bluuebunny/crossref_metadata_2025 huggingface dataset:
A Drop-in High-Temperature Pb-Free Solder Paste that Outperforms High-Pb Pastes in Power Discrete Applications
Authors: Zhang Hongwen , Richmond Tyler , Lytwynec Samuel , Harter Tybarius , Prado Diego
Published: May 2023

Sn-based high-temperature lead-free (HTLF) solder pastes have been developed as a drop-in solution to

replace the high-Pb solder pastes in power discrete applications. The pastes were designed to combine the

merits of two constituent powders. A SnSb-based Ag/Cu-containing high temperature powder, with the

melting temperature above 320°

C, was designed to maintain a high-temperature performance. A Sn-rich

SnAgCu-Sb powder, with a melting temperature around 228°

C, was added to the paste to enhance wetting

and improve joint ductility. In the design, the final joint will have the low-melting phase (the melting

temperature >228o

1. C) in a controllable quantity embedded into the high-melting SnSb matrix. HTLF-1, one

of the designs, maintained the bond shear strength up to 15MPa, even around 290°

C. Another design, HTLF-2, has a similar bond shear strength as Pb92.5/Sn5/Ag2.5 around 290°

C, but exceeds substantially below

250°

C. The power discrete components had been built with both HTLF solder pastes for both die-attach and

clip-bond through the traditional high-Pb process, which demonstrated the drop-in processing compatibility.

The components survived three additional SMT reflows (peak temperature of 260°

1. C) and passed moisture

sensitivity level 1. This confirmed that the maintained joint strength (comparable to or stronger than high-lead), helped to keep the joint integrity within the encapsulated components in the following SMT process,

even with the controlled quantity of the melting phases above 228°

C. Both HTLF solder pastes outperformed

Pb92.5/Sn5/Ag2.5 in the resistance from drain to source when power is on (RDS(on)), even after 1000cycles

of TCT (-55/175o

C), which is attributed to the intrinsic lower electrical resistivity of Sn of both HTLF pastes.

Microstructural observation had shown no corner cracks for both die-attach and clip-bond joints after TCT.
Assembly Technology for FO-MCM with HBM in HPC Application
Authors: Liu Shuai-Lin , Kao Nicholas , Lin Vito , Shih Teny , Wang Yu-Po
Published: May 2023

As the industry moves forward the age of more than Moore, the next generation of packaging moves

forward high density of chiplet or die splitting package integration. Especially for high performance

computing applications, the advance packaging is to provide the economic benefits to integrate multiple

chiplet dies by silicon or organic interposer. Organic interposer is one of the alternative interface for die to die

interconnection. It is well-known by FO-MCM to apply in chiplets integration and ASIC to Serdes dies

integration by the homogeneous package integration concept. Due to the motivation of AI computing and

HPC market growth, the trend is formed to integrate the packaged HBM into packaging module as the

heterogeneous integration package (HIP). Both of the platforms, 2.5D with silicon interposer base and

FO-EB with partial bridge die as interconnection media, have already launched to market in recent years.

FO-MCM with purely organic interposer, is also discussed to implement into the heterogeneous integration

field. The fully organic interposer can provide the flexible design in multiple RDL layers and line / space for

HPC products. In this study, it is to address FO-MCM platform with purely organic interposer to implement

heterogeneous packaging with integrated HBMs. Chip last approach in FO-MCM has the advantage to

control RDL quality and take “known-good RDL” for top die cost rescuing. The fan-out RDL configuration

is 4 layers with min, L/S of 2/2um. In the verification processes, based on the simulation analysis, the

warpage and stress are optimized by material and under-fill selections in this discussion. The assembly

results indicated the warpage and reliability validation passed by MSL4, TCT700x, uHAST96, and

HTST1000hrs conditions.
A Physics-of-Failure Investigation of Flip Chip Reliability Based on Lead-Free Solder Fatigue Modeling
Authors: Brinlee Sean , Popelar, Ph.D. Scott
Published: May 2023

Solder fatigue failure is one of the primary wear out failure mechanisms limiting reliability in

microelectronics flip chip packaging. Solder fatigue failure occurs when a crack initiates and subsequently

propagates through the entirety of the solder joint causing an electrical open. Crack initiation and propagation

within a solder joint is caused by a cyclic application of stress, typically induced by exposure to temperature

cycle excursions. Understanding the relationship between thermal cycling during product use and the

accelerated thermal cycles used for testing is critical for predicting device reliability.

MIL-PRF-38535 is the guiding aerospace and high reliability General Specification for Integrated Circuits

(Microcircuits) Manufacturing that defines manufacturing, qualification and certification requirements for

products to be listed on the Defense Logistic Agency’s (DLA) Qualified Manufacturer Listing (QML).

Revision M of this standard, targeted for release in 2022, for the first time includes the use of lead-free solder

alloys and organic substrates in the manufacturing of QML flip chip products. Hence there is a strong need

to understand the physics-of-failure (PoF) concerning solder fatigue of lead-free flip chip assemblies.

