Prostate-Specific Antigen Levels. Postnatal Growth Retardation. Intubation Types among Paramedic. Cytogenetic Findings in Children

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1 Online ISSN : Print ISSN : DOI : /GJMRA Pstnatal Grwth Retardatin Prstate-Specific Antigen Levels Cytgenetic Findings in Children Intubatin Types amng Paramedic VOLUME 19 ISSUE 6 VERSION 1.0

2 Glbal Jurnal f Medical Research: F Diseases Cancer, Ophthalmlgy & Pediatric

3 Glbal Jurnal f Medical Research: F Diseases Cancer, Ophthalmlgy & Pediatric Vlume 19 Issue 6 (Ver. 1.0) Open Assciatin f Research Sciety

4 Glbal Jurnal f Medical Research All rights reserved. This is a special issue published in versin 1.0 f Glbal Jurnal f Medical Research. By Glbal Jurnals Inc. All articles are pen access articles distributed under Glbal Jurnal f Medical Research Reading License, which permits restricted use. Entire cntents are cpyright by f Glbal Jurnal f Medical Research unless therwise nted n specific articles. N part f this publicatin may be reprduced r transmitted in any frm r by any means, electrnic r mechanical, including phtcpy, recrding, r any infrmatin strage and retrieval system, withut written permissin. The pinins and statements made in this bk are thse f the authrs cncerned. Ultraculture has nt verified and neither cnfirms nr denies any f the freging and n warranty r fitness is implied. Engage with the cntents herein at yur wn risk. The use f this jurnal, and the terms and cnditins fr ur prviding infrmatin, is gverned by ur Disclaimer, Terms and Cnditins and Privacy Plicy given n ur menu-id-1463/ By referring / using / reading / any type f assciatin / referencing this jurnal, this signifies and yu acknwledge that yu have read them and that yu accept and will be bund by the terms theref. All infrmatin, jurnals, this jurnal, activities undertaken, materials, services and ur website, terms and cnditins, privacy plicy, and this jurnal is subject t change anytime withut any prir ntice. Incrpratin N.: License N.: 42125/022010/1186 Registratin N.: Imprt-Exprt Cde: Emplyer Identificatin Number (EIN): USA Tax ID: Glbal Jurnals Inc. (A Delaware USA Incrpratin with Gd Standing ; Reg. Number: ) Spnsrs: Open Assciatin f Research Sciety Open Scientific Standards Publisher s Headquarters ffice Glbal Jurnals Headquarters 945th Cncrd Streets, Framingham Massachusetts Pin: 01701, United States f America USA Tll Free: USA Tll Free Fax: Offset Typesetting Glbal Jurnals Incrprated 2nd, Lansdwne, Lansdwne Rd., Crydn-Surrey, Pin: CR9 2ER, United Kingdm Packaging & Cntinental Dispatching Glbal Jurnals Pvt Ltd E-3130 Sudama Nagar, Near Gpur Square, Indre, M.P., Pin:452009, India Find a crrespndence ndal fficer near yu T find ndal fficer f yur cuntry, please us at ecntacts Press Inquiries: Investr Inquiries: Technical Supprt: Media & Releases: Pricing (E xcluding Air Parcel Charges): Yearly Subscriptin (Persnal & Institutinal) 250 USD (B/W) & 350 USD (Clr)

5 Editrial Bard Glbal Jurnal f Medical Research Dr. Jixin Zhng Department f Medicine, Affiliated Hspital f Guangdng Medical Cllege, Zhanjiang, China, Davis Heart and Lung Research Institute, The Ohi State University, Clumbus, OH 43210, United States Rama Ra Ganga MBBS MS (University f Health Sciences, Vijayawada, India) MRCS (Ryal Cllege f Surgens f Edinburgh, UK) United States Dr. Feng Feng Bstn University Micrbilgy 72 East Cncrd Street R702 Duke University, United States f America Dr. Lisa Kdie Ph.D. in Pharmaclgy, University f Minnesta Medical Schl, Minnesta, United States Dr. Krishna M Vukti Ph.D in Bichemistry, M.Tech in Bitechnlgy, B.S in Pharmacy, Case Western Reserve University, United States Dr. Xingnan Li Ph.D in Cell Bilgy, B.S in Mlecular Bilgy, Stanfrd University, United States Dr. Michael Wink Ph.D., Technical University Braunschweig, Germany Head f Department Institute f Pharmacy and Mlecular Bitechnlgy, Heidelberg University, Germany Dr. Han-Xiang Deng MD., Ph.D. Assciate Prfessr and Research Department Divisin f Neurmuscular, Medicine Davee Department f Neurlgy and Clinical Neursciences Nrthwestern, University Feinberg Schl f Medicine, United States Dr. Rbert Sanchez Assciate Prfessr Department f Structural and Chemical Bilgy Munt Sinai Schl f Medicine Ph.D., The Rckefeller University, United States Dr. William Chi-shing Ch Ph.D., Department f Clinical Onclgy Queen Elizabeth Hspital Hng Kng Dr. Yash Kapadia Dctr f Dental Surgery, University f Luisville Schl f Dentistry, United States Dr. Gudng Niu Ph.D. in Entmlgy, M.S. in Micrbilgy, B.S. in Envirnmental Science, The Pennsylvania State University, University Park, PA, United States Dr. Arpita Myles Ph.D, M.Sc. in Bitechnlgy, B.Sc in Micrbilgy, Btany and Chemistry, United States Dr. Wael Ibrahim Abd Aikhiary Ph.d, M.Sc in Clinical Pathlgy, MBBCH, M.D in Medicine, Mansura University, Faculty f Medicine, Egypt

6 Dr. Izzet Yavuz Ph.D, M.Sc, D Ped Dent. Assciate Prfessr, Pediatric Dentistry Faculty f Dentistry, University f Dicle, Turkey Dr. Rabiatul Basria SMN Mydin Ph.D in Cancer Genetics, BSC (HONS) in Bitechnlgy, University f Science Malaysia, Malaysia Dr. (Mrs.) Sunanda Sharma Ph.D, M.V.Sc., AH, M.V.Sc in Animal Reprductin, Veterinary Obstetrics and Gynaeclgy, Cllege f Veterinary & Animal Science, Rajasthan Agricultural University, Bikaner, India Dr. Subhadra Nandakumar Ph.D., M.Sc in Applied Micrbilgy, B.Sc in Micrbilgy, University f Madras, India Sanguansak Rerksuppaphl Department f Pediatrics Faculty f Medicine Srinakharinwirt University NakrnNayk, Thailand Antni Simne Lagan M.D. Unit f Gyneclgy and Obstetrics Department f Human Pathlgy in Adulthd and Childhd G. Barresi University f Messina, Italy Dr. Pejcic Ana Assistant Medical Faculty Department f Peridntlgy, and Oral Medicine University f Nis, Serbia Dr. Sunil Sirhi B.Pharm in Pharmaceutical Sciences, MS in Pharmaclgy, Ph.D in Pharmaclgy, Washingtn State University, Pullman, WA, United States Dr. Tsvetelina Velikva Ph.D, MD in Clinical Immunlgy, Medical University f Sfia Sfia University, Bulgaria Dr. M. Alagar Raja Ph.D in Pharmaceutical Sciences, M.Pharmacy in Pharmaceutical Analysis, B.Pharmacy S. Chattanatha Karayalar Cllege f Pharmacy, Nalanda Cllge f Pharmacy Tenkasi, Tamil Nadu, India Dr. Osama Hasan Alali Ph.D, Master's Degree, Pstgraduate Diplma in Orthdntics, Dentistry, Department f Orthdntics, University f Alepp Dental Schl Alepp, Syria Dr. Sultan Sheriff Dhastagir Ph.D, M.Sc in Medical Bichemistry, Faculty f Medicine, Garyunis/Benghazi University, Libya Dr. Seung-Yup Ku M.D., Ph.D., Seul Natinal University Medical Cllege, Seul, Krea Department f Obstetrics and Gyneclgy Seul Natinal University Hspital, Seul, Krea Dr. Ivandr Sares Mnteir M.Sc., Ph.D. in Psychlgy Clinic, Prfessr University f Minh, Prtugal

7 Dr. Pina C. Sanelli Assciate Prfessr f Radilgy Assciate Prfessr f Public Health Weill Crnell Medical Cllege Assciate Attending Radilgist NewYrk-Presbyterian Hspital MRI, MRA, CT, and CTA Neurradilgy and Diagnstic Radilgy M.D., State University f New Yrk Dr. Alfi Ferlit Prfessr Department f Surgical Sciences University f Udine Schl f Medicine, Italy Dr. Michael R. Rudnick M.D., FACP Assciate Prfessr f Medicine Chief, Renal- Electrlyte and Hypertensin Divisin (PMC) Penn Medicine, University f Pennsylvania Presbyterian Medical Center, Philadelphia Nephrlgy and Internal Medicine Certified by the American Bard f Int, United States Dr. Rajeev Vats Ph.D., M.Sc., B.Sc in Zlgy, M.Phil in Biinfrmatics, PGDCA, The University f Ddma, Tanzania

8 Cntents f the Issue i. Cpyright Ntice ii. Editrial Bard Members iii. Chief Authr and Dean iv. Cntents f the Issue 1. Intubatin Types amng Paramedic and Anesthesia Review f Cmplete Repertry t the Hmepathic Materia Medica Diseases f the Eyes, 2 nd Editin, by Dr. E. W. Berridge Cytgenetic Findings in Children with Pstnatal Grwth Retardatin Prstate-Specific Antigen Levels f Prstate Cancer Patients Three Mnths Fllwing LHRH Agnist Therapy v. Fellws vi. Auxiliary Memberships vii. Preferred Authr Guidelines viii. Index

9 Glbal Jurnal f Medical Research: F Diseases Vlume 19 Issue 6 Versin 1.0 Year 2019 Type: Duble Blind Peer Reviewed Internatinal Research Jurnal Publisher: Glbal Jurnals Online ISSN: & Print ISSN: Intubatin Types amng Paramedic and Anesthesia By Shammah A A, Abdullah M Bani Yusef, Ahmed Ali Khalid, Nasser B H & Hisham Karar Umm Al-Qura University Abstract- Backgrund: The rle f intubatin is practiced in mst respectful universities fr many medical students, especially the paramedic and anesthesia students thrugh cntrlled anesthesia simulatin labs. Aim: The study aims t evaluate the learning utcmes f varius types f intubatin fr paramedic and anesthesia students befre and after studying tw curses f airway management in the department f clinical technlgy. Methds: A mdel fr measuring, cmparing, and analyzing the fields f knwledge abut skills and experiences btained by the students is prepared. Students are enrlled frm the emergency medical service and the anesthesia department f clinical sciences at the Faculty f Applied Medical Sciences at Umm Al-Qura University in Makkah Al-Mukarramah. Results: Psychmtr skills were the mst imprtant dmain amng students in EMS department, fllwed by airway cmprmise knwledge, intentin r attitude, and effective cmmunicatin. Keywrds: EMS paramedics, endtracheal, glidescpe, intubatin, technlgy. GJMR-F Classificatin: NLMC Cde: WA 590 IntubatinTypesamngParamedicandAnesthesia Strictly as per the cmpliance and regulatins f: Shammah A A, Abdullah M Bani Yusef, Ahmed Ali Khalid, Nasser B H & Hisham Karar. This is a research/review paper, distributed under the terms f the Creative Cmmns Attributin-Nncmmercial 3.0 Unprted License cmmns.rg/licenses/by-nc/3.0/), permitting all nn-cmmercial use, distributin, and reprductin in any medium, prvided the riginal wrk is prperly cited.

10 Intubatin Types amng Paramedic and Anesthesia Shammah A A α, Abdullah M Bani Yusef σ, Ahmed Ali Khalid ρ, Nasser B H Ѡ & Hisham Karar Abstract- Backgrund: The rle f intubatin is practiced in mst respectful universities fr many medical students, especially the paramedic and anesthesia students thrugh cntrlled anesthesia simulatin labs. Aim: The study aims t evaluate the learning utcmes f varius types f intubatin fr paramedic and anesthesia students befre and after studying tw curses f airway management in the department f clinical technlgy. Methds: A mdel fr measuring, cmparing, and analyzing the fields f knwledge abut skills and experiences btained by the students is prepared. Students are enrlled frm the emergency medical service and the anesthesia department f clinical sciences at the Faculty f Applied Medical Sciences at Umm Al-Qura University in Makkah Al-Mukarramah. Results: Psychmtr skills were the mst imprtant dmain amng students in EMS department, fllwed by airway cmprmise knwledge, intentin r attitude, and effective cmmunicatin. Cmprmise knwledge was the mst imprtant dmain amng students in the Anesthesia department, fllwed by psychmtr skills, effective cmmunicatin, and intentin r attitude. Cnclusin: Medical student ETI prficiency was related t cumulative clinical prcedural experience in this study. A viable strategy might be presented by clinical experience t fster medical student prcedural skills. Keywrds: EMS paramedics, endtracheal, glidescpe, intubatin, technlgy. I. Intrductin Emergency airway management is an essential and crucial element f resuscitatin f critically ill patients [1]. The success rates f prehspital endtracheal intubatin vary frm 69% t 98.4%. There are several categries int which factrs cntribute t this differentiability in success [2]. These categries include paramedic experience, system factrs, and patient factrs. A cnstant challenge has been experienced by paramedics t btain apprpriate expsure t pprtunities fr perfrming this critical prcess as well as balancing this cgnitive skills and demanding guidelines [3-5]. The invasive prcedure is cnsidered fr airway management that allws futuristic apprpriate and sufficient administratin f medical Authr α: MD, FAMS EMS, Umm Al-Qura University. Authr σ Ѡ: FAMS EMS, Umm Al-Qura University. s: Authr ρ: MD, Anesthesia and ICU, Umm Al-Qura University. Authr : Umm Al-Qura University. gases t susceptible patients wh are incmpetent fr carrying ut apprpriate ventilatin thrughut different medical r surgical prcesses [4]. Intubatin is ne part f airway management, which is cnsidered a lifesaving prcedure in several cases [5, 6]. Endtracheal intubatin (ETI) has a 30% failure rate in pre-hspital settings by nn-physicians in extreme cnditins [7]. There are sme limitatins t use ETI in prehspital settings, even thugh EETI is a lifesaving and imprtant prcedure t secure the airway. Therefre, apprpriate guidelines f ETI indicate that it shuld be perfrmed by skillful, current, and expert persnnel such as paramedics r practitiners [8]. In cntrast, such persnnel lack due t financial crisis in mst f the emergency settings, specifically in rural and suburban areas [9]. Als, ETI has been dne by gag reflexes, laryngeal spasm, and paralyzing the patient fr preventing the head mvement. Drug usage is prhibited fr Emergency Medical Technician Intermediate, cntrversial fr paramedics, and emergency medical technician basic [10]. Cntinual and multiple intubatin effrts are related majrly with respiratry issues as the intubatin failure rate is cmparatively high. Als, intubatin is a technically difficult prcedure and time-cnsuming prcedure, which makes it unrealistic in sme cnditins, which include trauma patients suffering frm bleeding [11]. There is a lack f evidence regarding the requirement f ETI training experts fr achieving adequately high success rates with advanced airway management [12]. A median number f ttal ETIs per student f seven is described frm the cmplete survey f paramedic training prgrams with suggestins that apprximately 25 ETIs are required fr achieving an verall ETI success rate f 90% [13]. Several intermediate airway management techniques include placement f ral r nasal airway devices and bag-mask ventilatin used by Emergency Medical Technicians [14]. The placement f rpharyngeal airways such as King LT tube, Laryngeal Mask Airway, and Cmbitube is invlved fr the mst advanced airway management techniques. These airways are reserved fr the advanced level f prehspital prviders such as physicians r paramedics [4]. Als, airway rescue device placement, cricthyridtmy, capngraphy, and endtracheal intubatin remain the respnsibility f either physicians r paramedics with advanced airway training [9]. Recently, prgressins in the refinement f Year Glbal Jurnal f Medical Research ( F D) Vlume XIX Issue VI Versin I 2019 Glbal Jurnals

