bluuebunny/crossref_metadata_2025 huggingface dataset:
The effect of protocatechuic acid on neuropathic pain and possible mechanism
Authors: Cici Melda Ozgurbuz , Bektas Nurcan
Published: May 2024

OBJECTIVES:

The goal of the research is to investigate the protocatechuic acid (PCA) potential action, a phenolic acid derivative, on pain induced by neuropathy and to determine its efficacy on activation of KATP type channels and A1 receptors.

MATERIALS AND METHODS:

Neuropathic pain by cause of sciatic nerve damage was induced in Sprague-Dawley rats. Anti-allodynic and anti-hyperalgesic effects were evaluated with von Frey apparatus and Hargreave's plantar test apparatus, respectively. The effects of PCA at the doses of 75, 150 and 300 mg/kg, carbamazepine at the doses of 50 and 100 mg/kg, combination of low effective doses of PCA and carbamazepine were tested. Pretreatments 3 μg/kg DPCPX as adenosine A1 receptor antagonist and 60.7 nmol glibenclamide as KATP channel blocker were applied for mechanistic studies.

RESULTS:

PCA showed anti-allodynic and anti-hyperalgesic effects without impairing locomotor activity. In addition, the combination treatment was found to be more effective than the separate individual treatments of drugs. KATP channel activation related with A1 receptor stimulation makes a significant contribution to the anti-allodynia and anti-hyperalgesia induced by PCA.

CONCLUSIONS:

It can be said that PCA has similar effects with carbamazepine, which is used in clinical practice, and that PCA can take place as an adjuvant drug in neuropathic pain with the combination group. In addition, it is seen that the undesirable effects that drugs can cause alone can be avoided and a more effective treatment potential can be created with multiple mechanisms.
Pharmacological treatment of bipolar disorder in pregnancy
Authors: Singh Swarndeep , Deep Raman
Published: May 2024

Pregnancy in women with bipolar disorder (BD) can be considered a high-risk pregnancy in view of several clinical and pharmacotherapeutic considerations. Pharmacological treatment during pregnancy requires a careful weighing of psychotropic drug exposure against the risk of BD relapse. An untreated bipolar illness can negatively affect the health of mother as well as unborn child in the event of a relapse. Availability of well balanced, latest information on safety of prophylactic drugs for BD is crucial for making informed decisions. The review provides an evidence-based update (2015–2021) on the drug safety considerations involved in providing care for women with BD who are either pregnant or planning to conceive in near future. Literature review based on systematic reviews, meta-analyses, and data available from studies based on large-scale cohorts and birth registries has been synthesized and presented along with clinically relevant recommendations.
The rise of E-pharmacy in India
Authors: Dcruz Alison C. , Mokashi Vinay N. , Pai Sreedhar Ranganath , Sreedhar Dharmagadda
Published: May 2024

The recent worldwide pandemic has prompted several companies to turn to the online market. The pharmaceutical industry is one such significant and crucial in India. There has been an upsurge in online pharmacies throughout the Indian subcontinent over the last 3–5 years. This unique development of online or “E-pharmacy” field has been carefully examined and presented in this article. The distinction between online and offline pharmacies, the advantages and challenges faced by E-pharmacies, the driving forces that led to the growth of the E-pharmacy sector in India, and the various emerging Indian E-pharmacy companies are covered. A comprehensive review of the legal system under which the E-pharmacy industry operates is also briefed. The reader will also learn about the various initiatives implemented by the Government in support of the E-pharmacy sector in India.
A retrospective review of a 2-year strong antimicrobial stewardship program in a tertiary care institute in Mumbai
Authors: Saseedharan Sanjith , Shaffi Nausheen , Rambhad Sonal , Kadam Vaijyanti , Mathew Elizabeth J.
Published: May 2024

BACKGROUND INFORMATION:

Many institutes have implemented a strict antimicrobial stewardship (AMS) program in the postantibiotic era.

AIM:

To investigate how the resistance pattern changes after implementation of a stringent AMS programme.

METHODOLOGY:

It employs a defined daily dose methodology (DDD). The formulae listed below are used to compute this for two periods: October 2015 to October 2017 (Period 1) and October 2017 to October 2019 (Period 2) (Period 2).

DDD = Antibiotics used in total (g) per year

The length of stay was determined using the data from the hospital's information system (HIS). The patterns of resistance to the limited antibiotics are vancomycin, linezolid, tigecycline, and colistin. In both Periods 1 and 2, skin and soft-tissue infections, urinary tract infections, bloodstream infections, and respiratory tract infections were studied in both periods.

RESULTS:

In the year from October 2015 to October 2017, 4569 patients received limited antibiotics out of a total of 14,544 admissions. The average length of stay was 7.48 days in Period 1, however, it was reduced to 3.96 days in Period 2 out of 15,199 patients. In vitro isolate sensitivities to vancomycin, linezolid, tigecycline, and colistin were increased.

