bluuebunny/crossref_metadata_2025 huggingface dataset:
Exploring outside-in empowerment approach to improve the family's ability to manage schizophrenia disorder
Authors: Setyowati Wahyu Endang , Nursalam Nursalam , Nihayati Hanik Endang , Iswamti Dwi Indah , Agustiningsih Nia , Azizah Intan Rismatul
Published: December 2024

Families often encounter a sense of despair and exhibit diminished capability when providing care for schizophrenia patients, predominantly due to restricted knowledge and lack of formal training and support. Existing strategies to empower families have been insufficient in effectively dealing with schizophrenia care. This study objective was to explore the relationship between family knowledge, coping skills, and interaction within the framework of outside-in empowerment and their ability to care for individuals with schizophrenia. This explanatory research utilizes a cross-sectional design and involves a sample of 135 families, acting as caregivers for schizophrenia patients, selected through purposive sampling based on inclusion criteria. Regarding outside-in empowerment, knowledge is evaluated using a questionnaire developed from the concept of schizophrenia care, coping skills are measured using the Family Coping Questionnaire (FCQ), and family interaction is assessed through the Brief Family Relationship Scale (BFRS). The family's ability to manage schizophrenia is gauged using the Barthel Index and the Caregiving Tasks in Caring for an Adult with Mental Illness Scale (CTiCAMIS). All of the questionnaire has been tested for validity and reliability.The data analysis involves multiple linear regression at a 95% significance level.
Comparison of diagnostic yield and safety of endobronchial ultrasound-guided mediastinal lymph nodal cryobiopsy and endobronchial ultrasound-guided Franseen tip needle biopsy
Authors: Maturu Venkata Nagarjuna , Vijay Anand , Prasad Virender Pratibh , Rechal Rinoosha , Garg Vipul Kumar , Sethi Shweta
Published: December 2024

In this prospective study, we evaluated the diagnostic yield and safety of two endobronchial ultrasound (EBUS) biopsy techniques – mediastinal cryobiopsy (EBUS-MCB) and Franseen tip needle biopsy (EBUS-ANB) – in patients with undiagnosed mediastinal lymphadenopathy. The study included 30 patients who underwent both EBUS-MCB and EBUS-ANB, with four biopsies taken from each patient using both methods. The results demonstrated that EBUS-MCB provided a higher diagnostic yield (96.4%) compared to EBUS-ANB (73.3%). Specimens from EBUS-MCB showed fewer artifacts and a higher density of granulomas and were adequate for ancillary studies in all cases. The most common complication observed was minor bleeding, which was more common with EBUS-MCB (36.6% versus 13.3%, p=0.04). This study demonstrates that EBUS-guided cryobiopsy has a higher diagnostic yield when compared to EBUS-guided Franseen tip needle biopsy and that both biopsy techniques have an acceptable safety profile. Larger studies comparing these two techniques are necessary to confirm the findings of the current study.
La gestione dello shock anafilattico da parte di un mezzo di soccorso avanzato a leadership infermieristica: un case report
Authors: Righi Lorenzo , Migliorini Aurora , Trapassi Stefano , Pinzi Manuel
Published: December 2024

Introduzione: l'anafilassi è una reazione allergica sistemica acuta e potenzialmente letale che si manifesta rapidamente dopo l'esposizione a un allergene, con sintomi come difficoltà respiratorie, gonfiore delle vie aeree, ipotensione e rash cutanei. La somministrazione di adrenalina intramuscolare è il trattamento di prima scelta per gestirla. 
Materiali e Metodi: è stato condotto un case report su un caso di anafilassi grave gestito da un mezzo di soccorso avanzato (ambulanza) a leadership infermieristica in Regione Toscana, evidenziando l'efficacia del trattamento e le criticità nel processo.
Risultati: è stata somministrata adrenalina e altri farmaci secondo le procedure infermieristiche avanzate, con un miglioramento significativo dei parametri vitali della paziente durante il trasporto.
Discussione: questo caso clinico evidenzia l'importanza di un intervento rapido ed efficace da parte del personale infermieristico extraospedaliero nella gestione dell'anafilassi e sottolinea la necessità di promuovere l'educazione sull'uso tempestivo degli auto-iniettori di adrenalina a domicilio.
Direct lithium extraction from raw and CO2-mineralization treated oilfield brine using an electrochemically assisted lithium-ion sieve: a preliminary feasibility study
Authors: Jiang C. , Zhang X.
Published: December 2024