11 Intubatin Types amng Paramedic and Anesthesia Year Glbal Jurnal f Medical Research ( F D) Vlume XIX Issue VI Versin I rpharyngeal and vide-assisted laryngscpy (VAL) have shwn the ptential t add r change t the cnventinal apprach f prehspital airway management [11]. It is crucial t cntinue the prcess f evaluatin and refinement flearning utcmes fr the students taught airway curses during the successive years t adpt new strategic plans fr better student learning utcmes. The rle f intubatin is practiced in mst respectful universities fr many medical students especially the paramedic and anesthesia students thrugh cntrlled anesthesia simulatin labs prvided by highly cmputerized manikins that can sense even a small fractin f errr in intubatin prcedures. In this regard, the study aims t evaluate the learning utcmes f varius types f intubatin fr paramedic and anesthesia students befre and after studying tw curses f airway management in the department fclinical technlgy. The study is significant in the cntext f Saudi Arabia, where there lacks evidence regarding the assciatin between the level f bth educatin f students and their training abut intubatin with the clinical patient utcmes f care. II. Material and Methds The study had used Natinal Registry Checklist fr evaluating the student perfrmance befre and after the teaching f tw Airway Management Curses where students had practical sessins and lectures with labratry simulatins and vide demnstratins fr all types f intubatin ver a minimum f tw semesters (30 weeks). An evaluatin frm is develped fr measuring the fur dmains f learning, which include (1) intentin and attitude tward helping students; (2) psychmtr skills btained fr managing airways cmprmise; (3) effective cmmunicatin with self, patients, and all the health team members; and (4) knwledge abut anatmy, diagnsis, physilgy, and management f airways cmprmise. The study has cllected data frm the paramedic and anesthesia technlgy students pre and pst airways management curses (n = 128). The study has measured knwledge, attitude, skills, and effective cmmunicatin fr all students befre and after the tw curses in the class. An unblended bserver recrds the fllwing utcmes (1) verall intubatin success rate; (2) number f intubatin attempts; (3) mdified Crmack- Lehane scre; (4) intubatin time; (5) frequency f esphageal intubatin; (6) mucsal trauma; (7) lip r dental injury; and (8) desaturatin (SpO2 <95%). a) Prcedures Intubatin using Glide Scpe vide laryngscpes can be simplified when applying the fllwing pints: 1. Successful ral endtracheal tube (ETT) placement always requires sme frm f a stylet, such as the Glide Rite Rigid Stylet (Verathn) a reusable rigid stylet r the Satin-Slip (Mallinckrdt) dispsable intubating stylet. Otherwise, the ETT is flppy and very hard t direct thrugh the vcal crds. A stylet is nt used fr nasal intubatin. 2. The primary limitatin in using the Glide Scpe is nt in getting a gd view f the glttis, but rather in manipulating the ETT thrugh the vcal crds. This is because the ETT tip ften tends t hit against the anterir tracheal wall. When this happens, it is ften helpful t retract the stylet by 3 t 5 cm, as this ften advances the ETT int a mre favrable psitin. Smetimes, even when the stylet is remved cmpletely, the ETT still abuts against the anterir tracheal wall; in these cases, the ETT shuld be twisted by 180 degrees. When initially placing the Glide Scpe vide laryngscpe blade r the ETT, learners shuld first lk int the patient s muth and nt at the mnitr t prevent injury t any rpharyngeal structures. b) Statistical Analysis The baseline characteristics are presented using descriptive statistics. Categrical data are expressed as cunts, whereas cntinuus variables are given as mean ± standard deviatins. The general linear mdel analysis f variances (ANOVA) is used t cmpare the means f different dmains. All calculatins were perfrmed using the IBM SPSS sftware fr Windws, versin 20. III. Results Table 1 presents a descriptive analysis fr department and evaluatin. The findings have shwn that a ttal f 65 students belng t the anesthesia department (50.8%), whereas 63 students belng t the EMS department (49.2%). Als, a ttal f 67 students were evaluated fr pst-curse, and 61 students were evaluated fr pre-curse knwledge. Table 1: Descriptive Analysis fr Department and Evaluatin Department Frequency Percent EMS Anesthesia Ttal Evaluatin Frequency Percent Pre Pst Ttal The statistical difference fr dmains in the EMS department is presented in Table 2 using the ANOVA test. The findings have shwn a significant mean difference fr all dmain s knwledge amng students in the EMS department. Psychmtr skills were the mst imprtant dmain amng students in the EMS department, fllwed by airway cmprmise knwledge, intentin r attitude, and effective cmmunicatin Glbal Jurnals

12 Intubatin Types amng Paramedic and Anesthesia Table 2: ANOVA Test fr Different Dmains in EMS Department Dmain Name Intentin /attitude Cmmunicatin Knwledge P Skills Effective Cmmunicatin The statistical difference fr dmains in the Anesthesia department is presented in Table 2 using the ANOVA test. The findings have shwn a significant mean difference fr all dmain s knwledge amng students in the Anesthesia department. Cmprmise IV. Evaluatin Pre Number f r Pst cases Mean Pre Pst Pre Pst Pre Pst Pre Pst P- value knwledge were the mst imprtant dmain amng students in the Anesthesia department, fllwed by psychmtr skills effective cmmunicatin, and intentin r attitude. Table 3: ANOVA Test fr Different Dmains in Anesthesia Department Dmain Name Evaluatin Pre Number f r Pst cases Mean P- value Intentin /attitude Pre Pst Cmprmise Knwledge Pre Pst Psychmtr Skills Pre Pst Effective Cmmunicatin Pre Pst Discussin The study has evaluated the learning utcmes f varius types f intubatin fr paramedic and anesthesia students befre and after studying tw curses f airway management in the department f clinical technlgy. Psychmtr skills were the mst imprtant dmain amng students in EMS department, fllwed by airway cmprmise knwledge, intentin r attitude, and effective cmmunicatin. On the cntrary, cmprmise knwledge was the mst imprtant dmain amng students in the Anesthesia department, fllwed by psychmtr skills effective cmmunicatin, and intentin r attitude. The deliberate practice mdel f Ericssn ffers a theretical framewrk t understand the ETI skill utilizatin in this study. Repetitin alne might nt lead t an expert r superir skill levels, whereas experience might enhance perfrmance in an activity. It has been argued that students practicing deliberate practice must be invlved in intense galdirected learning fr achieving higher levels f prficiency [15, 16]. The student must pursue learning activities fr crrecting limitatins and enhancing perfrmance and must be merged with immediate crrectin, remediatin, repetitin, and feedback. Students must perfrm tasks utside their existing areas f authentic perfrmance t invlve in deliberate practice. This study has illustrated that students must perfrm tasks utside their current areas t depict the utilizatin f fundamental ETI skills by nvice medical students regardless f previus specialized airway management skills. Additinal specialized gal-directed learning must be achieved by an expert-level ETI beynd the scpe f the fundamental anesthesia curriculum [17]. In this study, the cmplementary using f human-simulatr training might have cntributed t use ETI skills. It has been argued that ETI prficiency must be btained by paramedic students using human simulatr r training based regardless f the live perating rm. Simulated ETI training is included by previus studies befre clinical experience [17, 18]. Intensive teaching withut any distractins f current clinical care is facilitated by simulatr/mannequin-based training theretically t allw fr islated r cncentratin elements f a skill r prcess. Hwever, the design f this study did nt allw assessment f the interactive r independent influence f simulatin upn clinical ETI perfrmance. This study cannt assess the safety f student ETI effrts in the perating rm, but it is assumed that the curses were relevant, cnsidering the culture and guidelines f the institutin. Fr instance, the institutin has a strict plicy t attend anesthesilgist during ETI and anesthesia inductin. The majrity f student ETIs ccurred n patients rated Mallampati class I r II, which indicated that easier cases were intubated preferentially by students. Als, nly ne medical student laryngscpy attempt was invlved in mstly patient experiences, which signaled the ptential limitatin f Year Glbal Jurnal f Medical Research ( F D) Vlume XIX Issue VI Versin I 2019 Glbal Jurnals

13 Intubatin Types amng Paramedic and Anesthesia Year Glbal Jurnal f Medical Research ( F D) Vlume XIX Issue VI Versin I student ETI effrts. It has been believed that early medical student expsure t ETI training is authentic until the experience is adequately supervised. Withut adequate supervisry culture r resurces, institutins might nt be able t achieve the same balance between patient safety and educatin. a) Limitatins The study was unable t adjust r quantify fr prir airway experience. Self-reprting bias might have resulted in ver-reprting f student ETI success while supervising anesthesilgy staff cnfirmed all lgbk entries. Students in this study might have differently perfrmed easier intubatins. In additin, there was a wide variatin in the number f ETI chances prvided t each student. Other airway management prcedures were nt evaluated, such as laryngeal mask airway insertin, r bag-valve-mask ventilatin. There was n infrmatin regarding the attributes f instructrs r students. The study has nt cntrlled fr patient selectin, educatin, r ETI techniques used and ther aspects f clinical care. Similarly, the study has nt cntrlled fr differences in instructinal technique r instructr, and changes in clinical skill ver time. Perfrmance might have differed with lnger r additinal clerkship experience. This study has nly evaluated psychmtr skills and knwledge-related abilities, which d nt allw t evaluate decisin-making skills. Intubatin perfrmance by medical students shuld be depicted under supervised and cntrlled perating rm cnditins, and cannt be examined utside f this clinical practice setting. Skill utilizatin might have been influenced by ther factrs. Fr instance, the learning prcess might be influenced by the quality and nature f instructr-trainee interactin. Students might be mtivated t pursue critical care-riented fields fr learning ETI, achieving higher rates f early ETI success, and perfrming a larger number f ETIs. V. Cnclusin The learning curve fr prehspital ETI success rates explains an increase in the dds f successful ETI with each cumulative training expsure t ETI in a paramedic training prgram with significant clinical pprtunities and resurces. High numbers f previusly perfrmed ETIs might be required fr firstpass placement f the ETT that may surpass the number available in training prgrams. Medical student ETI prficiency was related t cumulative clinical prcedural experience in this study. A viable strategy might be presented by clinical experience t fster medical student prcedural skills. Acknwledgment The authr is very thankful t all the assciated persnnel in any reference that cntributed in/fr this research. Further, this research hlds n cnflict f interest and is nt funded thrugh any surce. References Références Referencias 1. M. Gu, M. Lian, C. Gng, L. Chen, and S. LI, The teaching rder f using direct laryngscpy first may imprve the learning utcme f endtracheal incubatin, Medicine. 98 (2019) e Di: di.rg/ /md T. R. Okell, P. Mugabi, G. Hwang, M. Sutter, and R. Lett, Student self-assessment after Essential Surgical Skills training fr final-year medical students at Gulu University, nrthern Uganda, East and Central African Jurnal f Surgery. 23 (2018) 18. Di: di.rg/ /ecajs.v23i R. J. Karmali, J. M. Siu, D. Z. Yu, S. Span, A. L. Winthrp, J. F. Rudan, R. K. Reznick, A. T. Sanfilipp, and P. Belliveau, The Surgical Skills and Technlgy Elective Prgram (SSTEP): A cmprehensive simulatin-based surgical skills initiative fr preclerkship medical students, The American Jurnal f Surgery, 216 (2018) Di: di.rg/ /j.amjsurg J. N. Carlsn, M. Zcchi, K. Marsh, C. McCy, J. M. Pines, A. Christensen, R. Krnas, and A. Venkat, Prcedural Experience with Intubatin: Results frm a Natinal Emergency Medicine Grup, Annals f Emergency Medicine, (2019). Di: di.rg/ / j.annemergmed R. Kazan, M. Giacalne, J. Liu, E. Brgi, S. Cyr, and T. M. Hemmerling, Expsing medical students t varius difficulty levels f simulated endtracheal intubatins imprves success rate: a randmized nn-blinded trial, BMJ Simulatin and Technlgy Enhanced Learning, bmjstel , Di: di.rg/ /bmjstel H. Y. Kang, K. S. Han, S. W. Lee, H. J. Chi, T. H. Lim, C. W. Kim, C. H. S. J. Chang, Kim, The learneradjusted assessment tl fr endtracheal intubatin cnsidering examiners different expectatins f cmpetence. Jurnal f the Krean Sciety f Emergency Medicine 30 (2019) Satyapal, C. Rut, and T. Smmerville, Errrs and clinical supervisin f intubatin attempts by the inexperienced, Suthern African Jurnal f Anaesthesia and Analgesia, vl. 24, n. 2, pp , Feb Di: di.rg/ / G. Ramirez, Y. Hu, H. Kim, S. K. Rasmussen. Lng- Term Skills Retentin Fllwing a Randmized Prspective Trial n Adaptive Prcedural Training. Jurnal f surgical educatin. 75 (2018) Y. On, K. Tanigawa, T. Kakamu, K. Shinhara, K. Iseki. Out-f-hspital endtracheal intubatin experience, cnfidence and cnfidence-assciated factrs amng Nrthern Japanese emergency life Glbal Jurnals

14 Intubatin Types amng Paramedic and Anesthesia saving technicians: a ppulatin-based crsssectinal study. BMJ pen. 8 (2018) e Y. L. Ham, J. H. Kim, J. G. Lee. The necessity fr educatin n endtracheal intubatin thrugh vide laryngscpe-a fcused n paramedic students. The Krean Jurnal f Emergency Medical Services. 23 (2019) W. R. Leeper, E. R. Haut, V. Pandian, S. Nakka, J. Ddd-O, N. Bhatti, E. A. Hunt, M. Saheed, N. Dalesi, A. Schiavi, C. Miller. Multidisciplinary Difficult Airway Curse: An Essential Educatinal Cmpnent f a Hspital-Wide Difficult Airway Respnse Prgram. Jurnal f surgical educatin. 75 (2018) R. Pilbery. Hw d paramedics learn and maintain the skill f tracheal intubatin? A rapid evidence reviews. British Paramedic Jurnal. 3 (2018) A. Brwn III. Apprach t the difficult airway in adults utside the perating rm. Lippinctt Williams and Wilkins. 24 (2018) J. T. Abualenain, M. M. Al-Alawi. Simulatin-based training in Ebla Persnal Prtective Equipment fr healthcare wrkers: Experience frm King Abdulaziz University Hspital in Saudi Arabia. Jurnal f infectin and public health. 11 (2018) R. H. Hastings, S. Kedarisetty, J. M. Jhnsn, D. Glaser, N. Delsn. Manikin Laryngscpy Mtin as a Predictr f Patient Intubatin Outcmes: A Prspective Observatinal Study. The jurnal f educatin in periperative medicine: JEPM.20 (2018). 16. Strzelecki, C. L. Sheltn, J. Cunningham, C. Dean, S. Naz Thmas, K. Stcking, A. Dbsn. A randmised cntrlled trial f bag valve mask teaching techniques. The clinical teacher. (2019). 17. S. Y. Kim, S. O. Park, J. W. Kim, J. Sung, K. R. Lee, Y. H. Lee, D. Y. Hng, K. J. Baek. Hw much experience d rescuers require t achieve successful tracheal intubatin during cardipulmnary resuscitatin? Resuscitatin. 133 (2018) N. Arulkumaran, J. Lwe, R. Ins, M. Mendza, V. Bennett, M. W. Dunser. Videlaryngscpy versus direct laryngscpy fr emergency rtracheal intubatin utside the perating rm: a systematic review and meta-analysis. British jurnal f anaesthesia.120 (2018) Year Glbal Jurnal f Medical Research ( F D) Vlume XIX Issue VI Versin I 2019 Glbal Jurnals

15 Intubatin Types amng Paramedic and Anesthesia Year Glbal Jurnal f Medical Research ( F D) Vlume XIX Issue VI Versin I This page is intentinally left blank 2019 Glbal Jurnals

16 Glbal Jurnal f Medical Research: F Diseases Vlume 19 Issue 6 Versin 1.0 Year 2019 Type: Duble Blind Peer Reviewed Internatinal Research Jurnal Publisher: Glbal Jurnals Online ISSN: & Print ISSN: Review f Cmplete Repertry t the Hmepathic Materia Medica Diseases f the Eyes, 2 nd Editin, by Dr. E. W. Berridge By Dr. Ashutsh Kumar & Dr. E. W. Berridge Abstract- This Repertry is indispensable fr every hmepath wh is willing t practice with scientific accuracy & exactness. One f the clearest and best arranged very useful repertries in the interpretatin f the phthalmic cases, marshaling bth symptms and cnditins is adequate as the present state f ur understanding. GJMR-F Classificatin: NLMC Cde: WB 26.5 ReviewfCmpleteRepertryttheHmepathicMateriaMedicaDiseasesftheEyes2ndEditinbyDrEWBerridge Strictly as per the cmpliance and regulatins f: Dr. Ashutsh Kumar & Dr. E. W. Berridge. This is a research/review paper, distributed under the terms f the Creative Cmmns Attributin-Nncmmercial 3.0 Unprted License permitting all nncmmercial use, distributin, and reprductin in any medium, prvided the riginal wrk is prperly cited.