CONCLUSION:

Some of the most common antibiotics were used less frequently. This appears to be linked to a shorter stay in the hospital and increased antibiotic susceptibility.
Tongue and teeth hyperpigmentation in etoposide, prednisolone, vincristine, and cyclophosphamide regimen in the treatment of cutaneous lymphoma
Authors: Morabad Soumya Shivalingappa , Khan Zahed Ullah , Gad Richa , Kallur Nikitha , Madhabhavi Irappa Vithoba , Shalavadi Mallappa Hanumanthappa , Mangannavar Chandrashekhar Venkaraddi
Published: May 2024

Cutaneous extranodal non-Hodgkin lymphoma is a rare cancer and chemotherapeutic agents like etoposide, vincristine and cyclophosphamide are the drug of choice, which rarely cause hyperpigmentation in skin and nails. However, herein we present a case of hyperpigmentation that was seen in tongue and even in teeth. The hyperpigmentation of the tongue and teeth occurred shortly after the initiation of chemotherapy. Hyperpigmentation was self-limiting and rectified in a week without need of any pharmacological, surgical, or lifestyle interventions.
Information on migraine drugs in commonly available Indian drug information sources – Whether we satisfied the community needs?
Authors: Thangaraju Pugazhenthan , Mahesh Kothapalli , Venkatesan Sajitha
Published: May 2024

Drug information can be obtained from various drug information sources that were available as government (National Formulary of India [NFI]; Central Drugs Standard Control Organization [CDSCO]), as well as commercial documents (Current Index of Medical Specialties [CIMS] and Monthly Index of Medical Specialties [MIMS]). Irrational drug usage may happen due to wide variation in the information available in these sources. In this study, we tried to assess these variations in a sample of drugs for the acute-specific management of migraine with ergot and Triptans antimigraine drugs in drug information sources such as NFI, CIMS, MIMS, and CDSCO. Scoring was done for various drug information based on the completeness of information about drugs used in acute-specific management of migraine. The scores for the completeness of drug information about the selected antimigraine drugs are 18.37% for CIMS (Ergotamine, Sumatriptan, Rizatriptan, and Zolmitriptan), 21.1% for NFI (Dihydroergotamine, Sumatriptan), 72.79% for MIMS (Ergotamine tartrate, Sumatriptan, Rizatriptan, Naratriptan, zolmitriptan, Almotriptan) and 21.77% for CDSCO (Ergotamine tartrate, Sumatriptan, Rizatriptan, Naratriptan, Zolmitriptan, eletriptan and almotriptan). The information for the antimigraine drugs available from various sources found to so much deficient. Necessary steps need to be taken in case of government public or hard documents to streamline drug information available with them as well the commercial documents as to provide reliable drug information uniformly for promoting rational use of the drug.
Materiovigilance of unidirectional barbed and poliglecaprone 25 nonbarbed sutures used for intraoral incision closure
Authors: Deo Jaspreet Kaur , Rehan Harmeet Singh , Mehra Pravesh
Published: May 2024

INTRODUCTION:

The adverse events of sutures used for the closure of surgical incisions influence clinical outcomes. Literature on the safety profile of the application of unidirectional barbed sutures in oral and maxillofacial surgery is scarce. Hence, focused materiovigilance was done to monitor and compare the adverse events of unidirectional barbed and poliglecaprone 25 nonbarbed sutures for intraoral incision closure.

METHODS:

In a prospective randomized comparative study, 64 patients requiring intraoral incision closure were randomized to receive either unidirectional barbed or poliglecaprone 25 nonbarbed sutures. Postoperatively, patients were monitored for any adverse events for 15 days. Causality association of adverse events with sutures was done using the European Commission directives on safety reporting of medical devices.

RESULTS:

Adverse events observed with unidirectional barbed suture were suture extrusion (n = 7; 21.875%) and suture discomfort (n = 3; 9.375%). While subjects who received poliglecaprone 25 suture experienced suture discomfort (n = 6; 18.75%) and knot unraveling (n = 2; 6.25%). The number of adverse events in both groups was statistically comparable (P = 0.78). Causality assessment of adverse events was probable for suture extrusion and discomfort with nonbarbed and barbed sutures, while it was possible for knot unraveling for nonbarbed sutures.

CONCLUSION:

Both types of study sutures were associated with minor severity adverse events when used for the closure of intraoral surgical incisions. Suture extrusion had a probable causal association with barbed suture. Knot unraveling was possibly associated with the nonbarbed suture. Both types of suture materials were equally safe in oral and maxillofacial intraoral surgical incision closure.
Genital ulcers following all-trans-retinoic acid therapy
Authors: Saraswat Neerja , Kumar Sushil , Prem Rahul , Tripathi Durga Madhab
Published: May 2024

All-trans-retinoic acid (ATRA) has transformed the treatment of acute promyelocytic leukemia. Most of the adverse effects associated with this drug are minor barring differentiation syndromes. Genital ulcers feature among the underreported adverse effects of ATRA which needs to be kept in mind to avoid life-threatening complications. We describe two cases who developed genital ulcers while treated with ATRA.
Cost-minimization analysis of escitalopram, fluoxetine, and amitriptyline in the treatment of depression
Authors: Salian Harshit Hemant , Raghav M. V. , Rawat Vikram Singh , Divakar A.
Published: May 2024

INTRODUCTION:

Escitalopram, fluoxetine, and amitriptyline are the drugs commonly used in the treatment of depression. The pharmacoeconomic evaluation of these drugs becomes relevant as they are prescribed for a long period of time, and depression causes a significant economic burden. The cost-minimization study would contribute to bringing down the annual treatment costs, leading to better medication adherence and ultimately better patient outcomes.