Quatre (4) échantillons de saumure, différents dérivés d'un reflux et d'eau produite (FPW) provenant des opérations de fracturation hydraulique du réservoir de gaz étanche de Montney dans le nord-est de la Colombie-Britannique (BC), au Canada, ont été utilisés pour l'extraction directe du lithium (DLE) en utilisant la méthode électrochimique. technologie de tamis au lithium-ion assisté (eLIS) dans cette étude. Parmi les quatre échantillons de saumure, l'un était la saumure brute d'origine sans prétraitement, les trois autres échantillons de saumure ont été traités différemment en utilisant la minéralisation du CO2 et la précipitation chimique. La teneur en lithium (Li) et en impuretés (par exemple Ca, Mg, etc.) dans les échantillons de saumure traités était sensiblement différente, et une certaine quantité de perte de Li a été signalée lors des traitements. Dans cette étude eLIS, un oxyde de lithium et de manganèse commercial (LMO) dans une composition chimique de LiMn2O4 a été utilisé comme matériau adsorbant pour toutes les expériences. Le LMO a été protoné avant la fabrication de l'électrode eLIS. Le LMO proné a été chargé sur un feutre de carbone poreux (CF) pour former une électrode de travail. Des tests comparatifs ont été effectués sur les quatre échantillons de saumure dans trois conditions de test eLIS définies. Les performances de l'électrode LMO en termes de changement de potentiel d'électrode, de courant appliqué, de capacité Li, d'efficacité faradique (FE) et de cyclabilité électrochimique ont été étudiées. Les résultats expérimentaux ont révélé l'avantage potentiel du processus eLIS par rapport à l'adsorption chimique du DLE à partir de la saumure des champs pétrolifères. Bien que cette étude n'ait pas pu démontrer une récupération apparemment accrue du lithium à partir des saumures après le traitement de minéralisation du CO2 et la précipitation chimique, une réduction des précipitations d'hydroxydes et/ou de carbonates de calcium (Ca) et/ou de magnésium (Mg) sur les électrodes LMO a été observée pour les échantillons de saumure épuisés. des cations bivalents via la minéralisation du CO2. Nous attendons une autre étude collaborative dans le cycle de financement CMIN B22 avec une plate-forme de test améliorée et un processus eLIS avancé.
Evolution of Sleep Apnea and Arousals in Patients with Ischemic Stroke: A Longitudinal Follow-Up Study
Authors: Srijithesh PR , Mythirayee Sivasubramanian , Seshagiri Doniparthi Venkata , Kamble Nitish L , Sinha Sanjib , Yadav Ravi
Published: December 2024

Background and Objectives:

Sleep-disordered breathing (SDB) is characterized by pauses or shallow breathing during sleep. It is linked to poorer outcomes and increased stroke recurrence in stroke patients. We aimed to evaluate the proportion, severity, type, and evolution of SDB and arousals in ischemic stroke patients.

Methods:

Ischemic stroke patients were recruited to evaluate SDB. Patients underwent overnight polysomnography (PSG) twice – within 1 month of stroke onset and again after 3 months. Clinical outcomes were evaluated at 6, 18, and 24 months.

Results:

Of 141 acute ischemic stroke patients screened, 111 patients recruited in the study and 105 patients had technically adequate polysomnography. The mean age of patients was 50.5 years (standard deviation [SD]: 12.30), 78.4% of the patients were males, and the mean body mass index was 26 (SD: 5.4). Results showed that 81.9% had an apnea–hypopnea index (AHI) ≥5, with 12.5% having an AHI >30. The median arousal index (ArI) was 15.4 (interquartile range [IQR]: 0.5–50.5), which increased as the apnea increased. During follow-up, 56.8% patients had an AHI ≥5, with 12.5% having severe apnea. The median ArI decreased from 15.4 (IQR: 0.5–50.5) initially to 11.54 (IQR: 0.5-21.1) at follow-up. Numerical change in AHI severity categories were noted during the follow-up (mild: 8 vs 15; moderate: 17 vs 11; severe 19vs 7). For AHI >30, ArI decreased from 24.63 (IQR: 0.7-50.05) to 10.54 (IQR: 7.1-15.07) at follow-up. Sleep efficiency and rapid eye movement (REM) sleep duration increased on follow-up.