This paper demonstrates how finite element modeling can be used to predict solder fatigue for flip chip

package assemblies. The authors have leveraged fatigue lives measured for different flip chip daisy chain

package configurations, as well as fatigue lives defined and available in published papers. The authors then

use the resulting lead-free solder fatigue model to perform parametric studies looking at the impact of

different die sizes, underfill material properties, and package substrate materials. Comparisons are also made

between eutectic Sn/Pb and lead-free fatigue life predictions. In addition, the authors demonstrate how solder

fatigue predictions can be de-rated to use conditions in order to make reliability assessments for flip chip

package assemblies. This ultimately leads to a better understanding of the impact of solder alloy and material

selection on the mission life of aerospace and high reliability products that fall under the changes introduced

in MIL-PRF-38535 Revision M.
Dielectric Property Effect with Dielectric Constant for Millimeter Wave Antenna Design
Authors: Shih Chih-Yuan , Lai Chia Chu , Wang Yu-Po
Published: May 2023

The millimeter Wave transmission provides large bandwidth for data transfer which can satisfy the 5th

generation mobile network architecture three main features: High data rate, Low latency, Mass Connectivity.

Due to the high propagation attenuation characteristic of millimeter Wave, the Directivity of Antenna Array

greatly increase the transmitting distance. The antenna dimensions are designed relative to wave length for

better radiation performance. In millimeter Wave bands, the wave length is under millimeter scale which the

antenna can be integrated to Package called AiP (Antenna in Package)

This article will discuss the influence of substrate material property for antenna behavior. The Dielectric

Constant (Dk) of air is closed to 1, use substrate with low DK for Antenna in Package results better expression

to increase Gain and Wider bandwidth. However, the wave length is also affected by Dielectric Constant,

since the wavelength is inversely proportional to the square root of the Dk, the substrate with high Dk reduces

the AiP size obviously. In this paper, we will provide the comparison of antenna performance for Low/High

Dk by Patch Antenna which consider single antenna and antenna array.

In the simulation, the result shows the difference between High and Low Dk. When Dielectric Constant

increases to 6 from 3, the width of single antenna can be reduced 30% and in contrast the peak gain is 15%

higher with low Dk. For handheld devices such as smartphone, the internal space is limited, the size of

antenna becomes critical. With the help of pattern design to enhance antenna performance. The high Dk

material can be the choice of antenna for handheld devices.
Understanding Criticality of Thermal Performance in Thermal Interface Material Applications
Authors: Mohanty Dr. Rita
Published: May 2023

Thermal interface material (TIM) is used in between a heat generating component (e.g., microelectronic

packaging) and a heat spreading component (e.g., heatsink or cooling plate) to create an effective path for

the heat (Phonon) to travel. Standard heatsink and heat generating component surfaces are generally uneven

and rough. Actual metal to metal contact is no more than 10%. These surface imperfections allow air to get

trapped in between the two surfaces. Air, being a thermal insulator, prevents the heat from dissipating and

thus the device/system fails to maintain the required operating temperature to meet the reliability and

functionality needed. Replacing the air with the “right” thermal interface material is the focus of this research.

TIM is a composite of thermally conductive fillers dispersed in a polymer matrix. A higher filler loading

causes a higher bulk conductivity. Common practice among design engineers is to utilize output from thermal

modelling & simulation to specify a TIM with a certain thermal conductivity to meet the system’s thermal

needs. What many engineers miss is the impact of thermal boundary resistance that could have significant

effect on the overall thermal management of the design. This paper discusses how to characterize thermal

performance of TIM beyond the bulk thermal conductivity. Boundary/interfacial thermal resistance and

impedance will be explored as a function of TIM wetting ability, bond line thickness and surface conditions.

This paper will discuss the importance of thermal conductivity, thermal resistance/impedance in a real

application scenario.
Interfacial Diffusion Mechanism between ALD Al2O3 passivation/Cu in Direct Bonded Copper Substrate for Power Electronics
Authors: Son Kirak , Oh Aesun , Jeong Bongmin , Bae Hyun-Cheol
Published: May 2023

Direct bonded copper(DBC) substrate requires surface treatments for oxidation prevention and adhesion

enhancement to die-attachment. Conventional surface treatment, electroless nickel immersion gold (ENIG)

has a cost and environmental problems, and immersion silver is sensitive to temperature and humidity. To

solve these problems, this study presents the invention of aluminum oxide (Al2O3) passivation for DBC Cu

pads, which meets the requirements of oxidation prevention and adhesion enhancement to die-attachment.

Ultrathin Al2O3 passivation layers (~20nm) by atomic layer deposition(ALD) were coated on DBC Cu pads

for replacing conventional ENIG and immersion silver surface finishes. This paper presents bondability and

interfacial diffusion mechanism between ALD Al2O3 passivation/Cu in DBC substrate.
Investigation of CuAl IMCs Corrosion in Chloride Environment and its Prevention Strategy
Authors: Alptekin John , Gopalakrishnan Eswar , Kumaravel Dinesh Kumar , Antony Kevin , Langerak Hannah , Chyan Oliver , Mathew Varughese
Published: May 2023

Abstract

In most current wire-bonding applications, electrical interconnection is accomplished by fine Cu wires

bonded to Al bonding pads microfabricated on an IC chip and external contact pins of the PCB board.

