bluuebunny/crossref_metadata_2025 huggingface dataset:
Collagen dressing versus silver sulfadiazine dressings in partial thickness burns-prospective study
Authors: Mathew Sunil , Shariff Nawaz , P. N. Sreeramulu , . Krishnaprasad
Published: April 2021

Background: Occurrence, pathophysiology and management of burns is complex. It is a painful condition and topical management of burns is a challenging task. An ideal topical dressing which allows faster healing with reduction of pain, prevent infection, leads to a good scar formation and which is cost effective is required. Thus, there is a need to study the effectiveness of collagen dressing in comparison with conventional silver sulphadiazine dressing (SSD) in terms of pain score, healing time and cost efficiency.Methods: This prospective randomized comparative study includes patients with partial thickness burns, <40% BSA and not older than 48 hours, admitted to department of surgery of RL Jalappa hospital and research centre Tamaka Kolar during the period December 2019 to March 2020. 34 patients were studied, these patients were randomized into collagen dressing or silver sulphadiazine dressing group of 17 each.Results: The 34 patients admitted with partial thickness burns, <40% BSA were divided into two equal and comparable groups. Patients subjected to collagen dressings were classified under group I and those who underwent 1% silver sulphadiazine dressings were classified as group II.Conclusions: The collagen dressing is more cost effective than SSD. SSD has disadvantage of the large number of dressings prolonged hospital stay, amount pain, loss of time and labour of the patient and the accompanying person which make collagen dressing more cost effective as it is most of the time a single dressing.
Morphological study of cervical spinal body and vertebral body anatomy: CT scan based
Authors: Chaurasiya A. K. , Dawar Anil , Gour Rajneesh , Vaidya Kunal
Published: April 2021

Background: The morphometery of the cervical spine vertebra is of clinical importance in traumatic, degenerative and inflammatory condition requiring surgery and instrumentation. The aim of this study was to determine the mid-sagittal, AP Transverse diameter, AP diameter of cervical vertebral body, surface area of canal and torg ratio at level C2 –C7.Methods: Study was performed in the department of general surgery, GMC and Hamidia Hospital Bhopal from January 2016 - June 2020 in 300 patients with clinically apparent cervical spondylosis and cervical spine injury belongs to central India of age group 20- 88 years including males and females by gathering their parameters (height and weight) and CT of cervical region from C1 to D1 spine.Results: In our study maximum sagittal canal diameter in males was found at C2 vertebral level (14.14 mm) and minimum at C4 vertebral level (14.00 mm) whereas the maximum sagittal canal diameter in females was found at C2 and C7 vertebral level (14.00 mm) and minimum at C4 vertebral level (13.82 mm) while mean sagittal canal diameter was greater in males than females. The maximum transverse canal diameter in both males and female was found at C7 level, it measures 21.09 mm in males and 21.38 mm in females.Conclusions: The CT scan can provide accurate cervical canal measurement that could serve as useful guide in preoperative surgical planning, instrumentation and size of prosthesis.
Retroperitoneal liposarcoma of the intestine: a rare cause of acute abdomen
Authors: Tiwari Vikash C. , Mudhale Vaibhav , Sharang Kulkarni S. , Nyamagoud Jineshwar , Srividya Malluru
Published: April 2021

Retroperitoneal liposarcoma is a rare malignant mesenchymal tumor with an incidence of 2.5 per million individuals. It is usually asymptomatic until its large enough to compress the surrounding organs, so its early diagnosis is difficult. In current case a 41 year old male patient with no significant past medical history presented to emergency department with sudden onset of abdominal pain in the left lumbar region. On examination, the abdomen was distended, guarding and rigidity present with tenderness to palpation in the left lumbar region, and no mass was palpated. Abdominal USG revealed a large heterogeneous mass in the left lumbar region. As the origin of the mass was uncertain, the patient was evaluated with CECT of the abdomen which revealed a retroperitoneal mass highly s/o liposarcoma. Given the suspicion of a liposarcoma, the patient underwent an abdominal exploration and there was a retroperitoneal mass of 12x8 cm adherent to the left colon. Wide resection of this mass was done along with left colectomy and the specimen was sent for examination. The histopathology study determined lipomatous tumor well differentiated retroperitoneal liposarcoma. Retroperitoneal liposarcoma is a malignant tumor whose treatment is fundamentally surgical. These tumors tend to be resistant to radiotherapy and/or chemotherapy. Among the most important prognostic factors related to survival is surgery with non-affected margins.
Gall bladder carcinoma associated with anticoagulation-resistant, progressive, multi-focal venous thrombosis and gangrene of all limbs: a case report and review of literature
Authors: Aggarwal Manisha , Kundaikar Janitta , Manchikanti Dinesh , Thomas Shaji , Arsia Ashish , Pusuluri Rahul , Kumar Sanjay
Published: April 2021