17 Review f Cmplete Repertry t the Hmepathic Materia Medica Diseases f the Eyes, 2 nd Editin, by Dr. E. W. Berridge Dr. Ashutsh Kumar α & Dr. E. W. Berridge σ Abstract- This Repertry is indispensable fr every hmepath wh is willing t practice with scientific accuracy & exactness. One f the clearest and best arranged very useful repertries in the interpretatin f the phthalmic cases, marshaling bth symptms and cnditins is adequate as the present state f ur understanding. I. Intrductin T his Hmepathic Repertry is a guide t the pile f symptms f diverse drugs, and the numerus symptms can be accurately detected accrding t the requirement. It adds n nthing, als changes nthing, but prvide merely as a guide t the prfusin. we all are using ne Repertry in every case befre prescribing. The majrity f us use nly ur mental Repertry, which is naturally slender because f the limited capacity f the Human brain. Disparate repertries have evlved ver the curse f time, and the layut has changed in many f them. Besides the nature and utility f the repertries depends n the quality f the symptms included in them. This cncept f evlutin f repertries n the anatmical basis gave t the Reginal Repertries. In the sectin n anatmical regins, under the heading Eyeball (including cnjunctiva bulbi), we find Tubercles (warts) with fifteen remedies attached. We are baffled t knw if these remedies have caused r cured tubercles. II. Summary In this secnd editin f Dr. Berridge s Repertry cntains the symptms abut the eye. It is meant t be used, ntably in the treatment f phthalmic diseases. It cntains all the phthalmic symptms which ccur in the prving f 1171 remedies, arranged under different headings, smewhat after the manner f Dr. Benninghausen. The preface states that a perfect Repertry shuld cntain every symptm f the Materia medica under every rubric where it can be lked fr, and the bk is cmpiled in accrdance with that idea. T effect this, he has divided each chapter f this Repertry int tw Sectins: Authr α: B.H.M.S. M.D. (Hm), Lect. Dept. Anatmy R.B.T.S. Gv. H.M.C. & H. Muz. Bihar The Symptms themselves and 2. Their Cnditins, (including Cncmitants). The Cnditins including the Cncmitants are arranged in 23 grups as fllws: (1) Time, (2) Situatin, stages and External effect, (3) Psture, (4) Tuch, (5) Mtin, (6) Head (alng with Mental Symptms), (7) Eyes, (8) Ears, (9) Nse,(10) Face & Frnt f Neck, (11) Teeth, (12) Muth as well as Thrat, (13) Abdmen (alng with Stmach, Anus, including all Functinal Symptms theref, (14) Urinary Organs, (15) Sexual Organs, (16) Chest and Larynx, (17) Back and Nape f Neck, (18) Arms, (19) Legs, (20) Sleep, (21) Fever, (Chills, Sweat, and Heat), (22) Generalities (tgether with Cnvulsins, Skin, Bnes, Other Drugs, & c.) Clinical cases are decisive fr determining cncmitants as it is ften challenging r impssible t determine frm the prving alne what symptms are actually cnnected amng each ther. He was in the supprt f applicatin f the dctrine f analgy fr selectin f remedy as materia medica f his time was inadequate. As per Dr. E. W. Berridge, if we wish t btain maximum benefit frm Hmepathy, then we can nly d s by fllwing the three great rules f the Master as fllws careful selectin f Similimum, Single remedy, and Minimum dse. III. Gradatin f Rubrics a) 5 Grades 1 st Grade: Italic Capitals 2 nd Grade: Plain Capitals 3 rd Grade: Italics 4 th Grade: Rman Letters 5 th Grade: Rman(Bracketed) Dubt Full Symptms b) Surces C. Hering s Materia Medica Symptms frm later prving. Cases f pisning reprted in allpathic jurnals. Year Glbal Jurnal f Medical Research ( F D) Vlume XIX Issue VI Versin I 2019 Glbal Jurnals

18 Review f Cmplete Repertry t the Hmepathic Materia Medica Diseases f the Eyes, 2 nd Editin, by Dr. E. W. Berridge Year Glbal Jurnal f Medical Research ( F D) Vlume XIX Issue VI Versin I IV. Abbreviatins The authr has used cnsistent and scientific practice f cyphering f his time. But, it is cast away by scientific nmenclature. Cyphers f the elements and simple halid salts are the same as their chemical symbls The -ate salts are cyphered by adding a Ite salts are cyphered by adding I Ic acids are cyphered by adding x Ous acids are cyphered by adding ix. Hydracids cyper by adding hx t radical Ide salts are cyphered by adding S Na. = sdium. S. = sulphur Na-sa. = sulphate f sdium. Na-si. = sulphite f sdium. S-x = sulphuric acid. S-ix = sulphurus acid S-hx = sulphydric acid Na-s = sulphide f sdium In the medicines btained frm the Animal as well as Vegetable kingdms, each genus is custmarily revealed by a divergent cypher and by that nly. V. The Chapters as Fllws Table 1 Sectin I: Symptms (PP. 1-99) Further divided int 5 subsectins: IA: Functinal Symptms (PP. 1-14) IB: Anatmical regins (PP ) IC: General character, sequence & directins (PP ) ID: Right side (PP ) IE: Left side. (PP ) Sectin II: Cnditins (Including Cncmitants) (PP ) Further divided int 2 subsectins: II A: Aggravatins (PP ) II B: Ameliratins (PP ) T explain this Repertry use, Dr. E. W. Berridge mentined the fllwing cases frm his practice: Case 1 Aug 9, At 2 pm a child put his finger int his mther s left eye, scratching the upper part f eye ball; smarting in the eye fllwed with heat, redness and ht lachrymatin fllwed; cannt pen the eye Table 2 because f pain. Cld water applicatin relieves the pain and watering; the light f day increases the watering. Remedy Diagnsis As the symptms arse frm a mechanical cause, the authr did nt cnsider the lcality (left eye) as a characteristic f the case. Page N. Rubric Medicine 290 Relief frm Cld-Heat Al-, Amm-cl (thu). Relief frm Cld-Lachrymatin Al-. Relief frm Cld-Smarting Al-, N-x. 293 Relief frm Washing-Heat Al-, Amm-cl, asr, k-na (thu) Relief frm Washing-Lachrymatin Al-,Asr. Mg-ca. Relief frm Washing-Smarting Al-, Na-ca 175 Wrse frm Natural Light- Al-, Bry, dig, Dl-s, Dt, Eug.Grp, K-bicra, Lachrymatin Kre, Lyc, Mg-cl, Qu-sa, S-x. (Str-i), Vr-s, Zn. Thus Alumina alne crrespnds t all these symptms and it was fund als t have. Table 3 Page N. Symptms 16 Redness f eyes 47 Difficulty pening if eyelids 24 Ht Lachrymatin He gave a single dse f Alumina CM. in fifteen minutes all the symptms were gne, except a little stiffness. Case 2 On nv. 6 th, three weeks ag when blwing her nse, she felt as if smething brke in the right eye, which watered much. Since then, at times, when blwing the nse, has had a feeling as if a tight skin came halfway dwn ver right eye, preventing the sight f that eye; remved by rubbing. After it has gne feeling as if smething were pricking the eye; eye waters. On the last tw ccasins, this sensatin came n withut blwing the nse Glbal Jurnals

19 Review f Cmplete Repertry t the Hmepathic Materia Medica Diseases f the Eyes, 2 nd Editin, by Dr. E. W. Berridge Selectin f Remedy Page N. 209 Table 3 Rubric By blwing nse. Sight impaired By blwing nse. Pellicle. Medicine K-. K-. As Kali Oxidum (Causticum) was the nly medicine which pssessed these mst characteristic symptms, and, mrever crrespnd t the remaining symptms as a reference t the repertry, S he gave ne dse f Causticum 6 m. (Jenichen). Dec. 11 th Reprts that the symptms ceased at nce and did nt return. VI. Cnclusin Cmplete repertry t the hmepathic materia medica disease f the eye is ne f the useful repertries, in this repertry use perfectly anatmical parts f the eye and a several rubrics are given which help in the selectin f remedy. In this repertry given a large number f medicine fr supprting the practitiner. There are als sme Limitatins: Drugs are less in numbers. Drugs Grading has nt been dne. The abbreviatins are different frm the regular using repertries. References Références Referencias 1. Bger C M. Beninghausen s characteristics materia medica & repertry. Reprint editin New Delhi: Indian bks and peridicals publishers Berridge E. W. Cmplete repertry t the hmepathic materia medica diseases f eye 2nd Reprinted, New Delhi: B. Jain. Publishers. 3. J T. Repertry f the hmepathic material medica Reprint editin. New Delhi: B. Jain publishers (P.) Ltd Knerr C B. The cnversatin talks life & times f Hering. Reprint editin. New Delhi: B. Jain publishers (P.) Ltd Winstn J. The faces f Hmepathy an illustrated histry f the first 200 years. Califrnia: Great Auk publishing. March Year Glbal Jurnal f Medical Research ( F D) Vlume XIX Issue VI Versin I 2019 Glbal Jurnals

20 Review f Cmplete Repertry t the Hmepathic Materia Medica Diseases f the Eyes, 2 nd Editin, by Dr. E. W. Berridge Year Glbal Jurnal f Medical Research ( F D) Vlume XIX Issue VI Versin I This page is intentinally left blank 2019 Glbal Jurnals

21 Glbal Jurnal f Medical Research: F Diseases Vlume 19 Issue 6 Versin 1.0 Year 2019 Type: Duble Blind Peer Reviewed Internatinal Research Jurnal Publisher: Glbal Jurnals Online ISSN: & Print ISSN: Cytgenetic Findings in Children with Pstnatal Grwth Retardatin By Osman Demirhan, Nilgün Tanrıverdi, Ömer Faruk Demirhan & Dilara Süleymanva Çukurva University Abstract- Backgrund and Objective: Chrmsmal abnrmalities (CAs) might adversely affect fetal and pstnatal grwth. The aim f this study was t determine the prevalence and type f CAs in patients with pstnatal grwth retardatin (PGR). Design and Methds: This was the largest study t date in children with PGR in Turkey, and presented the cytgenetic characteristics f 362 patients diagnsed with age range frm 1 mnth t 18 years as having with PGR in a 17 years. The standard prtcl fr peripheral bld lymphcyte culture was fllwed by metaphase chrmsme preparatin and cnventinal analysis f G-banded chrmsmes. Results: The CAs were detected in 8,0% f 362 patients. The median age at diagnsis was 6,3 years in children. The incidence f abnrmal karytype was higher in females than that f males (the female-male rati=2.2). The 5,0% f these CAs were structural aberratins, and als numerical aberratins were 3,0%. Keywrds: pstnatal grwth retardatin; cytgenetic; chrmsmal aberratins. GJMR-F Classificatin: NLMC Cde: WQ 500 CytgeneticFindingsinChildrenwithPstnatalGrwthRetardatin Strictly as per the cmpliance and regulatins f: Osman Demirhan, Nilgün Tanrıverdi, Ömer Faruk Demirhan & Dilara Süleymanva. This is a research/review paper, distributed under the terms f the Creative Cmmns Attributin-Nncmmercial 3.0 Unprted License cmmns.rg/licenses/by-nc/3.0/), permitting all nn-cmmercial use, distributin, and reprductin in any medium, prvided the riginal wrk is prperly cited.

