bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparative analgesic, hemodynamic, pain and duration of sensory and motor block effects of dexmedetomidine, granisetron, and nitroglycerin added to ropivacaine in intravenous anesthesia for forearm surgeries
Authors: Moshiri Esmail , Modir Hesameddin , Kamali Alireza , Azami Mehran , Molouk Morteza
Published: November 2021

This trial-based paper strives to address the comparative efficacy of some ropivacaine adjuvant options, comprising dexmedetomidine, granisetron, and nitroglycerin, on pain and hemodynamic changes in intravenous anesthesia for forearm surgeries. This double-blind, placebo-controlled study enrolled four block-randomized eligible groups with patients (overall, n=128) undergoing orthopedic forearm surgeries in the dexmedetomidine, nitroglycerin, granisetron, and placebo groups. Intra- and post-operative vital signs (mean arterial pressure/heart rate/ oxygen saturation) were monitored at baseline and captured every 10 minutes until the end of the surgery, as well as the onset of sensory and motor block and length and duration of the block and mean opioid use within 24 hours. Lastly, pain was noted after tourniquet inflation (at 15, 30, and 45 minutes every 15 minutes until the end of surgery) and after deflation (every 30 minutes to 2 hours at 30, 60, 90, and 120 minutes), as well as 6, 12, and 24 hours after the tourniquet was deflated. The dexmedetomidine-sedated subjects appeared to demonstrate quicker onset and longer length and duration of sensory and motor block, plus less pain and opioid use at all scheduled times (both P = 0.0001). Dexmedetomidine is recommended as an adjuvant to regional anesthesia (Bier’s block), while being coupled with the rapid onset and prolonged length and duration of sensory and motor blocks, in addition to soothed pain and diminished opioid use within postoperative 24 hours. The study was approved by Ethics Committee of Arak University of Medical Sciences (approval No. IR.ARAKMU.REC.1398.112) on July 21, 2019, and registered at Iranian Registry of Clinical Trials (registration number IRCT20141209020258N123) on November 2, 2019.
Hydrogen-rich bath with nano-sized bubbles improves antioxidant capacity based on oxygen radical absorbing and inflammation levels in human serum
Authors: Tanaka Yoshiharu , Xiao Li , Miwa Nobuhiko
Published: November 2021

This study compared the effects of hydrogen-water (HW) bath on the oxygen radical absorption-based antioxidant capacity and the inflammatory indicator, C-reactive protein (CRP), in serum between healthy volunteers and inflammatory/collagen disease-patients. The HW bath apparatus supplied nano-bubbles with a diameter of 110 ± 10 nm and 338–682 μg/L of dissolved hydrogen after 120 minutes electrolysis, and nano-bubbles increased to 9.91 × 107/mL along with the increase of correlative dissolved hydrogen. Ten-minute HW bath increased the oxygen radical absorption-based antioxidant capacity to 110.9 ± 9.2% at post-bathing 120 minutes, although unaltered with 10-minute normal water bath at 40°C in healthy subjects. The CRP level was repressed to 70.2 ± 12.1% at 120 minutes after HW bath, although rather increased for normal water bath. In the patients with connective tissue diseases, the CRP level was repressed to 3–24% upon 9 days to 4 months of HW bathing. In another six patients with diverse autoimmune-related diseases, upon daily HW bathing as long as 2–25 months, the pre-bathing CRP level of 5.31 mg/dL decreased to 0.24 mg/dL being within the standard-range, with relief of visible inflammatory symptoms for some cases. Thus, the HW bath with high-density nano-bubbles has beneficial effects on serum antioxidant capacity, inflammation, and the skin appearance. The study was approved by the Committee of Ethics, Japanese Center of Anti-Aging Medical Sciences (Authorization No. H-15-03-2, on January 15, 2019), which was a non-profitable organization officially authenticated by the Hiroshima Prefecture Government of Japan.
Beard Reconstruction
Authors: Yaseen Ummer , Ahmed Shabir , Ahmed Muzaffar
Published: November 2021

Introduction:

Loss of beard can occur due to many reasons. As beard has huge cosmetic importance, loss of beard can be psychologically traumatic. Beard can be absent from puberty, called as congenital absence of beard. Beard loss can be secondary to dermatological conditions such as nodulocystic acne. In our setting, the most common cause of loss of beard is burn injury. There are many treatment options such as surgical excision of scar, flaps Z/W plasty, and hair transplantation to reconstruct the beard. We present the follicular unit extraction (FUE) method of beard reconstruction.

Aim:

The aim of our study was to describe the evaluation of the results using FUE method for beard reconstruction.

Materials and Methods:

We did a study in twenty male patients. Any patient having alopecia areata were ruled out of the study. Fifteen patients had postburn loss, three had postacne scarring, and two patients had congenital absence of beard. We evaluated all patients thoroughly by calculating the density of beard over the normal areas of beard, evaluating the elasticity of skin, preoperative photography, and doing dermatoscopy. Areas were marked. FUE was used for harvesting the grafts as a limited number of grafts were needed to complete the surgery. In the recipient area, adrenaline was avoided in patients of scarring alopecia. In cases of congenital absence of hair, 1:200,000 adrenaline was used to minimize bleeding. Grafts were placed. Results were noted after 1 year.

Results:

All patients followed up properly for 1 year. Growth started 3 months postoperatively and continued till 1 year postoperatively. Density was good in cases with congenital absence of hair. In cases of scarring alopecia, multiple sessions were needed to provide adequate density. Results were graded as “very good,” “good,” and “poor.” Eleven patients had “very good” result, eight had “good,” and one had “poor” result. Nineteen patients were satisfied with the final result, and one patient was dissatisfied with the result.