Cancer being a prothrombotic state, frequently has vascular complications, venous thrombosis, embolism, recurrent venous thromboembolism and a high frequency of anticoagulant failure. We present a rare case of anticoagulant-resistant, progressive, multifocal venous thrombosis and gangrene in all four limbs in a patient with carcinoma gallbladder. A 49 year old lady with locally advanced gallbladder cancer who had been on routine perioperative deep venous thrombosis (DVT) prophylaxis presented two months later with deep venous thrombosis of both lower limbs progressing to venous gangrene of both feet, despite being on anticoagulation. 7 days later, she presented with venous gangrene of both hands. Shortly thereafter, she developed right facial paralysis due to thrombus in the segmental branch of the left MCA despite being on anticoagulation. The hypercoagulable state in cancer involves procoagulant molecules produced by tumor cells, suppression of fibrinolytic activity and platelet activation and is contributed by interactions between the coagulation cascade, complement pathway and immune system. Upto 15% of patients with cancer will develop DVT following surgery, despite standard DVT prophylaxis. Extended DVT prophylaxis should be considered in high-risk patients. Patients with metastases should continue with indefinite anticoagulant therapy after a thrombotic event. In patients without metastasis, anticoagulant treatment is recommended for as long as the cancer is active and while the patient is receiving antitumor therapy. This rare case has been presented to highlight the hypercoagulable state of cancer, the importance of long-term anticoagulation in advanced and metastatic cancers and the high rate of anticoagulation failure associated with unfavourable tumor biology.
Pre-operative use of Lugol’s iodine in a case with toxic adenomatous goiter
Authors: Kulkarni Sharang , Murchite Sheetal , Parab Saurabh , Tiwari Vikash , Rajagopal Archa
Published: April 2021

Euthyroid state is considered a requisite before planning a thyroid surgery. Before such a surgery, pharmacotherapy can be used for managing a hyperthyroid state. It warrants a long-term treatment with pharmacotherapy agents like imidazole class (carbimazole, methimazole) or propylthiouracil. In cases with large goiters, with pressure symptoms like dyspnoea, dysphagia, dysphonia; a surgeon would prefer a pharmacotherapy with a quicker action than the established agents. Lugol’s iodine was used pre-operatively before the advent of newer agents. In rural areas, where patients present with large goiters, hyperthyroid states due to lack of awareness and availability of the modern pharmacotherapy, Lugol’s iodine can be a rescue pre-operative therapy to make such a patient euthyroid and to decrease the vascularity of the goiter, which facilitates a safer thyroid surgery.
Anal membrane: varied presentations
Authors: Basu Syamantak , Makan Apoorva , Tulsian Akriti , Joseph Vini , Gandhi Suraj , Shenoy Neha Sisodiya , Shah Hemanshi
Published: April 2021

An anal membrane is categorized as a low anorectal malformation and is noted under rare malformations in the International classification. It is very rare and may present variedly in different age groups and only a handful of cases have been ever described. It is one of the few anorectal malformations in which the anal canal is at a normal position, thus concealing itself from an attendant who is not suspicious. We present two cases of anal membrane. A newborn girl presenting at birth was treated by primary excision of the membranes. The second case was a 2 year boy with chronic constipation with an obstructive web of a persistent ruptured anal membrane. Both were short procedures with almost no morbidity. Both the cases would have been diagnosed earlier if the primary attendant had done a rectal examination. There was good post-operative outcome in terms of continence and constipation in both the cases. Neither of them needed any anal dilatations. Anal membrane is a rare low anorectal malformation which needs keen suspicion for diagnosis. It is easy to miss it if the attendant omits a rectal examination. Therefore, it is imperative to do a rectal examination of all neonates with non-passage of meconium and as well as children with chronic constipation.
Study of clinical and etiological profile of hypertensive emergencies in children admitted in pediatric emergency department
Authors: Kotapuri Sumathi , Putta Mahendranath , Chitgupikar Sudharshanraj
Published: April 2021

Background: Hypertension (HTN) in children, all though an uncommon entity is associated with end-organ damage. With increasing prevalence of hypertension and obesity in children; hypertensive emergencies are also increasing over recent years and screening is must. The primary objective of this study was to determine the incidence of hypertensive emergencies, the clinical presentation and etiological diagnosis at different age groups and to access the real burden of primary hypertension in causing hypertensive emergencies in children.Methods: This study was a prospective, descriptive, analytical cohort study done on children attending the emergency department of pediatrics, government general hospital, a tertiary referral pediatric center attached to Kurnool medical college, Kurnool, over a period of 18 months i.e., from january2016 to June 2017. Data was collected in a pre-determined proforma after institutional ethical committee clearance and appropriate informed concerned.Results: Among 98 children with hypertension; 30 had hypertensive emergency.  Incidence was 0.3%. Intrinsic renal and renal vascular causes were the commonest. Headache, dizziness and vomiting were the comment presentation. Half of them had encephalopathy. Younger children had more of secondary HTN and in children (older than 7 years) primary hypertension increased as did family history of hypertension.Conclusions: With increasing primary hypertension among older children, hypertensive emergencies are increasing. As most of the children with HTN are asymptomatic; detection of target organ damage is vital.
Fetal and neonatal outcomes in early onset versus late onset pre-eclampsia-a comparative study
Authors: R. Vikram
Published: April 2021

