bluuebunny/crossref_metadata_2025 huggingface dataset:
Demographic & clinical profile of patients with COVID-19 at a tertiary care hospital in north India
Authors: Soni Shiv Lal , Kajal Kamal , Yaddanapudi L.N. , Malhotra Pankaj , Puri Goverdhan Dutt , Bhalla Ashish , Singh Mini P. , Sehgal Inderpaul Singh , Koushal Vipin , Varma Neelam , Biswal Manisha , Lakshmi P.V.M. , Sharma Sadhna , Suri Vikas , Deepy Z. , Ram Sant , Yadav Jaivinder , Pandey Navin , Sharma Prashant , Malik Nabhajit , Goyal Kapil , Mehra Aseem , Sahoo Swapnajeet , Mohindra Ritin , Francis Jijo , Bhargava Mudit , Singla Karan , Babu Preena , Verma Amiy , Khaire Niranjan Shiwaji , Guru R.R.
Published: December 2021

Background & objectives:

The COVID-19 pandemic emerged as a major public health emergency affecting the healthcare services all over the world. It is essential to analyze the epidemiological and clinical characteristics of patients with COVID-19 in different parts of our country. This study highlights clinical experience in managing patients with COVID-19 at a tertiary care centre in northern India.

Methods:

Clinical characteristics and outcomes of consecutive adults patients admitted to a tertiary care hospital at Chandigarh, India, from April 1 to May 25, 2020 were studied. The diagnosis of SARS-CoV-2 infection was confirmed by real-time reverse transcriptase polymerase chain reaction (RT-PCR) on throat and/or nasopharyngeal swabs. All patients were managed according to the institute's consensus protocol and in accordance with Indian Council of Medical Research guidelines.

Results:

During the study period, 114 patients with SARS-CoV-2 infection were admitted. The history of contact with COVID-19-affected individuals was available in 75 (65.8%) patients. The median age of the patients was 33.5 yr (13-79 yr), and there were 66 (58%) males. Of the total enrolled patients, 48 (42%) were symptomatic. The common presenting complaints were fever (37, 77%), cough (26, 54%) and shortness of breath (10, 20.8%). Nineteen (17%) patients had hypoxia (SpO2<94%) at presentation and 36 (31%) had tachypnoea (RR >24). Thirty four (29.8%) patients had an accompanying comorbid illness. Age more than 60 yr and presence of diabetes and hypertension were significantly associated with severe COVID-19 disease. Admission to the intensive care unit (ICU) was needed in 18 patients (52%), with three (2.6%) patients requiring assisted ventilation. Mortality of 2.6 per cent (3 patients) was observed.

Interpretation & conclusions:

Majority of the patients with COVID-19 infection presenting to our hospital were young and asymptomatic. Fever was noted only in three-fourth of the patients and respiratory symptoms in half of them. Patients with comorbidities were more vulnerable to complications. Triaged classification of patients and protocol-based treatment resulted in good outcomes and low case fatality.
Feasibility, efficiency & effectiveness of pooled sample testing strategy (pooled NAAT) for molecular testing of COVID-19
Authors: Prakash Shantanu , Prakash Om , Mishra Hricha , Khan Danish N. , Shukla Suruchi , Pandey Ajay , Rade Kiran , Gupta Nivedita , Bhatt M.L.B. , Jain Amita
Published: December 2021

Background & objectives:

During the current COVID-19 pandemic, a large number of clinical samples were tested by real-time PCR. Pooling the clinical samples before testing can be a good cost-saving and rapid alternative for screening large populations. The aim of this study was to compare the performance characteristics, feasibility and effectiveness of pooling nasal swab and throat swab samples for screening and diagnosis of SARS-CoV-2.

Methods:

The pool testing was applied on a set of samples coming from low COVID-19 positivity areas. A total of 2410 samples were tested in pools of five samples each. A total of five pools of five samples each were generated and tested for E gene.

Results:

Of the total of 482 pools (2410 samples) 24 pools flagged positive. Later on pool de-convolution, a total of 26 samples were detected as positive for COVID-19, leading to positivity of about one per cent in the test population. For the diagnosis of individual samples, the pooling strategies resulted in cost savings of 75 per cent (5 samples per pool).

Interpretation & conclusions:

It was observed that testing samples for COVID-19 by reverse transcription (RT)- PCR after pooling could be a cost-effective method which would save both in manpower and cost especially for resource-poor countries and at a time when test kits were short in supply.
Performance evaluation of Truenat™ Beta CoV & Truenat™ SARS-CoV-2 point-of-care assays for coronavirus disease 2019
Authors: Basawarajappa Shantala Gowdara , Rangaiah Ambica , Padukone Shashiraja , Yadav Pragya D. , Gupta Nivedita , Shankar Sathyanarayan Muthur
Published: December 2021

Background & objectives:

The rapid diagnosis of coronavirus disease 2019 (COVID-19) is a significant step towards the containment of the virus. The surge of COVID-19 cases in India and across the globe necessitates a rapid and sensitive molecular assay. Rapid point-of-care (PoC) assays (Truenat Beta CoV and Truenat SARS-CoV-2 assays) for the diagnosis of COVID-19 have been developed which are expected to shorten the turnaround time of reporting of results and also can be used for field investigations of COVID-19. The objectives of the study were to validate the performance of Truenat Beta CoV and Truenat SARS-CoV-2 PoC assays for the detection of SARS-CoV-2 infected cases with reference to analytical sensitivity, precision/inter-machine variation, clinical sensitivity and clinical specificity.

