Relapsing polychondritis is a rare systemic inflammatory disease of cartilage resulting in structure changes of cartilage until its disappearance. The analysis of the present data on pathogenesis, different clinical manifestations and methods of treatment is performed.
A detailed description of sarcoidosis, pulmonary in specific but also covering the other systems. a rare entity in india or a better way to say, often an overlooked disease.
Solitary pulmonary nodules radiology ppt is very good power point presentation from various source radiology assistant and latest guidelines. this power-point also includes many sign with multiple xray, ct and mri images. this will help alot. Thanks.
A detailed description of sarcoidosis, pulmonary in specific but also covering the other systems. a rare entity in india or a better way to say, often an overlooked disease.
Solitary pulmonary nodules radiology ppt is very good power point presentation from various source radiology assistant and latest guidelines. this power-point also includes many sign with multiple xray, ct and mri images. this will help alot. Thanks.
DIFFERENTIAL DIAGNOSTIC OF INFECTIOUS DISEASES WITH MENINGEAL SYNDROMEtrinhtruong44
DIFFERENTIAL DIAGNOSTIC OF INFECTIOUS
DISEASES WITH MENINGEAL SYNDROME
-Differential diagnostic of infectious diseases with meningeal syn
drome. Methodical recommendations for foreign students of medical
faculty of the V and VI year (Диференційна діагностика інфекцій
них захворювань з менінгеальним синдромом).
V.M. Kozko, D.V. Katsapov, A.V. Bondarenko, G.I. Gradil, M.I.
Krasnov. - Kharkiv: KNMU, 2008. – 20 p.
Skull base osteomyelitis is a rare complication of otitis externa in which soft tissue pathogens have spread to the periosteum and temporal bone of the skull causing necrosis.
Rhematoid arthritis is systemic autoimmune inflammatory disorder of unknown etiology affecting multiple organ systems. These ppt includes comprehensive management of it.
Definitions, Epidemiology, Etiology, Pathophysiology, Clinical presentation/Clinical features/Signs & Symptoms, Diagnosis, Treatment: Non pharmacological treatment and Pharmacological treatment. All you need to know about Rheumatoid Arthritis. References. Pharm D 3rd year syllabus.
an overview of Lupus for journalist
Lupus has a wide spectrum of manifestation. Some mild but in most cases it has a high impact of life and quality of life
Sjögren’s (show-grin) syndrome - a syndrome describing xerophthalmia (dry eyes) and xerostomia (dry mouth)- (Sicca complex)-due to immune-mediated destruction of exocrine glands, predominately of lacrimal and salivary.
Acute rheumatic fever-definition,pathophysiology,clinical presentation and ma...onlinefreelancer1
A detailed approach to ACUTE RHEUMATIC FEVER,based on Harrison Principles of internal medicine and Braunwald Textbook of Cardiology.Useful for post graduate seminars.
UNRAVELLING THE MENTAL HEALTH LANDSCAPE: EXPLORING DEPRESSION AND ASSOCIATED ...indexPub
Introduction: The prevalence of depression and its correlates in Bangladeshi rural university students have been rarely investigated. We draw a literature review, a cross-sectional study and analysis of the rural students’ depression natures and mechanisms that influence their academic performance and health and well-being. Methods: A cross-sectional research was conducted during the period august 2019 to January 2020 in a university. We employed Beck Depression Inventory scale to collect data from 200 undergraduate and graduate students. Data were analysed using chi-square association test and ordinal logistic regression. Results: We discovered that mild to severe depression affected 60% of rural students [mild (16%), borderline (10%), moderate (12%), severe (11.5%), and extreme (10.5%)]. Family expectations, smoking, bad academic achievement, inability to enroll in a particular program, and inadequate household finances were significant risk factors for depression. When it comes to depression, male students scored noticeably higher than female pupils. The decreased depression was linked to both strong household economics and intellectual achievement. Conclusions: The intricate interactions among the risk factors influence the character and processes of depression in rural students.
IMPACT OF PERFORMANCE MANAGEMENT ON SUCCESSION PLANNINGindexPub
Motivation: HR in an organization faces various challenges in business environment, such as Building Capabilities, Improving Productivity, Building Performance Culture, Talent Management, Succession Planning for Key Leadership and Critical Roles, Developing Accountability and Ownership, Human Capital Management and transforming HR function into developmental Role from the legacy driven HR, etc. Succession Planning is the process of identifying and developing individuals, who have potential to hold the key leadership position in an Organization, whereas Performance Management includes assessing and improving upon the performance of an employee to meet the organizational goals. There are several Management Practices, which are adopted widely in Industry to make a successful Succession Planning. Workforce and Talent Management is one of them. The health of an organization majorly depends on the proper placement of people, which is a combined outcome of Talent Identification, Talent Development and Talent Retention. Performance Management plays a vital role in Talent Identification. It also has an impact on Talent Development and Talent Retention. The key idea of succession planning suggests that the right person to be placed at the right position at the right time. Succession planning is becoming a challenge these days in the corporate world. Organizations are often not found prepared with their successors to occupy the key positions as and when required. The positions are either kept vacant for a substantial period or more than one role is assigned to a single person. Identifying the right talent for the key positions from outside the organization and recruiting them is a much more difficult task at the eleventh hour. This has a significant impact on organizational health and in turn to organizational sustainability. Organizations must last longer than people. Role of organization continues even when the people move out. Employees must superannuate after attaining a certain age. Also, organizations must have a contingency plan for sudden vacancy arises out of attrition, health hazards and death of employee. Succession planning is the strategy to ensure that a suitable person is made available during exigencies. Employees are developed for taking on higher responsibilities and for the new roles that may emerge in future. The placement of Key Leadership positions can be executed either by inviting the talent from outside or developing the talent in-house. The latter is always in demand keeping in view the core values of the organization and the impact on loyalty and organizational culture in a long run. It is preferable to develop the in-house talent pool to reduce dependency on recruitment of experienced people from outside for the critical roles. It brings the talent acquisition cost low and contributes as a motivating factor for the team as well. The acceptability of a person placed at Top / Key Leadership Positions is high when these are occupied
EXTERNAL BEHAVIOURAL FACTORS IMPACT ON INVESTMENT DECISIONS OF INDIVIDUAL INV...indexPub
The study collects data from a sample of individual investors and analyses their responses to recent financial events, changes in market trends, and economic forecasts. By examining factors such as demographic profiles, financial literacy, risk tolerance, and market perceptions, the research aims to identify significant predictors of investment decisions in this demographic. The findings suggest that investors are predominantly influenced by financial news, peer influence, past investment performance, and the economic stability of the region. This study contributes to the field by highlighting the localized factors impacting investment choices and providing insights for financial advisors and investment firms to tailor their strategies according to investor needs and regional specifics.