MATERIALS AND METHODS:

All drug prices are mentioned in Indian National Rupee (INR). All expenses are based on 2022 pricing. No cost discounting was used because all expenditures were calculated over a year. We considered hypothetical scenarios where the patient was prescribed the lowest possible dose for depression, an equivalent antidepressant dose, a defined daily dose, and the maximum acceptable therapeutic dose for depression.

RESULTS:

Annual average treatment costs of amitriptyline, escitalopram, and fluoxetine in patients with depression at baseline with equivalent dosing as mono-drug therapy were 2765.53, 2914.78, and 1422.72 rupees (INR), respectively. Savings were high when the patient was shifted to fluoxetine from either escitalopram or amitriptyline. The savings from switching to fluoxetine were 50.66% and 56.42% from escitalopram and amitriptyline, respectively.

CONCLUSION:

The choice of an antidepressant depends on multiple aspects, among which the cost of treatment plays a crucial role. Among the drugs compared, fluoxetine seems to offer greater value for money. The study emphasizes that selective serotonin reuptake inhibitors are the most commonly prescribed antidepressants not only because of their favorable pharmacological profile but also because of their affordability.
Simultaneous determination of lactulose, sucrose, sucralose, and mannitol using high-performance liquid chromatography-refractive index to estimate intestinal permeability in patients with active ulcerative colitis
Authors: Sarotra Pooja , Dutta Usha , Gupta Hina , Ravindranathan Kartha K P , Kochhar Rakesh , Prakash Ajay , Sarma Phulen , Shah Jimil , Medhi Bikash
Published: May 2024

OBJECTIVES:

The intestinal permeability (IP) of sugars and their derivatives has been widely used to assess mucosal damage in gastrointestinal diseases. Ulcerative colitis (UC) is a recurring and relapsing disease that causes inflammation of the gut. IP of sugars can be evaluated and correlated with the flare of UC.

MATERIALS AND METHODS:

A prospective study was conducted on 91 patients with active UC at the tertiary care center in North India. Mayo grading system assessed disease activity, and IP was assessed by measuring sucrose, lactulose, mannitol, and sucralose in urine samples from UC patients. A high-performance liquid chromatography (HPLC) method to detect all of these sugars simultaneously using a refractive index detector was developed and further validated in patients with UC.

RESULTS:

The analytical recovery rate of the tested sugars ranged from 95% to 146% in the urine matrix. The limit of detection and limit of quantification were 78.838 mg/L and 262.79 mg/L for sucrose, 84.994 mg/L and 283.31 mg/L for lactulose, 74.789 mg/L and 249.30 mg/L for mannitol, and 50.908 mg/L and 169.69 mg/L for sucralose.

CONCLUSION:

The standardized HPLC method is sensitive and suitable for the simultaneous detection and determination of different sugar moieties in the urine sample. Patients with UC can be evaluated indirectly for the flare by estimating the recovery rate of sugars through gut permeability. The procedure is noninvasive and thus improves the quality of life of chronically ill patients.
Evaluation of mechanism(s) of action underlying the antioxidant and antiulcer activity of Sesamum indicum leaves extract in experimental rats
Authors: Shivam  , Chandra Phool , Sachan Neetu
Published: May 2024

OBJECTIVE:

The current study aimed to estimate phytochemical screening, in vitro antioxidant activity, and gastroprotective activity of Sesamum indicum Linn ethanolic extract.

MATERIALS AND METHODS:

The current study was held out by ulceration induced by pylorus ligation and indomethacin-induced ulcer screening models in Wister albino rats. The screening of antiulcer activity of ethanolic extract of S. indicum leaves (EESIL) at the different amounts (100, 200, and 400 mg/kg; per orally for 7 days) was compared with omeprazole as a usual antiulcer drug. Additional parameters such as gastric content, pH, total acidity, pepsin activity ulcer score, free acidity, ulcer index (UI), % inhibition of ulcers, mean mucin, pepsin content, and total protein content were observed.

RESULTS:

In the pylorus ligation model, the pepsin activity free acidity, pepsin content, UI, total acidity, ulcer score, total protein content, and percentage ulcer inhibition were considerably decreased (P < 0.05 and P < 0.01), and mean mucin and gastric content pH extensively elevated (P < 0.05 and P < 0.01) in EESIL tested groups in the comparison of the control group. Doses (100, 200, and 400 mg/kg p.o.) of EESIL showed dose-reliant gastro protective outcomes, a considerable (P < 0.05 and P < 0.01) decrease in gastric parameters as UI and ulcer score and induction in gastric pH and percentage inhibition of ulcer compared with the control group.

CONCLUSION:

Antioxidant, anti-Ulcer, EESIL, and EESIL show antioxidant activity at different concentration. The fallout of the study indicated that the EESIL had improved antiulcer potential due to the decrease in offensive factors and increase in defensive factors.
Intraperitoneal Instillation of Bupivacaine and Hydrocortisone for Postoperative Analgesia in Laparoscopic Cholecystectomy Under Spinal Anaesthesia – A Prospective Randomized Study
Authors: Kshirsagar Rajabhau , Kuttarmare Shital Mahendra , Bhalerao Pradnya Milind , Kshirsagar Sujit Jagannath
Published: May 2024

Background:

Laparoscopic cholecystectomy is a minimally invasive procedure requiring less hospital stay and early mobilization as compared to open procedure. The aim of our study was to compare the efficacy of intraperitoneal instillation of hydrocortisone with bupivacaine for postoperative analgesia in patients undergoing laparoscopic cholecystectomy under spinal anesthesia.