Methods:

The rapid PoC screening and confirmatory assays were prospectively validated at the State Level Virus Research and Diagnostic Laboratory at Bangalore Medical College and Research Institute, Bengaluru, under technical supervision by the Indian Council of Medical Research-National Institute of Virology (ICMR-NIV), Pune. Real-time reverse transcription-polymerase chain reaction (rRT-PCR) was considered as the reference standard against which the rapid assays were validated for all samples tested based on analytical sensitivity, precision/inter-machine variation, clinical sensitivity and clinical specificity.

Results:

Truenat Beta CoV and Truenat SARS-CoV-2 assays showed concordant results when compared with the reference standard rRT-PCR. These PoC assays exhibited 100 per cent sensitivity, specificity, positive predictive value and negative predictive value.

Interpretation & conclusions:

Truenat Beta CoV and Truenat SARS-CoV-2 assays showed concordance with the reference standard assay and may be recommended for screening and confirmation of SARS-CoV-2 in the field settings.
An overview of preclinical animal models for SARS-CoV-2 pathogenicity
Authors: Munshi Itti , Khandvilkar Aditya , Chavan Shrinivas M. , Sachdeva Geetanjali , Mahale Smita D. , Chaudhari Uddhav K.
Published: December 2021

Severe acute respiratory syndrome coronavirus (SARS-CoV)-2 has caused millions of fatalities globally since its origin in November 2019. The SARS-CoV-2 shares 79 and 50 per cent genome similarity with its predecessors, severe SARS-CoV and Middle East respiratory syndrome (MERS) coronavirus, all belonging to the same genus, Betacoronavirus. This relatively new virus has stymied the effective control of COVID-19 pandemic and caused huge social and economic impact worldwide. The FDA-approved drugs were re-purposed to reduce the number of fatalities caused by SARS-CoV-2. However, controversy surrounds about the efficacy of these re-purposed antiviral drugs against SARS-CoV-2. This necessitates the identification of new drug targets for SARS-CoV-2. Hence, the development of pre-clinical animal model is warranted. Such animal models may help us gain better understanding of the pathophysiology of SARS-CoV-2 infection and will be effective tools for the evaluation and licensure of therapeutic strategies against SARS-CoV-2. This review provides a summary of the attempts made till to develop a suitable animal model to understand pathophysiology and effectiveness of therapeutic agents against SARS-CoV-2.
Effects of infections on the pathogenesis of cancer
Authors: Emanuele Liardo Rocco Luca , Borzì Antonio Maria , Spatola Corrado , Martino Barbara , Privitera Giuseppe , Basile Francesco , Biondi Antonio , Vacante Marco
Published: December 2021

Several studies have shown an inverse relationship between acute infections and cancer development. On the other hand, there is a growing evidence that chronic infections may contribute significantly to the carcinogenesis. Factors responsible for increased susceptibility to infections may include modifications of normal defence mechanisms or impairment of host immunity due to altered immune function, genetic polymorphisms, ageing and malnourishment. Studies have demonstrated that children exposed to febrile infectious diseases show a subsequent reduced risk for ovarian cancer, melanoma and many other cancers, while common acute infections in adults are associated with reduced risks for melanoma, glioma, meningioma and multiple cancers. Chronic inflammation associated with certain infectious diseases has been suggested as a cause for the development of tumours. Mechanisms of carcinogenesis due to infections include cell proliferation and DNA replication by mitogen-activated protein kinase pathway, production of toxins that affect the cell cycle and lead to abnormal cell growth and inhibition of apoptosis. This review was aimed to summarize the available evidence on acute infections as a means of cancer prevention and on the role of chronic infections in the development and progression of cancer.
Computed tomography chest in COVID-19
Authors: Garg Mandeep , Prabhakar Nidhi , Bhalla Ashu Seith , Irodi Aparna , Sehgal Inderpaul , Debi Uma , Suri Vikas , Agarwal Ritesh , Yaddanapudi Laxmi Narayana , Puri Govardhan Dutt , Sandhu Manavjit Singh
Published: December 2021

Computed tomography (CT) of the chest plays an important role in the diagnosis and management of coronavirus disease 2019 (COVID-19), but it should not be used indiscriminately. This review provides indications of CT chest in COVID-19 suspect, positive and recovered patients based on the current scientific evidence and our personal experience. CT chest is not indicated as a routine screening modality due to its poor sensitivity and specificity. However, it is useful in a small subset of COVID-19 suspects who test negative on reverse transcription-polymerase chain reaction (RT-PCR) with normal/indeterminate chest X-ray (CXR) but have moderate-to-severe respiratory symptoms and high index of clinical suspicion. CT chest is not indicated in every RT-PCR–positive patient and should be done only in specific clinical scenarios, where it is expected to significantly contribute in the clinical management such as COVID-19 patients showing unexplained clinical deterioration and/or where other concurrent lung pathology or pulmonary thromboembolism needs exclusion. Serial CXR and point-of-care ultrasound are usually sufficient to evaluate the progression of COVID-19 pneumonia. CT chest is also indicated in COVID-19–positive patients with associated co-morbidities (age >65 yr, diabetes, hypertension, obesity, cardiovascular disease, chronic respiratory disease, immune-compromise, etc.) who, despite having mild symptoms and normal/indeterminate CXR, record oxygen saturation of <93 per cent at rest while breathing room air or de-saturate on six-minute walk test. Finally, CT chest plays a crucial role to rule out lung fibrosis in patients recovered from COVID-19 infection who present with hypoxia/impaired lung function on follow up. In conclusion, though CT chest is an indispensable diagnostic tool in COVID-19, it should be used judiciously and only when specifically indicated.
One Health, “Disease X” & the challenge of “Unknown” Unknowns
Authors: Chatterjee Pranab , Nair Parvati , Chersich Matthew , Terefe Yitagele , Chauhan Abhimanyu Singh , Quesada Fabiola , Simpson Greg
Published: December 2021