Conclusions:

The study showed a high proportion of SDB in acute ischemic stroke patients. In the follow-up, SDB improved, as reflected in AHI and ArI changes.
Correlation of Facial Skin Colour and Melanin Pigmentation in the Gingiva of Children in Primary, Mixed and Permanent Dentition: An Observational Study
Authors: Bane Pooja Vishwanath , Deshpande Anshula N , Dave Bhavna H , Bargale Seema S , Poonacha K S , Kariya Pratik B
Published: December 2024

Introduction:

Physiologic oral pigmentation is a typical finding in paediatric dentistry. Gingival pigmentation has a wide range of occurrence rates depending on race, country and the influence of genetics. This study aims to determine the anatomic distribution of physiologic gingival melanin pigmentation and the relationship between skin colour and gingival melanin pigmentation intensity in children with primary, mixed and permanent dentition.

Materials and Methods:

Patient photographs of the skin of the face and intraoral soft tissues were taken in the standardised photographic conditions. Photographs were reproduced on a computer for assessment at a standardised point for skin and intraorally for interdental, marginal and attached gingivae. The intensity of melanin pigmentation of the skin of the face and marginal, interdental and attached gingiva was observed by calculating CIE*L*a*b* values on Adobe Photoshop in 2008 individuals.

Results:

The P value was kept significant at <0.05. The mean value of the difference in marginal and attached gingiva pigmentation was statistically significant between the primary and permanent dentition groups. The correlation was positive and low between age and pigmentation at the attached gingiva as the correlation coefficient. The correlation was positive and low between skin pigmentation and pigmentation at attached and marginal gingiva as the correlation coefficient.

Conclusions:

The intensity of the skin’s pigmentation can be used as a predictor of the pigmentation of gingivae. Of all the other areas of the gingiva, the intensity of pigmentation in the attached gingiva is the highest. As one age, the intensity of pigmentation at the attached gingiva also increases.
A Case of Electric Cataract in High-voltage Electric Current
Authors: Bandgar Swapnali S. , Karwande Sonu R.
Published: December 2024

ABSTRACT

Electric cataract is a rare type of cataract caused by exposure to high-power electric currents, resulting in cloudiness in the eye’s lens or capsule, impairing vision and potentially leading to blindness. It can cause various ophthalmic injuries such as cataract, retinal edema, papilledema, chorioretinal necrosis/atrophy, retinal detachment, and optic atrophy. Most patients develop no early symptoms and become aware of the injury months later. Proper surgical management can result in stable visual acuity. A 40-year-old electrician man was referred to the ophthalmology department after experiencing low vision in his left eye after an electrical shock. After multiple injuries, he was referred to the plastic surgeon for burn treatment. An anterior segment examination revealed a mature cataract, and ophthalmoscopic examination revealed a dull red reflex in the left eye due to cataract. The patient was advised for left eye cataract surgery, which was successful. After 2 months, the patient’s vision was stable and no further ocular complications were observed.
Compensatory Corneal Epithelial Hyperplasia after Photorefractive Keratectomy Enhancement
Authors: Ahooja Hitendra , Gandhi Neha , Gautam Kaushal , Chhikara Neeru
Published: December 2024

ABSTRACT

This case report documents the clinical course of a 27-year-old female patient who underwent surface ablation (transepithelial photorefractive keratectomy [PRK]) refractive surgery for myopia correction, followed by transPRK enhancement for myopic regression 3 years postprimary refractive procedure. Postenhancement, the patient presented with blurred vision attributed to compensatory corneal epithelial hyperplasia. Epithelial thickness map (anterior segment optical coherence tomography) revealed the condition prompting conservative management and periodic monitoring. Over a 6-month follow-up period, the patient’s visual acuity improved significantly alongside a reduction in epithelial thickness. This case highlights the challenges and management strategies associated with epithelial responses following refractive surgeries along with the role of meticulous monitoring in optimizing outcomes. Hence, corneal epithelial hyperplasia must be a differential diagnosis in refractive surgery complications, guiding clinicians in decision-making and enhancing patient care.
Energy-efficient Chop: A Novel Technique of Nucleus Chopping
Authors: Desai Abhijeet U. , Mulchandani Ankita V.
Published: December 2024

ABSTRACT

We describe a novel technique of nucleotomy in phacoemulsification called “energy-efficient chop.” The technique aims at reducing the phaco energy inside the eye when emulsifying the nucleus of any grade. After hydrodissection, the phaco tip is embedded into the nucleus using ultrasound energy and stabilized using vacuum and divided into two halves using either horizontal or vertical chop. After rotating the nucleus by 180°, the balanced tip is embedded horizontally in the center of the heminucleus using phaco power and stabilized using vacuum and each heminucleus is further divided into 3 or 4 pieces depending on the grade of cataract and emulsified. The balanced tip when embedded horizontally allows a larger area of the heminucleus to be held and thus makes chopping easier without having to bury the tip at multiple places in the heminucleus. This technique decreases the total phaco energy dissipated in the anterior chamber during phacoemulsification.
House dust mite allergy – Management
Authors: Kathuria P. C. , Rai Manisha
Published: December 2024

