bluuebunny/crossref_metadata_2025 huggingface dataset:
Is Self-Reported Obstructive Sleep Apnea Associated with Cardiac Distress? A Network Analysis
Authors: Le Grande Michael R. , Beauchamp Alison , Driscoll Andrea , Kerr Debra , Jackson Alun C.
Published: July 2024

Introduction:

The relationship between obstructive sleep apnea (OSA), obesity, various metabolic variables, and psychosocial outcomes is complex. No studies have examined the association between these predictors and disease-specific distress related to heart disease (cardiac distress). We aimed to study the association between OSA and cardiac distress using a network analysis framework.

Methods:

This secondary analysis of an observational cross-sectional study conducted in 2021 consisted of 405 hospital- and community-sourced adults from Australia and the United States who reported an acute coronary event (such as a myocardial infarction, or procedures such as coronary artery bypass graft surgery, or percutaneous coronary intervention) in the previous 12 months. Participants were surveyed in relation to sociodemographic variables, clinical risk factors, comorbidities (including time since event, OSA, obesity, diabetes, hypertension, and hyperlipidemia), and cardiac distress (reported by the Cardiac Distress Inventory Short-Form). These data were subjected to bootstrapped exploratory graph analysis (EGA), which identifies the dimensions of variables that cluster together. Variables that contributed to the EGA dimensions were used to predict cardiac distress using multivariable logistic regression.

Results:

Three distinct dimensions were identified by the EGA: Dimension 1 – clinical risk factors and conditions including OSA, Dimension 2 – variables related to the heart event, and Dimension 3 – variables closely related to cardiac distress. For Dimension 1, only OSA was a significant predictor of cardiac distress in the fully adjusted model (adjusted odds ratio = 2.08, 95% confidence interval = 1.02–4.25, P = 0.044). Further analysis indicated that OSA was associated with physical challenges and changes in roles and relationships.

Conclusions:

This study identified that self-reported OSA is associated with cardiac distress, particularly distress that was associated with physical challenges and changes to roles and relationships. These findings imply that OSA could potentially increase stress in a relationship; however, distress was only assessed from the perspective of the participant with OSA in this study. EGA is a useful method for describing complex associations between diverse predictor variables such as OSA and cardiac distress. Owing to the self-reported aspect of the data, further investigation to confirm study outcomes is warranted.
A Narrative Review on Prolonged Neuropsychiatric Consequences of COVID-19: A Serious Concern
Authors: Theofilis Panagiotis , Oikonomou Evangelos , Vasileiadou Maria , Tousoulis Dimitris
Published: July 2024

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection is characterized by prolonged, postacute sequelae of COVID-19 (PASC). Marked by persistent or new-onset symptoms within 3 months following COVID-19 recovery, PASC significantly affects a diverse spectrum of survivors. Beyond cardiovascular implications, neuropsychiatric PASC demonstrates prolonged symptoms with diverse phenotypic profiles affecting memory, attention, and mood. The pathophysiologic basis points to SARS-CoV-2’s neurotropism, instigating inflammatory responses in the central nervous system. A comprehensive multimodal assessment, integrating psychological evaluations, fluid examinations, neurophysiology, and imaging, emerges as a critical diagnostic approach. Managing neuropsychiatric PASC necessitates personalized interventions to enhance resilience and coping mechanisms, emphasizing the role of physical fitness, creative engagement, and social support in mitigating its impact on identity and well-being. In addition, early initiation of cognitive rehabilitation and cognitive behavioral therapy is proposed to address symptom chronicity, emotional distress, and cognitive dysfunction, enhancing the quality of life. The urgency for targeted interventions, early neuropsychological support, and ongoing research to comprehensively address the multifaceted neuropsychiatric effects of COVID-19 is underscored in this review. Collaborative efforts involving health-care professionals, support networks, and affected individuals are imperative to navigate the evolving landscape of PASC and its persistent neuropsychiatric implications.
Building a healthy nation: A white paper on Olympic sports and the Indian education system
Authors: Kumar Raman
Published: July 2024

ABSTRACT

The Indian education system has produced top-class global corporate leaders in recent decades. The combination of a solid educational foundation, work ethic, adaptability, technical and analytical skills, leadership abilities, networking, entrepreneurial spirit, and cultural values collectively contribute to the success of Indian students and professionals in the corporate world. On the contrary, India’s overall performance in Olympic sports has been modest compared to its population and potential. The education system of any country has a significant role in sporting success. To fully harness the potential of sports in schools, addressing these challenges and creating a supportive environment that values and promotes sporting abilities alongside academic excellence is essential. This will require concerted efforts from various stakeholders, including the schooling system, educational institutions, government, sports organizations, corporate sponsors, and the community. This white paper aims to systematically organize the available knowledge and debates around India’s sporting performance in the background of mainstream education culture. This paper also addresses the systemic devaluation, exclusion, disfranchisement, and stereotyping of sports and sportspersons in India. One key argument put forward in this paper is to extend absolute equivalence to Olympic sports disciplines (e.g., football) at par with general academic disciplines (e.g., mathematics) in terms of examinations and award of qualifications within the mainstream education system of India. And India must host the Olympics before 2047.
Impact of COVID-19 pandemic on the elderly in the United Kingdom: A review study
Authors: Sharma Anurag , Sharma Sucheta
Published: July 2024