Materials and Methods:

Sixty patients were enrolled in this prospective randomized study. Patients either received 0.125% bupivacaine (Group B) or 0.125% bupivacaine with 100 mg hydrocortisone (Group H) through intraperitoneal drain at the end of surgery. Pain was evaluated every two hourly using the Visual Analog Scale (VAS) for 24 h. Analgesics were required during this period and the presence of shoulder pain was also noted.

Results:

Patients in the hydrocortisone group had lower pain scores (2.17 ± 0.47) compared to the bupivacaine group (3.51 ± 1.10). This difference in the mean VAS score was statistically significant (P < 0.01). Similarly, patients requiring rescue analgesia were 60.86% in Group B and 39.14% in Group H and were statistically significant. Time for rescue analgesia was longer in Group H as compared to Group B.

Conclusion:

Intraperitoneal bupivacaine and hydrocortisone decrease pain and analgesic requirements more effectively than bupivacaine alone after laparoscopic cholecystectomy without causing significant adverse effects.
Subcutaneous Platelet Rich Plasma Therapy for Management of Hyperalgesia in Complex Regional Pain Syndrome
Authors: Rout Aradhana , Thakur Kamparsh , Choubey Amit Kumar
Published: May 2024

Objectives:

Complex regional pain syndrome (CRPS), which usually develops after a traumatic event, often has a debilitating effect on the quality of life. Treatment is multidisciplinary and is based primarily on pain relief. Due to the symptoms of hyperalgesia and allodynia in patients with CRPS, dermatology opinion is often seeked. CRPS is a difficult disorder to treat and platelet-rich plasma (PRP) is a potential treatment modality for pain relief in this debilitating illness. We aimed to investigate the role of subcutaneous PRP for relief of hyperalgesia in patients with CRPS.

Materials and Methods:

A comparative prospective study of 15 male patients with CRPS diagnosed clinically by the Budapest criteria and radiologically by magnetic resonance imaging was enrolled for the study. PRP was injected subcutaneously at biweekly interval for 8 weeks and the results were assessed clinically by neuropathic pain score (NPS) score. The patient satisfaction was noted at baseline, 4 weeks, and 8 weeks. Patients were followed up for 3 months to assess the increase or decrease in hyperalgesia after stopping PRP. ANOVA was used with the Bonferroni correction for NPS score at various time interval. P ≤ 0.05 is considered statistically significant.

Results:

Numeric Rating Scale score showed statistically significant improvement at end of the study as compared to the baseline. Patients also had improvement in range of motion which was assessed at every visit. A few patients had mild redness and burning postprocedure which resolved spontaneously after a few hours.

Conclusions:

From this study, we concluded that subcutaneous PRP shows a significant reduction of hyperalgesia associated with CRPS.
COVID-19 vaccine: Culprit or innocent bystander in a rare adverse gastro-intestinal surgical event? A case report with review of literature
Authors: Nagula Mounish R. , Joshi Abhijit S.
Published: May 2024

ABSTRACT

Corona virus disease (COVID-19) initially appeared to be an exclusively respiratory ailment. While that is true in a vast majority of the cases, its evolution and later evidence have shown that it can afflict virtually any organ system in the human body after first gaining entry through the respiratory tract. The COVID-19 vaccines were one of the turning points in the campaign to control the COVID-19 pandemic. However, after their extensive use all over the world, it has emerged that they can cause some dangerous collateral damage. We, herein, report the case of a 58-year-old woman who presented to us with signs and symptoms of acute intestinal obstruction 4 months after receiving her first dose of Covishield® vaccination for COVID-19. Her blood tests showed a high D-dimer and normal platelet count. She was previously admitted to the hospital with an acute abdomen 3 months back. A contrast-enhanced computed tomography (CECT) scan of the abdomen done then had revealed thrombi in the aorta and inferior mesenteric and splenic arteries. She was started on low-molecular-weight heparin and discharged on tablet Warfarin after clinical improvement. CECT abdomen done during her present admission revealed a proximal small bowel stricture with dilated proximal and collapsed distal loops. She underwent a laparoscopic jejuno-ileal resection anastomosis. During the post-operative period, a repeat CECT abdomen done to evaluate multiple episodes of vomiting revealed pulmonary embolism in the lower chest cuts. A venous Doppler revealed extensive deep venous thrombosis of the left lower limb. A thrombophilia profile diagnosed anti-phospholipid antibody syndrome, an exacerbation of which was likely precipitated by the COVID-19 vaccine.
Hypothalamus-pituitary-adrenal axis (HPA axis) suppression with inappropriate use of steroids in recalcitrant dermatophytosis – A cross-sectional study
Authors: Kaur Tanureet , Bassan Manbir S. , Bisht Manisha , Kumar Nitish , Saini Poonam , Hazarika Neirita
Published: May 2024

ABSTRACT

Background:

Improper use of over-the-counter (OTC) steroid medication has been linked to recalcitrant dermatophytosis. There is proven evidence of HPA axis suppression by the use of long-term oral steroids. This study aims to determine the prevalence and pattern of inappropriate OTC steroid use and its effects on the hypothalamus-pituitary-adrenal (HPA) axis in adults with recalcitrant dermatophytosis.

Materials and Methods:

This cross-sectional study of 2 months was conducted in a hospital setting and included patients of recalcitrant dermatophytosis with a history of OTC steroid use. Clinico-demographic details and basal serum cortisol levels were recorded in all and analyzed.