The emergence of SARS-CoV-2 and its rapid spread globally emphasizes the ever-present threat of emerging and re-emerging infectious diseases. In this review, the pathogen pyramid framework was utilized to identify the “unknown unknowns” associated with the emergence and rapid transmission of novel infectious disease agents. Given that the evolutionary origin of most of the emerging infectious disease agents can be traced to an animal source, we argue the need to integrate the “One Health” approach as a part of surveillance activities. The need for focusing on undertaking global and regional mapping activities to identify novel pathogens is discussed, given that there are an estimated 1.67 million unknown viruses, of which around 631,000 to 827,000 unknown viruses have the capacity to infect human beings. The emerging risks due to the ever-expanding interface between human, animals, both domestic and wildlife, and the environment are highlighted, these are largely driven by the need for safe habitation, growing food, developing infrastructure to support the increasing human population and desire for economic growth. The One Health approach provides a holistic way to address these cross-sectoral issues, by bridging institutional gaps, enumerating priority risk areas and pathogens, and highlighting putative risk factors for subsequent spillover events involving emerging and re-emerging infectious disease pathogens at the human-animal-environment interface.
Outbreak prone communicable diseases of public health importance in the northern districts of West Bengal – Current status & the way forward
Authors: Sharma Puran Kumar , Tilak Rina
Published: December 2021

India is perilously poised on the threshold of an explosion of infectious diseases, some of which have witnessed re-emergence while others await apposite opportunity to do so. The State of West Bengal is uniquely positioned with its innate geographical vulnerabilities that favour outbreaks of a host of infectious diseases. The northern districts of this State are well known endemic areas for many outbreak prone communicable diseases like malaria, Japanese encephalitis, scrub typhus, dengue and kala-azar. An outbreak of Nipah virus in the recent past is a pointer towards the emerging and re-emerging threat in these regions and warrants urgent prioritization for surveillance and monitoring of these diseases. Identification of risk factors, challenges in delivery of primary healthcare, implementation of intervention strategies along with strengthening of healthcare setup are also the need of the hour. Multisectoral initiatives with emphasis on understanding the complex and rapidly evolving human-animal-vector dynamics as envisaged under the ‘One Health’ concept are indubitably important pillars in the effective management of these emerging public health challenges.
Investigations of seasonal outbreaks of acute encephalitis syndrome due to Orientia tsutsugamushi in Gorakhpur region, India
Authors: Murhekar Manoj V. , Vivian Thangaraj Jeromie Wesley , Sadanandane Candasamy , Mittal Mahima , Gupta Nivedita , Rose Winsley , Sahay Seema , Kant Rajni , Gupte Mohan D.
Published: December 2021

Gorakhpur division consisting of Gorakhpur and neighboring districts Deoria, Kushinagar and Maharajganj in Uttar Pradesh, India, have been witnessing seasonal outbreaks of acute encephalitis syndrome (AES) among children for the last three decades. Investigations conducted during 2005 identified Japanese encephalitis (JE) virus as an aetiology of AES. With the introduction of JE vaccination and other control strategies, the incidence of JE in the region declined, however, outbreaks of acute febrile illness with neurological manifestations continued to occur. Subsequent investigations identified Orientia tsutsugamushi, as the major aetiology of AES outbreaks in the region. This review details clinical, epidemiological, animal and entomological investigations conducted for AES due to O. tsutsugamushi during 2015 and 2017 in Gorakhpur region. Surveillance of acute febrile illness among children attending peripheral health facilities identified scrub typhus as an important aetiology of febrile illness during monsoon and post-monsoon months. Population-based serosurveys indicated high endemicity of scrub typhus. Entomological studies demonstrated natural infection of O. tsutsugamushi in small animal hosts and vector mites. Children acquired this infection through recent exposure to outdoor environment, while playing, or visiting fields or defecating in open fields. A few of the children with scrub typhus progress to develop CNS manifestations. Hence, early administration of appropriate antibiotics is crucial in preventing progression of AFI due to scrub typhus to AES. The investigations conducted by the multi-disciplinary team helped understand the transmission dynamics of scrub typhus in Gorakhpur division and recommend strategies for its control.
Animal disease surveillance
Authors: Chethan Kumar H.B. , Hiremath Jagadish , Yogisharadhya R. , Balamurugan V. , Jacob Siju Susan , Manjunatha Reddy G.B. , Suresh K.P. , Shome Rajeswari , Nagalingam M. , Sridevi R. , Patil S.S. , Prajapati Awadesh , Govindaraj G. , Sengupta P.P. , Hemadri Divakar , Krishnamoorthy P. , Misri Jyoti , Kumar Ashok , Tripathi B.N. , Shome Bibek Ranjan
Published: December 2021