Background: Pre-eclampsia is typed as two different entities: early-onset preeclampsia occurring at less than 34 weeks of gestation, and late-onset occurring at 34 or more weeks of gestation. The aim of this study is to compare the fetal and neonatal outcomes in early versus late onset preeclampsia.Methods: 208 patients diagnosed with pre-eclampsia in Shri Sathya Sai medical college and research institute over a period of three years (From January 2016 to January 2019) were retrospectively studied. Patients were classified as early onset and late onset pre-eclampsia based on the gestational age of onset. Data on fetal and neonatal outcomes were collected and analysed using Chi square and Fisher’s test and compared.Results:  Early onset and late onset pre-eclampsia were 34.6% and 65.3%. The incidence of oligohydramnios, SGA, low APGAR at 5 minutes of birth were high in early onset type. 64.9% of early onset type required NICU admission whereas only 38.23% new born of mothers with late onset type required NICU admissions.10.8% of babies of patients with early onset type were still born. The incidence of NICU admissions, requirement of respiratory support, duration of NICU stay were significantly high in early onset type.Conclusions: Patients with early onset pre-eclampsia are found to have higher rates of specific fetal and neonatal morbidity when compared to the late onset type. Prudent and close scrutinizing and follow up and delaying delivery in stable and appropriately selected patients with pre-eclampsia would be advantageous for neonates.
A chronic granulomatous disease masked by tuberculosis in a 2-year, 2-month old child: a case report
Authors: Sahoo Manas Ranjan , Jondhale Sunil Nath , Goel Anil Kumar
Published: April 2021

Chronic granulomatous disorder is a rare primary immunodeficiency disorder with phagocytic defect resulting in recurrent bacterial infections. Here we report a 2-year 2-month old male child, who presented with recurrent lymphadenitis and recurrent pneumonia since early infancy. In recent episode he presented with right cervical lymphadenopathy. Biopsy of lymph node revealed confluent necrotizing epithelioid cell granulomas and occasional giant cells but without evidence of tuberculosis and atypical organisms. His dihydrorhodamine 1,2,3 assay (DHR) was positive. Later he responded to prolonged parenteral antibiotics and discharged on itraconazole and trimethoprim-sulhamethaxazole prophylaxis. Here we are going to report a rare case of chronic granulomatous disease whose diagnosis was masked by tuberculosis
COVID-19 risk behaviors in humanitarian settings: a cross-sectional study among conflict refugees in Uganda
Authors: Lawoko Stephen , Seruwagi Gloria , Muhangi Denis , Ochen Eric A. , Okot Betty , Lugada Eric , Masaba Andrew , Ddamulira Dunstan P. , Luswata Brian , Nakidde Catherine L. , Kaducu Felix
Published: April 2021

Background: Worldwide, behavioral change interventions are at the core of prevention efforts to contain the novel Corona Virus (COVID-19). While the evidence base to inform such interventions in the general population is growing, equivocal research in humanitarian populations is lacking. The current study describes the nature, extent and predictors of COVID-19 risk behaviors among conflict refugees in Uganda in a bid to inform prevention strategies for humanitarian settings.Methods: Cross-sectional survey data on COVID-19 risk-behaviors, demographic, socio-economic, behavioral and clinical variables was gathered from 1014 adult refugees drawn from 3 refugee settlements in Uganda, using two-staged cluster sampling. Data was analyzed using t-test, Analysis of Variance (ANOVA) and Multivariable Linear Regression.Results: Many refugees (25-70%) were involved in hygiene, congestion and nutritional/physical activity related risk behaviors likely to contribute to community transmission of COVID-19. Refugees living in rural settlements, of male sex, young age and low socio-economic status were at heightened risk of exposure to COVID-19 risk behaviors. Physical activity and healthy nutritional practices reduced the likelihood of COVID-19 risk behavior. Indulgence in COVID-19 risk behaviors increased the risk of developing COVID-19 symptoms. Conclusions: COVID-19 risk behaviors among conflict refugees in Uganda are multifaceted in nature, widespread in extent and associated with symptom development, signaling for high risk for COVID-19 transmission in humanitarian settings. The data on predictors of COVID-19 risk behaviors have unmasked underlying inequalities, holding promise for development of evidence-based interventions to meet the needs of most vulnerable clusters in the refugee community.
Bacterial association in urinary tract infection and their drug resistance among patients in Rajshahi, Bangladesh
Authors: Farjana Noor E. , Islam Md A. , Zerin Tamanna , Begum Mosammat A.
Published: April 2021