Conclusion:

FUE is the ideal method of reconstructing beard loss. Proper preoperative evaluation, preparation, planning, and proper surgical technique produce the best possible result.
Prostate abscess with acute urinary retention as the initial presentation of granulomatosis with polyangitis
Authors: Bhargav KM , Manasa CVS , Sindhu G , Mohan Alladi , Chowhan A. K. , Sirisha K.
Published: November 2021

A 50-year-old male presented with acute urinary retention. He also had a history of cough, haemoptysis, exertional dyspnoea, loss of appetite, generalised weakness and left-ear discharge of 1-month duration. Prior episode of acute urinary retention had occurred 2 months ago; diagnostic evaluation revealed prostate abscess, and he had received treatment elsewhere for the same. He also had a history of hypertension. Physical examination revealed fever, pallor, bilateral parotid enlargement and left-ear serous discharge. Clinical examination, imaging of chest revealed consolidation with cavitation on the left side, bilateral pleural effusion. Laboratory testing revealed normocytic normochromic anaemia (haemoglobin 6.6 g/dL); neutrophilic leucocytosis (total leucocyte count 13,100 cells/mm3; polymorphs 87%); raised erythrocyte sedimentation rate (110 mm at the end of the first hour); elevated serum creatinine (2.69 mg/dL) and an active urine sediment. Flexible fibreoptic bronchoscopy showed alveolar haemorrhages. Bronchoalveolar lavage fluid Xpert MTB/RIF testing, cytopathology were negative. Computed tomography-guided biopsy from the lesion was suggestive of granulomatous vasculitis. Cytoplasmic antineutrophil cytoplasmic antibodies (C-ANCA) tested positive. The patient was diagnosed to have granulomatosis with polyangitis (GPA). As arterial hypoxaemia was evident, tracheal intubation and mechanical ventilatory support were initiated. Renal replacement therapy, intravenous (iv) methyl prednisolone and cyclophosphamide pulse therapy and five sessions of plasmapheresis were administered. As remission could not be achieved, iv rituximab was started. On the 36th day of admission, the patient developed septic shock and died. The present case documents the uncommon association of GPA with prostate abscess, acute urinary retention.
Median arcuate ligament syndrome
Authors: Karumuri Prudhvi Raj , Gandi Vikram , Kunjarapu Ravi Shankar , Girinadh L. R. S.
Published: November 2021

Chronic abdominal pain has several aetiologies, and many a times, the aetiology is one of the exclusions. Median arcuate ligament syndrome (MALS) also called coeliac artery compression syndrome is a form of chronic mesenteric ischaemia, although rare is an important cause. A 20-year-old male presented with recurrent episodes of pain abdomen, with a history of multiple admissions for the same, before the surgery. His physical examination and laboratories were normal, but the computed tomography (CT) done initially gave a doubtful diagnosis of MALS. A CT angiogram was done, which showed a definite kinking of the coeliac axis. After all the other causes of abdominal pain were ruled out, the patient was taken up for surgery with a provisional diagnosis of MALS. Intraoperatively, there was fibrosis around the coeliac axis with kinking. The fibrosis was cleared, and pulsations of the artery were confirmed. Postoperatively, the patient had an uneventful recovery.
Impact of COVID-19 on psychological and academic performance of medical students in Saudi Arabia
Authors: Allah Ahmad A , Algethami Nada E. , Algethami Rahma A. , ALAyyubi Raghad H. , Altalhi Wahaj A. , Atalla Aymen A. Ahmed
Published: November 2021

Background and Objectives:

The COVID-19 pandemic affected the mental health and psychosocial conditions of everyone worldwide according to the WHO. Public health emergencies affect college students and are expressed as anxiety, worry, and fear. The aim of this study was to assess the impact of COVID-19 on the psychological health and performance of medical students.

Design and Settings:

A cross-sectional study using an online survey was done.

Participants and Methods:

Participants were 1591 Saudi medical students. A predesigned questionnaire included questions on demographic characters, GPA, having a relative got COVID-19, how to face sad news and stressors, and satisfaction with online lectures. The Generalized Anxiety Disorder (GAD-7) scale was used that included seven items asking about the degree the participant was bothered by feeling anxious in the last 2 weeks.

Results:

A total of 59.4% of students had various degrees of anxiety. Participant age, unsteady family income, high grade point average (GPA,) satisfaction with the online lectures, and being female were associated with higher GAD-7 scores.

Conclusion:

Mental health of medical students was significantly affected by the COVID-19 pandemic. Psychological support programs for medical students during the pandemic and provision of high-quality distance learning is essential for psychological well-being during the pandemic.
Prevalence of alopecia and its contributing factors among primary healthcare attendees in the Jazan region, Saudi Arabia
Authors: Alomaish Abeer R. , Gosadi Ibrahim M. , Dallak Fatimah H. , Durayb Amjad A. , Dallak Ali H. , Hakami Jubran A. , Hakami Ayman M. , Alshamakhy Arar E. , Mleeh Nouf T.
Published: November 2021

Background:

Alopecia is a common health condition that can be associated with social and psychological consequences.

Aims:

This study aims to estimate the prevalence of hair loss and its associated risk factors among primary healthcare center (PHC) attendees in the Jazan region.