Animal disease surveillance encompasses systematic collection of long-term data on disease events, risk factors and other relevant parameters followed by analyzing the same with reference to temporal and spatial characteristics to arrive at a conclusion so that necessary preventive measures can be taken. In India, the animal disease surveillance is done through National Animal Disease Reporting System, which is a web-based information technology system for disease reporting from States and Union Territories with the aim to record, monitor livestock disease situation and to initiate the preventive and curative action in a swift manner during disease emergencies. National Animal Disease Referral Expert System is a dynamic geographic information system and remote sensing-enabled expert system that captures an incidence of 13 economically important livestock diseases from all over the country and also provides livestock disease forecasting. The laboratories under State and Central governments, several research institutes under the Indian Council of Agricultural Research and veterinary colleges are involved in livestock disease diagnosis including zoonotic diseases. An integrated surveillance system is necessary for early detection of emerging/zoonotic diseases in humans. This review provides information on disease reporting and surveillance systems in animal health sector and the need for One Health approach to improve and strengthen the zoonotic disease surveillance system in India.
One Health aspects & priority roadmap for fungal diseases
Authors: Banerjee Sayantan , Denning David W. , Chakrabarti Arunaloke
Published: December 2021

Fungal diseases have not been taken seriously in public health agendas as well as research priorities, despite of globally causing an estimated two million deaths every year, and the emergence of many troublesome fungal pathogens like Candida auris, azole resistant Aspergillus fumigatus, terbinafine and azole resistant dermatophytes, and zoonotic sporotrichosis in humans. Fungi are also responsible for huge losses of agricultural products and stored crops as well as recent massive and unexpected mortality in animals caused by white-nose syndrome in the bats and Chytridiomycosis in amphibians. This review aims to underscore the need for collaborative, multisectoral, and trans-disciplinary approach to include the One Health approach as an essential component of surveillance, prevention, and control of globally emerging fungal diseases. Rigorous evidence based surveillance of the environment as well as strengthening rapid and quality diagnosis of fungal diseases can save millions of lives and reduce significant morbidity.
Inflammatory bowel disease
Authors: Jain Mayank , Venkataraman Jayanthi
Published: December 2021

Inflammatory bowel disease (IBD) in recent times is causing a significant healthcare burden as both ulcerative colitis and Crohn's disease (CD) require lifelong therapy and constant monitoring. The current review highlights the concerns in a country like India with special reference to the changing trends of IBD, risk attribution and the financial issues. Indian immigrants behave like residential Indians, whereas their children show IBD prevalence similar to the West, highlighting the role of environmental triggers. However, the environmental and genetic factors in Indians with IBD are not well understood. Men appear to be more frequently affected than women in India. The disease severity is milder in the patients, both males and females, but the risk for colorectal cancer (CRC) is similar to the West. The incidence of paediatric IBD is on the rise. The major burden of IBD in the Indian subcontinent at present is in children, adolescents and teens. Cost towards the management of complications, non-adherence to treatment, differentiating tuberculosis from CD and finally screening for CRC in patients with IBD are the points to ponder in the Indian scenario.
Primary pulmonary NUT midline carcinoma: An elusive and a rare diagnostic entity
Authors: Pasricha Sunil , Jajodia Ankush , Sharma Anila , Bansal Divya , Batra Ullas , Gupta Gurudutt , Durga Garima , Kamboj Meenakshi , Nathany Shrinidhi , Mehta Anurag
Published: December 2021

Nuclear protein in testis (NUT) midline carcinoma is a poorly differentiated tumor, is more common in midline anatomic sites, and involves young adults and children mainly. Primary pulmonary NUT midline carcinoma (NMC) is a rare and poorly defined entity in the prevailing literature. Being a highly aggressive and fatal neoplasm, it gets incumbent for the oncologists and the pathologists to be aware of this entity as it holds distinct management protocol and prognosis. Currently, BET inhibitors (BETi) and histone deactylase inhibitors have shown promising results as targeted therapies in clinical trials in head and neck NMC. We present a case report of NMC of primary pulmonary location in a young male with widespread bony metastasis.
A large desmoid fibromatosis of mesentery presenting as ovarian tumor - A rare case report
Authors: Abhilashi Kavya , Kumari Pratibha , Kumari Satya , Rani Jyotsna , Imam Zeenat Sarmadi , Kumari Manisha , Choudhary Vijayanand , Pankaj Sangeeta
Published: December 2021