Background: Urinary tract infection (UTI) is a very common infection worldwide and drug resistance makes the treatment more difficult which may lead to complications along with extended hospital stay. Therefore, this study was designed to find out the prevalence of UTI, and antimicrobial susceptibility pattern of isolates collected from patients of UTI.Methods: This study was conducted among 1,760 suspected UTI patients from January 2019 to November 2020. Urine samples from mid-stream were transferred to microbiology laboratory following microbiological standard protocol. Microbial identification was performed by microscopy, colony morphology, and biochemical characteristics. Antibiogram was pursued following the standard Kirby-Bauer disk diffusion method.Results: Our study showed almost 30% of samples were positive and E. coli was found as the highest predominating organism (50.09%) followed by Klebsiella spp., Pseudomonas spp., Enterococcus spp., and Citrobacter spp. The percentage of infection in females was 65.28% which is higher than males. The highest prevalence of UTI has been observed in females aged 21-30 years and males aged 31-40 years. However, E. coli and Pseudomonas spp. showed the highest resistance against Amoxiclav whereas, Klebsiella spp. showed it against co-trimoxazole. Citrobacter spp. showed 100% resistance towards Amikacin, cefixime, nalidixic acid, co-trimoxazole, amoxiclav, ceftazidime, and Enterococcus spp. showed against nalidixic acid and amoxiclav. Moreover, 95.8% isolates collected were resistant towards 3 or more than 3 antibiotics which is very alarming.Conclusions: Changing trend in antibiotic sensitivity profile of the isolates needs to be monitored as there is limited availability of newer drugs.
Predictors of acceptance of COVID-19 vaccine among patients at a tertiary hospital in South-South Nigeria
Authors: Allagoa Dennis O. , Oriji Peter Chibuzor , Tekenah Ebiye S. , Obagah Lukman , Njoku Chidiebere , Afolabi Adeniyi Stephen , Atemie Gordon
Published: April 2021

Background: The coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome corona virus-2 (SARS-CoV-2), which was said to have emerged from a livestock market in Wuhan, China in December 2019. The objective of this study was to determine the predictors and willingness of patients to accept the COVID-19 vaccine.Methods: This survey was carried out at the federal medical centre, Yenagoa between 4t January and 15 February 2021. It was a descriptive cross-sectional study. The study population consisted of 1,000 consecutive patients that presented to the various out-patients departments of the hospital. Written informed consent was obtained. Data collected with a predesigned questionnaire were analysed using statistical software (SPSS for windows® version 23, SPSS Inc, Chicago, USA).Results: Out of 1,000 participants, only 246 (24.6%) were willing to receive the COVID-19 vaccine. About 2 in every 5 participants were unwilling to take the vaccine due to trust issues. Lack of trust in the manufacturers and government were the reasons given by 43.4% and 41.8% of participants, respectively. All sociodemographic factors were significant predictors of willingness to receive COVID-19 vaccine. The male participants (OR=2.34; p=001) were 2 times more willing than women to receive COVID-19 vaccine.Conclusions: The willingness to accept COVID-19 vaccine is low here. The highest predictor of willingness to accept the vaccine was the male gender and this is quite significant in our environment where decision-making in the family lies mostly on the man.
Exploration of traditional beliefs about human immunodeficiency virus and associated stigma among black Africans in the UK: a pilot study with implication for practice in Africa
Authors: Philip Aaron Akpu , Davis Samantha , Nwakasi Candidus , Baba Victor Oti
Published: April 2021

Background: In the UK, black Africans account for the most affected ethnic population with HIV. Black Africans hold traditional beliefs which have been reported to cause certain misconceptions about the cause of HIV. Also, despite being in a developed country like the UK, it has been noted that Black Africans still hold these beliefs. This study was aimed at exploring the influence of traditional beliefs about the cause of HIV and HIV related stigma among Black Africans in the diaspora.Methods: Semi structured interviews were conducted among six individuals (M-4, F-2), three of which were people living with HIV (PLHIV). Participants were selected purposively. The study included male and/or female English-speaking Black Africans who were 18 years+ and not born in the UK but had migrated to live there.Results: The resulting data was analysed thematically, and three themes were developed: “…God created disease as a punishment for mankind…”: Punishment from God, “…witches, they can make HIV…”: HIV as related to witchcraft and “hanging on to traditional beliefs thus mistreating people with HIV”: Traditional African beliefs cause stigma.Conclusions: The main finding of this study reveals that participants who are knowledgeable about HIV still hold traditional beliefs about HIV. These beliefs are reported to exacerbate stigma against PLHIV. The study recommends that traditional beliefs should be prioritised when planning HIV prevention programs.
Study on internet usage and internet addiction of medical students in universities of Myanmar
Authors: Oo Khin May , Soe Pa Pa , Oo Win Myint
Published: April 2021

Background: Internet is relatively new technology that can provide up to date knowledge in education. Even though the significant advantages, abuse of internet results in addiction disorder especially younger age. The aim of this study was to determine the internet utilization and internet addiction (IA) of third year medical students in medical universities of Myanmar.Methods: This was cross-sectional descriptive study in which the questionnaire mainly based on a questionnaire, IA test score. Total 412 medical students from medical universities were enrolled in the study.Results: This study shows 80.83% of students used internet more than five hours and 99.51% used internet every day. Common activities were social media 93.93%, entertainment 94.17%, watching movies 90.78%, communication 87.86% respectively. Among the reasons of use, education (p=0.003), shopping (0.002) and due to free wi-fi (p=0.006) were found to be significantly associated with IA. The majority (47.33%) was moderately addicted, (45.39%) was mildly addicted and 1.7 % was severely addicted. There was significant relationship between IA and time for more than five hours per day. Higher level of prevalence of IA was using online for watching movies, blogging, study information. Among the reasons of internet use, education, shopping and due to wi-fi were significantly associated with IA (p<0.05).Conclusions: IA is growing problem and medical students are vulnerable for IA and so necessary preventive measures are vital to provide safe usage of internet.
Family planning practices and prehospital care received by women seeking abortion services in a tertiary care hospital
Authors: Deb Upasana , Tiwary Narendra K.
Published: April 2021

