation for compressible stellar models is useful both in observational and theoretical astrophysics. Here I present simple Padé approximants for the rotational frequency of polytropic stars (index N = 1, 1.5, 3) as a function of the oblateness, which are valid at the order of


[

10

−
2

]

percent for the speed of rotation up to the mass-shedding limit.
Panser la santé mondiale
Authors: Velásquez Germán , Syam Nirmalya 
Published: October 2022

La crise du covid a démontré la fragilité des mécanismes dont dispose l’Organisation mondiale de la santé (OMS) pour se préparer et réagir aux pandémies. Pour y remédier, un appel en faveur d’un nouveau traité international a été lancé. À quelles conditions politiques et institutionnelles, la défense de l’intérêt général et de l’équité Nord-Sud pourra-t-elle l’emporter sur les avantages de l’industrie sanitaire et des pays riches ?
Barriers to family-centred care of hospitalised children at a hospital in Gauteng
Authors: Malepe Tsholofelo C. , Havenga Yolanda , Mabusela Paulina D. 
Published: October 2022

Background: Hospitalisation is a stressful event for the admitted child and the family. The unfamiliar and stressful hospital environment could increase children’s anxiety and pain experiences. Family-centred care has the potential to promote families’ holistic health, but its implementation is limited.Aim: To describe the barriers to family-centred care at a specific hospital in Gauteng.Setting: The study was contextual and was conducted at a specific hospital situated in Gauteng.Methods: A descriptive qualitative research design was used to collect data from 11 nurses and 14 primary caregivers of hospitalised children. Purposive sampling was used. Data were collected using semi-structured interviews and analysed using qualitative content analysis. Rigour through measures to enhance trustworthiness was ensured and ethical principles related to research with human participants were adhered to.Results: Three themes indicating the barriers to family-centred care emerged from the data, namely nurse-primary caregiver relationship, primary caregiver involvement, and ward structure and policy.Conclusion: Barriers to family-centred care involved interpersonal, environmental, and managerial dimensions of the hospital environment where children received care and treatment. A need to enhance family-centred care was therefore identified in order to address relational dimensions of the nurse-primary caregiver relationship, ward structure, and revision of current policies.Contribution: The article highlights barriers to family-centred care to enable action to be taken in the clinical environment to enhance a family-centred approach and improve the hospitalisation experience for children and caregivers.
Long-term experience with debulking surgery in extensive hepatic alveolar echinococcosis
Authors: Aliakbarian Mohsen , Di Martino Marcello , Saeidi Sara 
Published: October 2022

Objective:
To assess the role of debulking surgery in extensive hepatic alveolar echinococcosis (HAE).

Methods:
Five cases of extensive HAE undergoing debulking surgery with their long-term follow-ups were reported. Additionally, a systematic review was carried out.

Results:
The average age of patients in the study was (50.8±17.1) years (range 36 to 77 years). Three cases were female. The median follow-up period was 61 months (range 12 to 84 months). Left liver resections were performed in 2 cases and right hemihepatectomies were undertaken in 2 cases. Two patients (cases 2 and 4) developed early surgical complications, while one of them (case 4) who suffered from the recurrent sub-hepatic abscess died at 12 months postoperatively.

Conclusions:
This study highlights the importance of debulking surgery for the management of complex symptomatic HAE lesions in patients with no curative option available.
First-pass Success Rate and Number of Attempts Required for Intubation in Anticipated Difficult Airway
Authors: Raja Rameez , Gupta Sunana , Mehta Nandita , Attal Prerna 
Published: October 2022

Background and Aims:
Video laryngoscopy has been shown to improvise Cormack–Lehane grading and rate of successful tracheal intubation and is now incorporated in most of the difficult airway guidelines. Since there is scarce literature regarding the use of channeled blade of King Vision video laryngoscope (KVVL) in anticipated difficult intubation, we planned to undertake this randomized control trial to assess the performance of channeled blade of KVVL and Macintosh laryngoscope in patients with anticipated difficult intubation.

Design and Setting:
This prospective randomized study was conducted in a tertiary care hospital.

Materials and Methods:
Patients fulfilling the inclusion criteria were randomly assigned equally to the KVVL group or Macintosh group. The primary outcome of the study was intubation success in the first attempt and number of attempts required for intubation, and the secondary outcomes were Cormack–Lehane grading and time required to intubate in both the groups.

Results:
The first-pass success of intubation was 88.6% in the KVVL group and 76.5% in the Macintosh group (P = 0.035). The second attempt of intubation was required in 11.4% and 20.6% of patients in the KVVL and Macintosh groups, respectively. Cormack Lehane Grade I was achieved in 100% of patients of the KVVL group as compared to 29.4% of patients in the Macintosh group. Moreover, the difference was statistically significant (P = 0.035). The mean duration of intubation was prolonged in the KVVL group as compared to the Macintosh group, and the difference was statistically significant (P = 0.04).

Conclusion:
The channeled blade of KVVL had a higher first-pass success rate and required fewer attempts to intubate when used in patients with anticipated difficult intubation. Further, the KVVL was found to be significantly better than the Macintosh laryngoscope in terms of Cormack–Lehane grading, but the time taken to intubate the trachea was more in the KVVL group.