Methods:

This investigation was a cross-sectional study conducted in the Jazan region of southwest Saudi Arabia. A total of 23 PHCs were randomly selected from five governorates in the region. Data were collected via interviewing PHCs attendees and were asked about their demographic characteristics, presence of hair loss, and among attendees who confirmed having hair loss, they were further asked about associated clinical features, healthcare-seeking behavior, and factors that might contribute to the development of their condition.

Results:

A total of 729 participants consented to be involved in this study. The number of respondents who reported having hair loss was 483, representing 66.3% of the whole sample. Gender appears to have the highest level of variability, with the majority of participants reporting hair loss being female (P < 0.001). The most frequently reported type of hair loss was telogen effluvium, followed by androgenic alopecia. A total of 185 respondents reported taking medications to treat their hair loss, of whom 108 (58.3%) did not seek any medical advice to identify the cause of their condition.

Limitations:

The main weakness of this investigation is related to relying on a reported presence of hair loss without having it confirmed with a clinical diagnosis.

Conclusion:

A minority of participants who reported suffering from hair loss were further evaluated by healthcare professionals to learn the cause of their hair loss. This may indicate the presence of poor hair care and the probability of a higher risk of hair loss requiring the development of suitable preventive strategies.
Role of 2-Deoxy-D-Glucose (2-DG) in COVID-19 disease
Authors: Sahu Kamal K. , Kumar Raman
Published: November 2021

Virus infections can cause tissue damage in many ways. Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), a cause of the current COVID-19 pandemic, has been extensively studied so far to investigate its pathophysiology and evaluate its impact on the metabolic system of human cells. This has given a lead to study the role of 2-deoxy-D-glucose (2DG) against COVID-19 disease. We hereby would like to briefly discuss the concept and rationale behind the use of 2DG COVID-19.
Identifying role of public health and primary care as disparate entities in current health system
Authors: Raina Sunil K. , Kumar Raman
Published: November 2021

Arguably the worst health crisis in recent memory, Covid19 has been a great masterclass, albeit at a cost which no individual or nation would have wanted to afford. Besides other, what are the lessons for the academic medicine in general and primary care, community medicine, family medicine and public health in particular? Perhaps, identifying the roles of each in the healthcare system and building a thought process around these roles is the way forward. Only then will we have a chance to fight a pandemic like the Covid-19.
Epidemiological study to assess the impact of COVID-19 pandemic on the occurrence of monsoon-related diseases in the city of Mumbai
Authors: Chavhan Smita S. , Kashyap Vandana , Gokhale Chinmay N , Adsul Balkrishna B. , Gomare Mangala , Kumbhar Maharudra , Kadam Neelam , Dhikale Prasad T. , Kinge Kirti V.
Published: November 2021

Background:

The onset of monsoons in Mumbai poses an additional health disease burden in the form of rising vector-borne and water-borne diseases such as dengue, malaria, leptospirosis, hepatitis, typhoid, chikungunya, and acute gastroenteritis. These monsoon-related illnesses are preventable with hygienic and sanitation measures that are likely to have been adopted during COVID-19 pandemic.

Aim:

To assess the impact of COVID-19 pandemic on the occurrence of monsoon-related diseases in the city of Mumbai and find out determinants of variations if any.

Material and Methods:

This was a retrospective descriptive study. Universal sampling was done using secondary data collected from the Epidemiological Cell of Municipal Corporation of Greater Mumbai (MCGM). Data mining was performed to obtain the trends of the monsoon-related diseases in Mumbai.

Results:

COVID-19 pandemic has remarkably affected the city of Mumbai with approximately 3 lakh cases till December 2020. MCGM has taken a lot of efforts resulting in a recovery rate of close to 95% with less than 3% mortality. With the effective use of social behavior change communication, which focused on masks, frequent hand washing, and social distancing, there seems to be a decline in monsoon-related illnesses in the year 2020 as compared to the previous two years of 2018 and 2019.

Conclusion:

Monsoon-related illnesses are impacted by behavior and lifestyle modifications like hygiene and environmental sanitation practiced during the COVID-19 pandemic. This study highlights the importance of these universal hygienic practices and their utility in the long-term reduction of monsoon-related illnesses.
Implementing a “convergent” framework of action against childhood malnutrition in urban informal settlements of Mumbai
Authors: Ramani Sudha , Sridhar Rama , Shende Sushma , Manjarekar Shreya , Patil Sonali , Pantvaidya Shanti , Fernandez Armida , Jayaraman Anuja
Published: November 2021

Context:

The National Nutrition Mission (POSHAN Abhiyaan) intends to “converge” nutrition-related program components across sectors (nutrition, health, water, and sanitation). In this study, we have examined the perspectives of Anganwadi workers (AWWs), the frontline workers of the Integrated Child Development Services, on working in convergence with the public health sector.

Methods:

This exploratory qualitative study was done between June 2018 and June 2019 in two urban informal settlements in Mumbai. We conducted in-depth interviews with 26 AWWs and their supervisors, purposively sampled and diversified in terms of age, education, and years of experience. We used the software NVivo version 12 to aid analysis.

Results:

Most AWWs acknowledged that a convergent framework of action between “nutrition” and “health” was likely to be beneficial to the community. However, they also shared that cross-sector convergence was currently limited due to technical unfamiliarity with “health-sector” issues in the frontline, discomfort with data sharing, and lack of meaningful incentives for joint work. Broader organizational challenges such as poor infrastructure and lack of supervision, as well as challenges in the urban context (migration and cultural barriers) further hindered joint activities.