Desmoid fibromatosis is a rare tumor of locally aggressive nature and associated with a high risk of recurrence. Although it possesses benign morphologies such as the absence of necrosis and atypical mitoses, it is classified as an intermediate malignant neoplasm due to its potential of infiltrating into the adjacent structures and the high rate of local recurrence even after excision. A 22-year-old unmarried female came with the complaint of abdominal pain and lump. The preoperative diagnosis was in favor of ovarian leiomyosarcoma but to the surprise intraoperative, tumor was found to be arising from mesentery of ileum. Following the complete resection, tumor was sent for histopathology. The histopathology examination report along with immunohistochemistry was suggestive of desmoids fibromatosis. Mesenteric desmoids fibromatosis is a rare tumor. It should be differentiated from gastrointestinal stromal tumor, leiomyoma, leiomyosarcoma, neurofibroma, and solitary fibrous tumor because of its completely different management and outcome. Histopathology and immunohistochemistry is the key for its diagnosis.
Assessment of knowledge, attitude and practices regarding awareness of biomedical waste management among health care professionals in a tertiary care center in Patna
Authors: Kumar Ranveer , Sinha Richa
Published: December 2021

Background and Objectives:

Effective management of biomedical waste (BMW) is of paramount importance to avoid health hazards to care providers. The present study aimed to assess the knowledge, attitude, and practice of bio-medical waste management among the health care workers (HCWs) at a tertiary care center in North India.

Materials and Methods:

We conducted a questionnaire-based cross-sectional survey with closed-ended questions between June 2019 and October 2019.

Results:

Among 306 participants, 35% (107) were doctors, 52% (159) were nursing staff, 10% (31), and 3.26% (10) were laboratory technicians and cleaning staff, respectively. While >95% of doctors and nursing staff were aware of the BMW management, biohazard risks, categorization of waste, and personal protective measures, 55% of cleaning staff had not even heard about it. Less than half of the sanitation workers who segregate and transport the BMW were aware about the disinfection process (33%), transmission of HIV (44%), and permanent disposal of BMW (33%).

Conclusion:

Disparity in awareness about BMW management exists among HCWs. The sanitation staffs who handle the maximum amount of BMW are the most ignorant. Frequent surveillance and focused teaching sessions may help to improve the knowledge of HCWs and inculcate healthy practice.
Gliomatosis peritonei with ovarian teratoma
Authors: Abhilashi Kavya , Kumari Pratibha , Kumari Satya , Rani Jyotsna , Pankaj Sangeeta , Choudhary Vijayanand , Singh Reecha
Published: December 2021

Gliomatosis Peritonei (GP) is a rare condition characterized by the presence of neuroglial implants throughout the peritoneum. It is a benign lesion with a potential for malignant transformation. Its association with ovarian teratomas has been sparsely reported in the literature. As GP is a rarity, it lacks forth set and accepted guidelines for management. Here, we report three intriguing cases of histopathologically confirmed GP in association with ovarian teratoma. All three patients were young females between 18 and 22 years of age and presented with abdominal swelling and ascites. On evaluation, they had raised tumor markers (CA-125, Agence France-Presse, and lactate dehydrogenase) and radiological findings were in favor of ovarian malignancy. Two of them underwent primary debulking surgery, whereas one received neoadjuvant chemotherapy in view of recurrent ovarian tumor of nonseminal germ cell nature followed by interval debulking surgery. Intraoperative findings in all three cases were almost similar. Unexpectedly, the histopathological findings were reported as immature teratoma in two cases and mature teratoma in one along with GP.
Abdominopelvic mass in adolescents and young adults
Authors: Kumari Pratibha , Kumari Satya , Rani Jyotsna , Abhilashi Kavya , Pankaj Sangeeta , Choudhary Vijayanand , Kumar Pravin
Published: December 2021

Background:

The present study aimed to review the clinicopathologic profile of adolescent and young adult patients of abdominopelvic lump.

Materials and Methods:

The hospital records of the patients of age 10-29 years who underwent surgical intervention for suspected ovarian tumor at gynecological oncology department in a tertiary hospital were searched retrospectively for demographic characteristics, clinical findings, range of tumor markers, the surgical procedure patients underwent, and the histopathological findings of adnexal masses. The duration of the study was of 18 months (from August 2019 to February 2021).

Result:

During this period, 27 patients of age 10–29 years with abdominopelvic mass were operated. Out of 27, 14 patients had malignant ovarian mass and 13 were of benign nature. However, 3 patients had tumor of nonovarian origin. In the study, immature teratoma ranked first among malignant tumor, while inflammatory pathology was dominant in the list of benign adnexal tumor. There was a fair correlation between tumor markers and histopathological characteristics of the tumors.

Conclusion:

The study highlights the importance of early diagnosis and optimal management of adnexal masses in adolescents and young adult females for better outcomes. Fertility - sparing surgeries should be considered in indicated cases.
Need and role of continuing medical education programs to produce lifelong learners
Authors: Shrivastava Saurabh RamBihariLal , Shrivastava Prateek Saurabh
Published: December 2021

The branch of medicine is extremely vast and it keeps advancing with each day, and thus, there is an immense need that all medical students should develop competency of being lifelong learner. Regular participation in continuing medical education (CME) programs seems to be the solution to the challenge of staying abreast with the recent developments in medicine. The topic for any CME should be decided with the help of a thorough needs assessment either using a subjective or objective approach. The need assessment should be followed by the formulation of specific learning objectives and decisions about the format of the planned CME. In conclusion, CME programs are the answer to improve the knowledge and skills of healthcare professionals and thereby ameliorate the quality of care. It is the need of the hour to motivate doctors to periodically participate in such programs and in the process to become self-directed and lifelong learners.
Association of Preoperative Risk Factors and Mortality in Older Patients following Emergency Abdominal Surgery: A Retrospective Cohort Study
Authors: Hacım Nadir Adnan , Akbaş Ahmet , Ulgen Yigit , Aktokmakyan Talar Vartanoglu , Meric Serhat , Tokocin Merve , Karabay Onder , Ercan Gulcin , Altinel Yuksel
Published: December 2021