Allergen vulnerability is highly individual specific. House dust mites (HDMs) are major sources of airborne allergens, found not only in houses but also detected in workplaces and most schools. The two most common HDM species from the Pyroglyphidae family, namely Dermatophagoides pteronyssinus and Dermatophagoides farinae are responsible for 90% of sensitization and allergic symptoms. Clinical conditions due to HDM allergen are rhinitis, conjunctivitis, asthma and/or atopic dermatitis (AD), and rare severe systemic reaction. Accurate diagnosis by skin prick test, specific immunoglobulin E (extract and component-based), or nasal provocation test with standardized HDM extract in contest with clinically relevant exposure to dust mites is fundamental for successful treatment. Allergen immunotherapy (AIT) is the only treatment providing sustained efficacy for moderate-to-severe allergic rhinitis, allergic asthma, and AD. This review will mainly focus on the description of HDM allergens, immunology, efficacy, and HDM-AIT (subcutaneous immunotherapy and sublingual immunotherapy).
Correlation of neutrophil-to-lymphocyte ratio with chronic spontaneous urticarial: A case–control study
Authors: Vaz Veril , Fernandes Michelle Serene , Martis Jacintha , Bhat M. Ramesh , Monteiro Rochelle Cheryl , Jayaraman Jyothi , Fernandes Sonal , Shetty Prajna
Published: December 2024

BACKGROUND:

Chronic spontaneous urticaria (CSU) is a persistent immune-inflammatory condition. The urticaria activity score 7 (UAS7) evaluates its disease activity. The neutrophil-to-lymphocyte ratio (NLR) is recognized as a dependable marker for inflammation in various conditions.

AIM:

The aim of the study was to examine the NLR in CSU patients and its association with the UAS7.

MATERIALS AND METHODS:

This study included 60 patients diagnosed with CSU who visited the dermatology department and 60 healthy individuals for comparison. The patients were categorized based on the UAS7. NLR values were computed and compared between the case and control groups.

RESULTS:

The mean neutrophils level was higher in cases than in controls with no statistical significance (P = 0.2). The mean lymphocyte levels were higher in controls than in cases with no statistical significance (P = 0.591). Thus, the mean NLR was higher in cases than in controls (1.84 vs. 1.71), with no statistical significance (P = 0.283). There was no significant correlation established between the NLR and the severity of CSU (P = 0.912).

CONCLUSION:

The NLR serves as a practical, straightforward, and economical blood marker capable of identifying systemic inflammatory processes. This research did not establish that the ratio could function as an indicator of inflammation. Additional studies are imperative to confirm the existence of inflammation in CSU.
Evaluating allergic sensitization in pediatric patients: A cross-sectional multicentric analysis
Authors: Jayakrishnan V. Y. , Bhunia Rabindra , Balumani Sangeetha , Mohan R. Krishna , Saxena Neha , Kumar Anil
Published: December 2024

OBJECTIVES:

The study aims to outline the allergic sensitization patterns among pediatric patients presenting with allergic manifestations in the allergy clinics of three Indian Armed Forces hospitals one each from North, West, and South India. It seeks to identify the common allergens affecting children aged 1–14 years who exhibit symptoms of allergic conditions. In addition, it evaluates the clinical manifestations associated with various allergen exposures and aims to provide valuable insights for personalized management and preventive strategies in managing allergic diseases.

METHODS:

A cross-sectional study involving a detailed examination of children aged 1–14 years who presented with symptoms of allergic diseases such as allergic rhinitis (AR), asthma, eczema, and allergic conjunctivitis (AC). Skin prick tests were utilized to identify sensitization to common allergens including house dust mites (HDMs), pollens, spores, animal dander, and food allergens.

RESULTS:

The findings revealed that HDMs were the predominant allergens, followed by cockroach, mosquito, pollens, and animal dander. Clinical manifestations varied across different allergen exposures, with notable differences in the presentation of AR, asthma, eczema, and AC among the patients.