Conclusions:

The findings indicate that critical structural gaps in the urban setup of ICDS need to be addressed and AWWs need to be better familiarized with the changing roles expected from them under POSHAN Abhiyaan. To work better with the health sector, the work timings of AWWs need to be aligned with those of the health sector and meaningful financial incentives need to be put in place for cross-sector activities.
Effects of oxybutynin in children with posterior urethral valves post fulguration
Authors: Norris Joshua Jonathan , Raj Jeffrey Pradeep , Thomas Tia Teresa , Maleperambil Tijo Thomas , Shubha Attibele Mahadevaiah
Published: November 2021

Objectives:

Posterior urethral valves (PUV) is the commonest obstructive uropathy with varied consequences. Though valve fulguration is the treatment of choice, appropriate bladder management modifies outcome and includes rational use of anticholinergics. Here, we aim to evaluate the effects of oxybutynin on the bladder and urinary tract morphology and function. Concurrently, we document adverse effects encountered, patient compliance, and medication adherence.

Methods:

A retrospective study of children below 5 years of age (2012–2017) post fulguration and on oxybutynin for at least 6 months. Patient demographics, clinical features, renal ultrasound, micturating cystourethrogram, dimercaptosuccinic acid scan, adverse effects, and pill count for medication adherence were collated.

Results:

48 children below the age of 5 years were included, and 12 were excluded either due to the presence of concomitant problems or were not on oxybutynin. Of the 36, four were lost to follow-up and one had died due to an unrelated condition. Thus, a total of 31 children were analyzed. At follow-up, 28/31 patients were asymptomatic, two had daytime incontinence, and one had recurrent urinary tract infection. All patients except one have preserved renal function tests. On ultrasonography, hydroureteronephrosis worsened in only 1/25 children and two showed significant post void residues. The resolution of vesicoureteral reflux was noted in almost 50%. 4/31 renal units had progressive scars. Only two parents defaulted medication. Urodynamic study done in half of these children showed stable bladder pressures except in two.

Conclusion:

Oxybutynin therapy following adequate valve fulguration aids upper tracts preservation by stabilizing deranged bladder dynamics. The medication is well tolerated with minimal or no side effects.
Delayed-type hypersensitivity skin reaction to Covid-19 vaccine
Authors: Robb Mia L. , Robb Leo J.
Published: November 2021

Delayed-Type Hypersensitivity Skin Reaction following the Moderna mRNA COVID-19 Vaccine. This case is an unusually prolonged presentation of skin rash following vaccination for the novel COVID-19 virus. This case is clinically significant as it highlights an uncommon but not contraindicated potential side effect and details appropriate medical management. This case highlights that while potentially distressing patients who experience this side effect should be offered reassurance and conservative treatment
Altered pro-inflammatory and anti-inflammatory plasma cytokines levels in children with Down’s syndrome
Authors: Nigam Nitu , Singh Prithvi K. , Raizada Neena , Singh Balendra P. , Tripathi Shalini , Agrawal Monica , Gupta Harish , Singh Sharad , Fatima Ghizal , Nigam Sanjay K. , Saxena Shailendra K.
Published: November 2021

Background:

Down syndrome (DS) is the commonest chromosomal anomalies at birth. DS is portrayed by the event of extra complete/deficient duplicate of chromosome number 21 (trisomy 21). Around the world, this disordered influencing roughly 1 out of 1000 infants. Pro-inflammatory and anti-inflammatory cytokines engaged with a few physiological procedures involving the guideline of inflammatory reactions. In DS kids, the creation of few important inflammatory and anti-inflammatory cytokines is altered. Different investigations shows that the cytokines are dysregulated in patients with DS. In this study, we led a meta-analysis to evaluate the connections of pro-inflammatory and anti-inflammatory cytokine changes in youngsters with DS patients.

Methodology:

We searched PubMed, Google and Web of Science for studies in exploring the association of pro-inflammatory and anti-inflammatory serum level with DS patients. Total 10 studies were included in the meta-analysis. The random effects were used to analyze the pooled data. All statistical tests were two-sided.

Results:

High circulating level of serum MCP-1 was significantly associated with DS [Cohen’s d = 143.91 95% confidence interval (CI) =110.38-177.43]. However, the other circulating cytokines IL-2 and IL-17 level were lower whereas IL-13 level was higher but not significantly different in DS as contrasted to healthy controls. The heterogeneity level was higher in IL-2, IL-13 and IL-17 cytokines.

Conclusion:

This meta-analysis shows that the higher circulating level of MCP-1 was associated with DS.
Successful culture of Acanthamoeba remains a key towards diagnosis of unusual clinical presentation of keratitis
Authors: Wankhade Archana B. , Patro Priyadarshini , Mishra Neeta , Das Padma
Published: November 2021

A fifty-nine-year-old female with corneal ulcer with a history of trauma in the past having clinical presentation of fungal keratitis visited the Ophthalmology outpatient department with a history of redness, watering, pain and white discoloration of the right eye cornea for two months. Sample was cultured on non-nutrient agar medium and revealed Acanthamoeba. Patient was managed with Chlorhexidine eye drop and keratoplasty.
Emoqol 100, an ultra ultra-brief mood case-finding tool
Authors: Arroll Bruce , Mulcahy Connor F. , Roskvist Rachel P. , Mount Vicki
Published: November 2021

Background:

Case-finding for low mood in primary care can be time-consuming using current depression inventories.

Aim:

To assess the diagnostic accuracy, of a single verbally administered question on the emotional quality of life (Emoqol 100), for low mood in patients with symptoms of distress in an ambulatory care setting.