GLOBAL RESEARCH TREND AND FUTURISTIC RESEARCH DIRECTION VISUALIZATION OF WORK...indexPub
Purpose – The purpose of this research is to undertake a bibliometric analysis of working capital management. The study examines papers from time period 1974-2023and performed performance analysis, co-citation analysis, bibliographic coupling and scientific mapping. Design/methodology/approach – The study examines 174 articles retrieved from the Scopus database using bibliometric analysis, performance analysis and thematic clustering. The study looked at the scientific productivity of papers, prolific authors, most influencing papers, institutions and nations, keyword co-occurrence, thematic mapping, co-citations and authorship and country collaborations. VOSviewer was as a tool in the research to conduct the performance analysis and thematic clustering.The watchword "Working Capital Management" was used to include only English-language articles. Findings – The most productive year was 2022 with 26 publications. Martínez and García- are the most protuberant authors with 708 citations. The findings of the study shows that the most influential institutions are ‘The Department of Management and Finance, Faculty of Economy andBusiness and Department of Management and Finance, Faculty of Economics and Business, The University of Murcia, Spain with 381 & 297 citations. Among,thecountry analysis,Spain with 744 citations stands first of all other nations for publication on Working Capital Management. Kärri is the most productive author with 7 documents. Country-wise analysis reveals that the United States is the most productive country for Working Capital Management research with 40 documents.The authors also identified seven thematic clusters of Working Capital Management. Research limitations/implications – It informs and directs researchers on the current state of study in the field of Working Capital Management.The present study has quite a few implications forSmall & Medium enterprise managers, entrepreneurs, financial managers, academicians and scholars. It also outlines future research directions in this field.Present study provides an inclusive acquaintance about the working capital management till date. Originality/value – This is the first study which provides the performance analysis and scientific mapping of the all published documents on working capital management between the time periods 1974-2023
A SOCIAL CAPITAL APPROACH TO ENTREPRENEURIAL ECOSYSTEM AND INNOVATION: CASE S...indexPub
Despite being recognised as drivers of innovative development, Micro, Small, and Medium-Sized Enterprises (MSMEs) frequently confront resource limitations. Therefore, enhancing the ecosystem is contingent on the entrepreneurs’ social capital, which is crucial for the success of MSMEs. This study applies the social capital approach to analyse the entrepreneurial ecosystem enrichment and its impact on the innovation process of cosmetics MSMEs. The qualitative case study of six cosmetic manufacturing MSMEs explores that social capital is a multifaceted asset to MSMEs. Through an in-depth thematic analysis of three dimensions of social capital (structural, relational, and cognitive), this study states that the innovation process is supported by the synergistic transformation of one dimension of social capital into another. Entrepreneurs sharing the common norms, rules, and language enrich their cognitive as well as relational aspects of ecosystem. The study suggests that as network ties, trust, and norms collectively influence innovation in firms, hence, social capital needs to be studied with its contextualization in the ecosystem.
ASSESSING HRM EFFECTIVENESS AND PERFORMANCE ENHANCEMENT MEASURES IN THE BANKI...indexPub
This study employs an exploratory and quantitative research approach to systematically investigate the impact of Human Resource Management (HRM) practices on Organizational Performance within the Indian Banking sector. The research approach combines exploratory research, aimed at gaining insights into HRM practices, with a quantitative approach using a purposive sampling technique. Data is collected through a questionnaire from employees in both public (SBI) and private banks (HDFC Bank) who work in HR departments or are involved in HR activities. The Likert scale is utilized in the questionnaire to measure participant perceptions of HRM practices. The study utilizes two statistical tools: Neural Network and Exploratory Factor Analysis (EFA). The findings of the study highlight the significance of promotion and transfer policies, considered paramount in influencing organizational performance in both public and private banks. Additionally, the study underscores the importance of training and development initiatives in enhancing employee skills and competencies. Clear and effective communication within HR policies is identified as pivotal in improving organizational performance. Lastly, aligning HRM practices with sector-specific goals is recognized as a significant contributor to improved employee satisfaction and overall performance in the banking sector. The findings offer guidance for HR practitioners and policymakers in optimizing HRM practices to achieve better organizational performance.