Background: Older patients undergoing emergency laparotomy have high morbidity and mortality rates. Preoperative risk assessment with good predictors is an appropriate measure in this population. Frailty status is significantly associated with postoperative outcomes in older adults. This study aimed to investigate the effect of preoperative risk factors and frailty on short-term outcomes following emergency surgery for acute abdomen in older patients.Methods: This study included older patients (≥65 years of age) who underwent emergency abdominal surgery. We retrospectively analyzed their demographic and clinical variables and used the modified Frailty Index-11 to evaluate their frailty status. The primary outcome was the 30-day mortality rate. We also analyzed risk factors of mortality in these patients.Results: The study included 150 patients with a median age of 74 years. The mortality rate was 17.3% (n=26). We observed significantly higher mortality rates in patients who were obese and who had higher American Society of Anesthesiology (ASA grades) (p<0.05). Frailty status was worse in deceased group (p<0.001), when compared to individuals who survived. Septic shock was associated with the development of mortality (p<0.001). Multivariate regression analysis revealed that ASA grade was the only independent risk factor for mortality (odds ratio=19.642; 95% confidence interval, 3.886–99.274; p<0.001).Conclusion: Older patients with obesity and frailty presenting with higher ASA grades and septic shock had the worst survival following emergency abdominal surgery. The ASA grade was an independent risk factor for mortality.
Impact of Temperature and Rainfall on Typhoid/Paratyphoid Fever in Taizhou, China: Effect Estimation and Vulnerable Group Identification
Authors: Gao Qi , Liu Zhidong , Xiang Jianjun , Zhang Ying , Tong Michael Xiaoliang , Wang Shuzi , Zhang Yiwen , Liu Qiyong , Jiang Baofa , Bi Peng
Published: December 2021

The impact of temperature and rainfall on the occurrence of typhoid/paratyphoid fever are not fully understood. This study aimed to characterize the effect of daily ambient temperature and total rainfall on the incidence of typhoid/paratyphoid in a sub-tropical climate city of China and to identify the vulnerable groups for disease prevention. Daily notified typhoid/paratyphoid fever cases and meteorological data for Taizhou from 2005 to 2013 were extracted from the National Notifiable Disease Surveillance System and the Meteorological Data Sharing Service System, respectively. Distributed lag nonlinear model was used to quantify the association between daily mean temperature, total rainfall, and typhoid/paratyphoid fever. Subgroup analyses by gender, age, and occupation were conducted to identify the vulnerable groups. A total of 625 typhoid fever cases and 1,353 paratyphoid fever cases were reported during the study period. An increased risk of typhoid fever was detected with the increase of temperature (Each 2°C rise resulted in 6%, 95% [confidence interval] CI: 2–10% increase in typhoid cases), while the increased risk was associated with the higher temperature for paratyphoid (the highest cumulative risk of temperature was 33.40 [95% CI: 12.23–91.19] at 33°C). After the onset of mild precipitation, the relative risk of typhoid fever increased in a short-lasting and with a 13–26 days delay, and the risk was no significant after the continuous increase of precipitation (the highest cumulative risk of rainfall was 24.96 [95% CI: 4.54–87.21] at 100 mm). Whereas the risk of paratyphoid fever was immediate and long lasting, and increase rapidly with the increase of rainfall (each 100 mm increase was associated with 26% increase in paratyphoid fever cases). Significant temperature-typhoid/paratyphoid fever and rainfall-typhoid/paratyphoid fever associations were found in both genders and those aged 0–4 years old, 15–60 years old, farmers, and children. Characterized with a lagged, nonlinear, and cumulative effect, high temperature and rainfall could increase the risk of typhoid/paratyphoid fever in regions with a subtropical climate. Public health interventions such as early warning and community health education should be taken to prevent the increased risk of typhoid/paratyphoid fever, especially for the vulnerable groups.
Healthcare Seeking and Access to Care for Pneumonia, Sepsis, Meningitis, and Malaria in Rural Gambia
Authors: Hossain Ilias , Hill Philip , Bottomley Christian , Jasseh Momodou , Bojang Kalifa , Kaira Markieu , Sankareh Alhagie , Sarwar Golam , Greenwood Brian , Howie Stephen , Mackenzie Grant
Published: December 2021