Design and setting:

Eligible patients were consecutive patients seen by one of the authors over 13 months with possible distress/low mood. The index test was the verbally asked Emoqol 100, which is the patient’s emotional quality of life now, with 100 being perfect emotional health and 0 being the worst imaginable. The reference standard is the written version of the PHQ-9 with a cut point of ≥10.

Methods:

A retrospective audit of consecutive consultations in a single primary care clinic.

Results:

One hundred two patients were seen during the study period, of which 76 met the eligibility criteria for this audit, and there were 215 test results. For a cut point of <50 on the Emoqol 100 and the PHQ-9 ≥10 the sensitivity was 47% (95% CI 39-54), and the specificity was 93% (95% CI 86-100). The positive predictive value was 95%, and the negative predictive value was 37%.

Conclusion:

This is the first accuracy estimation of the Emoqol 100. It appears to have a high specificity which means when it is positive (<50) it is a good estimate of a high PHQ-9, i.e. a mood issue probably exists. The test will be helpful for busy primary care clinicians as it takes less than 15 seconds to verbally administer.
Clinical profile, outcomes and predictors of mortality in elderly patients admitted to the emergency medicine intensive care unit of a teaching hospital – A single-center registry
Authors: Wilson William , Ravindra Prithvishree , Khasage Udaykumar J. , Raj Jeffrey Pradeep , Jain Vinayak , Bose Bijoyini , Kosuri Sreenidhi
Published: November 2021

Aim:

Emergency intensive care of the elderly is often complicated and multifaceted. Understanding the clinical profile of elderly patients admitted in an emergency department-intensive care unit (ED-ICU) is crucial in planning health policies in geriatric emergency medicine. Thus, the aim of the study was to create a local registry of elderly people utilizing the ED-ICU services and to understand the rate and predictors of mortality.

Methods:

A retrospective chart analysis was performed including all patients aged ≥60 years who had an ED-ICU admission during a 6-month period (August 2018–January 2019). A structured case record form was used to capture information such as basic demography, clinical profile, and outcomes.

Results:

Total number of records considered for final analysis were 503. Mortality was seen in 21.07% (n = 106/503). The most common presenting complaint and cause of death was breathing difficulty (n = 48/503; 29.42%) and pneumonia (n = 41/106; 38.67%), repectively. The significant predictors of mortality [adjusted odds ratio; 95% confidence intervals; P value] were hypertension (2.195; 1.255, 3.840; 0.006), chronic liver disease (CLD) (4.324; 1.170, 15.979; 0.028), malignancy (2.854; 1.045, 7.796; 0.041), requiring noninvasive ventilation (NIV) (2.618; 1.449, 4.730; 0.001), requiring intubation (6.638; 3.705, 11.894; <0.001), and requiring vasopressors (3.583; 1.985, 6.465; <0.001).

Conlusion:

Approximately one in every five elderly patients getting admitted in ED-ICU died, and respiratory illness was the common diagnosis leading to death. Those with comorbidities such as hypertension, CLD, or malignancy and those requiring NIV, intubation, or vasopressors had higher mortality.
International Classification of Functioning, Disability, and Health augmented by telemedicine and artificial intelligence for assessment of functional disability
Authors: Vasudeva Abhimanyu , Sheikh Nishat A. , Sahu Samantak
Published: November 2021

The concept of functional disability is aligned with the biopsycho-social model of disability. However, there are reasons why the antiquated measurement of medical impairment continues to be in use. We propose solutions for a fairer process using the International Classification of Functioning, Disability, and Health (ICF) at the level of the medical boards augmented by telemedicine and artificial intelligence (AI). The proposed technologies (Level 1 and Level 2 AI) need to be tried in pilot projects. It will accomplish two goals, the first being the measurement of disability and not merely the impairment. Second, and perhaps more importantly, making the process more transparent in creating a “just” society.
The attitude and awareness of contact lens use among medical students of King Faisal University, Al Ahsa, Saudi Arabia
Authors: Boqursain Saad K. , Al-Hussain Ahmed S. , Al Mubarak Adeeb A. , Al-Bujays Dawood S. , Al-Mustahi Manayer
Published: November 2021

Background:

Not many studies have investigated the knowledge outcomes among medical students with regards to contact lenses (CL). Thus, in this study, we aim to assess the attitude and awareness of CL use and the associated factors among medical students of King Faisal University (KFU), Al Ahsa, Saudi Arabia.

Methods:

This a cross-sectional study that based developed based on a designed questionnaire that was composed of 31 questions with a maximum score of 57 points. We have also conducted a linear regression model to explore the possible important factors that may affect the level of knowledge and awareness about contact lenses care.

Results:

A total of 208 participants were included in this study, with a mean age of 21.0 ± 1.9, and 56.3% (n = 117) of them being females. The total mean knowledge score in our study was 30.1 ± 7.74, which was higher in females (31.5 ± 7.09) than in male participants (28.7 ± 7.69). The results of the linear regression model showed that being female (E = -0.37; 95%CI = -0.65— -0.10; P = 0.007), using contact lenses (E = 0.56; 95%CI = 0.29 — 0.82; P < 0.001), and in the third year (E = 0.66; 95%CI = 0.19— 1.13; P = 0.007) is significantly correlated with having higher knowledge scores about using CLs.

Conclusion:

Female participants had higher total mean knowledge scores than males. We recommend that further educational campaigns should be inaugurated to raise awareness about taking care of CLs and enhancing the related practices of wearing them.
Why parents bring their children with minor health problems to their family practitioners
Authors: Serour Maleka , Al-Weqayyan Adnan , Almazeedi Hind , Al-Fedhala Hanan , Bahroh Ahmed , Aljadi Fatma , AlHilali Mohammed
Published: November 2021

Background:

Parents’ of young children who frequently attend primary health care (PHC) services for mild health problems (MHPs) can present a complex and difficult challenge for staff. This phenomenon can expose the child to inappropriate overprescribing, unnecessary medical interventions and may impair the quality of life of parents and children.