CORRELATION BETWEEN EMPATHY AND FRIENDSHIP QUALITY AMONG HIGH SCHOOL STUDENTS...indexPub
In this research were used two questionnaires Empathy Formative questionnaire and Friendship Quality Scale. The aim of this study is to see the relationship between empathy and friendship quality among adolescent, to find out if there are gender differences in empathy and friendship quality, and to see if there are any differences between younger and older students on examined variables. This research was done with 65 high school students. Age of the students were 15 to 17 years old. Results show that there is a correlation between empathy and friendship quality. The results of t test show that there are not significant differences between females and males on variable empathy. Girls and boys have significant difference in friendship quality in Kosovo. There are no significant differences between older students and younger students in the level of empathy and also there are no significant differences between older students and younger students in the level of friendship quality.
LEVELS OF DEPRESSION AND SELF-ESTEEM IN STUDENTSindexPub
Introduction: among the most worrying problems in recent years are low self-esteem, family and friends problems, anxiety, stress, and depression, which are taking on alarming proportions in students and young people in general. Purpose: the study is a prediction, which focuses on analyzing and evaluating students' self-esteem and level of depression. Methodology: the population is 332 students (13-15 years old) in high schools in the Gjakova region. The study describes the analysis, classification, and evaluation of the collected data by doing the analysis and real examination of the findings. Results: in terms of gender there is no significant difference in self-esteem, while in depression there is a significant difference. The level of depression is higher in women (11.9) than in men (9.5). Economic status shows that students with employed fathers have lower depression (6.77) compared to those with unemployed fathers (10.80). Conclusions: The level of depression and self-esteem and parental reflection affect students. A link has been found between economic status and emotional problems and student behavior. To prevent it, the psychological service in schools should function, and together with families and the community should be as close as possible to the problems of students.
THE IMPACT OF SOCIAL FACTORS ON INDIVIDUALS DIAGNOSED WITH SCHIZOPHRENIAindexPub
The society with diverse structural and ideological influences, assumes its role in relation to behavior, attitude, belief and relations. The impact can be seen in every society globally, however the western nations have adjusted their social policies to suit these transformations, whereas nations in developing phase have failed to establish suitable systems. In Kosovo, the allocation of funds for mental health services remains insufficient, even though mental health disorders account for 12.3% of overall illnesses and 30.8% of work incapacities! The objective of this study is to examine the impact of society on the decline and recovery of individuals with schizophrenia. The study employs both qualitative and quantitative methods to provide a descriptive-analytical. A study was conducted in four municipalities of Kosovo, using individuals with schizophrenia from psychiatric institutions as subjects along with their caregivers/family members . The research found that social factors greatly contribute to the worsening of schizophrenia patients' condition. The presence of schizophrenia is evident through a higher likelihood of having a low level of education, high unemployment rates, and engaging in harmful behaviors like tobacco and alcohol use, as well as physical inactivity. Significant correlations have been observed in the subscales of positive and negative symptoms using the Self-Report PNS-Q questionnaires. It is crucial for individuals with schizophrenia to have a carefully designed strategy in place, developed in partnership with professionals from various relevant fields such as social protection, psychiatric medical services, education, and social integration plans.
RETURN ON EQUITY (ROE) AS MEDIATION OF BANK'S CAPITAL ADEQUATION RATIO (CAR)indexPub
Banks need to maintain their performance and the level of Capital Adequasi Ratio (CAR). This study wants to see the variables that affect the Capital Adequasi Ratio (CAR) and see ROE as a variable that mediates the Capital Adequasi Ratio (CAR) at Bank Rakyat Indonesia (BRI). The research method used multiple regression analysis, t-test, Anova test and Coefficient of Determination and the research period for 14 years from 2009 to 2022, by using SPSS Software version 26. The conclusion of the study, only the BOPO variable has a significant effect on the Capital Adequasi Ratio (CAR) and the ROE variable as a variable that can mediate the CAR variable at Bank Rakyat Indonesia (BRI). Keywords: Capital Adequasi Ratio, Bank Financial Ratio.
INNOVATIVE DESIGN FOR KIDS MASTERY IMPROVEMENT OF LANGUAGE FEATURES IN A STORYindexPub
One of the hardest things for people learning English as a third language is still reading and writing. Because they are still not good enough at language features, they often make big mistakes and assumptions that aren't true. To make learning more fun and useful, visual symbols were made for seven different kinds of language traits. It looks at the Vipicoll form a lot. Visual Symbols media, Picture and picture, and the Collaborative approach are all creatively put together in Vipicoll. This research used Reeve's design method. Research develops Vipicoll learning model, employing interviews, literature reviews, and questionnaires for iterative improvement and validation. Researchers identify problems, create Vipicoll, iteratively refine through trials, forming an effective English Language Education model. Study assesses individual English thinking development, emphasizing interpretive framework, relation, function, and unique visual symbols. From this research, it was found that using Vipicoll really helps improve kids' mastery of language features, especially those in a story. This is proven by the fact that after implementation, kids' correct answers when asked directly by their teachers and their written test answers increased greatly even though many direct answers and test answers used to be wrong and they often didn't understand.