Result:

Of a total of 103 patients, 59.22% (n = 61/103) were males, and the mean duration of steroid abuse was 17.78 months. About 48.54% (n = 50/103), 3.88% (n = 4/103), and 47.57% (n = 49/103) patients reported the use of topical steroids, oral steroids, and both oral and topical steroids, respectively. Among all the topical steroid users (n = 99), clobetasol propionate 48.48% (n = 48/99), while among oral steroid users (n = 53), prednisolone 45.28% (n = 24/53) were the most commonly used agents, respectively. The morning serum cortisol levels (8–9 AM) were found to be decreased in 42.7% (n = 44/103), with a mean value of 44.28 ± 17.34 μg/dL.

Conclusion:

Improper OTC steroid use in recalcitrant dermatophytosis leads to HPA axis suppression. This highlights the need for intervention from apex health officials.
Impact of the heartfulness program on stress and sleep among healthcare professionals: Pre experimental study
Authors: Kumar Deepak , Rohilla Kusum K. , Gupta Pratima , Kalyani Vasantha C. , Kumar Rajan
Published: May 2024

ABSTRACT

Background:

Healthcare professionals (HCPs) worldwide suffer from stress and poor sleep and the COVID-19 pandemic has further raised these issues. This study sought to determine whether HCPs had reduced stress and increased sleep quality while participating in a heartfulness meditation program.

Subjects and Methods:

For a 2-month (8 weeks) heartfulness meditation program, we included 41 individuals in a prospective one-group pretest post-test intervention design from February 2023 to April 2023. Scores on the Perceived Stress Scale and Pittsburgh Sleep Quality Index were gathered at baseline and 8 weeks. Forty-one (76%) of the 54 participants completed this study for 8 weeks.

Results:

Results showed a substantial decline in stress (preintervention mean ± standard deviation [SD] = 20.54 ± 4.46; postintervention mean ± SD = 18.42 ± 6.14; t-value = -1.947 [0.05*]) and improvement in sleep quality (preintervention mean ± SD = 6.63 ± 3.82; postintervention mean ± SD = 5.29 ± 2.44) among HCPs after following this 8-week heartfulness meditation program. In the end, a substantial decrease in perceived stress score and an improvement in the sleep quality index was found.

Conclusion:

Additionally, practicing heartfulness meditation may aid in developing the traits of empathy, acceptance, and inner serenity. We draw the conclusion that more extensive research is required to fully understand the impact of heartfulness meditation practice.
Vitamin B12 and homocysteine in patients with major depressive disorder
Authors: Harikaran S , Basu Sharbari , Mukherjee Moushumi P. , Kar Rakhee , Nair Sreekumaran , Priyadarssini M
Published: May 2024

ABSTRACT

Background:

Alterations in the level of neurotransmitters are evident in patients with major depressive disorder (MDD). Vitamin B12 mediates the synthesis of neurotransmitters, and hence, vitamin B12 deficiency could be associated with depression.

Aims and Objectives:

To assess the levels of serum vitamin B12, homocysteine (Hcy), and haematological profiles in patients of MDD.

Materials and Methods:

Fifty-nine patients with MDD were recruited based on ICD-10 criteria. Severity of depression was assessed by HAM-D scale. Vitamin B12, Hcy levels, and haematological profiles were analysed.

Results:

Vitamin B12 was deficient or depleted in all patients with MDD. The median level of vitamin B12 in serum was 164.2 pg./ml and significantly lower in patients with severe MDD. The mean value of Hcy was 18.34 μmol/L, which was high compared to the normal reference range. The red cell distribution width (RDW-CV) varied significantly between the three groups of MDD patients. Patients consuming non-vegetarian food had a significantly higher median value of serum vitamin B12.

Conclusion:

Vitamin B12 deficiency is found in patients with MDD and varies inversely with severity of MDD. Hcy is found to be higher in patients with MDD. The manifestation of depressive symptoms precedes the more commonly known haematological manifestations of vitamin B12 deficiency in this study.
Role of prophylactic tranexamic acid in reducing blood loss during cesarean section: A double-blind placebo-controlled randomized controlled trial
Authors: Sinha Nutan , Rajbhar Sarita , Thakur Pushpawati , Agrawal Sarita , Singh Vinita
Published: May 2024

ABSTRACT

Background:

Postpartum hemorrhage (PPH) is defined by the World Health Organization as blood loss of ≥500 mL within 24 h of delivery. Globally, hemorrhage accounts for 27.1% of maternal deaths, making it the leading direct cause of maternal death. PPH has been identified in more than two-thirds of reported hemorrhage-related deaths, causing 38% of maternal deaths in India. Tranexamic acid, an antifibrinolytic, has been used to control bleeding after PPH is identified.

Materials and Methods:

Antenatal women admitted for elective cesarean section were randomized into two arms: the case group (received one gram of tranexamic acid 20 min prior to skin incision) and the control group (received a placebo), each group consisting of 36 participants. Clinical Trials Registry – India (CTRI) registration number – CTRI/2021/02/031579.

Results:

The mean (±standard deviation [SD]) intraoperative blood loss in the case group was 241.25 (±67.83) mL, and in the control group, it was 344.92 (±146.67) mL (P = 0.001), while postoperative blood loss did not differ significantly between the groups (P = 0.1470). In terms of the difference in hemoglobin, there was a significant difference between the two groups (P = 0.001). No significant maternal or neonatal side effects were found.