Background: The study was carried out in the department of Gynaecology and Obstetrics at RG Kar Medical college and Hospital, among 114 attendees seeking induced or spontaneous abortion. The aim of the study was to assess their socio demographic characteristics, elicit their family planning knowledge, practices and prehospital care received by them before coming to this institute.Methods: An observational descriptive cross-sectional study was carried out using a predesigned, pretested schedule using systemic random sampling technique among women seeking abortion services at a tertiary care centre.Results: Out of the 114 interviewees, 53 (46.5%) underwent induced abortion and rest had spontaneous abortion. Statistically significant difference was found between the mean age of induced and spontaneous abortion seekers. Majority i.e. 28 (52.8%) of induced abortion seekers first sought help at illegal abortion service providers. Statistically significant difference was found in duration of marriage, gravidity and number of living children between induced and spontaneous abortion candidates. Contraceptive knowledge and practice were found to be higher among induced abortion seekers.Conclusions: This study clearly shows the need to focus on unmet need for family planning services including safe abortion services at pre-tertiary hospital level. The Government needs to stop advertisement and sale of over the counter abortifacients which is proving to be a menace to women’s health.
A cross-sectional study on determinants of immunization coverage in urban area Chidambaram, Tamil Nadu
Authors: Priya D. P. Lakshmi , Kalyani P. , Bala B. Sindhu
Published: April 2021

Background: Immunization is one of the cost effective measures preventing approximately 2 to 3 million deaths in young children every year. Inspite of the progress in vaccination coverage challenges still remain for underserved and inaccessible children. It is therefore essential to evaluate the immunization coverage at periodic intervals and improve coverage in vulnerable areas.Methods: A cross-sectional study was conducted among 152 children aged 12 to 42 months in urban Chidambaram from September to October 2018. We collected details regarding immunization from vaccination card or mother’s recall. A pretested semi-structured proforma was used to collect sociodemographic variables. Data were collected, compiled and tabulated using microsoft excel and analyzed using SPSS 20.0 version.Results: Complete immunization coverage was 80.3% and 19.7% were partially immunized. Lack of awareness is the major reason for failure of full immunization (63.3%). Immunization coverage was higher when parents studied up to higher secondary or graduates (mother 91.3%, father 87.5%, p value 0.01), father do skilled jobs (91.9%, p value 0.02), among first birth ordered children (88.3%, p value 0.01), children born in healthcare facility and among mothers who received antenatal care during pregnancy (80.8% each, p value 0.04).Conclusions: Lack of awareness, parents’ literacy and occupation, place of birth, antenatal services and number of children in the family are important determinants of immunisation coverage. Apart from strengthening of infrastructure for better delivery of mother and child health services other issues also need to be addressed for better immunization practices.
Study of risk factors associated with breast cancer: a case control study
Authors: Jadhao Ashok R. , Sharma B. K. , Jadhao Sanjivani A. , Tayade Hitesh C.
Published: April 2021

Background: Developing countries are facing double burden of infectious and non-communicable diseases. Omran gave epidemiological transition theory, which can be seen in India also. Lifestyle changes made Indian prone to non-communicable diseases. Cancer is among the most common non communicable diseases in India. Breast cancer contributes one fourth of all cancer burden in India. It is noted that more number of cases are being seen in 25 to 40 years age group. Objective of the study was to study risk factor associated with breast cancer.Methods: Hospital based case control study was conducted in tertiary cancer centre from July 2017 to December 2019. Sample size of 96 cases was calculated, though 100 cases was interviewed and similar number of age group matched controls was selected. Sociodemographic, past history of benign breast lesion, family history of breast cancer, body mass index, waist to hip ratio and reproductive risk factors was assessed.Results: The significant risk factors on multiple logistic regression were (adjusted odds ratios with 95% CI) age at menarche ≤11 years (1.16, 1.025–1.451), waist to hip ratio more than 0.85 (1.61, 1.473–1.963) and history of abortion (1.14, 1.006–1.366).Conclusions: Women with early age of menarche, higher waist to hip ratio and history of abortion were found to be at higher risk of developing breast cancer. Annual screening of high risk women, teaching self-breast examination to all women and promoting physical activity to maintain waist to hip ratio less than 0.85 should be done.
Second-hand smoke exposure prevalence among smokers versus non-smokers and relative change at sub-national level in India: a secondary analysis from Global Adult Tobacco Survey 1 and 2
Authors: Supehia Sakshi , Kapoor Shivam , Lal Pranay , Singh Rana J. , Dhankhar Anushikha
Published: April 2021