22 Cytgenetic Findings in Children with Pstnatal Grwth Retardatin Osman Demirhan α, Nilgün Tanrıverdi σ, Ömer Faruk Demirhan ρ & Dilara Süleymanva Ѡ Abstract- Backgrund and Objective: Chrmsmal abnrmalities (CAs) might adversely affect fetal and pstnatal grwth. The aim f this study was t determine the prevalence and type f CAs in patients with pstnatal grwth retardatin (PGR). Design and Methds: This was the largest study t date in children with PGR in Turkey, and presented the cytgenetic characteristics f 362 patients diagnsed with age range frm 1 mnth t 18 years as having with PGR in a 17 years. The standard prtcl fr peripheral bld lymphcyte culture was fllwed by metaphase chrmsme preparatin and cnventinal analysis f G-banded chrmsmes. Results: The CAs were detected in 8,0% f 362 patients. The median age at diagnsis was 6,3 years in children. The incidence f abnrmal karytype was higher in females than that f males (the female-male rati=2.2). The 5,0% f these CAs were structural aberratins, and als numerical aberratins were 3,0%. Specifically, translcatins are the mst cmmn karytype (1,4%) amng the patients; Inversins were detected in fur patients (1,1%). Deletins was present in 2 (0,6%) patients. The rati f fragilities and ischrmsmes was 0,8% and 0,6% f all patients, respectively. Amng numerical CAs, 11 patients (3,0%) had aneuplidies. Cnclusin: This study shwed that sme anmalies detected in PGR patients had shwn crrelatins clinical characteristics f the patients. But, sme f them are newly fund and need t be investigated. Turner syndrme with varius frms f chrmsmal cmplement is the mst cmmn chrmsmal abnrmality causing grwth failure in girls: This infrmatin culd cntribute t an understanding f the rle f chrmsmal changes in PGR. Keywrds: pstnatal grwth retardatin; cytgenetic; chrmsmal aberratins. I. Intrductin Grwth retardatin can be defined as the failure f the child t shw grwth apprpriate t his r her age and gender. Fr nrmal grwth, the grwth factrs and genetic structure f the individual must be healthy. Generally, grwth befre birth is clsely related t the envirnment in which the baby lives, that is t say, the mther's health, nutritin, and disease. Pstnatal grwth after intrauterine grwth retardatin (IUGR) depends n the cause f grwth retardatin, Authr α σ ρ Ѡ: Department f Medical Bilgy and Genetics, Faculty f Medicine, Çukurva University, Balcali-Adana/Turkey, Department f Bilgy, Faculty f Science, Hacettepe University, Ankara-Turkey. s: pstnatal nutritinal intake, and scial envirnment. IUGR affects 3-10% f pregnancies; 20% f stillbrn infants have IUGR. Perinatal mrtality rates are 4-8 times higher fr grwth-retarded infants, and mrbidity is present in 50% f surviving infants. There is a strng assciatin between IUGR, CAs, and cngenital malfrmatins. It is thught that an abnrmal fetal karytype is respnsible fr apprximately 20% f all IUGR fetuses, and the percentage is substantially higher if grwth failure is detected befre 26 weeks gestatin (1). Fetuses with chrmsme disrders are frequently grwth restricted (the cmmn trismies f chrmsmes 13, 18 and 21), and subptimal grwth is als reprted fr many autsmal abnrmalities such as duplicatins, deletins and ring chrmsmes. Furthermre triplidy with unbalanced chrmsme translcatins and deletins are als cmmn genetic events (2 4). In a recent study, CAs was fund in 15,0% f the children with pstnatal grwth retardatin (5). The present study was als aimed t detect varius CAs in Turkish ppulatin using cnventinal cytgenetic analysis in children with pstnatal grwth retardatin. II. Materials and Methds We present the cases with pstnatal grwth retardatin, develpmental delay, and ther anmalies with grwth retardatin; unable t walk, t nt speak, unable t sit, incntinence, eating difficulties, handles shrt, epilepsy, mental retardatin, cerebral atrphy, dysmrphism, giter, turners, and amenrrhea. This is a prspective bservatinal study f patients wh were newly diagnsed with PGR and presenting t the Pediatric Clinic, Faculty f Medicine, Çukurva University, The initial diagnsis f PGR as made by the referring clinical pediatric, based n the available clinical details. Turkey. A ttal f 362 patients (183 males and 179 females), with a median age f 6,3 years (range 1 mnthly-18 years), and the sex rati (male/female) 1,02 were referred t ur genetics labratry. Cytgenetic analysis was perfrmed using a cnventinal G banding technique. Cytgenetic analysis f bld samples was perfrmed in the Cytgenetics Labratry, at the Department f Medical Bilgy and Genetics, Faculty f Medicine, Çukurva University. Karytypes were dcumented accrding t the Internatinal System fr Cytgenetic Nmenclature (ISCN) recmmendatins (6). At least 20 metaphases were karytyped. Year Glbal Jurnal f Medical Research ( F D) Vlume XIX Issue VI Versin I 2019 Glbal Jurnals

23 Cytgenetic Findings in Children with Pstnatal Grwth Retardatin Year Glbal Jurnal f Medical Research ( F D) Vlume XIX Issue VI Versin I III. Results Cytgenetics was perfrmed in 362 patients diagnsed with PGR. The male-female rati was 1,02, and the median age at diagnsis was 6,3 years. The incidence f abnrmal karytype was higher in females (n=20, 69,0%) than that f males (n=9, 31,0%) (The female-male rati=2,2). Here we reprt nly n the identified cytgenetic anmalies. Out f 362 patients, 29 (8,0%) were fund t have abnrmal karytype and the rest f 333 (92,0%) were nrmal. The CAs were shwn in Table 1. The structural aberratins (translcatins, deletins, inversins, ischrmsme and fragilities) and numerical aberratins were 5,0% and 3,0%, respectively. Especially, translcatins are the mst cmmn karytype (1,4% and 5 cases) amng the patients, fllwed by t(6;11) (q25;q23); t(16;19) (q24;p11); t(5;12) (q34;p12); t(8;7) and rbt(14;21). The rati f inversins in all CAs was 1,1% (4 cases) [inv(14) (q13;q24); inv(9) (p12;q21); inv(9) (p12;q21); inv(9) (p11;q13)]. The deletins were present in apprximately 0,6% f children [(del(5p13); del(18) (p13)]. Ischrmsmes were present in 2 (0,6%) patients [Xi(Xq); 45, X/46, Xi(Xp)]. The rati f fragilities were 0,8% f all patients [fra (8p23); fra (5q24); fra(13q32)]. Amng numerical CAs, 11 patients (3,0%) had aneuplidies (XX,+21; XY,+21; XX,+21; 46,XX/47, XX+21; +mar; 45,X; 45,X; 45,X; 45,X; 45,X; 45,X/46,XX). (Table 1). Table 1: Characteristics f the patients and the results f karytypes Sex/Age Karytypes N. f cases Frequency in all cases (%) Nrmal Abnrmal 29 8 General Ttal 362 ABNORMALITIES Structural chrmsme abnrmalities Deletins F/1 F/13 46,XX, del(5p13) 46,XX/ del(18)(p13) Ttal 2 0,6 Translcatins F/2 F/6 M/9 F/13 M/15 F/11 M/7 M/13 M/5 F/1 F/18 M/3 M/6 M/13 F/1 M/4 mnthly F/1 mnthly F/5 mnthly F/4 46,XX,t(6;11)(q25;q23) 46,XX,t(16;19)(q24.1;p11) 46,XY,t(5;12)(q34;p12) 46,XX,t(8;7)(?) 45,XY,rbt(14;21) Ttal 5 1,4 Inversins 46,XX,inv(14)(q13;q24) 46,XY,inv(9)(p12;q21) 46,XY,inv(9)(p12;q21) 46,XY,inv(9)(p11;q13) Ttal 4 1,1 ischrmsme 46,Xi(Xq) 45,X/46,Xi(Xp) 2 0,6 Fragilities 46,XY,fra (8p23),(15%) 46,XY,fra (5q24)(20%) 46,XY,fra(13q32)(17%) Ttal 3 0,8 General ttal 18 5,0 Numerical chrmsme abnrmalities 47,XX,+21 47,XY,+21 47,XX,+21 46,XX/47,XX+21 47,XX, +mar 45,X 45,X 45,X 2019 Glbal Jurnals

24 Cytgenetic Findings in Children with Pstnatal Grwth Retardatin IV. F/9 F/14 F/15 F/11 F/7 F/10 45,X 45,X 45,X/46,XX(20%) Ttal 11 3,0 General ttal 11 3,0 Discussin CAs are amng the cmmn factrs that adversely affect bth fetal and pstnatal grwth. A large variety f chrmsmal abnrmalities are assciated with GR. These CAs can affect a variety f autsmes as well as the sex chrmsmes. Sme f the knwn genetic assciatins f intrauterine grwth restrictin are placental genes, maternal and fetal genes. These genes the causes phentypic changes, many f which are imprtant fr grwth and develpment. In a recent study, the ttal incidence f cytgenetic anmalies in patients with grwth retardatin was reprted t be 15,0% (5). In the present study, the ttal frequency f CAs was fund at 8,0%. This rati is imprtant that we fund. These CAs were the structural aberratins (translcatins, deletins, inversins, ischrmsme and fragilities) and numerical aberratins were 5,0% and 3,0%, respectively. A large variety f CAs is assciated with endcrine disrders. These CAs can affect a variety f autsmes as well as the sex chrmsmes. Intrauterine grwth restrictin (IUGR) is defined as fetal grwth less than the nrmal grwth ptential f a specific infant because f genetic r envirnmental factrs. Genetic causes can cntribute t 5-20 % f IUGR, especially fr early-nset grwth-restricted fetuses, and include varius abnrmalities, such as CAs, e.g., trismy 21, 18, 13, and 16 (7,8). A search f the Lndn Dysmrphlgy Database at hgmp.mrc.ac.uk/dhmhd/view.html identifies a series f partial chrmsme deletins r duplicatins that are assciated with shrt stature and pituitary abnrmalities. These include the fllwing deletins: del(4)pter-p16, del(7)q32-qter, del(13)q22-qter, del(14) q22-q23, del(18)p, del(18)q21-qter, del(22)pter-q11 and duplicatins: dup(1)q25-q32, dup(9)p, dup(9)pter-q22 and dup(11)q23-qter. Trismy 16 is knwn t be a lethal chrmsmal abnrmality in the nnmsaic state; hwever, in the presence f placenta msaicism, trismy 16 can result in IUGR. In the present study, we fund a higher rate (5,0%) f structural CAs. These ratis f structural CAs were translcatins (1,4%), inversins (1,1%), fragilities (0.8%), deletins (0,6%) and ischrmsmes (0,6%), respectively. The translcatins in all metaphases were fund in 5 cases (1,4%). These translcatins were fund in specific regins f chrmsmes t(6;11) (q25;q23); t(16;19) (q24.1;p11); t(5;12) (q34;p12); t(8;7) (?); rbt(14;21) (Table 1). Phentype-specific reciprcal translcatins are the mst bilgically and clinically significant karytypic changes in PGR. In the present study, the fur translcatins [t(6;11) (q25;q23); t(16;19) (q24.1;p11); t(5;12) (q34;p12); t(8;7) (?)], we fund are new structural frmatins that are nt fund in ther studies. Therefre, these structural frmatins may be imprtant new findings in the develpment f grwth retardatin. The mst cmmnly reprted manifestatins f 16q deletins are severe grwth and develpmental disrders and anmalies f the cranifacial, visceral, and musculskeletal systems. We fund ne translcatin instead f adeletin at 16q. This translcatin was between t(16;19) (q24.1;p11) chrmsme regins in ne patient. Here, the break in the 16q24.1 regin, the brken part des nt disappear, and adherence t the 19 chrmsmes may shw phentypic effect similar t the 16q deletin. Thus, nly ne f these deletins, 16q22.1; q24.1, (9) encmpasses ur patient s deletin. While nt reprted in patients with an islated 16q deletin. Autsmal abnrmalities, including the deletin f chrmsmes 4 (Wlf-Hirschhrn syndrme), 5 (Cri du chat syndrme), 13, 18, and ring chrmsme structural alteratins, have all been assciated with IUGR (8, 10). Indeed, we detected a patient with a Cri-du-chat syndrme amng ur patients. Hwever, del (18) (p13) was fund in ur patient fr the first time. Indeed, the grwth hrmne deficiency has been described with 18p- and 20p chrmsmal deletins (11,12). Therefre, this deletin may be imprtant new findings in the develpment f grwth retardatin. In the present study, pericentric inversinn the chrmsme 9 and paracentric inversin n the chrmsme 14 were nted in 4 cases [inv(14) (q13;q24); inv(9) (p12;q21); inv(9) (p12;q21); inv(9) (p11;q13)]. Only three cases with pericentric inversin n chrmsme 9 were detected. Althugh this finding is usually cnsidered as a nrmal variatin f chrmsme 9. But, paracentric inversin n chrmsme 14 was fund in ur patient fr the first time. This inversin may be imprtant new findings in the develpment f grwth retardatin. Abnrmalities f sex chrmsmes, including cmplete deletin f X chrmsme resulting in Turner s syndrme (45XO) (TS), extra r missing sex chrmsmes als have been assciated with IUGR. The mst cmmn features f TS are pre- and pstnatal Year Glbal Jurnal f Medical Research ( F D) Vlume XIX Issue VI Versin I 2019 Glbal Jurnals

25 Cytgenetic Findings in Children with Pstnatal Grwth Retardatin Year Glbal Jurnal f Medical Research ( F D) Vlume XIX Issue VI Versin I grwth retardatin and gnadal dysgenesis. Althugh Grwth hrmne (GH) secretin has been reprted t be nrmal r paradxically increased, in mst patients with gnadal dysgenesis, pituitary insufficiency has been reprted in several patients. These abnrmalities in GH secretin in Turner syndrme are prbably secndary t the absence f sex hrmnes during adlescence. Girls with TS have mild grwth impairment at birth, grw slwly during infancy and at the nset f childhd and have delayed nset f secndary sex characteristics as well (13). We fund that 1,7% f cases had abnrmal karytype wh had cytgenetic findings in favr f TS, and ne f these was a msaic frm f TS. In additin t numerical abnrmalities f chrmsme X, tw types f structural abnrmality f chrmsmes including ischrmsme f the lng and shrt arms f the X was fund in tw cases [Xi(Xq) and 45,X/46,Xi(Xp)]. Between numerical chrmsmal abnrmalities, the mst cmmn is Dwn syndrme (DS) which affect nearly 1:600 live brn infants. Delayed develpment and behaviral prblems are ften reprted in children with DS, and in girls with shrt stature and grwth retardatin. Affected individuals' speech and language is develp later, and may be mre difficult t understand. Indeed, we fund 1.1% (4 cases) DS amng ur patients, and ne f these was a msaic frm f DS. We als fund a marker chrmsme in ne f ur patients. We bserved chrmsmal fragilities in 0.8% f the patients, and these was a msaic frm. Identificatin f the basis f instability at FS and the related genes prvides an entree t understanding the imprtant aspects f chrmsmal instability, which may be a effect that PGR cause. Hwever, the FS is a very interesting subject fr the study f clinical disrders, which can lead t the frmatin f deletins and translcatins. At the same time, the characterizatin f FS has demnstrated that they are assciated with genes that relate t tumrigenesis and behaviural disrders (14,15). V. Cnclusin IUGR is an imprtant health prblem f develping cuntries arund the wrld. There are multiple causes fr IUGR including maternal, fetal, placental, and genetic factrs. At the same time, pstnatal grwth als depends n cause f grwth retardatin, pstnatal nutritinal intake, and scial envirnment. There is strng assciatin between IUGR, chrmsme aberratins and cngenital malfrmatins. We shwed that a significant prprtin f pediatric cases especially unexplained grwth retardatin had karytypic abnrmality, these are mst cmmnly translcatins, Turner syndrme and Dwn syndrme, respectively. We recmmend cytgenetic study fr such cases fr early diagnsis and management. It is necessary that children with TS and DS be diagnsed as sn as pssible s they may achieve the maximum benefit f grwth hrmne therapy. References Références Referencias 1. Snijders R J, Sherrd C, Gsden C M, Niclaides K H. Fetal grwth retardatin: assciated malfrmatins and chrmsmal abnrmalities. AmJ Obstet Gynecl 1993; 168: 547e Karl K, Heling K S, Sarut Lpez A, Thiel G, Chaui R. Thymic-thracic rati in fetuses with trismy 21, 18 r 13. Ultrasund Obstetr Gynecl 2012; 40: Kehinde F I, Andersn C E, McGwan J E, Jethva R N, Wahab M A, Glick A R, et al. C-ccurrence f nn-msaic trismy 22 and inherited balanced t(4;6) (q33; q23.3) in a livebrn female: case reprt and review f the literature. Am J Med Genet A 2014; 164: Daniel A, Wu Z, Bennetts B, Slater H, Osbrn R, Jacksn J, et al. Karytype, phentype and parental rigin in 19 cases f triplidy. Prenatal Diagn 2001; 21: Safaei A, Farzaneh M R, Nri S. Cytgenetic Analysis f Referral Cases with Grwth Failure and Clinical Suspicin f having Chrmsmal Abnrmality. Iranian Jurnal f Pathlgy (2013) 8 (2), Shaffer L G, Slvak M L, Campbell L J. ISCN 2009: An Internatinal System fr Human Cytgenetic Nmenclature. Karger, Basel Baschat A A, Galan H L, Gabbe S G. Intrauterine grwth restrictin. In: Gabbe S G, Neibyl J R, Simpsn J L, editrs. Obstetrics nrmal and prblem pregnancies. Philadelphia: Elsevier; p Excellent in-depth review f pathphysilgy, risk factrs and evaluatin f IUGR. 8. Hendrix N, Berghella V. Nn-placental causes f intrauterine grwth restrictin. Semin Perinatl. 2008; 32(3): Callen D F, Eyre H, Lane S, Shen Y, Hansmann I, Spinner N, Zackai E, McDnald-McGinn D, Schuffenhauer S, Wauters J, Van Thienen M N, Van Ry V, Sutherland G R, Haan E A (1993): High reslutin mapping f interstitial lng arm deletins f chrmsme 16: Relatinship t phentype. J Med Genet 30: Lin C C, Santlaya-Frgas J. Current cncepts f fetal grwth restrictin: part I. Causes, classificatin, and pathphysilgy. Obstet Gynecl. 1998; 92(6): Leisti J, Leiti S, Perheentupa J, et al, Absence f IgA and grwth hrmne deficiency assciated with shrt arm deletin f chrmsme 18. Arch Dis Child 1973; 48: Glbal Jurnals