Conclusion:

Preoperative tranexamic acid, when given in elective cesarean section, significantly reduces intraoperative blood loss.
Medical doctor’s perception of artificial intelligence during the COVID-19 era: A mixed methods study
Authors: Dongre Ashwini S. , More Sandeep D. , Wilson Vidhya , Singh R. Jai
Published: May 2024

ABSTRACT

Background:

Artificial intelligence (AI) has led to the development of various opportunities during the COVID-19 pandemic. An abundant number of applications have surfaced responding to the pandemic, while some other applications were futile.

Objectives:

The present study aimed to assess the perception and opportunities of AI used during the COVID-19 pandemic and to explore the perception of medical data analysts about the inclusion of AI in medical education.

Material and Methods:

This study adopted a mixed-method research design conducted among medical doctors for the quantitative part while including medical data analysts for the qualitative interview.

Results:

The study reveals that nearly 64.8% of professionals were working in high COVID-19 patient-load settings and had significantly more acceptance of AI tools compared to others (P < 0.05). The learning barrier like engaging in new skills and working under a non-medical hierarchy led to dissatisfaction among medical data analysts. There was widespread recognition of their work after the COVID-19 pandemic.

Conclusion:

Notwithstanding that the majority of professionals are aware that public health emergency creates a significant strain on doctors, the majority still have to work in extremely high case load setting to demand solutions. AI applications are still not being integrated into medicine as fast as technology has been advancing. Sensitization workshops can be conducted among specialists to develop interest which will encourage them to identify problem statements in their fields, and along with AI experts, they can create AI-enabled algorithms to address the problems. A lack of educational opportunities about AI in formal medical curriculum was identified.
Professionalism among family medicine residents at King Abdulaziz University Hospital, Jeddah, Saudi Arabia: A cross-sectional study
Authors: Alsharef Malikah S. Al Ghalib , Almaramihi Waad S. , Almuhyawi Razan A.
Published: May 2024

ABSTRACT

Background:

The Saudi Commission for Health Specialties (SCHS) recently proposed the Saudi Meds Family Medicine (FM) 2020 program, which is based on CanMEDS-FM 2017 and includes a number of competencies. The purpose of this study is to evaluate the professionalism of FM residents who follow the modified curriculum of the SCHS.

Materials and Methods:

A cross-sectional study was conducted between June and August 2023 at King Abdulaziz University Hospital in Jeddah among FM residents from year 1 to year 3 and postgraduates from the FM residency program of both genders. For data collection, a structured self-administered web-based questionnaire adapted from CanMEDS was used.

Results:

A total of 45 FM residents responded, with the majority (73.3%) between the ages of 20 and 30 (77.8%), and 62.2% females. In terms of patient professionalism, 93.3% frequently/always demonstrated appropriate professional behavior and relationships in all aspects of practice; 62.2% frequently/always demonstrated a commitment to excellence in all aspects of practice. In terms of professionalism and societal commitment, 80% frequently/always demonstrated accountability to patients, society, and the profession by responding to societal expectations of physicians, and 86.6% frequently/always demonstrated a commitment to patient safety and quality improvement. In terms of professional commitment, 88.9% frequently/always fulfil and adhere to professional and ethical codes, standards of practice, and laws governing practice. In terms of self-commitment, it was discovered that 86.6% frequently/always demonstrated self-awareness and managed influences on personal well-being and professional performance. The majority (80%) managed personal and professional demands for a sustainable practice throughout the physician lifecycle, and 86.7% frequently/always promoted a culture that recognizes, supports, and effectively responds to colleagues in need.

Conclusion:

FM residents in Jeddah, Saudi Arabia, demonstrated acceptable levels of dedication to patients, society, profession, and self, indicating a high level of professionalism.
Severity of respiratory illness among Covid-19-vaccinated and non-vaccinated admitted patients—An observational study from a teaching hospital of Tripura
Authors: Majumder Vaskar , Choudhury Chirasree , Goswami Bidhan , Sengupta Shauli , Bhattacharjee Bhaskar
Published: May 2024

ABSTRACT

Objective:

To determine the association between vaccination status and mortality among critically ill patients admitted in a dedicated Covid hospital of Tripura who required invasive mechanical ventilation.

Material and Methods:

This study was conducted at a dedicated Covid hospital of Tripura for a period of six months, i.e., from June 2021 to November 2021. A total of 304 patients were enrolled for this study. Baseline epidemiological, radiological data along with other information like heart rate, pulse rate, oxygen saturation (SpO2), etc., were collected through patient record sheet in all cases during hospitalization. Statistical analysis was done by using SPSS 25 version.

Results:

Admission and mortality rates in hospital and advanced oxygen support like bi-level positive airway pressure (BiPAP), high-flow nasal cannula (HFNOC), and ventilator use incidences were higher in non-vaccinated patients (17.1%) in comparison to double-dose-vaccinated (0.98%) and single-dose (2.3%)-vaccinated patients.