Corrosion-related failure defects between the Cu wire and Al bond pad have been an ongoing un-trackable

reliability issue plaguing the IC packaging industry for the past ten years, despite approaching ppb levels.

Most prior studies hypothesized that intermetallic compounds (IMCs) like Cu9Al4, and CuAl2 were

responsible for the observed acute wire-bond lift-off corrosion defects. Further studies sought to quantify the

rates of corrosion of these IMCs and explore the effects of mitigation efforts of adding Pd, relevant to Pd-coated Cu wire-bonding. However, utilizing a novel real-time corrosion screening approach, we previously

established that peripheral bimetallic contact between Cu ball-bonds and Al bond pads also plays a substantial

role in the aggressive Al pad corrosion, induced by chloride ion penetration, which often leads to device

failure. In this work, we further explored the role of IMCs corrosion in wire-bond lift-off failure utilizing

fundamental electrochemical studies to quantify rates of galvanic-induced corrosion of IMCs within the

broader context of an interconnected stack of Al bond pad, Cu-Al IMCs and Cu bonding wire. We also

explored the use of a corrosion inhibitor to suppress the galvanic corrosion currents of Al bond pad, and Al-rich IMCs when electrically connected to Cu wire or Cu-rich IMCs.
Pre-applied underfill Technique for Fine-pitch Cu Pillar 3D Die Stacking to Enable 2.5/3D Advanced Packaging
Authors: Lay Nicholas , DiNapoli Nicholas , Rahim, PhD. Kaysar , Razmyar, PhD. Soheil , Holliday Melissa
Published: May 2023

Increased performance and smaller form factor have driven demand for next generation architectures for

integrated circuit 3D (IC) chip packaging. Advanced chip packaging technologies, such as 2.5D and 3D, offer

greater chip compatibility and lower power consumption. Given these advantages, the adoption of advanced

packaging is inevitable. One key driver is the copper pillar interconnect technology which offers several

benefits such as improved electromigration resistance, improved electrical and thermal conductivity,

simplified under bump metallization (UBM), and higher input/output (I/O) density. The fine pitches that

copper pillars are capable of helps the technology to supersede solder bump technology, which reaches its

lowest pitch around 40 microns. Finer pitches allow for a higher I/O count, which enhances performance.

One of the major innovations has been 2.5/3D integration, a technique of vertically stacking multiple dies.

However, traditional encapsulation techniques become challenging because traditional capillary underfill

methods become restrictive as enlarged surface area is required in order to provide underfill protection on

multiple surfaces.

Here, we discuss a novel approach of vertically stacking dies with an integrated underfill process that

minimizes the required area for underfilling in fine-pitch IC chip packages by creating a technique to apply

underfill during thermo-compression bonding. This process offers a reliable method for vertical stacking of

multiple chips and eliminates post-processing need for underfill application. Additionally, the process

provides precise temperature control to both the substrate and die by using a mechanism of dual heat

application. This is used in combination with a controlled variable application of compressive force on the

package. Through fine-tuning of the force and temperature applied to the IC components, the bonding process

can be tailored to simultaneously provide the ideal underfill curing conditions while forming solder joints. In

this work, we used dies with 80µm pitch Cu pillar flip chip copper pillars with tin/silver caps bonded to

Electroless Nickel and Immersion Gold (ENIG) pads in conjunction with commercially available pre-applied

underfill material. The interconnect strength was determined though destructive shear testing and cross-sectional analysis to evaluate for the bonding quality and strength. A scanning electron microscope was used

to visually examine joint properties, and X-ray analysis was conducted to review for underfill voiding.

Finally, completed assemblies were thermal-cycled to evaluate for the degradation of joint strength and

voiding of underfill under induced stress.
Chiplet Integration by Die-to-Die Pillar-Suspended Bridge
Authors: Kono Ichiro , Wakisaka Shinji , Hirota Toshiaki , Saitou Takashi , Ukawa Ken , Kurita Yoichiro
Published: May 2023

Chiplet integration technology, which has the potential to scalable expand capabilities by integrating many

integrated circuit (IC) chips with different manufacturing processes, structures, and functions while maintaining

the data transfer bandwidth between IC chips, is attracting attention as a promising method to solve the problems

such as slowdown of Moore’s law and the von Neumann bottleneck. Die-to-die bridge structures that connect dies

via locally placed bridge chips with high-density interconnects is expected for scalable chiplet integration. We

proposed novel die-to-die bridge architecture called “Pillar-Suspended Bridge (PSB)” that connects between

chiplet and bridge via “MicroPillars” in molded form using panel-level manufacturing process. We successfully

demonstrated proof-of-concept (PoC) through prototyping chiplets/bridge integrated module with 40 µm pitch