26 Cytgenetic Findings in Children with Pstnatal Grwth Retardatin 12. Shhat M, Hermn V, Melmed S, et al. Deletin f 20p > pter with grwth hrmne neursecretry disrder but nrmal grwth hrmne releasing hrmne genes. Am J Med Genet Davenprt M L, Punyasavatsut N, Gunther D, Savendahl L, Stewart P W. Turner syndrme: apattern f early grwth failure. Acta Paediatr Suppl 1999; 88(433): J. Fan, M. Otterlei, H. K. Wng, A. E. Tmkinsn, D.M. Wilsn, XRCC1 c-lcalizes and physically interacts with PCNA, Nucleic Acids Res. 32 (2004) DOI: /nar/gkh G. S. Gericke, Chrmsmal fragility may be indicative f altered higher-rder DNA rganizatin as the underlying genetic diathesis in cmplex neurbehaviral disrders. Medical Hyptheses. 50(1998) PMID: Year Glbal Jurnal f Medical Research ( F D) Vlume XIX Issue VI Versin I 2019 Glbal Jurnals

27 Cytgenetic Findings in Children with Pstnatal Grwth Retardatin Year Glbal Jurnal f Medical Research ( F D) Vlume XIX Issue VI Versin I This page is intentinally left blank 2019 Glbal Jurnals

28 Glbal Jurnal f Medical Research: F Diseases Vlume 19 Issue 6 Versin 1.0 Year 2019 Type: Duble Blind Peer Reviewed Internatinal Research Jurnal Publisher: Glbal Jurnals Online ISSN: & Print ISSN: Prstate-Specific Antigen Levels f Prstate Cancer Patients Three Mnths Fllwing LHRH Agnist Therapy By Rbertus Bebet Prasety & Andy Universitas Indnesia Abstract- Backgrund: Luteinizing hrmne-releasing hrmne (LHRH) agnist therapy is an andrgen suppressin therapy aimed t treat prstate cancer by means chemical castratin. Despite being frequently used in clinical setting, there is n prir study examining the f LHRH agnist drugs in Indnesia. This study aims t assess the efficacy f LHRH agnists in prstate cancer patients, measured by the reductin f serum prstate specific antigen (PSA) three mnths fllwing treatment. Methds: The study used retrspective bservatinal chrt design upn medical recrd f 83 prstate cancer patients in GattSebrt Army Hspital, Jakarta, Indnesia. We analyzed the recrded patients age, TNM staging, histlgic grading, LHRH agnists used in therapy, alng with the average baseline PSA level prir and three mnths fllwing treatment. Paired T-test, Wilcxn, ANOVA, and Kruskal-Wallis Test were used where apprpriate. Keywrds: LHRH agnist, prstate cancer, prstate-specific antigen, drug efficacy. GJMR-F Classificatin: NLMC Cde: WJ 752, QZ 20.5 Prstate-SpecificAntigenLevelsfPrstateCancerPatientsThreeMnthsFllwingLHRHAgnistTherapy Strictly as per the cmpliance and regulatins f: Rbertus Bebet Prasety & Andy. This is a research/review paper, distributed under the terms f the Creative Cmmns Attributin-Nncmmercial 3.0 Unprted License permitting all nn-cmmercial use, distributin, and reprductin in any medium, prvided the riginal wrk is prperly cited.

29 Prstate-Specific Antigen Levels f Prstate Cancer Patients Three Mnths Fllwing LHRH Agnist Therapy Rbertus Bebet Prasety α & Andy σ Abstract- Backgrund: Luteinizing hrmne-releasing hrmne (LHRH) agnist therapy is an andrgen suppressin therapy aimed t treat prstate cancer by means chemical castratin. Despite being frequently used in clinical setting, there is n prir study examining the f LHRH agnist drugs in Indnesia. This study aims t assess the efficacy f LHRH agnists in prstate cancer patients, measured by the reductin f serum prstate specific antigen (PSA) three mnths fllwing treatment. Methds: The study used retrspective bservatinal chrt design upn medical recrd f 83 prstate cancer patients in GattSebrt Army Hspital, Jakarta, Indnesia. We analyzed the recrded patients age, TNM staging, histlgic grading, LHRH agnists used in therapy, alng with the average baseline PSA level prir and three mnths fllwing treatment. Paired T-test, Wilcxn, ANOVA, and Kruskal-Wallis Test were used where apprpriate. Results: We fund significant change in PSA levels befre and three-mnths fllwing the use f LHRH agnists(p < 0.001), with the median decreasing frm (4.24-7,445.00) t 7.08 ( ). Significant assciatin was als fund between PSA level prir t treatment and the prstate cancer grups accrding t stages (p < 0.001), histlgical grades (p = 0.020), and medicatins used (p = 0.010). Hwever, this study fund n significance f these grups in the PSA level reductin three mnths after therapy. Cnclusin: LHRH agnists were significant in reducing PSA level in any prir prstate cancer staging, histlgical grading, and medicatin type. Keywrds: LHRH agnist, prstate cancer, prstatespecific antigen, drug efficacy. I. Intrductin Prstate cancer is ne f the mst frequentlyccurring type f cancer, reprted in a study frm 2003 as the sixth mst cmmn cancer in the wrld and the third mst cmmn cancer amng men. 1 There are 513,000 new cases f prstate cancer was reprted glbally in the A data frm United States in 2011 shws that this disease was diagnsed in 240 thusand men and was the cause f 33 thusand deaths. 1,3 As prstate cancer s prgressin have lng since been fund t be dependent n hrmnes, Authr α: Urlgy Divisin, Department f Surgery, GattSebrt Army Hspital, Jakarta, Indnesia. Authr σ: Urlgy Department, Faculty f Medicine Universitas Indnesia, Cipt Mangunkusum Hspital, Jakarta, Indnesia. andrgen suppressin therapy (AST) is incrprated int the standard treatment f prstate cancer. 4 Histrically, AST was cmmnly accmplished by means f surgical prcedure r estrgen therapy. Advance in AST allws pharmaclgic castratin using luteinizing hrmne-releasing hrmne (LHRH) agnist drugs as they ffer wider use. LHRH agnists therapy was fund t lwer the number the hspital visits required, medical bill fr the treatment, alng with mental and physical burden that may ccur frm the drug injectin. 5 Althugh current studies shw that the tw mst cmmn LHRH agnist used in medical setting, Leuprrelin and Gserelin, have relatively equal efficacy, Leuprrelin are cmparably mre expensive than the latter. Althugh LHRH agnists are cmmnly used in the treatment regime f prstate cancer, there has yet been any study regarding the drug s influence n lwering the level f prstate-specific antigen (PSA), a prstate cancer bimarker, in Indnesia. Thus, this study aims t assess the efficacy f LHRH agnists in treating prstate cancer patients thrugh analyzing the change f PSA levels three mnths fllwing the therapy. II. Methds This is an bservatinal study using retrspective chrt design that was cnducted in the Urlgy Plyclinic f GattSebrt Army Hspital, Jakarta, frm January f 2014 t Octber f The study subjects were 127 male patients lder than 40 years f age wh were previusly diagnsed with prstate cancer and treated with LHRH agnists within the perid f research. Patients that had nt underg labratry testing fr PSA prir t the treatment, develped a castrate-resistant prstate cancer, r failed t attend the fllw-up care in plyclinic within three mnths are excluded frm the study. The subjects were sampled cnsecutively, in which patients were selected in rder f utpatient scheduling until the apprpriate sample size was reached. Data were cllected frm the subjects medical recrd. Of the extracted data were the patient s age, cancer staging accrding t Eurpean Sciety fr Medical Onclgy (ESMO) classificatin, histlgical grading, treatment received, alng with PSA levels Year Glbal Jurnal f Medical Research ( F D) Vlume XIX Issue VI Versin I 2019 Glbal Jurnals

30 Prstate-Specific Antigen Levels f Prstate Cancer Patients Three Mnths Fllwing LHRH Agnist Therapy Year Glbal Jurnal f Medical Research ( F D) Vlume XIX Issue VI Versin I befre and after treatment. Infrmatin regarding the treatment cllected fr in this study were the LHRH medicatin type used and ther therapies dne fr the patient. All data were analyzed using SPSS versin 23. Descriptive statistics were used t summarize the demgraphic characteristics f subjects accrding t age, TNM stage, and histlgic grade. This statistics were als used t describe the usage f LHRH agnists alng with average baseline and pst-therapy PSA levels. Statistical analysis was used t bserve the changes f PSA level three mnths fllwing therapy. Paired-T test analysis was cnducted with dispersed data, whereas Wilcxn test was dne fr under dispersed data. Anther statistical analysis used in this study is ANOVA and Kruskal Wallis, fr dispersed and under dispersed data respectively, t bserve the difference f PSA-lwering efficacy in different medicatin types, cancer stages, and histlgic grades. III. Results Frm January f 2014 t Octber f 2018, there were 83 prstate cancer patients that underwent LHRH Stage T1-T2a, N0M0 IIA IIC IIIA IIIC T2bN0M0 IIA IIIA IIIC T2c-T4 rn1 rm1 IVA IVB Histlgic grading LHRH Medicatin Gserelin Leuprrelin Gserelin and Leuprrelin Table 1: Patients Characteristic agnist therapy with the median age f 70 years. The yungest f the subjects was 51 years ld, whereas the ldest was 80 years ld. The median f baseline PSA level was 5.40 ng/ml, with maximum and minimum value 4.24 and 7, ng/ml, respectively. The demgraphic characteristic f this study is further described in Table 1. Wilcxn analysis shws significant difference between circulating PSA level befre and three mnths fllwing prstate cancer treatment with LHRH agnists (p < 0.001), with median value f decrease frm (4.24-7,445.00) t 7.08 ( ). Significant difference was als fund using Kruskal-Wallis analysis upn baseline PSA levels between prstate cancer stages, histlgic grades, and LHRH medicatin used (stage, p < 0.001; histlgic grade, p = 0.020; LHRH medicatin, p = 0.009). Hwever, there were n significant distinctin f PSA levels three mnths fllwing therapy between there grups. (stage, p = 0.135; histlgic grade, p = 0.067; LHRH medicatin, p = 0.139) (Table 2) Ttal (n = 83) Precentage (%) Table 2: Changes in PSA levels accrding t cancer stage, histlgic grade, and LHRH medicatin used in treatment Stage T1-T2a, N0M0 T2bN0M0 T2c-T4 r N1 r M1 PSA prir t treatment ( ) ( ) (4.70-7,445.00) P-value < PSA 3 mnths fllwing treatment 6.70 ( ) 0.30 ( ) ( ) 2019 Glbal Jurnals

31 Prstate-Specific Antigen Levels f Prstate Cancer Patients Three Mnths Fllwing LHRH Agnist Therapy IV. Histlgic grade ( ) ( ) (7.89-7,445.00) ( ) ( ) 3.30 ( ) 9.65 ( ) 3.30 ( ) 6.20 ( ) ( ) P-value LHRH Medicatin Gserelin Leuprrelin Bth ( ) (9.40-7,445.00) ( ) ( ) 6.20 ( ) ( ) P-value Discussin In this study, there were 83 ut f 172 prstate cancer patients administered with LHRH agnists as andrgen suppressin therapy. The median age f the subjects was 70 years, ranging frm 51 t 80 years. These result are supprted by a study cnducted in 2013 t 2015 in Prf. Dr. R. D. Kandu Central General Hspital in Manad, where it was fund the age prfile f prstate cancer patients ranges frm 51 t 90 years, with years as the largest age grup. 6 A majrity f the patients that received LHRH agnists were als fund with high-risk prstate cancer, with 63.9% in the staging f T2c-T4 r N1 r M1 (61.4% in the IVB prgnstic grup) and 33.7% with the histlgic grade f 5. The 2016 glbal treatment pattern f prstate cancer have shwn andrgen-suppressin therapy as the treatment f chice f men with late stage prstate cancer. This treatment was chsen with the patient s disease status as the primary driver in 29% f the cases, while patient s age was deemed the mst imprtant factr in nly 7% f the case. 7 This pattern supprts the findings f this study, as the majr age grup f patients sampled resembles the general age prfile f prstate cancer patients, while in cntrast, the majrity were in pathlgically advanced stage f disease. Andrgen suppressin therapy are indicated after the failure f definitive therapy and lcal salvage, thus mst patients received the treatment at a later prgressin. 8 LHRH agnist therapy were efficacius in suppressing PSA level during three-mnth fllw-up. Current evidence have shwn that LHRH mntherapyis an equal alternative f surgical castratin in terms f efficacy and adverse effects. Hwever, patients usually experience a transient flare-up f prstate cancer and PSA level. In thery, LHRH agnists act by mdulating the actin f hypthalamus and vertaking the cntrl impsed by gnadtrpin-releasing hrmne (GnRH). Initially, the secretin f luteinizing hrmne (LH), fllicle stimulating hrmne (FSH), and teststerne will surge, leading t transient surge f PSA. Then, after 2-4 weeks f treatment, this drug will inhibit the expressin f LHRH in pituitary cells, thus restricting the secretin f gnadal sterids by desensitizatin. The inhibitin f sex sterid secretin will interfere with tumr s mitgenic stimuli, eventually leading t the decline f circulating PSA The median value f PSA 3 mnths after LHRH agnists treatment fund in this study was 7,08 (0,01-942,00). Similarly, Ishizuka shwed that bth 1-mnth and 3-mnths dept f LHRH agnist drugs caused a drp f PSA levels frm baseline since 4-weeks after treatment, and gradually decreased until mst f the samples reached <4.0 ng/ml f PSA after week PSA and its derivatives are well knwn as an indicatr f prstate cancer prgressin fr the use f screening and pst-therapy bservatin Prir t LHRH agnists therapy, PSA levels between prstate cancer stages in this study were largely variable. Hwever, 3-mnths after therapy, n significance difference was fund. The same phenmenn was bserved with PSA levels between histlgic grades prir and after therapy. This can be attributed t the initial PSA levels befre therapy, as Chueiri als bserved invariable PSA levels after reaching nadir with the time f 6 mnths. His study als reprted that prstate cancer patients with higher PSA levels (median f 146) wh received AST have significantly faster rate f PSA decline (>52 ng/ml/year) and higher PSA nadir. Crucially, fasted PSA decline rate are assciated with higher mrtality. 13 Anther study has reprted that PSA level can predict the utcme f prstate cancer LHRH medicatin, as a level belw 0,3 ng/ml shwn better respnse tward LHRH agnist therapy. 14 Neither Gserelin, Leuprrelin, r the use f bth drugs have any significance twards the utcme f LHRH therapy, as the PSA levels 3 mnths fllwing the treatment was insignificant. This finding is supprted by ther studies that als fund n difference between LHRH medicatin types and the respnse f AST The limitatins f this study are due t the nature f the data cllected, as the accuracy depends n crrect dcumentatin in the medical recrds. Als, andrgen suppressin therapy is given fr patients in late stage r failed definitive therapy. Thus, each patients have a unique clinical scenari and treatment plan prir t study. These variables, cupled with small samples, might interfere with ur result. Hwever, PSA Year Glbal Jurnal f Medical Research ( F D) Vlume XIX Issue VI Versin I 2019 Glbal Jurnals