CARDIOVASCULAR DISEASE DETECTION USING MACHINE LEARNING AND RISK CLASSIFICATI...indexPub
The global prevalence of heart disease indicates a major public health issue. It causes shortness of breath, weakness, and swollen ankles. Early heart disease diagnosis is difficult with current approaches. Hence, a better heart disease detection tool is needed. Treatment requires more than just diagnosis. Risk classification is critical for accurate diagnosis and treatment. In this analysis, a novel cardiovascular disease (CVD) detection paradigm using machine learning (ML) and risk classification based on a weighted fuzzy system is proposed. The system is developed based on ML algorithms such as artificial neural network (ANN) and Long Short-Term Memory (LSTM) and uses standard feature selection techniques knowns as Principal Component Analysis (PCA). Furthermore, the cross-validation method has been used for learning the best practices of model assessment and for hyperparameter tuning. The accuracy-based performance measuring metrics are used for the assessment of the performances of the classifiers. Finally, the outcomes revealed that the proposed model achieved an accuracy of 94.01% which is higher than another conventional model developed in this domain. Additionally, the proposed system can easily be implemented in healthcare for the identification of heart disease.
ANALYSIS OF FLOW CHARACTERISTICS OF THE BLOOD THROUGH CURVED ARTERY WITH MIL...indexPub
Narrowing of the arteries caused by atherosclerosis reduces blood flow to the heart, which results shows ischemia, angina pectoris, cerebral strokes, and other coronary artery disease signs and symptoms. Curvature is seen in blood vessels at various locations. The stenotic surface provides an additional curvature and the point of maximum shear which varies with the cross-section. A cylindrical form of the Navier-Stokes equations in polar coordinate system have been extended to include dynamic curvature along the axial direction. The blood flow behavior of taking different values of blood parameters like viscosity, the radius of the artery, and the thickness of the stenosis has been studied with and without curvature by using an extended blood flow model with dynamic curvature. Moreover, the aspects of blood flow, such as dynamic curvature velocity profile, volumetric flow rate, pressure drop, and shear stress, have been studied in relation to blood flow around curved arteries with stenosis, variations in the radii of the artery, thickness of the stenosis, and viscosity. The information may reveal that by increasing the values of curvature, viscosity, and thickness of stenosis, velocity, and volumetric flow rate can be quickly reduced. Increasing the curvature, viscosity, and thickness of stenosis also results in an increase in shear stress and a pressure drop. The presence of curved stenotic arteries has a significant impact on the flow parameters, and it is crucial to know about these dynamics in order to study the cardiovascular system.
ANALYSIS OF STUDENT ACADEMIC PERFORMANCE USING MACHINE LEARNING ALGORITHMS:– ...indexPub
Student academic performance is the great value of institutes, universities and colleges. All colleges majorly focus on the career development of students. The academic performance of students plays a vital role in the establishment of a bright career. On the basis of better academic performance, the placement of the students will be better and the same will be reflected in the form of better admission and future. Machine learning can be deployed for the prediction of student performance. Various algorithms are playing an important role in the prediction of the accuracy of various machine learning models. These articles discuss various algorithms that can be helpful to deploy for predicting student academic performance. The article discusses various methods, predictive features and the accuracy of machine learning algorithms. The primary factors used for predicting students performance are academic institution, sessional marks, semester progress, family occupation, methods and algorithms. The accuracy level of various machine learning algorithms is discussed in this article.
IMPLEMENTATION OF COMPUTER TECHNOLOGY IN BLENDED LEARNING MODELS: EFFECTS ON ...indexPub
This study was conducted to identify the influence of computer technology in blended learning on the achievement in the Principles of Accounting subject through of self-directed learning. The research also assessed the relationship of the elements of blended learning on student achievement. Despite the encouragement by the Ministry of Education for the use of Computer Technology In Education, there is a lack of research on a measurable and testable model of the influence of computer technology. In reality, various aspects such as schools, teachers, content, and technology exist to provide and utilize computer technology through learning in Malaysia. A quantitative study using a correlational design was conducted on 400 Form Four students in secondary schools in the Southern Zone of Malaysia, namely in the states of Johor, Melaka, and Negeri Sembilan, to identify the influence of computer technology in blended learning on achievement. Data were collected using adapted and modified questionnaires from previous studies. Descriptive data analysis was performed using SPSS version 28, while inferential analysis was conducted using the Smart PLS analysis technique. Smart PLS version 4.0 software was utilized to test the mediator relationships in the study. The results of the study showed high minimum scores for blended learning through computer technology and self-directed learning, as well as achievement. The influence of blended learning elements also had a significant relationship with student achievement in the Principles of Accounting subject. This study is expected to contribute to the effectiveness of blended learning through information technology on the achievement in the Principles of Accounting subject by enhancing self- directed learning among students. The development of this conceptual model is hoped to serve as a guide for policymakers, the Ministry of Education, teachers, students, and other stakeholders in ensuring that blended learning practices can be implemented more effectively. Furthermore, it is hoped that the achievement and interest in the Principles of Accounting subject can be improved by applying computer technology in learning.
ACADEMIC BANK OF CREDIT: A WORLDWIDE VIEWPOINTindexPub
To make higher education more accessible and successful in the world today, the Academic Bank of Credits (ABC) is a new concept. Successful learning adaptation requires the transfer of credits and the acknowledgment of academic accomplishment. Recognition of credits is the process by which one educational organisation verifies that the educational experiences gained and assessed at another institution meet the requirements of one of their courses. The use of Academic Bank of Credits allows for a more adaptable method of curriculum building and design while also encouraging transparency. The credit system at this university is designed to accommodate different curricula while encouraging students to explore beyond traditional academic boundaries. The purpose of this research is to educate the audience about the Academic Bank of Credit. The demand for flexible and transferable credits in the education system led to the creation of the Academic Bank of Credits. In the past, students had a hard time moving their credits from one school to another because of the many credit systems and curriculums. Students and schools alike wasted time, energy, and materials because of this. Readers will have a better understanding of the following topics from this article: ABCs' objectives, functions, organisational structures, implementation plan, and eligibility criteria for higher education institutions to register with Academic Bank of Credits.