Background: Exposure to second-hand smoke (SHS) has been linked to the expanded risk of ill-effects on health every year. This study compared prevalence rates of SHS exposure between smokers and non-smokers within three different settings and states/union territories (UT) in India, during the period 2009-10 and 2016-17.Methods: The data from two rounds of nationally representative cross-sectional Global Adult Tobacco Survey (GATS) conducted in 2009-10 and 2016-17 were used. Further, the sociodemographic variables associated with exposure to SHS at different settings were analysed using multiple logistic regression analysis. All statistical inferences were based on a significance level of p<0.05.Results: Although there was a significant decrease in overall prevalence of SHS exposure among smokers and non-smokers at home, government offices, restaurants and, public transportation and slight decrease in health care facility (p<0.05); increased level of exposure was observed at workplace which was not statistically significant (p>0.05). The prevalence of exposure to SHS varied significantly between smokers and non-smokers and differed greatly among states/UT as assessed by the relative change between GATS-1 and GATS-2. While Maharashtra, Andhra Pradesh and, Odisha were among the best-performing states; Jammu and Kashmir, Chhattisgarh and, Madhya Pradesh were the worst-performers.Conclusions: The results confirmed that the prevalence rates of SHS exposure among non-smokers, were much higher as compared to smokers in all different settings along with state-wise disparities. This calls for the Policymakers for targeted effective enforcement of tobacco control laws, leading to a reduction in the consequences of SHS exposure.
Incubation period of COVID-19: analysis of COVID-19 cases admitted in a tertiary care center, northern district of Kerala, India
Authors: Saraswathy Anitha Subhadra , Sanya Rameela , Kumaran Jayasree Anandabhavan
Published: April 2021

Background: Coronavirus disease 19 (COVID-19) started as pneumonia of unknown cause detected first in Wuhan, China in December 2019 and spread as a pandemic affecting more than 200 countries worldwide. The most common symptoms of COVID-19 are fever, dry cough, breathing difficulty and tiredness. The median incubation period is about 5 days as per current understanding. The present study was done to estimate the median incubation period of COVID-19 cases admitted in a tertiary care center in north Kerala.Methods: This cross-sectional study included COVID-19 cases admitted in a tertiary care center during three months study period.Results: The median incubation period of COVID-19 was estimated to be 4 days (interquartile range 7). It was also found that females, those persons with comorbidities and those who got infected by local transmission had a longer mean incubation period compared to males, those without comorbidities and imported cases, respectively.Conclusions: The median incubation period of COVID 19 was estimated to be 4 days. Factors like presence of comorbidities, gender, type of transmission were found to affect incubation period, but further studies are needed to have a thorough understanding.
Awareness of health insurance policies among cardiac patients visiting a tertiary care cardiac hospital in South India
Authors: Krishnan Archana S. , Pillai Jawahar S. K. , Mondal Ramkrishna
Published: April 2021

Background: Healthcare expenditure is becoming a point of discussion in the recent past. Cardiac problems are the major non-communicable disease burden in the society. Health insurance play a major role to share individual health risks and there by provide better access to health care. In this study an attempt was made to find out the level of awareness of health insurance policies among cardiac patients in a tertiary care hospital.Methods: One hundred and twenty patients were surveyed using a pretested questionnaire comprising of thirty different questions related to health insurance. Simple statistical test and Chi square test was used to assess the association between the variables.Results: Only 41% were aware of health insurance among non-insured patients (n=100). It was found that only 16.7% (N=20) had chosen insurance policy and reason for having taken insurance was to cater to the huge medical expenses (14.2%). 45% patients were opted Insurance due to low premium and good reputation. Majority (42.5%) meet their medical expenses from salary. It was found that majority (55%) were satisfied with the insurance.Conclusions: It is found that less than one fifth of the patients opted for health insurance policy, which is very low. The level of awareness about insurance among the non-insured is also very poor. Study concluded that the awareness of health insurance is very poor especially in rural and semi-rural areas. Continuous awareness creation is needed to enhance the health insurance benefits and various features.
Assessment of knowledge and perception of rain water harvesting among rural population of Kancheepuram District, Tamil Nadu
Authors: V. Pragadeesh Raja , T. Muthukumar , A. Kalaivani
Published: April 2021

Background: Water is a fundamental need for human being, animals and plants to live in the world for drinking and sanitation purpose. The main source of water is rain, and surface water also originates from rain only rain water harvesting is the technique of collection and storage of rain water in surface (or above the ground natural or man-made structures) or in under-ground aquifers (the under-ground water table), before it is lost as surface run-off. Objective of the study was to assess the awareness and the perception about rain water harvesting in rural population of Tamil Nadu.Methods: A community based cross sectional Study conducted among population of residence, Sembakkam, Kancheepuram district, Tamil Nadu. The study duration from June 2019 to July 2019. Data collected through semi structured questionnaire from participants. Data collected was entered in Microsoft (MS) office excel and analyzed in statistical package for the social sciences (SPSS) version 21.Results: In the education status of study population, 75.5% (151) are literate and followed by 24.5% (49) were illiterate. In socioeconomic status most of them from class IV, 36.5% (73) and class III, 33% (66). 90.5% (181) are not have rainwater harvesting their houses, most of them 50.5% are answered financial issues to construct the rainwater harvesting followed by 21.5% they don’t know where to approach.Conclusions: An increasing number of population will soon increase the demand for water consumption. Rainwater harvesting which offers a lot of benefits not just for the users, but also to the government and environment, is a suitable alternative that could minimize the anticipated water supply crisis.
A case study: emerging role of telehealth and local health practitioners during COVID-19 pandemic
Authors: Husain Absar , Akinola Ajoke , Akhtar S. M.
Published: April 2021