32 Prstate-Specific Antigen Levels f Prstate Cancer Patients Three Mnths Fllwing LHRH Agnist Therapy Year Glbal Jurnal f Medical Research ( F D) Vlume XIX Issue VI Versin I level is reduce significantly in any prstate cancer patients fllwing 3 mnths f LHRH agnist therapy. V. Cnclusin This study shws that within three mnths fllwing therapy, LHRH agnists were significant in reducing PSA level in any prir cancer status (stage, histlgic grade, and medicatin). Hwever, neither cancer stage, histlgy grade, nr medicatin type were significantly assciated with the decline f PSA level prir and after therapy. Due t the limitatin f the retrspective nature used in this study, the authr recmmends further research f LHRH agnists and ther yet-t-be apprved AST drugs in Indnesia, such as GnRH antagnist, using larger and better-cntrlled chrt. Cnflict f interest There are n cnflicts f interest Funding disclsure There is n financial disclsure. Funding/Supprt: Nne. References Références Referencias 1. Brawley O W. Prstate cancer epidemilgy in the United States. Wrld J Url Apr 1; 30(2): Parkin D M, Whelan S, Ferlay J, RTepp L, Thmas D. Cancer incidence in five cntinents(vlume VIII). IARC Sci Publ. 2002; (155): Siegel R, Ward E, Brawley O, Jemal A. Cancer statistics, 2011: the impact f eliminating sciecnmic and racial disparities n premature cancer deaths. CA Cancer J Clin. 2011; 61(4): Huggins C, Hdges C V. Studies n Prstatic Cancer. I. The Effect f Castratin, f Estrgen and f Andrgen Injectin n Serum Phsphatases in Metastatic Carcinma f the Prstate. Cancer Res Apr 1; 1(4): Ishizuka O, Nishizawa O, Nishizawa S, Sath T, Wajiki M, Kiykawa H, et al. Cmparisn f efficacy and safety f 1- and 3-mnth luteinizing hrmnereleasing hrmne agnist depts as initial therapies fr prstate cancer. Int J Clin Oncl. 2013; 18(3): Slang V R, Mnarfa A, Tjandra F. Prfil penderita kanker prstat di RSOP Prf. Dr. R. D. Kandu Manad peride tahun ECL. 2016; 4(2): Clarke N W, De Santis M, Cstell A J, Chang Y-H, Pickles T, Pmpe A C, et al. Glbal treatment patterns fr late-stage prstate cancer: Updated results frm ASPIRE-PCa. Ann Oncl. 2016; 27(6): Hellerstedt B A, Pienta K J. The Current State f Hrmnal Therapy fr Prstate Cancer. CA Cancer J Clin. 2009; 52(3): Limnta P, Marelli M M, Mretti R M. LHRH analgues as anticancer agents: pituitary and extrapituitary sites f actin. Expert Opin Investig Drugs Apr; 10(4): Van Pppel H, Kltz L. Gnadtrpin-releasing hrmne: An update review f the antagnists versus agnists. Int J Url Jul 1; 19(7): O Brien M F, Crnin A M, Fearn P A, Smith B, Stasi J, Guillnneau B, et al. Pretreatment prstatespecific antigen (PSA) velcity and dubling time are assciated with utcme but neither imprves predictin f utcme beynd pretreatment PSA alne in patients treated with radical prstatectmy. J Clin Oncl Off J Am Sc Clin Oncl Aug 1; 27(22): Palma D, Tyldesley S, Bld P, Liu M, Mrris J, Pickles T, et al. Pretreatment PSA velcity as a predictr f disease utcme fllwing radical radiatin therapy. Int J Radiat Oncl Bil Phys Apr 1; 67(5): Chueiri T K, Xie W, D'Amic A V, Rss R W, Hu J C, Pmerantz M, et al. Time t prstate-specific antigen nadir independently predicts verall survival in patients wh have metastatic hrmne-sensitive prstate cancer treated with andrgen-deprivatin therapy. Cancer. 2009; 115: Cury F L, Hunt D, Rach M, Shipley W, Gre E, Hsu I-C, et al. Prstate-specific antigen respnse after shrt-term hrmne therapy plus external-beam raditherapy and utcme in patients treated n Radiatin Therapy Onclgy Grup study Cancer Jun 1; 119(11): Silva É D, Ferreira U, Matheus W, Faria E F, Silva GD, Sait M, et al. Gserelin versus leuprlide in the chemical castratin f patients with prstate cancer. Int Url Nephrl Aug 1; 44(4): Fujii Y, Ynese J, Kawakami S, Yamamt S, Okub Y, Fukui I. Equivalent and sufficient effects f leuprlide acetate and gserelin acetate t suppress serum teststerne levels in patients with prstate cancer. BJU Int May 1; 101(9): Glbal Jurnals

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37 We shall prvide yu intimatin regarding launching f e-versin f jurnal f yur stream time t time.this may be utilized in yur library fr the enrichment f knwledge f yur students as well as it can als be helpful fr the cncerned faculty members. The MARSM member can apply fr apprval, grading and certificatin f standards f their educatinal and Institutinal Degrees t Open Assciatin f Research, Sciety U.S.A. Once yu are designated as MARSM, yu may send us a scanned cpy f all f yur credentials. OARS will verify, grade and certify them. This will be based n yur academic recrds, quality f research papers published by yu, and sme mre criteria. It is mandatry t read all terms and cnditins carefully. Cpyright by Glbal Jurnals Guidelines Handbk IV

38 Auxiliary Memberships Institutinal Fellw f Open Assciatin f Research Sciety (USA)- OARS (USA) Glbal Jurnals Incrpratin (USA) is accredited by Open Assciatin f Research Sciety, U.S.A (OARS) and in turn, affiliates research institutins as Institutinal Fellw f Open Assciatin f Research Sciety (IFOARS). The FARSC is a dignified title which is accrded t a persn s name viz. Dr. Jhn E. Hall, Ph.D., FARSC r William Walldrff, M.S., FARSC. The IFOARS institutin is entitled t frm a Bard cmprised f ne Chairpersn and three t five bard members preferably frm different streams. The Bard will be recgnized as Institutinal Bard f Open Assciatin f Research Sciety -(IBOARS). The Institute will be entitled t fllwing benefits: The IBOARS can initially review research papers f their institute and recmmend them t publish with respective jurnal f Glbal Jurnals. It can als review the papers f ther institutins after btaining ur cnsent. The secnd review will be dne by peer reviewer f Glbal Jurnals Incrpratin (USA) The Bard is at liberty t appint a peer reviewer with the apprval f chairpersn after cnsulting us. The authr fees f such paper may be waived ff up t 40%. The Glbal Jurnals Incrpratin (USA) at its discretin can als refer duble blind peer reviewed paper at their end t the bard fr the verificatin and t get recmmendatin fr final stage f acceptance f publicatin. The IBOARS can rganize sympsium/seminar/cnference in their cuntry n behalf f Glbal Jurnals Incrpratin (USA)-OARS (USA). The terms and cnditins can be discussed separately. The Bard can als play vital rle by explring and giving valuable suggestins regarding the Standards f Open Assciatin f Research Sciety, U.S.A (OARS) s that prper amendment can take place fr the benefit f entire research cmmunity. We shall prvide details f particular standard nly n receipt f request frm the Bard. The bard members can als jin us as Individual Fellw with 40% discunt n ttal fees applicable t Individual Fellw. They will be entitled t avail all the benefits as declared. Please visit Individual Fellw-sub menu f GlbalJurnals.rg t have mre relevant details. V Cpyright by Glbal Jurnals Guidelines Handbk

39 We shall prvide yu intimatin regarding launching f e-versin f jurnal f yur stream time t time. This may be utilized in yur library fr the enrichment f knwledge f yur students as well as it can als be helpful fr the cncerned faculty members. After nminatin f yur institutin as Institutinal Fellw and cnstantly functining successfully fr ne year, we can cnsider giving recgnitin t yur institute t functin as Reginal/Znal ffice n ur behalf. The bard can als take up the additinal allied activities fr betterment after ur cnsultatin. The fllwing entitlements are applicable t individual Fellws: Open Assciatin f Research Sciety, U.S.A (OARS) By-laws states that an individual Fellw may use the designatins as applicable, r the crrespnding initials. The Credentials f individual Fellw and Assciate designatins signify that the individual has gained knwledge f the fundamental cncepts. One is magnanimus and prficient in an expertise curse cvering the prfessinal cde f cnduct, and fllws recgnized standards f practice. Open Assciatin f Research Sciety (US)/ Glbal Jurnals Incrpratin (USA), as described in Crprate Statements, are educatinal, research publishing and prfessinal membership rganizatins. Achieving ur individual Fellw r Assciate status is based mainly n meeting stated educatinal research requirements. Disbursement f 40% Ryalty earned thrugh Glbal Jurnals : Researcher = 50%, Peer Reviewer = 37.50%, Institutin = 12.50% E.g. Out f 40%, the 20% benefit shuld be passed n t researcher, 15 % benefit twards remuneratin shuld be given t a reviewer and remaining 5% is t be retained by the institutin. We shall prvide print versin f 12 issues f any three jurnals [as per yur requirement] ut f ur 38 jurnals wrth $ 2376 USD. Other: The individual Fellw and Assciate designatins accredited by Open Assciatin f Research Sciety (US) credentials signify guarantees fllwing achievements: The prfessinal accredited with Fellw hnr, is entitled t varius benefits viz. name, fame, hnr, regular flw f incme, secured bright future, scial status etc. Cpyright by Glbal Jurnals Guidelines Handbk VI

40 In additin t abve, if ne is single authr, then entitled t 40% discunt n publishing research paper and can get 10%discunt if ne is c-authr r main authr amng grup f authrs. The Fellw can rganize sympsium/seminar/cnference n behalf f Glbal Jurnals Incrpratin (USA) and he/she can als attend the same rganized by ther institutes n behalf f Glbal Jurnals. The Fellw can becme member f Editrial Bard Member after cmpleting 3yrs. The Fellw can earn 60% f sales prceeds frm the sale f reference/review bks/literature/publishing f research paper. Fellw can als jin as paid peer reviewer and earn 15% remuneratin f authr charges and can als get an pprtunity t jin as member f the Editrial Bard f Glbal Jurnals Incrpratin (USA) This individual has learned the basic methds f applying thse cncepts and techniques t cmmn challenging situatins. This individual has further demnstrated an in depth understanding f the applicatin f suitable techniques t a particular area f research practice. Nte : In future, if the bard feels the necessity t change any bard member, the same can be dne with the cnsent f the chairpersn alng with anyne bard member withut ur apprval. In case, the chairpersn needs t be replaced then cnsent f 2/3rd bard members are required and they are als required t jintly pass the reslutin cpy f which shuld be sent t us. In such case, it will be cmpulsry t btain ur apprval befre replacement. In case f Difference f Opinin [if any] amng the Bard members, ur decisin will be final and binding t everyne. VII Cpyright by Glbal Jurnals Guidelines Handbk

41 Preferred Authr Guidelines We accept the manuscript submissins in any standard (generic) frmat. We typeset manuscripts using advanced typesetting tls like Adbe In Design, CrelDraw, TeXnicCenter, and TeXStudi. We usually recmmend authrs submit their research using any standard frmat they are cmfrtable with, and let Glbal Jurnals d the rest. Alternatively, yu can dwnlad ur basic template frm Authrs shuld submit their cmplete paper/article, including text illustratins, graphics, cnclusins, artwrk, and tables. Authrs wh are nt able t submit manuscript using the frm abve can the manuscript department at r get in tuch with if they wish t send the abstract befre submissin. Befre and during Submissin Authrs must ensure the infrmatin prvided during the submissin f a paper is authentic. Please g thrugh the fllwing checklist befre submitting: 1. Authrs must g thrugh the cmplete authr guideline and understand and agree t Glbal Jurnals' ethics and cde f cnduct, alng with authr respnsibilities. 2. Authrs must accept the privacy plicy, terms, and cnditins f Glbal Jurnals. 3. Ensure crrespnding authr s address and pstal address are accurate and reachable. 4. Manuscript t be submitted must include keywrds, an abstract, a paper title, c-authr(s') names and details ( address, name, phne number, and institutin), figures and illustratins in vectr frmat including apprpriate captins, tables, including titles and ftntes, a cnclusin, results, acknwledgments and references. 5. Authrs shuld submit paper in a ZIP archive if any supplementary files are required alng with the paper. 6. Prper permissins must be acquired fr the use f any cpyrighted material. 7. Manuscript submitted must nt have been submitted r published elsewhere and all authrs must be aware f the submissin. Declaratin f Cnflicts f Interest It is required fr authrs t declare all financial, institutinal, and persnal relatinships with ther individuals and rganizatins that culd influence (bias) their research. Plicy n Plagiarism Plagiarism is nt acceptable in Glbal Jurnals submissins at all. Plagiarized cntent will nt be cnsidered fr publicatin. We reserve the right t infrm authrs institutins abut plagiarism detected either befre r after publicatin. If plagiarism is identified, we will fllw COPE guidelines: Authrs are slely respnsible fr all the plagiarism that is fund. The authr must nt fabricate, falsify r plagiarize existing research data. The fllwing, if cpied, will be cnsidered plagiarism: Wrds (language) Ideas Findings Writings Diagrams Graphs Illustratins Lectures Cpyright by Glbal Jurnals Guidelines Handbk VIII

42 Printed material Graphic representatins Cmputer prgrams Electrnic material Any ther riginal wrk Authrship Plicies Glbal Jurnals fllws the definitin f authrship set up by the Open Assciatin f Research Sciety, USA. Accrding t its guidelines, authrship criteria must be based n: 1. Substantial cntributins t the cnceptin and acquisitin f data, analysis, and interpretatin f findings. 2. Drafting the paper and revising it critically regarding imprtant academic cntent. 3. Final apprval f the versin f the paper t be published. Changes in Authrship The crrespnding authr shuld mentin the name and cmplete details f all c-authrs during submissin and in manuscript. We supprt additin, rearrangement, manipulatin, and deletins in authrs list till the early view publicatin f the jurnal. We expect that crrespnding authr will ntify all c-authrs f submissin. We fllw COPE guidelines fr changes in authrship. Cpyright During submissin f the manuscript, the authr is cnfirming an exclusive license agreement with Glbal Jurnals which gives Glbal Jurnals the authrity t reprduce, reuse, and republish authrs' research. We als believe in flexible cpyright terms where cpyright may remain with authrs/emplyers/institutins as well. Cntact yur editr after acceptance t chse yur cpyright plicy. Yu may fllw this frm fr cpyright transfers. Appealing Decisins Unless specified in the ntificatin, the Editrial Bard s decisin n publicatin f the paper is final and cannt be appealed befre making the majr change in the manuscript. Acknwledgments Cntributrs t the research ther than authrs credited shuld be mentined in Acknwledgments. The surce f funding fr the research can be included. Suppliers f resurces may be mentined alng with their addresses. Declaratin f funding surces Glbal Jurnals is in partnership with varius universities, labratries, and ther institutins wrldwide in the research dmain. Authrs are requested t disclse their surce f funding during every stage f their research, such as making analysis, perfrming labratry peratins, cmputing data, and using institutinal resurces, frm writing an article t its submissin. This will als help authrs t get reimbursements by requesting an pen access publicatin letter frm Glbal Jurnals and submitting t the respective funding surce. Preparing yur Manuscript Authrs can submit papers and articles in an acceptable file frmat: MS Wrd (dc, dcx), LaTeX (.tex,.zip r.rar including all f yur files), Adbe PDF (.pdf), rich text frmat (.rtf), simple text dcument (.txt), Open Dcument Text (.dt), and Apple Pages (.pages). Our prfessinal layut editrs will frmat the entire paper accrding t ur fficial guidelines. This is ne f the highlights f publishing with Glbal Jurnals authrs shuld nt be cncerned abut the frmatting f their paper. Glbal Jurnals accepts articles and manuscripts in every majr language, be it Spanish, Chinese, Japanese, Prtuguese, Russian, French, German, Dutch, Italian, Greek, r any ther natinal language, but the title, subtitle, and abstract shuld be in English. This will facilitate indexing and the pre-peer review prcess. The fllwing is the fficial style and template develped fr publicatin f a research paper. Authrs are nt required t fllw this style during the submissin f the paper. It is just fr reference purpses. IX Cpyright by Glbal Jurnals Guidelines Handbk