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic has significantly altered the lives and lifestyles of several older populations in the United Kingdom. It was important to note how it has affected their physical, mental, and social health and well-being during the first wave of the Covid-19 pandemic. To study the impact of the Covid-19 pandemic and the imposed restrictions on the day-to-day lives of the elderly population in the United Kingdom. A review of the published literature on the first wave of the Covid-19 pandemic and its consequences on the older population in the United Kingdom is done. Search engines used for medical databases were Pubmed, Google Scholar, and Internet Explorer. It was found that physical as well as mental well-being was affected in the elderly citizens of the United Kingdom. Mental health studies noted an obvious increase in anxiety and depressive symptoms. Social isolation and reduced access to healthcare services had a deteriorating impact on their social health. Covid-19-related lockdown and pandemic-associated physical, mental, and social well-being effects have been evident in the elderly population in the United Kingdom. The reasons identified for such findings are lack of physical activity, poor social interactions, social isolation, the perceived threat of a pandemic, and poor access to healthcare facilities.
A study to assess medication adherence and quality of life among epilepsy patients seeking treatment at AIIMS Bhopal
Authors: Pallavi  , Verma Ranjana , Gupta Rajratan , Shafqat Naseema , Phalswal Uma
Published: July 2024

ABSTRACT

Background:

Epilepsy is a disorder of the brain with a permanent predisposition to produce epileptic seizures. There are cognitive, psychological, neurological, and social causes of this condition. It is the second most common problematic neurologic disorder, affecting more than 70 million people throughout the world. More than 65% of the global burden of epilepsy occurs in developing countries.

Objective:

To assess medication adherence and quality of life among epilepsy patients and to find any correlation between medication adherence and quality of life.

Material and Methods:

This descriptive study was conducted on epileptic patients who were seeking treatment at AIIMS Bhopal. Two hundred epileptic patients were enrolled in this study via purposive sampling techniques. Data was collected through face-to-face interview method. The data was analysed using descriptive and inferential statistics

Results:

In this study, a total of 200 patients with epilepsy were found to be eligible to participate; there were 23 patients (11.5%) with low medication adherence, 95 patients (47.5%) with moderate medication adherence, and 82 patients (41%) with high medication adherence. Patients with epilepsy who follow recommended treatment have a good quality of life, particularly in the spiritual sector (169; 85%). The overall quality of life is moderate for 142 patients (71%) and good for 58 patients (29%). Medication adherence and quality of life were shown to be strongly positively correlated, with a Karl Pearson correlation coefficient of 0.67.

Conclusion:

The result of this study concluded that improving medication adherence is important to improving the quality of life among epilepsy patients.
Influence of shift work on sleep quality and circadian patterns of heart rate variability among nurses
Authors: Panwar Aprajita , Bagla Rahul K. , Mohan Mamta , Rathore Bharti B.
Published: July 2024

ABSTRACT

Background:

Shift work implementation is essential for providing continuous patient care in hospitals. However, working in shifts on a routine basis may disrupt the circadian pattern and alter the sleep-wakefulness cycle in nurses. Stress due to shift work can influence the adaptability of the cardiovascular system, produce psychophysiological strain and deteriorate work performance in female nurses.

Objective:

This study investigated the effect of morning and night shift work on sleep quality and circadian patterns governing heart rate variability (HRV) in female nurses working in a tertiary care hospital.

Methods:

Thirty-eight healthy female nurses were recruited. Frequency and time domain parameters of HRV were recorded as markers of cardiac autonomic function. A student t-test was used to investigate differences in HRV between morning and night shift workers. Mann-Whitney non-parametric test was applied for the difference between Pittsburgh Sleep Quality Index (PSQI) scores in the two groups

Results:

Standard deviation of the normal-to-normal interval (SDNN) (msec), total power (ms2) and high-frequency (HF) band power (ms2) were significantly reduced in night shift nurses than in morning shift nurses. The low-frequency (LF)/HF ratio was significantly increased in night shift nurses. The differences in standard deviation of the averages of NN intervals (SDaNN) (msec), root mean square of successive differences between adjacent NN intervals (RMSSD), mean NN, very low-frequency (VLF) band power (ms2) and LF band power (ms2) were not statistically significant. The global PSQI score was significantly higher among night shift workers than in morning shifts.

Conclusion:

Inadequate sleep can disrupt the body’s ability to regulate heart rhythm and increase the risk of cardiovascular diseases and mortality. The research suggests a propensity for autonomic imbalance in night shift workers when compared to their counterparts on morning shifts.
Utility of anthropometry in defining overweight and obesity in urban South Indian children
Authors: Solomon Ritchie S. , Solomon Adlyne R.
Published: July 2024

ABSTRACT

Introduction:

Waist-based indicators of obesity are being used to detect central obesity and are predictive for metabolic syndrome (MS). The aim of the study is to assess the basic anthropometric indices in children, to determine the prevalence of overweight and obesity, and to determine the association between various waist-based measurements and body mass index (BMI).

Methodology:

A cross-sectional study was conducted among children aged 10 to 15 years attending government corporation schools in Chennai. Basic anthropometric measurements were taken. BMI, waist circumference/height ratio (WHtR), and waist circumference/hip circumference ratio (WHR) were calculated. The percentiles (Indian reference cutoffs) were determined for waist circumference (WC) and BMI. The prevalence of overweight and obesity was determined and compared to waist-based parameters.