Aim:

To define driving factors for frequent attenders (FAs) preschool children in PHC services in Kuwait.

Design and Setting:

An unmatched case-control study was conducted in the PHC setting in Kuwait.

Method:

A sample comprised of 300 parents from 10 PHC centres was selected. The top third children with higher frequency (FAs) visits to their family practitioners (FPs) were compared with the lower third with lower frequency (NFAs) visits to their FPs during the same duration. The Brief Illness Perception Questionnaire (Brief IPQ) was used to assess parents’ response to their children’s illness. The sociodemographic data for both groups were collected. Culture and background heath status for child and family were collected (order of the child in the family, if the family is living with the extended family and additional help received regarding childcare). The previous medical history of parent, child, and siblings was also included.

Results:

The mean number of consultations in FAs versus NFAs within the previous year was 15.5 ± 7.6 and 4.3 ± 2.1, respectively. There was no significant difference in means between the two groups of parents in responses to the questions of the adapted Brief IPQ. FAs were more likely to be the first-order child (odds ratio (OR) 2.4; 95% confidence interval (CI) =1.2–4.6), have chronic disease (OR 4.7; 95% CI = 2.1–10.6), and live with the extended family (OR 1.8; 95% CI = 1.1–3.3). They experienced an acute, potentially life-threatening episode previously (OR 2.6; 95% CI = 1.1–6.4), with the same applying to a sibling (OR 72.6; 1.2–6.2) or parent (OR 2.6; CI = 1.1–6.4).

Conclusion:

Identification of the hidden reasons that affect parents’ decisions to consult their FPs frequently for their children’s MHPs were important predictors for defining preschool FAs children in the PHC centres and can help the staff provide effective management plans to help them.
Evaluation of changes in corneal volume, volume and angle of anterior chamber in keratoconus patients using Pentacam after CXL
Authors: Ostadian Farshad , Nickkhah Sona , Farrahi Fereydoun , Rad Atefeh Mahdian
Published: November 2021

Introduction and Objective:

Corneal collagen cross-linking (CXL) with riboflavin and ultraviolet-A (UVA) is a new technique of mechanical stability of the cornea and prevention of keratoconus progression. The present study aimed at the evaluation of the changes in the corneal volume (CV), volume, and the angle of anterior chamber in keratoconus patients using the Pentacam after CXL.

Methods:

This prospective study was performed on 48 eyes of 24 patients (including 12 men, 17–33 years old) with progressive keratoconus undergoing CXL treatment at collagen cross-linking Imam Khomeini Hospital in Ahvaz in 2019. The CV (CV) and anterior chamber parameters such as anterior chamber volume (ACV) and anterior chamber angle (ACA) were measured using the Pentacam before CXL and at 6 and 12 months after CXL. Also, all of the patients were evaluated in terms of best-corrected visual acuity (BCVA), during the follow-up.

Results:

The pre-CXL values of BCVA was significantly lower than the post-CXL values in 6 and 12 months (0.18 ± 0.11, 0.15 ± 0.10, and 0.11 ± 0.10, respectively, P < 0.0001). In general, there was a significant improvement in the BCVA (P < 0.0001), a significant decrease in the CV (P = 0.001), and a significant increase in the ACV (P < 0.0001), and angle (P < 0.0001) 6 and 12 months after CXL.

Conclusion:

It seems that CXL has a positive effect on the anterior chamber parameters (ACV and ACA) and CV after 6 months and 1 year in the treatment of keratoconus patients. In addition, the visual acuity improves after CXL. Finally, further studies with a higher sample size and longer follow-up periods are recommended.
Laparoscopic common bile duct exploration after failed endoscopic retrograde cholangio-pancreatography
Authors: Bhardwaj Arun M. , Trehan Kamal K. , Sharma Vishwas
Published: November 2021

Aim:

Laparoscopic CBD exploration (LCBDE) for Common bile duct (CBD) stones with laparoscopic cholecystectomy (LC) is an alternative to open CBD exploration, in patients with failed endoscopic retrograde cholangio-pancreatography (ERCP). It is being performed at few centres with adequate surgical expertise. Herein, we present our experience of LCBDE with LC over a period of 10 years.

Patients and Methods:

A retrospective analysis of prospectively recorded data of 121 consecutive patients was performed from February 2010 to November 2019, who underwent LC and LCBDE by choledochotomy in a single surgical unit. These included all patients with failed pre-operative ERCP.

Results:

Out of 121 patients, LCBDE successfully cleared the CBD in 118, and three patients were converted to open surgery. All these patients underwent choledochotomy for adequate exploration of CBD. T-tube closure of CBD was performed in 103 patients and removed after a mean of 14.6 ± 2.4 days. Primary closure was performed in 15 patients. The mean hospital stay post-procedure was 3.4 ± 0.7 days. Complete ductal clearance was achieved in 115 patients, and residual stone fragments reported in three patients were removed by ERCP. None of the patients experienced biliary peritonitis, biliary fistula, pancreatitis or cholangitis. There was no 30-day mortality and no recurrent stones reported with a mean follow-up of 12.4 ± 3.9 months.