43 Manuscript Style Instructin (Optinal) Micrsft Wrd Dcument Setting Instructins. Fnt type f all text shuld be Swis721 Lt BT. Page size: 8.27" x 11', left margin: 0.65, right margin: 0.65, bttm margin: Paper title shuld be in ne clumn f fnt size 24. Authr name in fnt size f 11 in ne clumn. Abstract: fnt size 9 with the wrd Abstract in bld italics. Main text: fnt size 10 with tw justified clumns. Tw clumns with equal clumn width f 3.38 and spacing f 0.2. First character must be three lines drp-capped. The paragraph befre spacing f 1 pt and after f 0 pt. Line spacing f 1 pt. Large images must be in ne clumn. The names f first main headings (Heading 1) must be in Rman fnt, capital letters, and fnt size f 10. The names f secnd main headings (Heading 2) must nt include numbers and must be in italics with a fnt size f 10. Structure and Frmat f Manuscript The recmmended size f an riginal research paper is under 15,000 wrds and review papers under 7,000 wrds. Research articles shuld be less than 10,000 wrds. Research papers are usually lnger than review papers. Review papers are reprts f significant research (typically less than 7,000 wrds, including tables, figures, and references) A research paper must include: a) A title which shuld be relevant t the theme f the paper. b) A summary, knwn as an abstract (less than 150 wrds), cntaining the majr results and cnclusins. c) Up t 10 keywrds that precisely identify the paper s subject, purpse, and fcus. d) An intrductin, giving fundamental backgrund bjectives. e) Resurces and techniques with sufficient cmplete experimental details (wherever pssible by reference) t permit repetitin, surces f infrmatin must be given, and numerical methds must be specified by reference. f) Results which shuld be presented cncisely by well-designed tables and figures. g) Suitable statistical data shuld als be given. h) All data must have been gathered with attentin t numerical detail in the planning stage. Design has been recgnized t be essential t experiments fr a cnsiderable time, and the editr has decided that any paper that appears nt t have adequate numerical treatments f the data will be returned unrefereed. i) Discussin shuld cver implicatins and cnsequences and nt just recapitulate the results; cnclusins shuld als be summarized. j) There shuld be brief acknwledgments. k) There ught t be references in the cnventinal frmat. Glbal Jurnals recmmends APA frmat. Authrs shuld carefully cnsider the preparatin f papers t ensure that they cmmunicate effectively. Papers are much mre likely t be accepted if they are carefully designed and laid ut, cntain few r n errrs, are summarizing, and fllw instructins. They will als be published with much fewer delays than thse that require much technical and editrial crrectin. The Editrial Bard reserves the right t make literary crrectins and suggestins t imprve brevity. Cpyright by Glbal Jurnals Guidelines Handbk X

44 Frmat Structure It is necessary that authrs take care in submitting a manuscript that is written in simple language and adheres t published guidelines. All manuscripts submitted t Glbal Jurnals shuld include: Title The title page must carry an infrmative title that reflects the cntent, a running title (less than 45 characters tgether with spaces), names f the authrs and c-authrs, and the place(s) where the wrk was carried ut. Authr details The full pstal address f any related authr(s) must be specified. Abstract The abstract is the fundatin f the research paper. It shuld be clear and cncise and must cntain the bjective f the paper and inferences drawn. It is advised t nt include big mathematical equatins r cmplicated jargn. Many researchers searching fr infrmatin nline will use search engines such as Ggle, Yah r thers. By ptimizing yur paper fr search engines, yu will amplify the chance f smene finding it. In turn, this will make it mre likely t be viewed and cited in further wrks. Glbal Jurnals has cmpiled these guidelines t facilitate yu t maximize the webfriendliness f the mst public part f yur paper. Keywrds A majr lynchpin f research wrk fr the writing f research papers is the keywrd search, which ne will emply t find bth library and internet resurces. Up t eleven keywrds r very brief phrases have t be given t help data retrieval, mining, and indexing. One must be persistent and creative in using keywrds. An effective keywrd search requires a strategy: planning f a list f pssible keywrds and phrases t try. Chice f the main keywrds is the first tl f writing a research paper. Research paper writing is an art. Keywrd search shuld be as strategic as pssible. One shuld start brainstrming lists f ptential keywrds befre even beginning searching. Think abut the mst imprtant cncepts related t research wrk. Ask, What wrds wuld a surce have t include t be truly valuable in a research paper? Then cnsider synnyms fr the imprtant wrds. It may take the discvery f nly ne imprtant paper t steer in the right keywrd directin because, in mst databases, the keywrds under which a research paper is abstracted are listed with the paper. Numerical Methds Numerical methds used shuld be transparent and, where apprpriate, supprted by references. Abbreviatins Authrs must list all the abbreviatins used in the paper at the end f the paper r in a separate table befre using them. Frmulas and equatins Authrs are advised t submit any mathematical equatin using either MathJax, KaTeX, r LaTeX, r in a very high-quality image. Tables, Figures, and Figure Legends Tables: Tables shuld be cautiusly designed, uncrwned, and include nly essential data. Each must have an Arabic number, e.g., Table 4, a self-explanatry captin, and be n a separate sheet. Authrs must submit tables in an editable frmat and nt as images. References t these tables (if any) must be mentined accurately. XI Cpyright by Glbal Jurnals Guidelines Handbk

45 Figures Figures are suppsed t be submitted as separate files. Always include a citatin in the text fr each figure using Arabic numbers, e.g., Fig. 4. Artwrk must be submitted nline in vectr electrnic frm r by ing it. Preparatin f Eletrnic Figures fr Publicatin Althugh lw-quality images are sufficient fr review purpses, print publicatin requires high-quality images t prevent the final prduct being blurred r fuzzy. Submit (pssibly by ) EPS (line art) r TIFF (halftne/ phtgraphs) files nly. MS PwerPint and Wrd Graphics are unsuitable fr printed pictures. Avid using pixel-riented sftware. Scans (TIFF nly) shuld have a reslutin f at least 350 dpi (halftne) r 700 t 1100 dpi (line drawings). Please give the data fr figures in black and white r submit a Clr Wrk Agreement frm. EPS files must be saved with fnts embedded (and with a TIFF preview, if pssible). Fr scanned images, the scanning reslutin at final image size ught t be as fllws t ensure gd reprductin: line art: >650 dpi; halftnes (including gel phtgraphs): >350 dpi; figures cntaining bth halftne and line images: >650 dpi. Clr charges: Authrs are advised t pay the full cst fr the reprductin f their clr artwrk. Hence, please nte that if there is clr artwrk in yur manuscript when it is accepted fr publicatin, we wuld require yu t cmplete and return a Clr Wrk Agreement frm befre yur paper can be published. Als, yu can yur editr t remve the clr fee after acceptance f the paper. Tips fr writing a gd quality Medical Research Paper 1. Chsing the tpic: In mst cases, the tpic is selected by the interests f the authr, but it can als be suggested by the guides. Yu can have several tpics, and then judge which yu are mst cmfrtable with. This may be dne by asking several questins f yurself, like "Will I be able t carry ut a search in this area? Will I find all necessary resurces t accmplish the search? Will I be able t find all infrmatin in this field area?" If the answer t this type f questin is "yes," then yu ught t chse that tpic. In mst cases, yu may have t cnduct surveys and visit several places. Als, yu might have t d a lt f wrk t find all the rises and falls f the varius data n that subject. Smetimes, detailed infrmatin plays a vital rle, instead f shrt infrmatin. Evaluatrs are human: The first thing t remember is that evaluatrs are als human beings. They are nt nly meant fr rejecting a paper. They are here t evaluate yur paper. S present yur best aspect. 2. Think like evaluatrs: If yu are in cnfusin r getting demtivated because yur paper may nt be accepted by the evaluatrs, then think, and try t evaluate yur paper like an evaluatr. Try t understand what an evaluatr wants in yur research paper, and yu will autmatically have yur answer. Make blueprints f paper: The utline is the plan r framewrk that will help yu t arrange yur thughts. It will make yur paper lgical. But remember that all pints f yur utline must be related t the tpic yu have chsen. 3. Ask yur guides: If yu are having any difficulty with yur research, then d nt hesitate t share yur difficulty with yur guide (if yu have ne). They will surely help yu ut and reslve yur dubts. If yu can't clarify what exactly yu require fr yur wrk, then ask yur supervisr t help yu with an alternative. He r she might als prvide yu with a list f essential readings. 4. Use f cmputer is recmmended: As yu are ding research in the field f medical research then this pint is quite bvius. Use right sftware: Always use gd quality sftware packages. If yu are nt capable f judging gd sftware, then yu can lse the quality f yur paper unknwingly. There are varius prgrams available t help yu which yu can get thrugh the internet. 5. Use the internet fr help: An excellent start fr yur paper is using Ggle. It is a wndrus search engine, where yu can have yur dubts reslved. Yu may als read sme answers fr the frequent questin f hw t write yur research paper r find a mdel research paper. Yu can dwnlad bks frm the internet. If yu have all the required bks, place imprtance n reading, selecting, and analyzing the specified infrmatin. Then sketch ut yur research paper. Use big pictures: Yu may use encyclpedias like Wikipedia t get pictures with the best reslutin. At Glbal Jurnals, yu shuld strictly fllw here. Cpyright by Glbal Jurnals Guidelines Handbk XII

46 6. Bkmarks are useful: When yu read any bk r magazine, yu generally use bkmarks, right? It is a gd habit which helps t nt lse yur cntinuity. Yu shuld always use bkmarks while searching n the internet als, which will make yur search easier. 7. Revise what yu wrte: When yu write anything, always read it, summarize it, and then finalize it. 8. Make every effrt: Make every effrt t mentin what yu are ging t write in yur paper. That means always have a gd start. Try t mentin everything in the intrductin what is the need fr a particular research paper. Plish yur wrk with gd writing skills and always give an evaluatr what he wants. Make backups: When yu are ging t d any imprtant thing like making a research paper, yu shuld always have backup cpies f it either n yur cmputer r n paper. This prtects yu frm lsing any prtin f yur imprtant data. 9. Prduce gd diagrams f yur wn: Always try t include gd charts r diagrams in yur paper t imprve quality. Using several unnecessary diagrams will degrade the quality f yur paper by creating a hdgepdge. S always try t include diagrams which were made by yu t imprve the readability f yur paper. Use f direct qutes: When yu d research relevant t literature, histry, r current affairs, then use f qutes becmes essential, but if the study is relevant t science, use f qutes is nt preferable. 10. Use prper verb tense: Use prper verb tenses in yur paper. Use past tense t present thse events that have happened. Use present tense t indicate events that are ging n. Use future tense t indicate events that will happen in the future. Use f wrng tenses will cnfuse the evaluatr. Avid sentences that are incmplete. 11. Pick a gd study spt: Always try t pick a spt fr yur research which is quiet. Nt every spt is gd fr studying. 12. Knw what yu knw: Always try t knw what yu knw by making bjectives, therwise yu will be cnfused and unable t achieve yur target. 13. Use gd grammar: Always use gd grammar and wrds that will have a psitive impact n the evaluatr; use f gd vcabulary des nt mean using tugh wrds which the evaluatr has t find in a dictinary. D nt fragment sentences. Eliminate ne-wrd sentences. D nt ever use a big wrd when a smaller ne wuld suffice. Verbs have t be in agreement with their subjects. In a research paper, d nt start sentences with cnjunctins r finish them with prepsitins. When writing frmally, it is advisable t never split an infinitive because smene will (wrngly) cmplain. Avid clichés like a disease. Always shun irritating alliteratin. Use language which is simple and straightfrward. Put tgether a neat summary. 14. Arrangement f infrmatin: Each sectin f the main bdy shuld start with an pening sentence, and there shuld be a changever at the end f the sectin. Give nly valid and pwerful arguments fr yur tpic. Yu may als maintain yur arguments with recrds. 15. Never start at the last minute: Always allw enugh time fr research wrk. Leaving everything t the last minute will degrade yur paper and spil yur wrk. 16. Multitasking in research is nt gd: Ding several things at the same time is a bad habit in the case f research activity. Research is an area where everything has a particular time slt. Divide yur research wrk int parts, and d a particular part in a particular time slt. 17. Never cpy thers' wrk: Never cpy thers' wrk and give it yur name because if the evaluatr has seen it anywhere, yu will be in truble. Take prper rest and fd: N matter hw many hurs yu spend n yur research activity, if yu are nt taking care f yur health, then all yur effrts will have been in vain. Fr quality research, take prper rest and fd. 18. G t seminars: Attend seminars if the tpic is relevant t yur research area. Utilize all yur resurces. 19. Refresh yur mind after intervals: Try t give yur mind a rest by listening t sft music r sleeping in intervals. This will als imprve yur memry. Acquire clleagues: Always try t acquire clleagues. N matter hw sharp yu are, if yu acquire clleagues, they can give yu ideas which will be helpful t yur research. XIII Cpyright by Glbal Jurnals Guidelines Handbk