Conclusion:

This retrospective data analysis of Covid-19 positive patients admitted in the dedicated Covid Hospital of Tripura suggests that severe infection, need for invasive and non-invasive ventilation, and death were significantly less in the vaccinated patients as compared to the vaccine-naive one.
Descriptive cross-sectional study to evaluate perception, attitude, and practice of parents regarding COVID-19 vaccination in children 10–12 years of age—A step toward prevention of future COVID-19 outbreaks in India
Authors: Mehta Vivek , Inder Deep , Kumar Pawan , Raheja Anupma
Published: May 2024

ABSTRACT

Purpose:

COVID-19 was declared a global pandemic and all age groups were equally affected. Coronavirus had devastating effects worldwide due to the emergence of new variants till vaccination was adopted to eradicate the transmission of the virus and restore normalcy. However, children were not included in the initial phase of vaccination. The purpose of the study was to assess the level of perception, attitude, and practice among parents toward the COVID-19 vaccination drive in children 10–12 years of age.

Design and Study:

The present research is a cross-sectional questionnaire-based survey including parents of children aged 10–12 years as participants. The survey was conducted between May 2022 and July 2022 with a sample size of 320.

Results:

A high willingness (80%) among parents was found for getting their children vaccinated. COVID-19 vaccines were perceived to be safe by the parents (59%) and efficacious (75%) for their children. Parents (67%) felt that the benefits of getting their children vaccinated against COVID-19 prevail over the risks of the vaccine. Parents 214 (67%) feel the need of getting their child vaccinated for sending them to school followed by availing of daycare facilities after school 54 (17%) among working parents. A significant association (P < 0.05) was seen between the variables of practice being followed by parents and their children as per COVID-19 norms. Parent’s negative attitude toward COVID-19 vaccination was associated with availability of no/unclear safety information (36%), fear of adverse effects of vaccine (3%), and false belief of having long-term immunity due to natural infection (32%). The positive attitude of parents was due to trust in positive information/news about the vaccine (42%), belief in the safety and efficacy of the vaccine (5%), acceptability for mild adverse effects (1%), and the necessity of vaccine to send children to schools (1%).

Conclusion and Recommendations:

The awareness of parents regarding COVID-19 vaccination for children was limited, high level of acceptance for vaccination was seen in our study. We recommend to continuing educational programs through mass campaigns to increase increasing awareness among parents for getting COVID-19 vaccination for their children. Vaccine hesitancy including vaccine safety concerns of parents should be addressed by presenting myths and facts related to COVID-19 vaccine using television, radio, and social media platforms.
Machine learning–aided algorithm design for prediction of severity from clinical, demographic, biochemical and immunological parameters: Our COVID-19 experience from the pandemic
Authors: Kumari Suchitra , Tripathy Swagata , Nayak Saurav , Rajasimman Aishvarya S.
Published: May 2024

ABSTRACT

Background:

The severity of laboratory and imaging finding was found to be inconsistent with clinical symptoms in COVID-19 patients, thereby increasing casualties. As compared to conventional biomarkers, machine learning algorithms can learn nonlinear and complex interactions and thus improve prediction accuracy. This study aimed at evaluating role of biochemical and immunological parameters–based machine learning algorithms for severity indexing in COVID-19.

Methods:

Laboratory biochemical results of 5715 COVID-19 patients were mined from electronic records including 509 admitted in COVID-19 ICU. Random Forest Classifier (RFC), Support Vector Machine (SVM), Naive Bayesian Classifier (NBC) and K-Nearest Neighbours (KNN) classifier models were used. Lasso regression helped in identifying the most influential parameter. A decision tree was made for subdivided data set, based on randomization.

Results:

Accuracy of SVM was highest with 94.18% and RFC with 94.04%. SVM had highest PPV (1.00), and NBC had highest NPV (0.95). QUEST modelling ignored age, urea and total protein, and only C-reactive protein and lactate dehydrogenase were considered to be a part of decision-tree algorithm. The overall percentage of correct classification was 78.31% in the overall algorithm with a sensitivity of 87.95% and an AUC of 0.747.

Conclusion:

C-reactive protein and lactate dehydrogenase being routinely performed tests in clinical laboratories in peripheral setups, this algorithm could be an effective predictive tool. SVM and RFC models showed significant accuracy in predicting COVID-19 severity and could be useful for future pandemics.
Exploring young adults’ fears related to healthcare and dental procedures
Authors: Chidley Ellie , Burns-Nader Sherwood
Published: May 2024

ABSTRACT

Background and Purpose:

Fear and anxiety related to dental and healthcare procedures are common among young adults and can negatively impact dental and healthcare consumership, resulting in poor health outcomes.

Purpose:

This cross-sectional study aimed to examine young adults’ experiences of fear related to dental and healthcare procedures and the potential relationships between the two forms of fear experiences and demographic factors.

Methods:

Young adults (252) were recruited from a large public university and completed a survey about their dental and healthcare fear/anxiety as well as their confidence in healthcare professionals. Descriptive and correlational analyses were completed to describe the experiences of young adults and the relationships between variables.

Results:

Ten types of fear/anxiety were identified related to healthcare procedures, with the most common being needles and pain. Nine fears/anxieties were identified for dental visits, of which pain and sensory experiences other than pain were most common. Female participants were significantly more likely to report fear/anxiety related to dental procedures, and there was a statistically significant relationship between fear/anxiety related to healthcare procedures and that related to dental procedures. There was also a significant negative relationship found between confidence in healthcare providers and fear/anxiety related to healthcare procedures.