This case study investigates the experiences of planning and strategies to respond to a medical emergency and healthcare delivery during the COVID-19 pandemic, the local health practitioners from rural and urban areas of northern India; we included the experiences of telemedicine among the practitioners of Allopathic medicine System, Indian medicine System, and Allied health services. The case study recorded descriptive telephonic interviews about the situation, task, and action towards telehealth. The 35 respondents from Uttar Pradesh, Madhya Pradesh, Delhi, and Rajasthan. Find the results approximately 10-90% of telehealth services increase in clinical and non-clinical facilities. Approximately 95% of healthcare providers adapted telehealth delivery in the pandemic situation. The observation of preparedness in telehealth services and continued effort to address the situation by local health care providers. The status of real-time response to the prevention and control of new incidents. The role of telehealth setting in COVID-19, situation disembarrass through Voice call, text message, picture/video message, and all other possible measures were employed to accumulate maximum clinical information in real-time.
Clinical and epidemiological characteristics and hormonal profile of adult females with acne vulgaris: a cross-sectional study from a tertiary care hospital
Authors: Shah Nidhi , Ali Faaria , Radhakrishnan Aswathy , Chaudhari Parag , Patil Anant , Patil Sharmila
Published: April 2021

Background: To study clinical and epidemiological characteristics and hormonal profile of adult females with acne

Methods: Adult female patients of >25 years of age with acne were enrolled. Demographic profile, habits, location of acne lesions, associated disease and acne flare association with menstrual cycle were noted. Prevalence of abnormalities in testosterone, dihydroepiandrosterone-sulfate (DHEAS), prolactin, luteinizing hormone (LH), follicle stimulating hormone (FSH), LH:FSH ratio, anti-mullerian hormone (AMH), and serum insulin were noted. Ultrasound (abdomen and pelvis) was performed for screening the presence of any abnormality.

Results: Fifty one patients [mean (SD) age 30.96 (4.93) years] were included in the study. Thirty six (70.59%) patients had persistent type of acne. Grade 2 acne was present in 40 (78.43%) patients. Oily skin was seen in 27 (52.94%) patients. Hirsuitism and menstrual irregularity was present in 24 (47.06%) and 13 (25.49%) patients respectively. Pigmentation and scarring was present in 27 (52.94%) and 35 (68.63%) patients respectively. Acne lesions were seen on cheeks in 36 (70.59%) patients. Eight (15.69%) patients had elevated testosterone. DHEAS and prolactin levels were normal in all patients. Elevation of LH and decreased FSH levels were seen in five (9.80%) and three (5.88%) patients respectively. Five (9.80%) patients had elevated LH:FSH level. Raised insulin level was seen in 8 (15.69%) patients.

Conclusions: Derangement of hormonal profile is not very common among adult female patients with acne. However, in some patients laboratory markers of hyperandrogenism are seen.  
Giant pyogenic granuloma complicating a folliculitis decalvans
Authors: Hamich Soumaya , Elgaitibi Fatima Azzahra , Znati Kaoutar , Meziane Meriem , Senouci Karima
Published: April 2021

Pyogenic granuloma or lobular capillary hemangioma is a common and benign vascular proliferation that affects the skin and mucosa. It that can take many forms and be misleading in some cases. Its giant variant is very rare. The pathogenesis is unknown but multiple factors can play a role on its onset. It is considered to be a pseudotumoral reaction to various stimuli, such as trauma, hormonal changes or the use of some medications. We report the case of a 35 years old male patient who presented with a large, ulcerated tumefaction of the scalp evolving since 4 months. The physical examination revealed a crescent shaped large ulcerated tumor with signs folliculitis decalvans in the rest of the scalp. A skin biopsy was made and confirmed the diagnosis of pyogenic granuloma. The treatment consisted of a shave excision of the entire lesion. No recurrences were noted after two years of follow-up. This case illustrates the possible association of pyogenic granuloma with underlying dermatoses such as folliculitis decalvans.
Fuzzy-MOORA Based Optimization of Machining Parameters for Machinability Enhancement of Titanium
Authors: Jhodkar Durwesh , Khan Akhtar , Gupta Kapil
Published: April 2021

The aim of this study is to determine the optimal combination of process parameters when machining commercially pure titanium grade 2. The unification of Multi objective optimization based on ratio analysis (MOORA) and fuzzy approach has applied to optimize the process parameters. Three process parameters i.e. cutting speed, tool overhang, and microhardness have been varied at three levels each and a total of twenty seven experiments have been conducted based on Taguchi’s L27 design of experiment technique. Cutting force, tool flank wear, and average surface roughness have been considered a machinability indicators to measure the process performance. Feed rate and depth of cut have been kept constant. Successful optimization is done and results show that machining titanium at higher cutting speed (140 m/min) and higher tool overhang length (65 mm) with medium hardness (1934 HV) results in lower cutting force, tool flank wear, and surface roughness. Outcomes of the present work reveal that the hybrid fuzzy-MOORA method is convincing enough to obtain the best process parameter combination for the best machinability while machining titanium type difficult-to-machine materials.
Control the Hydraulic Stabilizer Bar to Improve the Stability of the Vehicle When Steering
Authors: Nguyen Tuan Anh
Published: April 2021