47 20. Think technically: Always think technically. If anything happens, search fr its reasns, benefits, and demerits. Think and then print: When yu g t print yur paper, check that tables are nt split, headings are nt detached frm their descriptins, and page sequence is maintained. 21. Adding unnecessary infrmatin: D nt add unnecessary infrmatin like "I have used MS Excel t draw graphs." Irrelevant and inapprpriate material is superfluus. Freign terminlgy and phrases are nt aprps. One shuld never take a brad view. Analgy is like feathers n a snake. Use wrds prperly, regardless f hw thers use them. Remve qutatins. Puns are fr kids, nt grunt readers. Never versimplify: When adding material t yur research paper, never g fr versimplificatin; this will definitely irritate the evaluatr. Be specific. Never use rhythmic redundancies. Cntractins shuldn't be used in a research paper. Cmparisns are as terrible as clichés. Give up ampersands, abbreviatins, and s n. Remve cmmas that are nt necessary. Parenthetical wrds shuld be between brackets r cmmas. Understatement is always the best way t put frward earth-shaking thughts. Give a detailed literary review. 22. Reprt cncluded results: Use cncluded results. Frm raw data, filter the results, and then cnclude yur studies based n measurements and bservatins taken. An apprpriate number f decimal places shuld be used. Parenthetical remarks are prhibited here. Prfread carefully at the final stage. At the end, give an utline t yur arguments. Spt perspectives f further study f the subject. Justify yur cnclusin at the bttm sufficiently, which will prbably include examples. 23. Upn cnclusin: Once yu have cncluded yur research, the next mst imprtant step is t present yur findings. Presentatin is extremely imprtant as it is the definite medium thugh which yur research is ging t be in print fr the rest f the crwd. Care shuld be taken t categrize yur thughts well and present them in a lgical and neat manner. A gd quality research paper frmat is essential because it serves t highlight yur research paper and bring t light all necessary aspects f yur research. Infrmal Guidelines f Research Paper Writing Key pints t remember: Submit all wrk in its final frm. Write yur paper in the frm which is presented in the guidelines using the template. Please nte the criteria peer reviewers will use fr grading the final paper. Final pints: One purpse f rganizing a research paper is t let peple interpret yur effrts selectively. The jurnal requires the fllwing sectins, submitted in the rder listed, with each sectin starting n a new page: The intrductin: This will be cmpiled frm reference matter and reflect the design prcesses r utline f basis that directed yu t make a study. As yu carry ut the prcess f study, the methd and prcess sectin will be cnstructed like that. The results segment will shw related statistics in nearly sequential rder and direct reviewers t similar intellectual paths thrughut the data that yu gathered t carry ut yur study. The discussin sectin: This will prvide understanding f the data and prjectins as t the implicatins f the results. The use f gd quality references thrughut the paper will give the effrt trustwrthiness by representing an alertness t prir wrkings. Writing a research paper is nt an easy jb, n matter hw truble-free the actual research r cncept. Practice, excellent preparatin, and cntrlled recrd-keeping are the nly means t make straightfrward prgressin. General style: Specific editrial clumn necessities fr cmpliance f a manuscript will always take ver frm directins in these general guidelines. T make a paper clear: Adhere t recmmended page limits. Cpyright by Glbal Jurnals Guidelines Handbk XIV

48 Mistakes t avid: Insertin f a title at the ft f a page with subsequent text n the next page. Separating a table, chart, r figure cnfine each t a single page. Submitting a manuscript with pages ut f sequence. In every sectin f yur dcument, use standard writing style, including articles ("a" and "the"). Keep paying attentin t the tpic f the paper. Use paragraphs t split each significant pint (excluding the abstract). Align the primary line f each sectin. Present yur pints in sund rder. Use present tense t reprt well-accepted matters. Use past tense t describe specific results. D nt use familiar wrding; dn't address the reviewer directly. Dn't use slang r superlatives. Avid use f extra pictures include nly thse figures essential t presenting results. Title page: Chse a revealing title. It shuld be shrt and include the name(s) and address(es) f all authrs. It shuld nt have acrnyms r abbreviatins r exceed tw printed lines. Abstract: This summary shuld be tw hundred wrds r less. It shuld clearly and briefly explain the key findings reprted in the manuscript and must have precise statistics. It shuld nt have acrnyms r abbreviatins. It shuld be lgical in itself. D nt cite references at this pint. An abstract is a brief, distinct paragraph summary f finished wrk r wrk in develpment. In a minute r less, a reviewer can be taught the fundatin behind the study, cmmn appraches t the prblem, relevant results, and significant cnclusins r new questins. Write yur summary when yur paper is cmpleted because hw can yu write the summary f anything which is nt yet written? Wealth f terminlgy is very essential in abstract. Use cmprehensive sentences, and d nt sacrifice readability fr brevity; yu can maintain it succinctly by phrasing sentences s that they prvide mre than a lne ratinale. The authr can at this mment g straight t shrtening the utcme. Sum up the study with the subsequent elements in any summary. Try t limit the initial tw items t n mre than ne line each. Reasn fr writing the article thery, verall issue, purpse. Fundamental gal. T-the-pint depictin f the research. Cnsequences, including definite statistics if the cnsequences are quantitative in nature, accunt fr this; results f any numerical analysis shuld be reprted. Significant cnclusins r questins that emerge frm the research. Apprach: Single sectin and succinct. An utline f the jb dne is always written in past tense. Cncentrate n shrtening results limit backgrund infrmatin t a verdict r tw. Exact spelling, clarity f sentences and phrases, and apprpriate reprting f quantities (prper units, imprtant statistics) are just as significant in an abstract as they are anywhere else. Intrductin: The intrductin shuld "intrduce" the manuscript. The reviewer shuld be presented with sufficient backgrund infrmatin t be capable f cmprehending and calculating the purpse f yur study withut having t refer t ther wrks. The basis fr the study shuld be ffered. Give the mst imprtant references, but avid making a cmprehensive appraisal f the tpic. Describe the prblem visibly. If the prblem is nt acknwledged in a lgical, reasnable way, the reviewer will give n attentin t yur results. Speak in cmmn terms abut techniques used t explain the prblem, if needed, but d nt present any particulars abut the prtcls here. XV Cpyright by Glbal Jurnals Guidelines Handbk

49 The fllwing apprach can create a valuable beginning: Apprach: Explain the value (significance) f the study. Defend the mdel why did yu emply this particular system r methd? What is its cmpensatin? Remark upn its apprpriateness frm an abstract pint f view as well as pinting ut sensible reasns fr using it. Present a justificatin. State yur particular thery(-ies) r aim(s), and describe the lgic that led yu t chse them. Briefly explain the study's tentative purpse and hw it meets the declared bjectives. Use past tense except fr when referring t recgnized facts. After all, the manuscript will be submitted after the entire jb is dne. Srt ut yur thughts; manufacture ne key pint fr every sectin. If yu make the fur pints listed abve, yu will need at least fur paragraphs. Present surrunding infrmatin nly when it is necessary t supprt a situatin. The reviewer des nt desire t read everything yu knw abut a tpic. Shape the thery specifically d nt take a brad view. As always, give awareness t spelling, simplicity, and crrectness f sentences and phrases. Prcedures (methds and materials): This part is suppsed t be the easiest t carve if yu have gd skills. A sundly written prcedures segment allws a capable scientist t replicate yur results. Present precise infrmatin abut yur supplies. The suppliers and clarity f reagents can be helpful bits f infrmatin. Present methds in sequential rder, but linked methdlgies can be gruped as a segment. Be cncise when relating the prtcls. Attempt t give the least amunt f infrmatin that wuld permit anther capable scientist t replicate yur utcme, but be cautius that vital infrmatin is integrated. The use f subheadings is suggested and ught t be synchrnized with the results sectin. When a technique is used that has been well-described in anther sectin, mentin the specific item describing the way, but draw the basic principle while stating the situatin. The purpse is t shw all particular resurces and brad prcedures s that anther persn may use sme r all f the methds in ne mre study r referee the scientific value f yur wrk. It is nt t be a step-by-step reprt f the whle thing yu did, nr is a methds sectin a set f rders. Materials: Materials may be reprted in part f a sectin r else they may be recgnized alng with yur measures. Methds: Apprach: Reprt the methd and nt the particulars f each prcess that engaged the same methdlgy. Describe the methd entirely. T be succinct, present methds under headings dedicated t specific dealings r grups f measures. Simplify detail hw prcedures were cmpleted, nt hw they were perfrmed n a particular day. If well-knwn prcedures were used, accunt fr the prcedure by name, pssibly with a reference, and that's all. It is embarrassing t use vigrus vice when dcumenting methds withut using first persn, which wuld fcus the reviewer's interest n the researcher rather than the jb. As a result, when writing up the methds, mst authrs use third persn passive vice. Use standard style in this and every ther part f the paper avid familiar lists, and use full sentences. What t keep away frm: Resurces and methds are nt a set f infrmatin. Skip all descriptive infrmatin and surrundings save it fr the argument. Leave ut infrmatin that is immaterial t a third party. Cpyright by Glbal Jurnals Guidelines Handbk XVI

50 Results: The principle f a results segment is t present and demnstrate yur cnclusin. Create this part as entirely bjective details f the utcme, and save all understanding fr the discussin. The page length f this segment is set by the sum and types f data t be reprted. Use statistics and tables, if suitable, t present cnsequences mst efficiently. Yu must clearly differentiate material which wuld usually be incrprated in a study editrial frm any unprcessed data r additinal appendix matter that wuld nt be available. In fact, such matters shuld nt be submitted at all except if requested by the instructr. Cntent: Sum up yur cnclusins in text and demnstrate them, if suitable, with figures and tables. In the manuscript, explain each f yur cnsequences, and pint the reader t remarks that are mst apprpriate. Present a backgrund, such as by describing the questin that was addressed by creatin f an exacting study. Explain results f cntrl experiments and give remarks that are nt accessible in a prescribed figure r table, if apprpriate. Examine yur data, then prepare the analyzed (transfrmed) data in the frm f a figure (graph), table, r manuscript. What t stay away frm: Apprach: D nt discuss r infer yur utcme, reprt surrunding infrmatin, r try t explain anything. D nt include raw data r intermediate calculatins in a research manuscript. D nt present similar data mre than nce. A manuscript shuld cmplement any figures r tables, nt duplicate infrmatin. Never cnfuse figures with tables there is a difference. As always, use past tense when yu submit yur results, and put the whle thing in a reasnable rder. Put figures and tables, apprpriately numbered, in rder at the end f the reprt. If yu desire, yu may place yur figures and tables prperly within the text f yur results sectin. Figures and tables: If yu put figures and tables at the end f sme details, make certain that they are visibly distinguished frm any attached appendix materials, such as raw facts. Whatever the psitin, each table must be titled, numbered ne after the ther, and include a heading. All figures and tables must be divided frm the text. Discussin: The discussin is expected t be the trickiest segment t write. A lt f papers submitted t the jurnal are discarded based n prblems with the discussin. There is n rule fr hw lng an argument shuld be. Psitin yur understanding f the utcme visibly t lead the reviewer thrugh yur cnclusins, and then finish the paper with a summing up f the implicatins f the study. The purpse here is t ffer an understanding f yur results and supprt all f yur cnclusins, using facts frm yur research and generally accepted infrmatin, if suitable. The implicatin f results shuld be fully described. Infer yur data in the cnversatin in suitable depth. This means that when yu clarify an bservable fact, yu must explain mechanisms that may accunt fr the bservatin. If yur results vary frm yur prspect, make clear why that may have happened. If yur results agree, then explain the thery that the prf supprted. It is never suitable t just state that the data apprved the prspect, and let it drp at that. Make a decisin as t whether each premise is supprted r discarded r if yu cannt make a cnclusin with assurance. D nt just dismiss a study r part f a study as "uncertain." XVII Cpyright by Glbal Jurnals Guidelines Handbk

51 Research papers are nt acknwledged if the wrk is imperfect. Draw what cnclusins yu can based upn the results that yu have, and take care f the study as a finished wrk. Apprach: Yu may prpse future guidelines, such as hw an experiment might be persnalized t accmplish a new idea. Give details f all f yur remarks as much as pssible, fcusing n mechanisms. Make a decisin as t whether the tentative design sufficiently addressed the thery and whether r nt it was crrectly restricted. Try t present substitute explanatins if they are sensible alternatives. One piece f research will nt cunter an verall questin, s maintain the large picture in mind. Where d yu g next? The best studies unlck new avenues f study. What questins remain? Recmmendatins fr detailed papers will ffer supplementary suggestins. When yu refer t infrmatin, differentiate data generated by yur wn studies frm ther available infrmatin. Present wrk dne by specific persns (including yu) in past tense. Describe generally acknwledged facts and main beliefs in present tense. The Administratin Rules Administratin Rules t Be Strictly Fllwed befre Submitting Yur Research Paper t Glbal Jurnals Inc. Please read the fllwing rules and regulatins carefully befre submitting yur research paper t Glbal Jurnals Inc. t avid rejectin. Segment draft and final research paper: Yu have t strictly fllw the template f a research paper, failing which yur paper may get rejected. Yu are expected t write each part f the paper whlly n yur wn. The peer reviewers need t identify yur wn perspective f the cncepts in yur wn terms. Please d nt extract straight frm any ther surce, and d nt rephrase smene else's analysis. D nt allw anyne else t prfread yur manuscript. Written material: Yu may discuss this with yur guides and key surces. D nt cpy anyne else's paper, even if this is nly imitatin, therwise it will be rejected n the grunds f plagiarism, which is illegal. Varius methds t avid plagiarism are strictly applied by us t every paper, and, if fund guilty, yu may be blacklisted, which culd affect yur career adversely. T guard yurself and thers frm pssible illegal use, please d nt permit anyne t use r even read yur paper and file. Cpyright by Glbal Jurnals Guidelines Handbk XVIII

52 CRITERION FOR GRADING A RESEARCH PAPER (COMPILATION) BY GLOBAL JOURNALS Please nte that fllwing table is nly a Grading f "Paper Cmpilatin" and nt n "Perfrmed/Stated Research" whse grading slely depends n Individual Assigned Peer Reviewer and Editrial Bard Member. These can be available nly n request and after decisin f Paper. This reprt will be the prperty f Glbal Jurnals. Tpics Grades A-B C-D E-F Abstract Clear and cncise with apprpriate cntent, Crrect frmat. 200 wrds r belw Unclear summary and n specific data, Incrrect frm Abve 200 wrds N specific data with ambiguus infrmatin Abve 250 wrds Intrductin Cntaining all backgrund details with clear gal and apprpriate details, flw specificatin, n grammar and spelling mistake, well rganized sentence and paragraph, reference cited Unclear and cnfusing data, apprpriate frmat, grammar and spelling errrs with unrganized matter Out f place depth and cntent, hazy frmat Methds Prcedures and Clear and t the pint with well arranged paragraph, precisin and accuracy f facts and figures, well rganized subheads Difficult t cmprehend with embarrassed text, t much explanatin but cmpleted Incrrect and unrganized structure with hazy meaning Result Well rganized, Clear and specific, Crrect units with precisin, crrect data, well structuring f paragraph, n grammar and spelling mistake Cmplete and embarrassed text, difficult t cmprehend Irregular frmat with wrng facts and figures Discussin Well rganized, meaningful specificatin, sund cnclusin, lgical and cncise explanatin, highly structured paragraph reference cited Wrdy, unclear cnclusin, spurius Cnclusin is nt cited, unrganized, difficult t cmprehend References Cmplete and crrect frmat, well rganized Beside the pint, Incmplete Wrng frmat and structuring Cpyright by Glbal Jurnals Guidelines Handbk XIX

53 Index A Aneuplidies 11, 12 M Msaicism 13 C Capngraphy 1 Cranifacial 13 Cricthyridtmy 1 Cytgenetics 11, 12 D Dysmrphism 11 Dysmrphlgy 13 E Endtracheal 1, 2, 4, 5 G O Orpharyngeal 1, 2 P Pericentric 13 Prfusin 7 Psychmtr 1, 2, 3 T Tumrigenesis 14 U Unrealistic 1 Glidescpe 1 Gnadtrpin 19 Gserelin 17, 18, 19 I Intrauterine 11, 13, 14 Intubatin 1, 2, 4, 5 Ischrmsmes 11, 13 K Karytypes 11, 12 L Lachrymatin 8 Laryngeal 1, 4 Leuprrelin 17, 18, 19 Luteinizing 17, 19 Lymphcyte 11

54 save ur planet Visit us n the Web at www. r us at edicalresearchjurnal.rg 9 2 ISSN > by Glbal 201 Glbal Jurnals Jurnals

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