Results:

Of 820 children, males constituted 47.1%. Stunting was seen in 9.8% and 7.8% were underweight. 8.2% had BMI less than the 3rd percentile. The prevalence of overweight and obese children was 9% and 3.2%, respectively, with female predominance. The majority had WC less than the 5th percentile. The prevalence of children under risk for MS based on WC >70th percentile was 4.5% and based on WHtR >0.5 was 8.2%. A significant association was identified between all waist-based anthropometric measurements to detect children at risk for MS and overweight/obese children as per BMI category. WHtR >0.5 was an indicator of overweight/obese children in logistic regression analysis.

Conclusion:

Early identification of children at risk of MS would require a combination of BMI to detect general obesity and waist-based anthropometric measurements to identify central obesity.
Unsettling trend: The alarming rise of human abuse of veterinary drugs and its consequences
Authors: Sharma Ambika , Choudhary Chahat , Vardhan Gyan , Kumar Vikas , Dhamija Puneet , Kumar Ashish
Published: July 2024

ABSTRACT

Veterinary practitioners often prescribe many controlled drugs to animals that may include sedatives, tranquilizers, and painkillers. Unfortunately, many of these drugs are drugs that can be abused by humans, especially among the pet owners. Adequate measures are required to prevent or detect the misuse of veterinary drugs. In this article, the phenomenon of the rising misuse of veterinary medications by humans and their potential health hazards which can accompany the unsettling trends in society has been highlighted. This article aims to shed light on the extent of issues, exploring reasons behind human abuse and its consequences.
Work and health habits of Thai physicians
Authors: Tangjitgamol Siriwan , Bunsiricomchai Paisan , Kaewwanna Watcharagan , Ativanichayapong Natapon , Parinyachet Supattra , Manusirivithaya Sumonmal
Published: July 2024

ABSTRACT

Background:

Physicians usually have a high responsibility in caring for people. Many times, they encounter work-life imbalances that can impact both their personal health and the quality of medical services they provide.

Objective:

To evaluate the works and health habits of Thai physicians.

Methods:

Thai physicians who participated in the hospital’s Corporate Social Responsibility “Save Doctors’ Heart” project, conducted between February 14, 2022 and October 31, 2022, were invited to participate in the study. Data collected was personal data, work habits, including workplace, work hours, and health habits, including fiber in the diet, exercise, sense of well-being, history of health surveillance, and health coverage system. The characteristic features associated with their work and health habits were studied

Results:

The responses to each question varied among the 1,244 physicians who agreed to join the study. The median age was 45.0 years (IQR 39,56 years). Almost all (98.6%) were still active in medical practice, with >1 workplace in 14.7%. Nearly half (44.5%) worked >40 hours per week. Most reported a moderate to high fiber diet (80.8%), but only 29.7% exercised >3 days per week. Some degree of stress was revealed in 82.1%, being moderate to severe in 25.8%. The younger physicians with less exercise were significantly associated with moderate/severe stress. Only slightly more than half (53.0%) had a good sense of well-being. Nearly 30% had irregular health surveillance. The two most common reasons were unavailability/no time and having no symptoms.

Conclusion:

Thai participating physicians were still active professionally and had mixed health habits. Most consumed a moderate to high fiber diet and had regular health surveillance; however, with less exercise and some degree of stress. More than half were self-assessed to have a good sense of well-being.
Analysis of occurrences and causes of abnormal liver function in 109 patients with COVID-19
Authors: Deng Man-Ling , Min Fu , Peng Jing-Lin , Yang Xia , Dai Yan-Dan , Yang Xue-Feng
Published: July 2024

ABSTRACT

Context:

COVID-19 is a novel coronavirus pneumonia, which is related to abnormal liver function. Thus, it is important to explore the occurrences and causes of abnormal liver function with COVID-19.

Methods:

We chose 109 patients with COVID-19 in 2020 and studied the relationship between gender, age, basic diseases, antiviral drug treatment, disease classification, and abnormal liver function, and analyzed the causes of abnormal liver function in patients with COVID-19

Results:

Among patients, 46 (42.20%) had abnormal liver function at admission; 37 (80.43%) had mild abnormal liver function; and 9 (19.57%) had severe liver function. Compared with other age groups, the abnormal rate of serum ALP in the group younger than 21 years old were the highest (P < 0.05). The abnormal rates and concentrations of serum ALT, AST and γ-GT in the male groups were higher than in female groups (P < 0.05), basic disease group were higher than those in the non-basic disease group (P < 0.05). Serum γ-GT concentration after 1 week of antiviral treatment was higher than that before treatment (P < 0.05). The abnormal rate of ALT and AST at discharge was lower than that after antiviral treatment for 1 week (P < 0.05). Serum TB and AST concentrations at discharge were lower than those before treatment (P < 0.05). Serum AST and γ-GT concentrations in severe/critical type group were higher than those in mild or ordinary type group (P < 0.05)

Conclusions:

In this study, we found male sex, basic diseases, antiviral drugs, and severe/critical types are related to the occurrence of abnormal liver function in COVID-19 patients.
A retrospective analysis of the trends in the prevalence of female genital mutilation and associated factors among women of reproductive age in Nigeria 2011–2021
Authors: Sanni Felix O. , Sanni Elizabeth A. , Onyeagwaibe Collins , Ahamuefula Tukwasi
Published: July 2024

ABSTRACT

Background:

Female genital mutilation (FGM) is widely acknowledged globally as a violation of the fundamental human rights of girls and women. FGM is still widely practiced in Nigeria but at diminishing rates. Primary care physicians must educate and campaign to end this hazardous practice in Nigeria, especially in high-incidence areas. This study fills the knowledge gap by identifying FGM determinants to help policymakers reduce it.