MicroPillars using 300 mm × 300 mm panel-level manufacturing process. We confirmed fine-pitch die-to-die

connection with MicroPillars and 20 µm thick bridge die by cross-sectional analysis of the module. We also

evaluated warpage behavior of the PSB module in the reflow temperature range using shadow moiré method and

confirmed warpage of less than 10 µm. Finally, we discussed scalability of this technology including external

connections for Fan-Out RDL and optics.
Simulation of the COVID-19 handling policy in Indonesia
Authors: Aminullah Erman , Erman Erwiza , Soesilo Tri Edhi Budhi
Published: May 2023

Background. This study’s background was inspired by the current COVID-19 handling policy, which focuses on the balance of public health and social economy. However, there is a knowledge gap on the dynamic complexity of balancing public health and social economy during the new normal period of COVID-19 handling policy. A system dynamics simulation of the COVID-19 handling policy could be used to understand that gap.Objective. This study aims to uncover the simulation of the COVID-19 handling policy in Indonesia.Methods. This study combined quantitative and qualitative modeling methods with a system dynamics tool.Results. This study revealed 3 elements in the dynamic balance of public health and social economy in the COVID handling policy system: i) COVID-19 and social-economic control; ii) COVID-19 escalation and de-escalation; iii) people’s immunity enhancement. Such a mix of COVID-19-controlling policy instruments has maintained a dynamic equilibrium between easing economic suppression at the expense of worsening COVID-19 and tightening public health resolution at the expense of more economic suppression.Conclusions. The study conclusions are as follows: i) the COVID-19 handling policy worked as a leverage factor in balancing public health resolution and economic interest during the new normal period in Indonesia; ii) experiential creativity to respond to the newly serious public health problems triggered by COVID-19 implies adding public health knowledge; iii) the study’s outcomes imply re-examining the strengths and deficiencies of the entire health system for a better health system.
Research in family medicine: Contribution, priorities, and barriers in Saudi Arabia
Authors: Al-Khaldi Yahia M.
Published: May 2023

BACKGROUND:

Research in family medicine is important. The objectives of this study were to explore the contribution of family physicians, their attitudes and practice, and the barriers to research in family medicine in Saudi Arabia.

MATERIALS AND METHODS:

This study was conducted on Saudi family physicians in 2021. A self-administered questionnaire was sent to family physicians through WhatsApp and email. Information sought included demographic data, scientific profile, number of publications, reasons for conducting research, barriers to the conduct of research, attitudes and skills for the conduct of research, and priority areas of research. Data were analyzed using SPSS version 15. Descriptive statistics included mean and standard deviation for continuous variables and frequencies and percentages for categorical variables. Student’s t-test was used to compare the means of two groups of physicians. Chi-square test and logistic regression analysis were performed to determine the association between categorical variables.

RESULTS:

A total of 313 family physicians filled the questionnaire; majority were male (65%), were married (90%), and worked under the Ministry of Health (73%). The total number of publications since graduation was 1165 papers with an average of 3.8 papers per physician. More than 70% were interested in conducting research, and more than two-thirds considered research important to the advancement of family medicine. One-third of the family physicians were currently involved in conducting research, while 30% were supervising at least one research project. The top five areas of priority were chronic diseases, mental health, health promotion, quality of healthcare, and medical education/training; whereas the top five obstacles to the conduct of research were the lack of time, lack of research environment, lack of financial and technical support, and the absence of skills.

CONCLUSION:

Saudi family physicians make a good contribution to research. The researchers and research bodies should focus on identifying the priority areas for research in family medicine in the next few years and provide support to achieve some of the objectives of the National Vision of 2030.
Investigation of Computed Tomography Numbers on Multiple Imaging Systems using Single and Multislice Methods
Authors: Mehta Akash , Arrington Daniel , Ramachandran Prabhakar , Motley Ryan , Seshadri Venkatakrishnan , Anderson Darcie , Lehman Margot , Perrett Ben
Published: May 2023

Aim:

The aim of this study is to determine the variation in Hounsfield values with single and multi-slice methods using in-house software on fan-beam computed tomography (FCT), linear accelerator (linac) cone-beam computed tomography (CBCT), and Icon-CBCT datasets acquired using Gammex and advanced electron density (AED) phantoms.

Materials and Methods:

The AED phantom was scanned on a Toshiba computed tomography (CT) scanner, five linac-based CBCT X-ray volumetric imaging systems, and Leksell Gamma Knife Icon. The variation between single and multi-slice methods was assessed by comparing scans acquired using Gammex and AED phantoms. The variation in Hounsfield units (HUs) between seven different clinical protocols was assessed using the AED phantom. A CIRS Model 605 Radiosurgery Head Phantom (TED) phantom was scanned on all three imaging systems to assess the target dosimetric changes due to HU variation. An in-house software was developed in MATLAB to assess the HU statistics and the trend along the longitudinal axis.