Conclusions:

Young adults experience fear/anxiety related to healthcare and dentist visits, and this fear/anxiety can impact their confidence in healthcare providers, such as primary physicians. The findings of the current study suggest primary care providers should be aware of potential fears/anxieties and offer patients appropriate supports.
A closer look at the link between cycle threshold, clinical features and biomarkers: An observational study in COVID-19 patients
Authors: Kannuri Sriram , Patil Rajashri , Mukhida Sahjid , Bhaumik Shalini , Gandham Nageswari
Published: May 2024

ABSTRACT

Background:

Symptoms for severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) appear 2–3 days after exposure to the virus. Being a virus, detection is primarily by polymerase chain reaction as this offers superior sensitivity and specificity. There was a misconception that patients with low cycle threshold (Ct) have severe coronavirus disease (COVID), and for individuals with higher Ct, it is the other way around. The prognosis for COVID was derived from various biomarkers and physicians heavily relied on them.

Materials and Methods:

A cross-sectional study spanning a duration of 2 years was conducted at a tertiary care centre in western India. A total of 201 individuals were included and the correlation between Ct, clinical features and biomarkers was studied.

Results:

In the E-gene, 43.28% had lower Ct values and 40.79% had low Ct values in the RdRp gene. 50% of all patients had diabetes, with 60% being between the ages of 61 and 80. 54.1% of hypertension patients belonged to ages between 61 and 80. 90.54% of COVID-positive individuals had lactose dehydrogenase levels ranging from 440 to 760. 79% of patients had a procalcitonin value of more than one but less than six. 79.1% of patients had an erythrocyte sedimentation rate between 36 and 90.

Conclusion:

Ct value though has a research value; it is a poor prognostic marker when compared to the various biomarkers that have been studied earlier. We cannot conclusively state that all our findings are accurate due to a lack of data but further research into the prognostic value of Ct should be conducted which will help in the ongoing scenario.
Safety monitoring of precautionary third dose of COVID-19 vaccines in a district in Northern India
Authors: Deb Tirthankar , Misra Saurav , Kaur Manmeet , Verma Neelam , Kairi Jayant Kumar , Sindhu Nitika
Published: May 2024

ABSTRACT

Background:

The World Health Organization (WHO) declared Coronavirus disease-19 (COVID-19) caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) a pandemic on March 11, 2020. On 16th January 2021, India began its vaccination programme using two COVID-19 vaccines (Covishield and Covaxin). Precautionary dose (booster shots) was administered to health and front-line workers in the beginning and then to all eligible populations.

Material and Methods:

This was a descriptive observational study conducted in the COVID-19 vaccination centres of Karnal district and the ADR monitoring centre, KCGMC, Karnal. During the visits to vaccination centres, all beneficiaries of the precautionary third dose of COVID-19 vaccines as well as healthcare workers were sensitized to report in case of any adverse event following vaccination as part of the policy of the vaccination programme run by the government and Pharmacovigilance Programme of India. The data were collected in suspected adverse drug reaction (ADR) reporting form version 1.4, and causality assessment was done as per the WHO–UMC scale. The data were analysed as simple proportions and percentages.

Results:

The booster dose was administered to 72,853 individuals, while the 1st dose and 2nd dose were given to 13,30,042 and 10,73,050, respectively. Only three ADRs were reported with the booster dose in 34 vaccination centres in the Karnal district. These three ADRs were classified as unlikely on causality assessment and hence not included in the analysis.

Conclusion:

The booster dose administered for the prevention of COVID-19 has been found to be reasonably safe. The population who received COVID-19 booster doses was significantly less than the populations who received the first and second doses, which suggests a low acceptance rate.
Carcinosarcoma of breast – A chimera among breast neoplasms
Authors: Tomey Vandana , Ashwini Kumar Raj Kumar , Nikhade Pravin , Akulwar Anil
Published: May 2024

ABSTRACT

Malignant phyllodes, along with ductal carcinoma, is known as metaplastic cancer of the breast. This tumor is additionally known as breast carcinosarcoma. Malignant phyllodes in conjunction with ductal carcinoma is a rare finding in routine clinical practice. We describe the case report of a 47-year-old female patient who arrived with a large right breast mass. A core biopsy was performed, and histopathological examination indicated that the tumor was a malignant phyllodes tumor. A positron emission tomography (PET) scan revealed hyper-metabolic and hypo-metabolic tumors with perilesional stranding and satellite nodularity. There were a few metastatic right axillary nodes visible. There was no indication of distant metastases. Due to the presence of both components, a modified radical mastectomy surgery with axillary dissection was undertaken for this patient. Histopathological analysis of paraffin sections revealed ductal carcinoma in situ (DCIS) comedo-epithelial component and spindle-shaped cells with hyper-chromatic oval nuclei and scanty cytoplasm.
Neurosarcoidosis: An under-diagnosed cause of myelopathy
Authors: Chaubey Manaswi , Meena Kapil , Singh Tamanna , Reddy Sudheer , Raj Rajhans , Chaudhary Akhilendra , Mishra Vaibhav , Chakravarty Jaya
Published: May 2024

ABSTRACT

Sarcoidosis is a granulomatous disorder with multi-organ involvement, and etiology still remains unknown. Neurosarcoidosis is the involvement of the nervous system in sarcoidosis. Spinal cord involvement is usually intra-dural, but extra-dural involvement can also occur. Here, we report a case of 30 years old lady presenting with subacute onset paraparesis with bladder and bowel involvement, which was finally diagnosed as sarcoidosis-associated myelopathy with the longitudinally extensive transverse myelitis (LETM) phenotype.