Method:

The study employed a retrospective cross-sectional design using data from the United Nations International Children’s Emergency Fund for 2011, 2016–2017, and 2021. The sampling involved multistage cluster sampling. Data analysis utilized IBM-SPSS, presenting FGM prevalence across years and exploring associations with various factors.

Results:

This study analyzed 63,365 Nigerian women across a decade (2011, 2016–2017, and 2021). FGM awareness fluctuated (35.1% in 2016–2017, 33.0% in 2011, and 31.9% in 2021), while FGM prevalence increased from 46.6% (2011) to 69.5% (2021). Education correlated with lower FGM prevalence. Geographic disparities were observed, with the Southwest having the highest (70.1%) and the Northeast having the lowest (34.5%) prevalence. Religion influenced FGM rates, with Christians (54.2%) and those with other/no religion (58.0%) showing higher rates than Muslims (52.6%). Urban women had a slightly lower prevalence (52.6%) than rural women (54.2%), and wealth quintiles displayed variations. Variability was also evident among states, ranging from 2.0% to 86.3%. Daughters’ circumcision was influenced by maternal circumcision status, education, region, religion, and wealth quintile. Common FGM procedures involved removing genital flesh (63.7%) and nicking without removal (55.1%), often performed by nurses/midwives (63.7%).

Conclusion:

The study emphasized the urgent need for continuous awareness campaigns and education to combat FGM among Nigerian women. Education emerged as a critical factor in reducing FGM, highlighting the importance of investing in girls’ education.
Clinical cohort of nonalcoholic fatty liver disease in a primary care setting
Authors: Gips Julia R. , Yanek Lisa , Wu Jiajun , Hamilton James P. , Woreta Tinsay A. , Clark Jeanne M.
Published: July 2024

ABSTRACT

Background and Aims:

Nonalcoholic fatty liver disease (NAFLD) is increasingly common, and primary care physicians (PCPs) are often the first to diagnose NAFLD. While guidelines on NAFLD management in primary care exist, there are limited data on clinical practice patterns.

Approach:

We gathered data from over 370,000 patients with at least one PCP visit between July 2016 and September 2023. Using ICD-10 codes to identify patients with a diagnosis of NAFLD or Nonalcoholic Steatohepatitis (NASH), we extracted demographics, comorbidities, laboratory results, prescriptions, imaging orders, and referrals to describe their care.

Results:

We identified 10,334 patients with a diagnosis code of NAFLD (93.1%) and/or NASH (16.7%) during a PCP visit. Just over half (54.8%) were female, mean age was 52.8 years, and mean BMI was 33.2 kg/m2 with 90% having overweight or obese. More than 50% had hypertension and hyperlipidemia, and 38% had diabetes. At the diagnosis visit, 2.7% had ultrasound elastography ordered, 2.7% liver biopsy, and less than 1% magnetic resonance elastography. During follow-up ranging from 0 to 7 years, patients had a mean of 15 encounters, during which 4% were diagnosed with fibrosis or cirrhosis. Only 24.2% of patients were referred to a nutritionist and 18% had an appointment, and only 0.7% were referred to hepatology and 3.8% saw a hepatologist.

Conclusion:

PCPs have not widely implemented clinical practice guidelines for NAFLD, resulting in suboptimal care including for the substantial minority with fibrosis or cirrhosis. Patients might benefit from targeted NAFLD education for PCPs and improved decision and management support.
Assessing the knowledge and skill of ASHA community health workers in blood pressure measurement and primary care of hypertension
Authors: Dewangan Mukesh , Garg Samir , Nanda Prabodh , Sahu Ashu , Xalxo Lalita , Tandan Pradeep , Quereishi M Jawed , Sahu Anand Kumar
Published: July 2024

ABSTRACT

Introduction:

India has a high burden of hypertension, and community health workers (CHWs) can contribute to its primary care. Studies of small-scale interventions have shown that trained CHWs can be useful contributors to hypertension care. No assessments are available in India on effectiveness of CHW training when conducted on a large scale.

Methods:

A study was conducted in Chhattisgarh, where 38,000 Accredited Social Health Activist (ASHA) CHWs had been trained in blood pressure (BP) measurement and counselling skills related to hypertension. The study involved a skill test and a knowledge test with ten points each, administered to two representative samples of trained CHWs – 433 in rural areas and 422 in urban slums.

Results:

The mean skill score out of 10 was 7.79 (7.59–7.99) and 8.11 (7.93–8.29) for the rural and urban CHWs, respectively. Around 75.3% (71.0–79.1%) of the rural and 80.3% (76.2–83.9%) of urban CHWs were able to score 70% (7 out of 10) or higher in the skill test. The mean knowledge score out of 10 was 8.18 (8.04–8.33) and 8.82 (8.78–8.93) for the rural and urban CHWs, respectively. Around 83.2% (79.3–86.4%) and 95.0% (94.4–96.7%) of the rural and urban CHWs, respectively, were able to score 70% or higher in the knowledge test.