Results:

The FCT dataset showed a minimal variation (central slice ± 3 HU) in HU values along the long axis. A similar trend was also observed between the studied clinical protocols acquired on FCT. Variation among multiple linac CBCTs was insignificant. In the case of the water insert, a maximum HU variation of −7.23 ± 68.67 was observed for Linac 1 towards the inferior end of the phantom. All five linacs appeared to have a similar trend in terms of HU variation from the proximal to the distal end of the phantom, with a few outliers for Linac 5. Among three imaging modalities, the maximum variation was observed in gamma knife CBCTs, whereas FCT showed no appreciable deviation from the central value. In terms of dosimetric comparison, the mean dose in CT and Linac CBCT scans differed by <0.5 Gy, whereas at least a 1 Gy difference was observed between CT and gamma knife CBCT.

Conclusion:

This study shows a minimal variation with FCT between single, volume-based, and multislice methods, and hence the current approach of determining the CT-electron density curve based on a single-slice method would be sufficient for producing a HU calibrations curve for treatment planning. However, CBCTs acquired on linac, and in particular, gamma knife systems, show noticeable variations along the long axis, which is likely to affect the dose calculations performed on CBCTs. It is highly recommended to assess the Hounsfield values on multiple slices before using the HU curve for dose calculations.
Optimization of Radiation Shielding Considerations for Designing Halcyon Vault
Authors: Kaur Amanjot , Sahani G. , Shrivastava Ashish , Pawaskar Padmaja N.
Published: May 2023

Purpose:

To determine the radiation shielding considerations for optimization of Halcyon vault shielding requirements.

Materials and Methods:

The primary and leakage workloads were estimated using actual clinical treatment planning and treatment delivery data acquired from three busy operational clinical Halcyon facilities. The effective use factor was determined based on a newer approach proposed in this paper using the percentage of patients treated with different treatment techniques. The transmission factor of the primary beam block, maximum head leakage, and patient scatter fractions around the Halcyon machine were experimentally determined. The first tenth-value layer (TVL1) and equilibrium tenth-value layer (TVLe) for 6 MV - flattening-filter-free (FFF) primary X-ray beam for ordinary concrete were measured.

Results:

The primary and leakage workloads are estimated as 1 × 105 cGy/wk and 3.1 × 105 cGy/wk at 1 m respectively. The effective use factor is found as 0.114. The primary beam-block transmission factor is determined as 1.7 × 10−4 at 1 m distance from isocenter along the central beam axis. The maximum head leakage is noted as 6.23 × 10−4. The patient scatter fractions are reported for various planar angles around the Halcyon machine at a radial distance of 1 m in a horizontal plane passing through isocenter. The TVL1 and TVLe of 6 MV-FFF X-ray beam energy for ordinary concrete are found to be 33 and 29 cm, respectively.

Conclusion:

Using experimentally determined shielding considerations, the optimized vault shielding requirements for the Halcyon facility are calculated and a typical layout drawing is proposed.
Ktrans Calculation Using Reference Method Corrected Native T10 for Breast Cancer Diagnosis
Authors: Negi Pradeep Singh , Mehta Shashi Bhushan , Jena Amarnath , Rana Prerana
Published: May 2023

Purpose:

The objective of the study is to use multiple tube phantoms to generate correction factor at different spatial locations for each breast coil cuff to correct the native T10 value in the corresponding spatial location of the breast lesion. The corrected T10 value was used to compute Ktrans and analyze its diagnostic accuracy in the classification of target condition, i.e., breast tumors into malignant and benign.

Materials and Methods:

Both in vitro phantom study (external reference) and patient’s studies were acquired on simultaneous positron emission tomography/magnetic resonance imaging (PET/MRI) Biograph molecular magnetic resonance (mMR) system using 4 channel mMR breast coil. The spatial correction factors derived using multiple tube phantom were used for a retrospective analysis of dynamic contrast-enhanced (DCE) MRI data of 39 patients with a mean age of 50 years (31–77 years) having 51 enhancing breast lesions.

Results:

Corrected and non-corrected receiver operating characteristic (ROC) curve analysis revealed a mean Ktrans value of 0.64 min−1 and 0.60 min−1, respectively. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy for non-corrected data were 86.21%, 81.82%, 86.20%, 81.81%, and 84.31%, respectively, and for corrected data were 93.10%, 86.36%, 90%, 90.47%, and 90.20% respectively. The area under curve (AUC) of corrected data was improved to 0.959 (95% confidence interval [CI] 0.862–0.994) from 0.824 (95% CI 0.694–0.918) of non-corrected data, and for NPV, it was improved to 90.47% from 81.81%, respectively.

Conclusion:

T10 values were normalized using multiple tube phantom which was used for computation of Ktrans. We found significant improvement in the diagnostic accuracy of corrected Ktrans values that results in better characterization of breast lesions.
Psychotropic medications around perioperative period: How to go about?
Authors: Naskar Chandrima , Grover Sandeep
Published: May 2023

Background:

Medical comorbidities are frequent in patients suffering from psychiatric disorders. Many of these patients would need emergency or elective surgeries in their lifetime. The perioperative period is a unique and critical phase, and thoughtful, informed management can prevent various medical misadventures in this period, thus improving the postoperative outcomes.