Conclusion:

With adequate surgical expertise, LCBDE is a feasible alternative to open surgery for CBD stones after failed ERCP with early recovery and low morbidity.
A multicenter study of clinical and biochemical profiles, treatments, and short-term outcomes in children with multisystem inflammatory syndrome associated with SARS-CoV-2 infection from Western India
Authors: Mehta Rachit , Joshi Vinay H , Joshi Preetha , Bhondve Amit , Otiv Madhu , Udani Soonu , Mohite Mahesh , Sarang Bhakti U , Andankar Parmanand , Bagade Abhijit , Sadawarte Sameer , Lad Sagar Sharad , Suryawanshi Pradeep , Dhongade Ashish Ramchadra
Published: November 2021

Background:

Severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) infection can lead to multisystem inflammatory syndrome in children (MIS-C). This study was conducted to study epidemiology, clinical profile, treatment strategies associated in children MIS-C in two cities in Western India.

Subjects and Methods:

This is a retrospective, observational study of children who fulfilled the criteria for MIS-C, admitted to eleven pediatric intensive care units (PICUs) in Western India during the first wave SARS-CoV-2 infection in India, between February 2020 and December 2020. Demographic and clinical data including laboratory parameters, treatment regimens, and outcomes were collected and analyzed.

Results:

Of the 234 children presenting with MIS-C, they were categorized into 3 clinical phenotypes: fever and hyperinflammation, Kawasaki disease (KD)-like, and shock with multisystem organ dysfunction syndrome (MODS). C-reactive protein, procalcitonin (PCT), D-dimer, and pro-B-type natriuretic peptide levels were elevated in all patients. Intravenous immunoglobulin (IVIG) was used in 128 (54.7%), corticosteroids in 214 (91.45%), tocilizumab in 1 (0.4%), and remdesivir in 4 (1.7%). 95 (40.5%) children required vasopressors and invasive mechanical ventilation was necessary in 26 (11.1%). Two hundred and twenty-nine patients were discharged home with median duration of PICU stay of 4 days and hospital stay of 7 days, and 5 (2.1%) patients died during treatment. Significant reduction in the duration of hospital stay was observed in those who received both steroid and IVIG (P < 0.05) and also in the shock ± MODS group (P < 0.05).

Conclusions:

Combination of steroid and IVIG for the treatment of MISC, especially with Shock and MODS reduce the duration of PICU stay than treated with steroid alone.
Scrub typhus meningoencephalitis in children
Authors: Parida Preetinanda , Agrawal Aman Kumar , Biswal Sebaranjan , Patnaik Sibabratta , Behera Chinmay Kumar
Published: November 2021

Background:

Scrub typhus is being reported from different parts of India. Meningitis or meningoencephalitis among various neurological complication seen in scrub typhus is not uncommon. Delay in diagnosis may cause higher mortality without prompt treatment. The aim of the study was to describe the various manifestations of scrub typhus meningoencephalitis and their outcome from eastern part of India.

Subjects and Methods:

A prospective observational study of scrub meningoencephalitis was carried out at Kalinga Institute of Medical Sciences, between October 2018 and August 2020. The diagnosis was made based on the compatible clinical features, positive Scrub Ig M by ELISA and cerebrospinal fluid lymphocytosis (>5 cell/cmm), after excluding other causes of meningoencephalitis.

Results:

Twenty-seven (12.38%) cases of scrub meningoencephalitis were included in the study with male (66.6%) predominance. All had presented with fever of mean duration of 8.5 days of illness. Altered sensorium and seizure was observed in 70.5% and 62.9% of our patients along with two patients who had sixth cranial nerve palsy. Eschar was found in 25.9% of our children. The mean CSF cell count, protein and glucose were 25 cells/cmm,84.2 mg/dL and 62.9 mg/dL respectively with lymphocytosis in all cases. There was no mortality in this study.

Conclusion:

Meningoencephalitis is an important complication of scrub typhus in children. Unlike most viral encephalitis cases, it has a definite treatment with good outcome, if treated early.
Persistent left superior vena cava presenting as brain abscess
Authors: Rao Neha Mohan , Shankar Guruprasad Hassan , Sarangi Bhakti U , Bafna Sanjay , Joshi Priscilla , Jahagirdar Rahul
Published: November 2021

A persistent left superior vena cava (PLSVC) draining into the left atrial appendage can exist as an unidentified right-to-left shunt often with no demonstrable evidence of hypoxia on history but predisposing to life-threatening clinical implications. We present a 7-year-old boy with a brain abscess who was incidentally noted to have features of hypoxia on examination. His evaluation revealed the presence of a PLSVC on computed tomography pulmonary angiogram, draining into the left atrium, thereby acting as a right-to-left shunt explaining the brain abscess. He underwent a craniotomy with a course of intravenous antibiotics, remained well on follow-up, and was referred for definitive surgery for PLSVC. Children with unidentified right-to-left shunts may present with brain abscesses in the event of which both intracardiac and extracardiac shunts have to be ruled out with the help of history, a focused clinical assessment, and more advanced imaging.
Field Level Experiences in Delivering COVID-19-Related Services by Accredited Social Health Activists in a Block of Purba Bardhaman District, West Bengal
Authors: Gupta Sukanya , Samsuzzaman Md , Banerjee Niladri , Das Dilip Kumar
Published: November 2021

Background:

Health-care workers at all levels are putting their best efforts to contain the COVID-19 pandemic. In resource-poor country like India, the community health workers are given primary responsibility for prevention and control measures at the village level. Learning from their experiences and addressing constraints will ensure improved service delivery in the face of further waves of pandemic.