Conclusion:

The ASHAs in Chhattisgarh demonstrated the necessary competence to contribute to BP measurement and primary care of hypertension. It shows feasibility of training a large number of CHWs in such skills. Efforts to equip and support the 1 million strong cadre of ASHAs across India need to be speeded up.
Nutritional status, food security and other correlates among adult tuberculosis patients in a block of Murshidabad district, West Bengal
Authors: Roy Avik K. , Adhikary Mrinmoy , Bandyopadhyay Prithwish , Ghosh Ritu , Das Dilip K.
Published: July 2024

ABSTRACT

Background:

Tuberculosis (TB) and malnutrition are epidemiologically interrelated two major public health problems in India. Food security also influences nutritional status. This aspect needs evaluation in diverse geographical areas. This study aimed to assess the level of food security, nutritional status and correlates among adult TB patients in a block of Murshidabad, West Bengal.

Methods:

This cross-sectional study was undertaken in the Nabagram block of Murshidabad district during April–July 2023. All adult (≥18 years) patients registered under the Tuberculosis Unit of the block during a reference period of 6 months (October 2022–March 2023) were considered study subjects. Eighty such eligible participants recruited randomly were interviewed with a pre-designed schedule for socio-demographic and programmatic characteristics. Household food security was measured using a validated U.S. Household Food Security Survey Module. Anthropometric measurements were taken, and nutritional status was determined based on body mass index. Statistical Package for the Social Sciences (SPSS) version 26 was used for analysis.

Results:

Among 80 TB patients, 51% were underweight and 20% were severely underweight. The majority (90%) of them had high or marginal food security, and 10% had low or very low food security. On multivariable logistic regression, Hindu religion (adjusted odds ratio (AOR): 6.74, 95% confidence interval (CI): 2.12–29.39), presence of any chronic morbidity (AOR: 11.61, 95%CI: 2.71–49.78) and receipt of dietary counselling by a health worker (AOR: 7.25, 95%CI: 1.22–43.13) appeared as predictors of underweight.

Conclusions:

Underweight among TB patients is quite prevalent in the area, and few programmatic interventions are influencing factors. This underscores the importance of nutritional counselling services and the universal provision of Poshan benefits.
Understanding pediatric snakebites: Clinical and epidemiological insights from a healthcare center in Bihar, India
Authors: Kumar Rajan , Kumar Manoj , Kumar Deepak , Raj Akanksha , Sheikh Nishat A.
Published: July 2024

ABSTRACT

Background:

Snakebites are a common medical emergency and occupational hazard for children in India, particularly in rural areas where poverty is prevalent. However, there is limited data on the epidemiology of snakebites on the Indian subcontinent.

Objective:

This cross-sectional, observational study aims to investigate the epidemiology, major clinical manifestations, and outcomes of snakebites in children under the age of 15 who were admitted to a tertiary care center in Bihar, a state in East India, and draw attention to this public health concern.

Methods:

A cross-sectional observational study was conducted at the Department of Paediatrics, Patna Medical College and Hospital, Patna. The study included all cases of snakebites with features of envenomation involving patients less than 15 years of age who were brought to the department over a 2-year period. Data were collected using a data collection form and analyzed using the Statistical Package for the Social Sciences, version 11.0 (SPSS Inc., Chicago, IL, USA).

Results:

A total of 59 cases were recorded, with 62.71% (n = 37) being male and 37.28% (n = 22) being female. Kraits were responsible for 38.9% (n = 23) of cases, vipers for 42.3% (n = 25), and cobras for 5% (n = 3). Fang marks were present in 67.7% (n = 40) of cases, and the majority of bites (84.7%, n = 50) occurred on a lower limb during the day. The age distribution showed that 16.9% (n = 10) were below 5 years old, 44% (n = 26) were between 5 and 10 years old, and 22% (n = 13) were above 10 years old. Traditional treatment was used in 44.7% (n = 22) of cases, with the most common treatments being local incision + tourniquet (22%, n = 13) and no traditional treatment (55.9%, n = 33). The highest number of cases occurred during July–September (35.5%, n = 21).

Conclusion:

Snakebites are a significant public health issue in Bihar, India, with the majority of cases occurring in rural areas. The study highlights the importance of increased awareness and preparedness among healthcare providers and the general public, particularly during the monsoon season. Early hospital transfer, prehospital management, and prevention should be promoted through regular public health initiatives.
Outcome of Fournier’s gangrene in relation to Fournier Gangrene Severity Index (FGSI) score
Authors: Kundan Meghraj , Ambedkar Shivlok N , Kumar Rambharosh , Nyekha Vekhotso
Published: July 2024

ABSTRACT

Introduction:

Fournier’s gangrene is a rapidly progressive necrotizing fasciitis, involving perineum mainly. The purpose of the study is to evaluate etiology, treatment, and outcome of Fournier’s gangrene so that such type patient’s management can be done by primary care physicians with best outcomes.

Method:

This was a retrospective study including 156 patients, treated for Fournier’s gangrene, between Jan 2012 and Dec 2018. The outcome and prognosis of Fournier’s gangrene were reviewed.