IMPACT OF MICROFINANCE ON POVERTY REDUCTION IN SOUTHERN PUNJAB PAKISTANindexPub
Microfinance has been adopted by several developing nations to raise their inhabitants' standards of living. It also contributes to their improved economic growth. Pakistan is now implementing this idea and seeing positive results from microfinance. In Pakistan, Khushhali Bank is a notable player in the microfinance industry. The results of the sample data selection indicate that microfinance operations have an effect on the standard of life of individuals residing in a particular region in Muzaffargarh. For this study, 100 clients of Khushhali Bank have been chosen. The primary goal of the research is to determine how Khushhali Bank's microfinance initiatives affect people's ability to live better lives. A Ex-post Facto research model was used to the gathered data in order to determine the relationship between the microfinance loan and living standard metrics. The analysis's conclusion indicates that microfinance operations have very little influence on raising people's standards of living, meaning they don't play a significant part in raising living standards. Apart from microfinance loans, there are additional variables that contribute to the improvement of people's standard of life.
A NOVEL DENSITY-BASED CLUSTERING ALGORITHM FOR PREDICTING CARDIOVASCULAR DISEASEindexPub
Cardiovascular diseases (CVDs) remain a leading cause of global morbidity and mortality. Early identification of individuals at risk of heart disease is crucial for effective preventive interventions. To improve the prediction accuracy, this paper proposed Heart Disease Prediction using the Density-Based Ordering of Clustering Objects (DBOCO) framework. The Dataset has been pre-processed using Weighted Transform K-Means Clustering (WTKMC). Features are selected using Ensemble Feature Selection (EFS) with a Weighted Binary Bat Algorithm (WBBAT) used to ensure that the emphasis is on the most relevant predictors. Finally, the prediction has been done using the Density-Based Ordering of Clustering method, which has been designed exclusively for cardiovascular disease prediction. DBOCO, a density-based clustering approach, effectively finds dense clusters within data, allowing for the inherent overlap in cardiovascular risk variables. DBOCO captures complicated patterns by detecting these overlapping clusters, improving the accuracy of disease prediction models. The proposed approach has been verified with heart disease datasets, displaying higher performance than traditional methods. This study marks a substantial leap in predicting cardiovascular disease providing a comprehensive and dependable framework for early identification and preventive concern.
INFLUENCE OF ADDITIVES ON THE MECHANICAL PROPERTIES OF HIGH-MODULUS ASPHALT C...indexPub
The appearance of premature cracks in freeway chase bodies is a worrying problem that requires in-depth analysis and remedial action. By identifying potential causes and proposing targeted recommendations, this study aims to help the responsible authorities make informed decisions to prevent such problems in the future and ensure the durability of road infrastructure. Premature cracking and rutting are common problems in pavements that can compromise their durability and safety. The use of specific additives in asphalt concrete can help prevent these deficiencies. The use of ZQ1 additive alone can lead to premature cracking in pavements, while PR FLEX 20 additive can increase the risk of rutting. However, a judicious combination of the two additives, with specific percentages of 2% for ZQ1 and 5% for PR FLEX 20, can prevent these shortcomings, improve pavement durability and optimize the mechanical properties of high-modulus asphalt concrete (BBME). In addition, this approach offers a promising solution for improving pavement durability and performance over time, opening the door to further studies to optimize the use of this additive combination in field applications.
DIALECTAL VARIABILITY IN SPOKEN LANGUAGE: A COMPREHENSIVE SURVEY OF MODERN TE...indexPub
Main fundamental challenge for recent research work on speech based on science and technology is to understand and model the user variants in Spoken Languages. Users have their style of speaking, reliant on various factors, adding the dialect and accent of the speaker as well as the social and economic background of the speaker and contextual attributes like degree of knowledge between the listener, speaker and the position or rank of the speaking condition, from very normal to formal. In the past few decades, an extensive progress has been seen in automatically verifying the language of a speaker offered a sample speech. The main purpose of dialect verification is the recognition of a speaker’s region dialect, within a pre-determined language, offered the acoustic signal alone. DR (Dialect Recognition) is a main issue in particular, since even within the similar dialect and accent or register user change may occur. For illustration, In Spontaneous speech, few speakers tend to exhibit more optimizing and alteration of function words than others. The main issue of dialect recognition system has been viewed as challenging than that of language classification or recognition due to the maximum similarity among dialects of the similar language. While, dialects may differ in any dimensions of the linguistic spectrum such as syntactic, lexical, morphological, phonological differences, these changes are likely to be more indirect across dialects than those across languages such as Hindi, Punjabi and English etc.
Francesca Gottschalk - How can education support child empowerment.pptxEduSkills OECD
Francesca Gottschalk from the OECD’s Centre for Educational Research and Innovation presents at the Ask an Expert Webinar: How can education support child empowerment?
Welcome to TechSoup New Member Orientation and Q&A (May 2024).pdfTechSoup
In this webinar you will learn how your organization can access TechSoup's wide variety of product discount and donation programs. From hardware to software, we'll give you a tour of the tools available to help your nonprofit with productivity, collaboration, financial management, donor tracking, security, and more.