Aim:

This article attempts to provide an overview of the use of psychopharmacological agents during the perioperative period, the current recommendations about continuing or discontinuing various psychotropics in the perioperative period, and how to restart medications in the postsurgical period.

Material and Methods:

For this narrative review, literature search was done on PubMed and Google Scholar and relevant articles were identified and included.

Results:

For elective surgery, the psychiatrist should review the available investigation, severity of the physical illness, physical health status of the patient as per the American Society of Anaesthesiology (ASA) category, severity and stability of psychiatric disorder, comorbid substance use, and the ongoing psychotropics and their interactions with ongoing medications. In patients with ASA categories I and II, psychotropic medications can be continued. For patients with ASA categories V and VI, preferably psychotropics should be stopped. For patients belonging to ASA categories III and IV, antipsychotics except for clozapine can be continued; however, if feasible antidepressants and lithium should be stopped. For elective surgery, clozapine needs to be stopped 12 h before surgery, lithium 48–72 h before surgery, antidepressants to be tapered about 7–10 days before surgery, and monoamine oxidase inhibitors to be tapered and stopped 14 days before surgery. Other antipsychotics, mood stabilizers, and benzodiazepines can be continued till the day of surgery. When there is lack of time due to emergency surgery then a proper discussion with the primary team and the anesthetist need to be done about the possible risks.

Conclusion:

The psychiatrists handling patients in the perioperative period should have an idea about how psychotropics interact with different anesthetic agents and ensure that the anesthesiologist and the surgeon are made aware of the possible complications that might occur during the surgical and anesthetic procedure due to the concurrent use of specific psychotropics.
Correlation of Pericoronal Radiographic Width with Histopathology of Dental Follicle of Impacted Teeth using Modified Gallego's and H and E Stain
Authors: Tamgadge Sandhya , Pereira Treville , Venkateshwar Gokul , Waghmare Mandavi , Bhutani Hemant , Girotra Charu , Acharya Siddharth
Published: May 2023

Background:

Dental follicles are involved the development of tooth and periodontal structures. Dental follicles are known for pleuripotency and inductive changes but are also known for origin for various pathologies.

Materials and Methods:

Fifty eight asymptomatic dental follicle tissues were examined histologically and radiographically wherein orthopantomogram radiographic width was correlated with various histological parameters of dental follicle and evaluated for the presence of various pathologies using modified Gallego's stain.

Observation and Results:

There was evidence of pathological changes associated with asymptomatic dental follicle. We also found variations in epithelial lining, stromal calcifications, and variable compositions.

Conclusion:

We encourage researchers to examine this peculiar tissue as a unique model and explore its potential to avoid future complications.
Serum Lactate Levels in Critically Ill Patients
Authors: Kabra Ruchita , Acharya Sourya , Kumar Sunil
Published: May 2023

Hyperlactatemia (excess blood lactate) is common in severely unwell individuals. Although lactate levels are routinely used to indicate insufficient tissue oxygenation, they can also be elevated by mechanisms unrelated to tissue oxygenation. Increased glycolysis may be a major cause of hyperlactatemia, especially in critically sick individuals. Despite this, elevated lactate levels have serious consequences for the morbidity and mortality of hyperlactatemia individuals. Despite the widespread use of the phrase lactic acidosis, a substantial link between lactate and pH appears only at higher lactate levels. As a result, the phrase lactate-related acidosis is more suitable. In early resuscitation, two recent studies have emphasized the necessity of monitoring lactate levels and adjusting treatment to changes in lactate levels. Structured lactate measures should be included in resuscitation protocols since lactate levels may be assessed quickly at the bedside from a variety of sources.
Serum Calcium Levels and its Association with Coronary Artery Disease
Authors: Patel Mansi A. , Agrawal Sachin Ratanlal , Acharya Sourya , Kumar Sunil
Published: May 2023

Thousands of people took part in prospective studies lasting up to 30 years, and the results showed that circulating calcium is a risk factor for vascular disease. Other cardiovascular risk factors such as circulating lipid levels, blood pressure, and body mass index may partially mediate these relationships, but serum calcium appears to have a residual independent influence. Polymorphisms in calcium-sensing receptors connected to small elevations in serum calcium have also been linked to cardiovascular disease, suggesting that calcium is a causative component. Calcium supplements have been shown to increase mortality and/or accelerate vascular disease in dialysis patients and those with less severe renal failure, and meta-analyses of trials in adults without overt renal disease imply a similar effect. A strong interaction between baseline calcium supplement use and the effect of calcium randomization hampered the interpretation of the largest research. The fact that the study only looked at calcium-deficient people highlights the dangers that are always present. Observational studies of dietary calcium have not consistently demonstrated that it is deleterious to cardiovascular health, albeit exceptionally high or extremely low intakes may be harmful. As a result, eating calcium rather than taking supplements should be encouraged. The current systematic review addresses serum calcium levels and their relationship with coronary artery disease using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards. For studies published through December 2021, electronic and manual data resources were reviewed using the following databases: PubMed/MEDLINE, Embase, ScienceDirect, Cochrane Library. The findings were filtered to exclude studies that were written in English.
Evaluation of Insulin Resistance and Beta-Cell Dysfunctions in Newly Diagnosed Polycystic Ovarian Syndrome Patients
Authors: Ghatnatti Vikrant , Patil Shwetha , Kour Harpreet
Published: May 2023