Result:

The mean age and mode among survival patients were 47.94 ± 14.9 and 60 years, and the mean age and mode in nonsurvival patients was 47.64 ± 15.9 and 65 years. The most common predisposing factor was diabetes mellitus (n = 49, 31.4%) having mortality rate was 9% (n = 14). Most common causative bacteria were E. coli. In the study, the survival rate was 100% in patients having Fournier Gangrene Severity Index (FGSI)≤3. As FGSI increased from 3, the mortality rate increased.

Conclusion:

Fournier gangrene is a surgical emergency. Early diagnosis, serial surgical debridement, and broad-spectrum antibiotics decrease the mortality and morbidity of patients. The sensitivity and specificity of FGSI determine the prognosis of Fournier’s gangrene. FGSI is a simple method to know the severity and prognosis.
Yoga and nutritional therapies for promoting health-related quality of life in persons with metabolic syndrome—An interventional observational study
Authors: Sorout Jitender , Kacker Sudhanshu , Saboo Neha , Kumar Munesh
Published: July 2024

ABSTRACT

Introduction:

A group of related risk factors known as central obesity, elevated blood pressure, impaired fasting glucose, elevated triglycerides (TGs), and low levels of high-density lipoprotein (HDL) are collectively referred to as metabolic syndrome (MetS). A low quality of life (QoL) in terms of health is linked to MetS. This study sought to determine how lifestyle modifications affected the health-related quality of life (HRQoL) of primary care patients with MetS.

Materials and Methods:

In this study, we randomized 300 subjects diagnosed with MetS as per the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria, into control, yoga, and yoga + diet groups according to their intervention which was given for 6 months. Socio-demographic, anthropometric, and physiological and biochemical parameters were collected at baseline, 3 months, and 6 months. The 36-Item Short Form Health Survey (SF-36) was also used to assess HRQoL.

Results:

The results of this study indicate that yoga + diet and yoga intervention led to significant decrease in metabolic risk factors, such as waist circumference (WC), systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting blood glucose (FBG), TGs, and increase in HDL at 3 months and 6 months from baseline. SF-36 score also showed increment (from 0 score to 100) at 3 months and 6 months, which indicates improvement in HRQoL.

Conclusion:

Dietary changes and yoga are useful strategies for reducing the risk of MetS, which improves QoL in relation to health. Incorporating yoga practices and advocating a balanced diet within primary care systems can significantly benefit individuals with or at risk of MetS.
Falling into complexity: A case of digitalis-induced fall, trauma, symptomatic bradycardia, and syncope
Authors: Ravikumar Rajathadri H. , Pegu Baby , Bansal Himanti , Soni Kapil Dev
Published: July 2024

ABSTRACT

Digoxin, a cardiac glycoside, functions by inhibiting the sodium potassium ATPase pump. It’s crucial to note that digoxin has a very narrow therapeutic range. Its serum level vary due to changes in body weight, age, renal function, hepatic impairment and concomitant drug therapy. Chronic toxicity can lead to different types of arrrythmia,which span from heart blocks to ventricular tachycardia.This report present a case of an elderly male, where Digoxin toxicity resulted in syncope and mild traumatic brain injury. Initially upon patient’s presentation ECG indicated myocardial infarction, subsequently bradycardia and complete heart block. The patient had a known history of chronic kidney disease and was prescribed 0.25mg of digoxin regularly without dose adjustment, which might have resulted in reduced digoxin elimination, leading to toxicity. Thus this case demonstrates a classic presentation of digoxin toxicity. Multiple risk factor such as old age, impaired renal function with continued digoxin treatment without dose adjustment was likely the cause of toxicity.
Fatty liver disease - non alcoholic to metabolic - A transition of concepts!!
Authors: Bawiskar Nipun , Acharya Sourya , Kumar Sunil
Published: July 2024

ABSTRACT

Metabolic dysfunction associated fatty liver disease (MAFLD) was a concept suggested lately. Initially, the only criterion for the diagnosis of MAFLD was the absence of alcohol intake. With rising prevalence and studies assessing this condition, certain “positive criteria” were put forth. Experts from 22 countries proposed a simple yet comprehensive definition for the condition independent of other liver diseases. The presence of hepatic steatosis in addition to diabetes mellitus type 2, metabolic dysregulation, and obesity is generally observed. Criteria to define MAFLD-associated cirrhosis were also proposed. Reaching an agreement on MAFLD criteria will help define a protocol (for example: for International classification of Diseases (ICD) - coding), which will improve clinical care and advance the clinical and scientific field of liver research. As it is a condition that increases the risk of diabetes mellitus, chronic kidney disease (CKD), cirrhosis, hepatocellular carcinoma, and cardiac disorders it is important to recognize it at an early stage which makes it essential part of family medicine and primary care.
Influences of role models and other factors on physical activity amongst 6 to 16 years overweight and obese students
Authors: Batish Rohit , Oberoi Simmi , Singh Harmanjeet , Jain Ira , Singh Amandev , Garg Arsh , Suri Bani , Kaur Avneet
Published: July 2024

ABSTRACT

Background:

Physical activity is an essential aspect of living a healthy lifestyle, which offers a myriad of benefits for both the body and the mind. Nonetheless, a family history of obesity can pose significant challenges to achieving and maintaining a healthy weight, which is further exacerbated by the academic stress. Individuals who have a role model that prioritizes physical activity are more likely to develop positive and healthy habits in their lives.