How to Make a Field invisible in Odoo 17Celine George
It is possible to hide or invisible some fields in odoo. Commonly using “invisible” attribute in the field definition to invisible the fields. This slide will show how to make a field invisible in odoo 17.
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
Palestine last event orientationfvgnh .pptxRaedMohamed3
An EFL lesson about the current events in Palestine. It is intended to be for intermediate students who wish to increase their listening skills through a short lesson in power point.
Synthetic Fiber Construction in lab .pptxPavel ( NSTU)
Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
Introduction to AI for Nonprofits with Tapp NetworkTechSoup
Dive into the world of AI! Experts Jon Hill and Tareq Monaur will guide you through AI's role in enhancing nonprofit websites and basic marketing strategies, making it easy to understand and apply.
Introduction to AI for Nonprofits with Tapp Network
CLINICAL CASE OF RELAPSING POLYCHONDRITIS
1. 65 | V 1 8 . I 1 1
CLINICAL CASE OF RELAPSING POLYCHONDRITIS
DJURAEVA E.R 1, GANIEVA N.A 2, ZIYAEVA F.K 3 and MAKHMUDOVA M.S 4
1, 2, 3, 4
Tashkent Medical Academy.
Abstract
Relapsing polychondritis is a rare systemic inflammatory disease of cartilage resulting in structure changes of
cartilage until its disappearance. The analysis of the present data on pathogenesis, different clinical manifestations
and methods of treatment is performed. The own clinical observation of relapsing polychondritis is described.
Keywords: Relapsing Polychondritis, Diagnostic, Treatment
Relapsing polychondritis (RPC) is a rare systemic disease with an undulating course,
presumably of an autoimmune nature, characterized by periodic exacerbations of the
inflammatory process in cartilage tissues, leading to their destruction. RPC was first described
by Jaksch-Wartenhorst in 1927. This disease can be found under the names systemic
chondromalacia, panchondritis, chronic atrophic polychondritis.
To date, about 800 cases of RPC have been described in the world, with about 30 new patients
appearing annually. According to the Mayo Clinic, the incidence of the disease is 3.5 cases per
1 million population. Men and women get sick with the same frequency; people of any race
can get sick, but more often whites (Caucasians) [1].
To date, the etiological factor of the disease has not been identified. There are indications of an
autoimmune mechanism of development, which is confirmed by the discovery in patients
during a period of high activity of the process of a large number of antibodies to type II collagen
in the blood, and in damaged cartilage tissue, immunofluorescence detects deposits of IgG,
IgA, IgM and C3. The fact that a feature of the autoimmune process is damage to cartilage has
led researchers to the hypothesis that cartilage-specific antibodies occupy a central place in the
pathogenesis of RPC. Circulating immune complexes (CIC) to cartilage-specific collagen types
II, IX and XI were detected in 30-70% of patients with RPC. The most characteristic are
antibodies to type II collagen, which are present in the acute phase of the disease and their level
clearly correlates with the activity of the disease. However, these antibodies cannot be
considered specific for RPC, since they are also detected in rheumatoid arthritis (RA).
Antineutrophil antibodies are also important in pathogenesis. The role of infectious agents as
a trigger for the development of autoimmune disorders cannot be ruled out [2, 3].
Clinical manifestations of RPC vary in location, severity and duration. All types of cartilage
can be involved in the pathological process: elastic cartilage of the ear and nose, hyaline
cartilage of joints, cartilaginous tissue of the tracheobronchial tree, as well as other structures
rich in proteoglycans: eyes, inner ear, blood vessels.
Nasal chondritis is observed in 82% of patients. The cartilaginous septum of the nose is
affected, which is manifested by its saddle-shaped deformity. This is the result of long-term
inflammation of the cartilage tissue of the nose, in which the collapse of the cartilage and the
2. 66 | V 1 8 . I 1 1
collapse of the nasal bridge occur. However, this symptom may appear during the first attack
of the disease. In addition, nasal congestion, rhinorrhea, nosebleeds, and a painful feeling of
fullness in the bridge of the nose are noted. Sometimes nasal inflammation is clinically hidden;
pain does not always accompany the development of nasal deformity.
Most patients (84% of cases) experience inflammatory changes in the ears. Soreness, swelling,
induration, and a violet-erythematous coloration of the outer ear appear, not affecting the lobe.
The inflammatory process is usually two-sided: if at the beginning of the disease one ear is
affected, then the contralateral or both ears subsequently become inflamed. The attacks can last
from several days to several weeks and sometimes end spontaneously. Prolonged and repeated
episodes of inflammation lead to a gradual decrease in cartilage tissue and deformation of the
auricle. The ear becomes flabby, drooping, shapeless - “cauliflower-shaped ear.” Inflammation
can involve retroauricular soft tissues, the auditory canal, and structures of the middle and inner
ear, causing auditory and vestibular disorders [4, 5].
A variety of eye symptoms occur in 1/2 of patients. They are caused by inflammation of the
connective tissue membrane of the eye. Proptosis develops (displacement of the eyeball
forward and downward) with chemosis, periorbital edema, and ophthalmoplegia. Cases of
scleritis or episcleritis, non-granulomatous uveitis, conjunctivitis, sicca keratoconjunctivitis,
retinopathy (microaneurysms, hemorrhages, exudates), venous and arterial thrombosis of the
retina, and ischemic neuropathy of the optic nerve have been described.