Introduction:

Women with polycystic ovary syndrome (PCOS) are at increased risk of developing glucose intolerance and diabetes attributed to increased insulin resistance (IR). However, it is not clear whether β-cell dysfunction has a central role in pathogenesis. The distinction has important implications for the prevention of type 2 diabetes in PCOS with interventions that ameliorate IR. This study aimed to find if IR differs among the various phenotypes of PCOS and perform a quantitative estimation of β-cell dysfunction versus IR in patients of PCOS participants.

Materials and Methods:

This case–control study was conducted for 1 year in the Endocrinology and Gynaecology outpatient departments at Gauhati Medical College. Fifty women newly diagnosed with PCOS, as per the Rotterdam criteria, were considered cases. Fifty, age- and body mass index-matched healthy females were taken as controls. Fasting and postprandial blood glucose, serum insulin, testosterone, and oral glucose tolerance test values were taken. Impaired fasting glucose, impaired glucose tolerance (IGT), and type 2 diabetes mellitus T2DM were diagnosed according to ADA 2011 criteria. IR and β-cell function were determined by “homeostasis model assessment (HOMA)”.

Results:

We observed an altered relationship between IR and insulin secretion, consistent with an intrinsic β-cell defect, wherein IR led to a decreased amount of compensatory insulin secretion in PCOS compared with normal women. The correlation coefficients relating HOMA%B to HOMA-IR were lower in PCOS, indicating less compensatory insulin secretion for a given increment in IR.

Conclusion:

PCOS patients are at increased risk of developing glucose intolerance and diabetes.
Peritoneal Closure versus Nonclosure in Cesarean Delivery
Authors: Quraishi Azhar Un Nisa , Farooq Ruksana , Andrabi Syed Aadil , Quraishi Athar Un Nisa , Quraishi Kamran Ahmad
Published: May 2023

Background:

Routine closure of parietal peritoneum during cesarean section has been a custom. However, current evidence argues against peritoneal closure.

Methods:

A total of 100 pregnant women who had to undergo cesarean delivery were taken for the study. They were divided into two groups: Group C (50 patients) and Group NC (50 patients). Group C included the patients in whom parietal peritoneum was sutured during cesarean delivery, whereas, Group NC included the patients in whom parietal peritoneum was left unsutured during cesarean delivery. The two groups were then compared in terms of postoperative morbidity and outcome.

Results:

The mean operating time was significantly less in Group NC than in Group C (P < 0.001). The mean analgesia requirement in Group C was 210.4 ± 31.45 mg, whereas it was 178.5 ± 28.63 mg in Group NC (P < 0.001). Mean time for ambulation after cesarean delivery in Group C was 12.9 ± 3.42 h, whereas it was 10.1 ± 3.19 h in Group NC (P < 0.001). There was a longer duration of hospital stay in the C group (mean = 4.3 ± 1.07 days) than NC group (mean = 2.9 ± 0.95 days).

Conclusion:

Nonclosure of parietal peritoneum at cesarean delivery is associated with reduced operation time, lesser postoperative analgesia requirement, and lesser duration of hospital stay with no increased morbidity.
Incidence, Risk Factors, and Microbiology of Central Venous Catheterization-Associated Bloodstream Infections at a Surgical Tertiary Intensive Care Unit
Authors: Shrivastava Abhishek , Singh Shalendra , Taank Priya , Kaur Kaminder Bir , Pradip KC , Marwah Vikas , Sood Munish
Published: May 2023

Background:

Central venous catheters (CVCs) can act as a portal for bloodstream infections, which increases the morbidity and mortality in intensive care units (ICUs).

Objective:

The primary aim of this study was to find out the incidence, to ascertain risk factors of bloodstream infections related to CVC, and to know the microbiological profile of organisms causing catheter-related bloodstream infection (CRBSI) in an ICU of a tertiary level hospital.

Methodology:

All patients who had CVC insertion in the operation theater before the procedure and were later transferred to ICU, and those patients who were directly admitted to the ICU and had CVC inserted were included in the study. On suspicion of an insertion-site infection, site swabs were sent for microbiological analysis. If catheter tip colonization/infection or CRBSI was suspected, the CVC was removed, and the tip of the catheter along with two sets of blood (peripheral and central) was sent for culture analysis. A semi-quantitative culture analysis was done to confirm CRBSI.