Objectives:

The study aimed to examine how role models affect physical activity and its impact on addressing challenges of family obesity history and academic stress in school children.

Methods:

This cross-sectional study was conducted from October 2019 to April 2020 in three schools in Amritsar district selected by lottery method of simple random sampling. Out of 4226 students, 355 overweight and obese students were interviewed regarding their physical activity. An informed written assent and consent was taken from the children and guardians respectively. Mothers of 6 to 11-year-old students and students aged 12 to 16 were interviewed using a pre-designed, validated, semi-structured questionnaire.

Results:

51.3% had a family history of obesity while 14.9% and 14.6% of parents of overweight students had hypertension and diabetes, respectively. Over half (52.7%) lacked interest in physical activity and almost 33.5% of males were inactive. Students who chose movie actors as role models (71.1%) and those who found their role models’ information reliable (83.2%) were more likely to participate in physical activity. Of the 247 students who were knowledgeable about healthy living, a significant majority of 70.4% engaged in physical activity while 76% of overweight/obese students reported academic stress as a barrier.

Conclusions:

Study shows majority engage in physical activity regardless of gender. Over 70% have family history of obesity and healthy lifestyle knowledge. Stress reduces physical activity and students with movie/sports/fitness role models have better activity levels. Reasons for not engaging included dislike for sports and lack of time.
A retrospective study of prostate-specific antigen and international prostate symptoms scores from participants at a men’s health screening initiative in Trinidad
Authors: Khan Raveed , St. Hill Ramona , Awe Olusegun , Bhola O’Reon , Orumwense Osayimwense , Deosaran Pavitra , Seecharan Priya , Avula Puneeth , Mohammed Rafiah , Terapalli Ashni , Jardine Rebecca M.
Published: July 2024

ABSTRACT

Background:

This study describes the characteristics of men attending a primary health care screening initiative, determines the proportion of men who have elevated International Prostate Symptom Score (IPSS) scores and prostate-specific antigen (PSA) levels, and determines any correlation between these scores as indicators for benign prostatic hyperplasia (BPH) or prostate cancer.

Methods:

Data were collected from all patient records during men’s health screening initiatives that occurred in December 2018, January 2019, and March 2019 in Trinidad and Tobago. A total of 350 medical records were analyzed to record patient demographics, PSA levels, and IPSS scores. Analysis of the data was performed with the use of Statistical Package for the Social Sciences software (version 27).

Results:

Most men who attended the screening initiative belonged to the 61–65 age group (20.57%), with more than half of the men being married (57.71%) and employed (52.57%) and of patients with comorbidities (17%), the most prevalent included hypertension (6%) and diabetes mellitus (3.7%). A mean PSA level of 2.94 ng/ml and a mean IPSS of 7.62 were recorded. Moreover, 11.5% of the males had elevated PSA levels (>4 ng/ml) and 32.9% had elevated IPSS levels (>8). There were correlations between PSA and IPSS values (r = 0.161 and P = 0.006). Age was a predictor of both IPSS and PSA values (r = 0.214, P = 0.000 and r = 0.192, P = 0.000, respectively). Among diabetic participants, a small but significant correlation between IPSS and diabetes was shown (r = 0.223, P = 0.028). As a predictor of elevated IPSS, diabetes had an odds ratio of 1.132 (95% confidence interval (CI): 1.021–1.255).

Conclusion:

Our findings are similar to those described in previous studies; however, further investigations are required to fully describe the relationship between PSA and IPSS. This may assist in advancing screening measures and improving health outcomes for men with BPH and prostate cancer. Primary care physicians should recognize the possible association between BPH and diabetes mellitus and offer appropriate screening where indicated.
Assessment of clinical and histopathological characteristics in COVID-19-associated mucormycosis (CAM) patients correlating with outcome: A hospital-based cross-sectional study
Authors: Gupta Rakesh K. , Nagarkar Nitin M. , Chowhan Amit K. , Mehta Rupa , Singh Alok , Simon Ankita
Published: July 2024

ABSTRACT

Background:

The second wave of the COVID-19 pandemic led to a very dreaded complication of mucormycosis. Immunosuppressive action of the COVID-19 virus, co-morbidities, for example, diabetes mellitus (DM), hypertension, use of steroids, and humidified oxygen, are among the important factors that make the patients susceptible to developing mucormycosis.

Objective:

The present study was conducted to identify and understand all the significant histological changes including the type and extent of tissue involvement, the pattern of inflammation, the volume of fungal hyphae, hemorrhage, etc., in patients with COVID-19 associated mucormycosis (CAM) and correlate with clinical outcome.

Method:

It was a retrospective cross-sectional observational study involving all the patients of CAM, who underwent debridement or biopsy over a period of 5 months, from April 01, 2021, to August 31, 2021. CAM was classified based on the radiological evaluation, clinical features, and organs involved. Different demographic, clinical, laboratory, and histologic parameters were recorded. The variables were assessed for their association with poor clinical outcomes using multiple logistic regression. P < 0.05 was considered statistically significant.