Aim:

The aim of the study is to explore the field level experiences of Accredited Social Health Activists (ASHAs), working in Bhatar block of Purba Bardhaman district, West Bengal, while delivering COVID-19 response services and to elicit the nature of constraints faced by them.

Materials and Methods:

This was a qualitative study with phenomenological approach conducted among ASHA workers from December 2020 to January 2021. Convenient sampling was done to select 8 participants for data collection by focused group discussion (FGD) using FGD guide. A total of four FGDs with 32 participants were conducted. Data were analyzed using thematic framework approach to identify codes and themes.

Results:

The experiences are presented under five broad themes and in subthemes. ASHAs were engaged in extensive work amidst various challenges, though they received ample support and cooperation from society and general administration. ASHAs faced issues with inadequate supply of protective equipment and were in need for refresher trainings. Events of social stigma and ostracizations had also surfaced. Limited financial incentives, increased susceptibility to COVID-19, and detachment from family were the main source of stress among ASHAs.

Conclusion:

The issues identified in this study can be addressed to further utilize ASHAs in delivering services in pandemic context.
A Prospective Interventional Study to Assess the Advantage of Premedication with Sublingual Nitroglycerin in Evaluation of Peripheral Vascular Disease with Computed Tomography Peripheral Angiography
Authors: Dhanalakshmi B. , Shijith K. P. , Sharma Prafull
Published: November 2021

Objectives:

The objectives of this study were to investigate the influence of sublingual nitroglycerin (NTG) administration on peripheral vessel diameter, the number of evaluable segments, image quality, and adverse effects in patients with peripheral vascular disease (PVD) undergoing multidetector computed tomography (MDCT) angiography.

Methods:

A prospective randomized comparative interventional study was conducted on 48 inpatients with clinical diagnosis of PVD. The study patients were divided into two groups: one which was premedicated with 5 mg of sublingual NTG (NTG group) and the other without the use of NTG. MDCT images were recorded after 5 min of drug administration. The 10 segments of upper-limb vessels and 15 segments of lower-limb vessels were evaluated for diameter (mm), intraluminal contrast opacification (Hounsfield unit), collaterals, and stenosis (%). The data were entered in MS Excel and analyzed using SPSS. P < 0.05 was considered statistically significant.

Results:

The NTG group showed a statistically significant increase in diameter of radial artery (P = 0.01), common femoral artery, and all arterial segments of lower limb (P<0.05). The intraluminal contrast attenuation was higher in all segments (P < 0.05) in lower limbs. Good and continuous visualization of collateral vessels in segments with > 50% stenosis or occlusion was seen in the NTG group than the non-NTG group (P < 0.05).

Conclusion:

Sublingual NTG administration results in significant peripheral vessel dilatation, thus improving number of evaluable distal branches and collaterals with minimal side effects requiring no medical intervention. It helps increase the MDCT diagnostic accuracy and select appropriate treatment protocol.
Cytodiagnosis of anaplastic thyroid carcinoma with osteoclast-like giant cells − A case report with a review of the literature
Authors: Govindaraman Padmanaban Krishnan , Balakumar Selvaraj , Lawrence Anthuvan Jeyarani
Published: November 2021

Anaplastic thyroid carcinoma (ATC) accounts for 5%–10% of primary thyroid malignancies. Cytodiagnosis of osteoclast-like giant cells (OLGCs) variant of ATC is very rare with only few cases reported in literature. We report a case of ATC with OLGC variant in an 85-year-old female who presented with swelling in the right lobe of thyroid and scalp nodule, which on radiological evaluation and subsequent fine-needle aspiration biopsy (FNAB) was diagnosed as ATC having numerous OLGC with metastases in skull bones. Cytologically, thyroid aspirate revealed sheets of epithelioid neoplastic cells admixed with many OLGC. Aspirate from the scalp nodule showed neoplastic cells with follicular differentiation. She also had radiological evidence of lung metastasis. Such a presentation of this rare variant being diagnosed by FNAB is rarely reported in literature and highlights the importance of this simple procedure in diagnosing and planning management of this rare condition.
The relationship between academic resilience and academic performance among pharmacy students
Authors: Abubakar Usman , Mohd Azli Nur Ain Shafiqah , Hashim Izzatil Aqmar , Adlin Kamarudin Nur Fatin , Abdul Latif Nur Ain Izzati , Mohamad Badaruddin Abdul Rahman , Zulkifli Razak Muhammad , Zaidan Nur Ain
Published: November 2021

Objective: To evaluate academic resilience and investigate its relationship with academic performance among undergraduate pharmacy students.   
Methods: This was a cross-sectional study conducted among undergraduate pharmacy students in a public university in Malaysia using an adapted and pretested 16-item academic pharmacy resilience scale (APRS-16). Demographic and academic performance data were collected using an online self-administered questionnaire from December 2019 and January 2020 and analysed using descriptive and inferential analyses.   
Results: A total of 247 students completed the survey (response rate was 55.6%). Overall, the students had moderate academic resilience score (median: 59; interquartile range [IQR]: 37 – 80). Female students had significantly higher academic resilience score than males (60 [41 – 80] versus 56 [37 – 69]). Academic resilience score was higher among year one students (62 [42 – 74]) compared to year two (57.5 [37 – 80]), year three (59 [37 – 78]) and year four (58 [44 – 77]) students. There was a positive relationship between academic resilience score and students’ cumulative grade point average (CGPA) (r = 0.250) and GPA (r = 0.154).   
Conclusion: Undergraduate pharmacy students have moderate academic resilience. Academic resilience varies based on gender and year of study, and it is significantly associated with academic performance.