Results:

On review of data, 150 patients with cumulative 1056 catheter surveillance days revealed an incidence of 24.66% for CVC-related infections, which included exit site infections (5.33%), catheter tip infections (13.33%), and CRBSI (6%). The rate of CRBSI associated with CVCs placed in the surgical ICU was 35.3 per 1000 catheter surveillance days. Staphylococcus aureus was the most common organism causing CRBSI and CONS (coagulase-negative staphylococcus) was the most common organism causing catheter tip and exit site infections.
Advocating Active and Meaningful Involvement of Patients in the Delivery of Medical Education
Authors: Shrivastava Saurabh RamBihariLal , Shrivastava Prateek Saurabh
Published: May 2023

The onus of knowledge acquisition and learning has demonstrated a paradigm shift in the field of medical education. The present review has been carried out to explore and understand the role of patient involvement in the training of medical students. An extensive search of all materials related to the topic was carried out in the PubMed search engine, and a total of 26 articles were selected based on the suitability with the current review objectives. The involvement of patients in medical education has been linked with a wide range of proven benefits and learning progression. The patients can discharge multiple roles, namely a teacher, developing curriculum, assessor, and someone who can select students for the course. The role of actively involving patients in the teaching process is bound to have some challenges and barriers considering the different aspects in heterogeneous settings. The ideal approach to involve patients in medical education has to start with sensitizing the faculty members and the medical students about the benefits that can be derived out of such clinical interactions. The successful implementation will essentially require adequate resource support and faculty involvement. To conclude, the patient involvement in medical training is not a new practice, but the ground reality is that we are falling short to optimize the benefits of the overall practice. The need of the hour is to adopt a systematic approach and structure the overall program, so that we can derive tangible benefits out of the same and prepare the future generation of doctors in the delivery of patient-centered care.
Perceptions about Nonpharmacological Interventions in the Prevention of COVID-19 in the Field Practice Area of Jawaharlal Nehru Medical College
Authors: Manimaran N S , Kadeangadi Deepti M , Manoli Aniket D , Shivaswamy M S , Patil Anjali J
Published: May 2023

Introduction:

COVID-19 pandemic is a major global public health threat. Coronavirus includes a large group of viruses, which infects both humans and animals. China reported the outbreak on December 31, 2019, to World Health Organization. Center for Disease Control and Prevention, USA, has published nonpharmacological interventions such as social distancing, zonal lockdown, rolling lockdown, wearing masks, and washing hands to combat the spread of COVID-19. The present study was conducted to assess the perceptions of people about nonpharmacological interventions in the prevention of COVID-19.

Materials and Methods:

A facility-based study was conducted among 220 participants from December 01, 2020, to February 28, 2021, among outpatients in the field practice area of urban primary health care Rukmini Nagar, under the administrative control of J. N. Medical College in Belagavi district, Karnataka.

Results:

A total of 220 participants were interviewed and analyzed for the study. Out of which, 36 (16.4%) were male and 184 (83.6%) were female. One hundred and seventy (77.2%) of the participants practiced good hand hygiene and personal hygiene. One hundred and forty-five (65.9%) of the participants always wore a face mask, when they were going outside. One hundred and eighty-one (82.2%) of the participants started drinking more fluids in the form of water compared with normal days.

Conclusion:

There was a lack of awareness about face protection and the use of hand sanitizer among the common public. Grassroots level health-care workers such as Accredited Social Health Activist, Anganwadi workers, and community volunteers should be trained for giving health education about nonpharmacological interventions to the public for COVID-19 prevention.
Iron and Zinc Deficiency in Children with Febrile Convulsions Aged 6[FIGURE DASH]60 Months [FIGURE DASH] A 1-Year Hospital-Based Case[FIGURE DASH]Control Study
Authors: Mallela Jyothirmai , Metgud Tanmaya , Kamate Mahesh , Kadeangadi Deepti M.
Published: May 2023

Context:

Febrile seizures are one of the most common seizures in childhood. Febrile seizures occur in 2%–5% of children who are younger than 5 years of age. Studies have shown that iron, zinc, selenium, copper, and magnesium play a significant role in febrile seizures. This study was intended to study the relationship between iron and zinc deficiency with febrile seizures. Aim: To find the association of febrile convulsions with iron and zinc deficiency.

Methodology:

This hospital-based case[FIGURE DASH]control study was done in a tertiary care center in North Karnataka from January 2017 to December 2017. A total of 52 children fulfilling the inclusion criteria were included in case group. Control group contained 52 children who had fever without convulsions and matched for age, sex, and background disease with respective cases.

Results:

Both the groups were matched for age and gender. Majority of the children (76.92%) had a simple seizure. Cases had lower serum (Sr.) ferritin levels compared to controls with high odds ratio (OR) (25% vs. 1.92%; P < 0.001; OR = 17.00; P = 0.0075). Furthermore, cases had zinc deficiency compared to controls (84.62% vs. 25%; OR = 12.269; P < 0.001). The mean Sr. zinc levels (37.16 ± 22.07 vs. 75.75 ± 15.25 μg/dL; P < 0.001) were significantly low in cases.

Conclusion and Interpretation:

There was a significant association between febrile seizures with iron and zinc deficiency.