The phenomenon of the lateral instability of the vehicle when the steering is one of the extremely serious and dangerous problems. To improve safety and stability, vehicles often are equipped with stabilizer bars at the front and rear axles. However, the passive stabilizer bar cannot guarantee safe and stable performance in dangerous cases. Therefore, the active stabilizer bar is used to replace the passive stabilizer bar. The active stabilizer can automatically generate an anti-roll moment depending on the condition of the vehicle at each time. In dangerous cases, the anti-roll moment of the active stabilizer bar is much greater than the passive stabilizer bar. This research focused on the problem of establishing a spatial dynamics model in combination with a nonlinear double-track dynamic model to describe the state of oscillation of the vehicle when steering. The PID control method is used to control the hydraulic stabilizer bar. The results of the research indicated that when the vehicle was equipped with the hydraulic stabilizer bar, the values of the roll angle, the displacement of the un-sprung mass, the vertical force at the wheel, ... were significantly reduced.
Primeros debates sobre legislación del uso de drogas en Argentina a comienzos del siglo XX: la propuesta del Dr. Leopoldo Bard y su contexto sociohistórico
Authors: Sánchez Antelo Victoria
Published: April 2021

Este trabajo analiza los discursos del médico higienista argentino Leopoldo Bard a partir de tres publicaciones que realizó entre 1923 y 1933 sobre toxicomanías. Las mismas condensan los debates en torno al papel del Estado, de las políticas públicas nacionales, regionales y, particularmente, la influencia norteamericana en Argentina a través de su figura. Las medidas legislativas y políticas de la época, de indudable corte represivo, fueron significativas para los avances del Estado en la esfera privada, la creciente importancia de los cuerpos profesionales en la definición de fronteras materiales y simbólicas sobre lo socialmente aceptable, incluyendo lo relativo al consumo de drogas. También se destacan los múltiples propósitos que parecen satisfacer estas políticas: en el plano local habilitan otras formas de represión de los conflictos derivados de la inmigración mientras que, en el internacional, complacen a los requerimientos norteamericanos.
La lucha contra la poliomielitis: una alianza médico-social, Buenos Aires, 1943
Authors: Testa Daniela Edelvis
Published: April 2021

El presente artículo analiza el surgimiento de una de las organizaciones voluntarias de asistencia social que tuvo una activa participación en la atención sanitaria de la poliomielitis en Argentina: la Asociación para la Lucha contra la Parálisis Infantil. Esta institución fue conformada en la ciudad de Buenos Aires, en 1943, por un grupo de mujeres de sectores sociales altos y medios. En un contexto de incertidumbre biomédica la entidad movilizó recursos materiales y simbólicos para dar respuesta al problema de la rehabilitación de las afecciones físicas permanentes que la enfermedad provocaba en sus víctimas. Utilizando como fuente las memorias institucionales de la organización, se muestra cómo médicos y filántropas constituyeron una alianza médico-social y desarrollaron el interés fundamental de practicar una modalidad de tratamiento –en un contexto donde todo estaba por hacerse– sostenidos en un andamiaje que amalgamaba ideas cristianas con innovaciones de la medicina y la rehabilitación.
Origen y calidad del agua para consumo humano: salud de la población residente en el área de la cuenca Matanza-Riachuelo del Gran Buenos Aires
Authors: Monteverde Malena , Cipponeri Marcos , Angelaccio Carlos , Gianuzzi Leda
Published: April 2021

El objetivo del estudio es analizar el origen y la calidad del agua domiciliaria utilizada para el consumo, en una muestra de hogares del área de la cuenca Matanza-Riachuelo del Gran Buenos Aires, Argentina. Según su origen, el 9% de las muestras de agua provenientes de la red pública, el 45% de las de agua envasada y el 80% de las provenientes de perforaciones o pozos individuales resultaron no potables por exceso de coliformes, Escherichia coli o nitratos. Los individuos de la muestra de hogares en los que la fuente principal de agua para el consumo eran pozos individuales presentaron una probabilidad 55% superior de padecer alguna enfermedad de origen hídrico, probabilidad que llegaría al 87% en el caso de las diarreas y al 160% en el de las dermatitis. El agua para consumo humano en este territorio debería provenir de fuentes centralizadas que aseguren el control de la calidad del agua.
Where the Normal is Crisis: Service Delivery to Underserved Populations during the COVID Pandemic
Authors: Nourpanah Shiva
Published: April 2021

Women and children subject to violence. Refugees. The incarcerated and criminalized. The homeless. Ethnic and racialized minorities. When a global pandemic hits populations that are already vulnerable, racialized, marginalized, historically subject to oppression, and underserved, the civil society organizations mandated to serve them need all their ingenuity and resourcefulness to provide support while following public health guidelines. As the COVID‑19 global pandemic forced the closure of many workplaces and the re-direction of public social life, the daily lives of vulnerable people, many already struggling on the margins of society, and those mandated to serve and support them changed shape drastically in some ways, and in other ways, not so much. My main argument is that the pandemic of 2020 and consequent imposed restrictions brought about a moment of difference in how our society treats those who are usually and in “normal” times pushed to the margins, invisible and overlooked. Policy spotlight, propelled by panic and a global public health crisis, shone on them, rendering them sharply visible.