Children with acute infectious diseases may not present to health facilities, particularly in low-income countries. We investigated healthcare seeking using a cross-sectional community survey, health facility-based exit interviews, and interviews with customers of private pharmacies in 2014 in Upper River Region (URR) The Gambia, within the Basse Health & Demographic Surveillance System. We estimated access to care using surveillance data from 2008 to 2017 calculating disease incidence versus distance to the nearest health facility. In the facility-based survey, children and adult patients sought care initially at a pharmacy (27.9% and 16.7% respectively), from a relative (23.1% and 28.6%), at a local shop or market (13.5% and 16.7%), and on less than 5% of occasions with a community-based health worker, private clinic, or traditional healer. In the community survey, recent symptoms of pneumonia or sepsis (15% and 1.5%) or malaria (10% and 4.6%) were common in children and adults. Rates of reported healthcare-seeking were high with families of children favoring health facilities and adults favoring pharmacies. In the pharmacy survey, 47.2% of children and 30.4% of adults had sought care from health facilities before visiting the pharmacy. Incidence of childhood disease declined with increasing distance of the household from the nearest health facility with access to care ratios of 0.75 for outpatient pneumonia, 0.82 for hospitalized pneumonia, 0.87 for bacterial sepsis, and 0.92 for bacterial meningitis. In rural Gambia, patients frequently seek initial care at pharmacies and informal drug-sellers rather than community-based health workers. Surveillance underestimates disease incidence by 8–25%.
COVID-19 versus Seasonal Influenza: Comparison of Profiles of Older Adults Hospitalized in a Short-Term Geriatric Ward in France
Authors: Godaert Lidvine , Cebille Agnès , Proye Emeline , Dramé Moustapha
Published: December 2021

The objective was to compare the profile and outcomes of older adults admitted to a geriatric short-stay unit for COVID-19, to those of older adults admitted to the same unit for seasonal influenza infection. This was an observational study performed in a General Hospital in France. Patients ≥ 70 years admitted to a geriatric short-stay unit for COVID-19 between March 18 and November 15, 2020 were included. They were compared with patients of the same age group, admitted to the same geriatric short-stay unit for seasonal influenza infection over the periods January to March 2019 and January to March 2020. Data collection included demographic information, medical history, clinical signs and symptoms, outcomes, and hospital discharge patterns. Descriptive and intergroup comparison analyses were performed. In total, 153 patients were included in the study, 82 in the seasonal influenza group, and 71 in the COVID-19 group. The average age was 87.6 ± 4.8 and 87.6 ± 6.5 years in the COVID-19 and seasonal influenza groups, respectively. There was no difference between groups regarding the Charlson comorbidity index (3.4 ± 3.0 versus 3.4 ± 2.8). The seasonal influenza group more often had fever, cough, sputum, and renal failure, whereas the COVID-19 group more often experienced diarrhea, and death. The COVID-19 group was frequently living in collective housing. The profile at admission of older adults hospitalized for COVID-19 or seasonal influenza infection was similar. Although fever and respiratory signs were less common in the COVID-19 group, these patients experienced more complications (such as renal failure or oxygen therapy requirement) and higher mortality.
School Sanitation-Related Psychosocial Stressors among Nigerian Students
Authors: Wada Ojima Zechariah , Amusa Aminat Opeyemi , Asaolu Fiyinfoluwa Taiwo , Akinyemi David Olatunde , Oloruntoba Elizabeth Omoladun
Published: December 2021

Psychosocial stressors are indicative of challenges associated with the social and environmental conditions an individual is subjected to. In a bid to clearly understand the present gaps in school sanitation, this cross-sectional study aimed to identify the sanitation-related psychosocial stressors experienced by students in a Nigerian peri-urban community and their associated impacts. A three-stage sampling technique was used to select 400 students from 10 schools. The students to toilet ratio were 1,521:0 and 1,510:0 for the public-school boys and girls, respectively, and 74:1 and 70:1 for the private-school boys and girls, respectively. Furthermore, public-school students had a significantly higher average stress level (P < 0.001, η2p = 0.071) and a significantly higher proportion of students experiencing school absenteeism (P < 0.001; odds ratio [OR] = 4.8; 95% confidence interval [CI] = 2.7–8.2), missed classes (P < 0.001; OR = 5.8; CI = 2.8–12.0), long urine/fecal retention time (P < 0.001; OR = 2.9; CI = 1.8–4.7), open defecation practice (P < 0.001; OR = 4.2; CI = 2.5–7.1), and open defecation-related anxiety (P < 0.001; OR = 3.6; CI = 2.0–6.5). Moreover, the inability to practice menstrual hygiene management was significantly associated with student-reported monthly school absence among girls (P < 0.001; OR = 4.5; CI = 2.2–9.4). Overall, over 50% of the respondents had reportedly been subjected to at least 14 of the 17 stressors outlined. The most prevalent stressors identified were concerns about disease contraction, toilet cleanliness, toilet phobia, privacy, and assault/injury during open defecation/urination. In conclusion, results show that the absence of functional sanitation facilities purportedly has a grievous effect on the mental, physical, social, and academic well-being of the students. This was clearly seen among public-school students. Subsequent sanitation interventions need to be targeted at ameliorating identified stressors.
Oswajanie patologii matematycznych
Authors: Pogonowski Jerzy
Published: December 2021