Results:

A total of 146 patients were included in the study with a mean age of 49.4 years and 71.2% were male. Sino-naso-palatal was the most common type of CAM (32.9%), while sino-naso-cerebral was the least common (14.3%). DM was present in 54.1% of patients, out of which 26.6% were recently diagnosed. The death occurred in 21.9% of patients. Maximum mortality was observed in CAM of sino-naso-cerebral involvement (42.9%). Total leucocyte count (TLC) [OR = 0.87; 95%CI: 0.76-0.97; P = 0.02] and C-reactive protein (CRP) [OR = 0.97; 95%CI: 0.96-0.99; P = 0.008] were significantly associated with poor outcomes. Other factors, that is, high prothrombin time, DM, ferritin, and the involvement of muscle, skin, and cartilage, were also associated with poor clinical outcomes but were not statistically significant. Similarly, high fungal volume and the presence of thrombosis were also associated with poor outcomes but were not statistically significant.

Conclusion:

CAM more commonly affects males with co-morbidities. TLC and CRP were significantly associated with poor outcomes. Histologically, the involvement of skin, muscle, and cartilage and the presence of excessive fungal hyphae and thrombosis were also associated with poor outcomes.
A postmortem study of demographics and severity of thoracoabdominal injuries among patients attending a teaching hospital in northeast India
Authors: Datta Anupam , Siddappa Santhosh C. , Dey Debaleena , Nath Anamika
Published: July 2024

ABSTRACT

Introduction:

The global estimate reflects 4.4 million injury-related deaths every year and the thoracoabdominal region is frequently injured since it is a wide area.

Methods:

An autopsy-based cross-sectional study was conducted using a convenient sampling technique for three years. A Chi-square test was conducted for categorical variables. A P value of less than 0.01 was considered statistically significant.

Results:

Out of 80 cadavers, the male:female ratio was 1:0.31. The commonest age group was 20–29 years. Victims of road traffic accidents were 54 (67.5%) followed by falls from height 10 (12.5%). External thoracic injuries were commoner than internal and vice versa in abdominal injuries. Liver injuries were major in number. Combined thoracic-abdominal and associated injuries were observed in 67 (83.75%) victims. The commonest cause of death was craniocerebral injury combined with hemorrhagic shock (36.25%). Eighteen (22.5%) victims died on the spot having an Injury Severity Score (ISS) of 73.37 followed by a survival time of 1–7 days in 17 (21.25%) cases. A significant correlation was found between ISS and survival period.

Conclusion:

All thoracic and abdominal injuries represent a possible increase in morbidity and mortality; hence, working toward their prevention and timely intervention is necessary.
Serotype-specific clinical features and spatial distribution of dengue in northern Kerala, India
Authors: Vaman Raman Swathy , Valamparampil Mathew J. , Somasundaran Aswathi Kodenchery , Balakrishnan Anjali Jayasree , Janardhanan Prajit , Rahul Arya , Pilankatta Rajendra , Anish Thekkumkara Surendran
Published: July 2024

ABSTRACT

Background:

Collection and compilation of spatial, meteorological, entomological, and virological data are critical in mitigating climate-sensitive emerging infections like dengue. This study was a holistic attempt to understand the dengue situation in the Kasaragod district of Kerala, India.

Methods:

This cross-sectional study was conducted in 13 health institutions from June to July 2021. Adult patients presenting with fever and testing positive for NS1 ELISA were subjected to Dengue RT-PCR and serotyping. The spatial and clinical features of the RT-PCR-positive patients, the district’s meteorological data, and the vector indices were studied.

Results:

The pre-epidemic months were marked by intermittent rainfall, peak ambient temperature and high larval indices. Among the 136 dengue RT-PCR patients studied, 41.2% had DENV2 followed by DENV1 (22.8%), DENV3 (5.9%) and DENV4 (4.4%); with 25% mixed infections. DENV1 showed a higher risk of gastrointestinal manifestations (80.6%, p=0.019) and musculoskeletal symptoms (77.4%, p=0.026) compared with other serotypes.

Conclusions:

In the context of dengue hyperendemicity, the possibility of an emerging serotype’s dominance coupled with the mixing up of strains should warn the health system regarding future outbreaks. Furthermore, the study emphasizes the importance of monitoring larval indices and the window of opportunity to intervene between environmental predictors and dengue outbreaks.
Neutrophil-to-lymphocyte ratio in community-acquired pneumonia: Diagnostic potential and its limitations in the COVID era
Authors: Abrol Ritika , Ahmed Sohaib , Khanduri Rakhee
Published: July 2024

ABSTRACT

Objective:

To determine the diagnostic potential of neutrophil-to-lymphocyte ratio (NLR) as a POC marker to discriminate tuberculous from non-tuberculous CAP and identify limitations if any at a tertiary care centre in Uttarakhand, India.

Methods:

225 patients presenting with respiratory complaints were recruited from the General Medicine clinics and investigated. NLR was noted at onset and correlated with final diagnosis.

Results:

NLR from both groups did not exhibit a statistically significant difference. The area under curve (AUC) exhibited an accuracy of 49.1% in differentiating tuberculous from non-tubercular CAP, and an anomalous effect of prior steroid exposure on NLR was noted as a limitation.

Conclusion:

The disparity of our results from previous studies warranted a review of literature which rendered a significant limitation of NLR. The NLR is affected by catecholamines, which makes the marker unreliable in patients with exogenous steroid exposure. This was not noted in the previous studies. We presume indiscriminate steroid usage in the pandemic confounded our findings. We propose that this limitation be accounted for in future studies so that NLR’s true utility may be identified.