Articular syndrome in RPC varies from arthralgia to monoarthritis or polyarthritis involving
large and small joints and parasternal joints. The classic manifestation of arthropathy in RPC
is asymmetric, non-erosive, non-deforming arthritis that resolves spontaneously or with
nonsteroidal anti-inflammatory drugs (NSAIDs). Involvement of the sternocostal joints can
lead to chest pain and limited respiratory excursion [1].
Damage to the cardiovascular system occurs in 25% of cases of RPC. Aortic insufficiency most
often develops due to expansion of the aortic root, which distinguishes it from aortic
insufficiency in other rheumatic diseases. Less common are mitral insufficiency, pericarditis,
arrhythmias and disorders of the cardiac conduction system. Cases of myocardial infarction
have been described.
Respiratory tract involvement is the most severe and prognostically significant manifestation
of RPC. Limited airway involvement may be asymptomatic. When inflammation is localized
in the area of the larynx and trachea, a nonproductive cough, dysphonia, wheezing, inspiratory
shortness of breath, hoarseness, and pain in the area of the thyroid cartilage or the anterior wall
of the trachea appear. When the bronchi of the 1st
and 2nd
order are affected, the clinical picture
resembles bronchial asthma. In the early stages of the disease, swelling and proliferation of
inflammatory tissue into the lumen of the trachea, pharynx, subpharyngeal space, and larynx
predominate. Subsequently, contractures develop due to fibrotic changes, cartilaginous support
decreases, which leads to dynamic collapse of the airways during forced inhalation and
exhalation. Shortness of breath develops with little physical exertion, a painful cough, and
repeated intercurrent infections occur. In severe cases, swelling of the larynx and epiglottis can
3. 67 | V 1 8 . I 1 1
lead to severe increasing shortness of breath, wheezing, asthma attacks, or respiratory failure
requiring emergency tracheostomy. Inflammatory processes in the respiratory tract,
periodically exacerbating or persistent, lead either to tracheal stenosis or to dynamic collapse
of the respiratory tract due to melting of the cartilaginous rings of the trachea and bronchi.
Kidney damage manifests itself in the form of focal proliferative glomerulonephritis, segmental
necrotizing glomerulonephritis, which can lead to uremia.
Gastroenterological symptoms: dysphagia due to damage to the pharyngeal cartilage.
Damage to the central nervous system: persistent headache, neuropathy of cranial nerves (II,
VI, VII, VIII pairs), seizures, encephalopathy, hemiplegia and ataxia.
The diagnosis of the disease is made taking into account clinical and laboratory data according
to diagnostic criteria developed by McAdam in 1976.
To establish a diagnosis of RPC, three or more diagnostic criteria must be met:
Recurrent chondritis of both ears;
Nonerosive inflammatory polyarthritis;
Chondritis of nasal cartilage;
Inflammation of the tissues of the eyeball (conjunctivitis, keratitis, scleritis/episcleritis
and/or uveitis);
Chondritis of the cartilages of the larynx and/or trachea;
Damage to the cochlea and/or vestibular apparatus, manifested by sensorineural hearing
loss, tinnitus and/or dizziness.
There are no pathognomonic laboratory and instrumental tests for the diagnosis of RPC.
Laboratory data are nonspecific and reflect the course of the inflammatory process: increased
erythrocyte sedimentation rate (ESR), leukocytosis, thrombocytosis, chronic anemia and
increased levels of α- and γ-globulins in the blood serum. Low titers of rheumatoid factor and
antinuclear antibodies may be detected. In most patients, ESR is an accurate indicator of
disease activity [1].
A biopsy of cartilage tissue is recommended only in extreme cases due to the high likelihood
of subsequent wound infection and poor healing. The morphological picture implies foci of
fibrosis and necrosis of cartilage tissue against the background of granulation-type
inflammation. When performing an immunofluorescence study, class G immunoglobulins are
detected, as well as signs of activation of the complement system, including C3D, C4d and
C5b-9. At the same time, it is reported that soft tissue biopsy is informative - signs of
leukocytoplastic or granulomatous type of vascular damage are revealed [6].
The goal of treatment is to reduce the severity of the symptoms of the disease and prevent
cartilage destruction.
4. 68 | V 1 8 . I 1 1
Due to the fact that RPC is a very rare disease, no controlled studies of treatment options have
been conducted. The main method of treatment at present is glucocorticoid therapy (GCS). In
the acute phase of the disease, prednisolone is prescribed up to 60 mg per day. If the
effectiveness is insufficient, the dose of the drug can reach 100 mg per day. Cytostatic drugs
are also used: azathioprine, metatrexate, cyclophosphamide, cyclosporine A. There are reports
of the effectiveness of the anti-leprosy drug dapsone, which suppresses the lysosomal activity
of polymorphonuclear leukocytes. In recent years, the possibility of using genetically
engineered biological drugs from the group of tumor necrosis factor inhibitors (infliximab,
etanercept), antibodies to diabetes (20 (rituximab) has been widely discussed in the literature.
Descriptions of isolated cases of the effectiveness of the use of these drugs are provided, but
no specially organized studies have been conducted due to the rare occurrence of the disease
[1, 7, 8].
We present a striking case of RPC in a patient observed in the 1st
clinic of the Tashkent Medical
Academy (TMA).
Clinical case. Patient D, 43 years old, was admitted to the cardio-rheumatology department of
TMAon January 30, 2022 with complaints of redness, swelling of both ears, decreased hearing,
pain when swallowing, dry cough, hoarseness, redness of the eyes and decreased vision, pain
and swelling in small joints of the hands, knees, ankles, dizziness, loss of appetite, weight loss,
general malaise.