Terminy: patologia, patologiczny występują w tekstach matematycznych. Istotne jest to, że w odróżnieniu od negatywnych skojarzeń wiązanych z tymi terminami w życiu codziennym oraz w niektórych naukach (np. patologie społeczne, psychopatologie, itp.), w matematyce użycie tych terminów oznacza zwykle, że mamy do czynienia z czymś twórczym. Ten kreatywny aspekt patologii matematycznych jest tematem niniejszych refleksji. Dodam też uwagi dotyczące miar stopni dostępności poznawczej obiektów matematycznych. Niniejszy tekst opracowany został w ramach projektu badawczego NCN nr 2015/17/B/HS1/02232 Aksjomaty ekstremalne: aspekty logiczne, matematyczne i kognitywne. Prezentowany był podczas XI Polskiego Zjazdu Filozoficznego w Lublinie w 2019 roku. Domestication of mathematical pathologies Certain mathematical objects are called paradoxical or pathological. Such terms have negative connotations in common usage, in psychology, and in social science. However, the situation is different in mathematics. Emergence of mathematical paradoxes or pathologies always indicates a creative moment in the process of mathematical discovery. The paper contains reflections on this creative aspect of mathematical pathologies, the process of their domestication, and the cognitive accessibility of mathematical objects. The work on this paper was sponsored by the National Scientific Center research grant 2015/17/B/HS1/02232 Extremal axioms: logical, mathematical and cognitive aspects. The paper was presented during the 11th Polish Philosophical Congress in Lublin (2019).
Partnering with Hospital Providers to Facilitate Handoff for Persons with Dementia in the Acute Care Setting
Authors:   , Jeune Vanessa
Published: December 2021

Practice Problem: Individuals with Alzheimer's disease and related dementias cannot verbalize their care needs during transitions of care (TOC) and rely on their home caregivers (HCs) for advocacy. The lack of communication between clinicians in one setting and HCs can lead to detrimental health outcomes for the length of stay. PICOT: The PICOT question that guided this project was: With the assistance of family nurse consultants (P), how does the implementation of standardized care needs communication tool for support persons of persons with dementia (I) vs. no standardized process (C) enhance the ability for the support person to communicate care needs during TOC (O) within 5 weeks (T)? Evidence: The review of high-quality studies reveals evidence that supports clinician-home caregiver communication as an approach to bridge gaps for the person with dementia (PWD) across health care settings. Intervention: The clinician-home caregiver communication checklist was used as an evidence-based tool to enhance the HC’s ability to communicate care needs for the PWD during care transitions. Outcome: There was a clinically significant improvement with the family nurse consultants’ utilization of the tool, and HCs who were offered the tool benefited from that time of preparation for their loved ones. There was a statistically significant improvement in family nurse consultants’ perception of the value and usefulness of the tool after they were introduced to it. Conclusion: The project findings revealed that using the standardized care needs communication tool, HCs can be crucial members to strengthen TOC for the cognitively impaired individual.
Gestão escolar: um estudo do processo de implantação do Projeto “Escola Segura e Cidadã-PESC” na Escola Estadual de Tempo Integral Maria do Céu Vaz D’oliveira-Manaus-AM, Brasil
Authors: Lima Rute Costa
Published: December 2021

As dificuldades encontradas nas salas de aulas pelos docentes relacionadas ao comportamento dos alunos são caracterizadas nos dias atuais como uma grande barreira para a construção do conhecimento. Essa barreira, classificada muitas vezes como intransponível, dado o elevado índice de indisciplina apresentado nas escolas brasileiras, foi o que motivou o desenvolvimento da pesquisa de mestrado intitulada “Gestão Escolar: um estudo do processo de implantação do Projeto Escola Segura e Cidadã na Escola Estadual de Tempo Integral Maria do Céu Vaz D’Oliveira- Manaus-AM, Brasil, haja vista, notadamente o perfil dos jovens estudantes contemporâneos esteja marcado por atitudes de desrespeito e que, em situações excepcionais podem culminar para a violência física. Problemática acentuada quando este público se depara com Professores com pouco ou sem nenhum domínio de classe ou quando há omissão pela escola. Partindo dessa premissa, entende-se que a escola ao cumprir seu papel no que concerne à oferta de educação de qualidade, deve desenvolver estratégias que visem minimizar tal inquietude. Esta pesquisa estudou todo o desenho do processo de implantação em uma Escola de Tempo Integral de um Projeto de cunho disciplinar com escopo desenvolvido pela Polícia Militar do Estado do Amazonas e utilizado como ferramenta pedagógica. Dessa forma, foi possível identificar, a partir de observações sistemáticas, as ações dos discentes antes e após a implantação do projeto, concomitantemente mapear os conflitos, tensões, resistências e expectativas abrolhadas no decorrer do estudo. Os resultados obtidos a partir da tabulação de dados e entrevistas realizadas vislumbraram mudança significativa no comportamento individual dos discentes, o que concorreu para maior rendimento pedagógico, atrelado resgate do entusiasmo docente, mas também sugere-se alguns ajustes no escopo do Projeto, a fim de subsidiar uma proposta mais eficiente.
The Messiness of (De)Coloniality: An Autoethnography of the Cross-Cultural Researcher
Authors: Kelley Amber
Published: December 2021

In this paper I explore the complexity of psychological cross-cultural research, particularly noting the ways in which cross-cultural mental health research and the global mental health movement are still driven by Western conceptualizations of mental health. By taking up decolonial theory through autoethnographic methods, I consider the responsibility, ethics, and tensions in conducting cross-cultural mental health research, particularly as a White researcher with non-White, non-Western participants. Ongoing reflexivity as a researcher and practitioner offers the opportunity to engage in culturally responsive practices that continue challenging the coloniality of Western psychology which can pervade global mental health studies when unchecked. I put forth liberatory practices such as attending to insider voices and engaging in relational practices between researcher and participants as opportunities for cross-cultural researchers to engage in rigorous research that is responsive to the local culture and active in decolonizing the field of psychological and mental health research.