From his medical history, he considers himself sick since October 2021, when a cough and
hoarseness appeared. She received outpatient treatment, but there was no effect from the
treatment. In January, swelling and redness of the ears appeared, after 10 days there was
swelling of the joints and pain, redness of the eyes and decreased vision. The patient received
inpatient treatment for 3 days in the clinic of TMA with the diagnosis: “Diffuse connective
tissue disease. Bilateral chondroperichondritis of the auricles, acute sensorineural deafness of
the first degree. Chronic fibrinous-plastic uveitis. The following treatment was carried out:
ceftriaxone per 1g once a day, rhinoxyl nasal spray 0.1% - 10.0 3-4 drops in each nasal passage,
dexamethasone 0.4% - 1 ml IM 1 time No. 3. After improvement of her condition, the patient
was referred to the rheumatology center of the TMA and hospitalized in the cardio-
rheumatology department. On examination: the general condition is moderate, consciousness
is clear. Body type: asthenic type. The skin is pink. Subcutaneous fat tissue is poorly developed.
There is no edema, the right axillary lymph node is enlarged. The eyeballs were of normal
shape, the sclera were hyperemic, and decreased vision was noted. The ears are swollen,
hyperemic, and painful on palpation, hearing is reduced. The nose is deformed like a saddle.
Pain, swelling and tenderness when moving in both small joints of the hands, right elbow, right
knee, ankle joints. There is vesicular breathing in the lungs, no wheezing. On auscultation,
heart sounds are rhythmic and muffled. Blood pressure 110/80 mmHg. Pulse at rest is 96 per
minute, rhythmic. The abdomen is soft and painless. The liver is not palpable. Diuresis is free
and painless.
5. 69 | V 1 8 . I 1 1
Blood test: hemoglobin – 102 g/l, erythrocytes – 3.6 x 1012/l, leukocytes – 11.8 x 109/l, ESR
– 20 mm/hour. Dynamics: hemoglobin – 85 g/l, erythrocytes – 2.8 x 1012/l, leukocytes – 6.2 x
109/l, ESR – 10 mm/hour. Coagulogram: hematocrit - 32%, fibrinogen - 7.87, PTI 91,
Thrombotest - 7 degrees.
HbsAg - negative, RW - negative, HVC - negative, TIV - negative. SRB-6 (negative), ASLO –
250.
General urine analysis: protein - 0.099%, epithelium. 7-8/1, leukocytes. 11-15/1, red blood
cells. 2-3/1. Dynamics: protein - 0.033%, epithelium. 0-1/1, leukocytes. 2-3/1, red blood cells.
0-1/1.
ECG: sinus tachycardia. Heart rate 112, incomplete blockade of the right bundle branch,
metabolic changes in the myocardium.
Chest X-ray: no changes.
MSCT (soft tissues of the neck and chest organs): CT scan did not reveal any signs of
pathological formations in the soft tissues of the neck. Uniform narrowing of the glottis should
be combined with clinical findings and laryngoscopy data. Chronical bronchitis. Adenopathy
of the mediastinal lymph nodes. Pericarditis. Ultrasound (liver, kidneys): echo signs of
inflammation of the left kidney.
Currently, there are no standards for the treatment of RPC. A combination of NSAIDs with
colchicine and corticosteroids is used. Clinical observations have shown that GCS suppress the
activity of the disease, but do not reduce the frequency of relapses, and ¾ of patients require
constant therapy with prednisolone at an average daily dose of more than 25 mg, but some
patients show resistance to GCS.
Our patient was started on treatment with prednisolone at a dose of 30 mg/day per os, and
symptomatic therapy was carried out. Already on the second day of taking prednisolone, an
improvement was noted: pain in the joints decreased significantly, scleral injection, cyanosis
and swelling of the ears decreased, and body temperature normalized. The patient underwent
3-day pulse therapy: 1st
and 3rd
days - solumedrol 1.0 g intravenously, 2nd
day solumedrol 1.0
g in combination with cyclophosphamide. Over time, ESR decreased and Hb increased. The
liver function tests showed some improvement. The patient was discharged with improvement
and was recommended to take a dose of prednisolone 30 mg/day under the supervision of a
rheumatologist.
Thus, the rapid and pronounced clinical and laboratory effect of GCS treatment confirms the
diagnosis of RPC. We think that this disease is little known to doctors of other specialties and
the given literature review and description of a clinical case will be useful.
RPC is an urgent disease. It takes 10 months from diagnosis to death. Up to 20 years. The most
dangerous manifestations of the disease, in addition to damage to the respiratory tract (56%),
is the involvement of the cardiovascular system in the inflammatory process (24%), with the
development of aortitis, aortic aneurysm, arterial thrombosis, aortic and mitral valve
insufficiency, conduction blocks and myocardial infarction, vasculitis .
6. 70 | V 1 8 . I 1 1
Poor prognostic signs are: onset at a young age, systemic vasculitis, early saddle nose
deformity, anemia in the elderly. A large study conducted at the Mayo Clinic found that in a
group of 112 patients, the 5-year survival rate was 74% and the 10-year survival rate was 55%.
The main causes of death were infectious diseases and systemic vasculitis, 15% of patients died
from damage to the respiratory tract and heart. The rarity of the disease and the low awareness
of doctors of various specialties encourage patients and specialists dealing with the problem of
cancer to unite.
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