CONCLUSION:

This research underscores the importance of early diagnosis, targeted management, and preventive measures in mitigating the impact of allergies on children’s health. It highlights the necessity for healthcare providers in military settings to be aware of regional allergen patterns and adapt their clinical practices accordingly to improve patient outcomes.
Infarction of breast and infarction of phyllodes tumor during pregnancy – A case report and review of literature
Authors: Lanjewar Dhaneshwar N. , Davda Mansi M. , Garg Sameep , Agrawal Ranjan
Published: December 2024

The breast can be affected by a variety of specific and unique disorders during pregnancy and lactation. One of these disorders is spontaneous infarction of the breast which is a rare condition seen in physiologically hyperplastic mammary tissue associated with pregnancy and lactation. The causes and mechanism of the development of breast infarct remain largely unknown. Only 25 cases of breast infarct have been reported in the English literature. Phyllodes tumor is uncommon in pregnant women, and to date, only one report of spontaneous infarction of the phyllodes tumor has been reported in a postpartum woman. In this report, we describe the first case of coexistent infarction of the hyperplastic breast parenchyma with infarction of phyllodes tumor in a 25-year-old female.
Distal Humerus Intercondylar Fracture in an 11-Year-Old Child: A Case Report
Authors: Yadav Navin Kumar , Pradhan Pavan , Kumar Surendra
Published: December 2024

A pediatric distal humerus intercondylar fracture is an exceptionally rare injury. The objective of this study is to address management guidelines and provide data to the limited amount of prior literature works. Because pediatric distal humerus intercondylar fracture is uncommon in children and growth plate preservation is complicated, the best results depend on prompt diagnosis and adequate treatment. We report a case of an 11-year-old boy who suffered a right elbow injury due to falling from a tree. The radiographs showed a distal humerus intercondylar fracture and rotation of the lateral and medial columns. Using the posterior triceps sparing approach, open reduction and internal fixation (ORIF) was carried out. K-wires have been used to fix the medial and lateral columns after reduction to the shaft. After that, two K-wires positioned transversely were used to fix the condyles to one another. For 4 weeks, the patient received the above elbow backslab. To avoid misdiagnosis, a proper radiograph should be taken, including oblique views. For best results, these fractures should be treated by ORIF using K-wires.
Factors influencing surgical site infections and health economic evaluation in patients undergoing robot-assisted radical resection for colorectal cancer
Authors: Liu Guangying , Ma Limei
Published: December 2024

Aims:

To investigate the incidence and factors influencing surgical site infections (SSIs) in patients undergoing robot-assisted radical resection for colorectal cancer and assess their health and economic impact on the patients and hospital.

Materials and Methods:

This retrospective case-controlled study comprised patients who underwent robot-assisted radical resection for colorectal cancer at a tertiary hospital in China. Information about baseline characteristics, perioperative details, postoperative SSI incidence, hospitalization costs, and follow-up was collected. Univariate and multivariate analyses were performed to identify the independent risk factors for SSI. Propensity score matching was used to evaluate the health and economic impacts of SSI on the patients and the hospital.

Results:

The overall incidence of colorectal SSI in 546 patients undergoing robot-assisted radical resection for colorectal cancer was 11.72% (64/546). Intraoperative blood loss, duration of operation, preoperative absolute lymphocyte count, preoperative and postoperative serum albumin levels, tumor location, gender, history of radiotherapy or chemotherapy, surgical wound classification, and preoperative hypoalbuminemia levels were associated with SSI. Rectal cancer, male gender, and class 3 or 4 surgical wounds were identified as independent risk factors for postoperative SSI. SSI prolonged the hospital stay by 6.60 days, increased the patient’s direct costs by 31,669.88 CNY, increased the economic burden by 3,262.38 CNY, and caused an indirect economic loss of 50,546.79 CNY for the hospital.

Conclusions:

Patients undergoing robot-assisted radical resection for colorectal cancer are at a high risk for SSI. SSI can prolong postoperative hospital stays and increase the economic burden for patients and hospitals.
Ensuring safe and effective pharmacotherapy: The role of “community pharmacology” in attaining “health for all” from the Indian perspective
Authors: Deb Tirthankar , Das Alapan , Ojha Bisweswar , Das Prasanjit
Published: December 2024

ABSTRACT

The novel approach of “Community Pharmacology” integrates pharmacological principles with community health to achieve the “Health for all” goal through safe and efficient health care. Pharmacovigilance, medication errors (ME), irrational prescriptions, and antimicrobial resistance in the community could be the key areas. Though life expectancy and other health indicators have improved in India, the disparity between rural and urban quality healthcare access should be addressed. Despite India’s enormous progress in vaccine manufacture, supply, and mass immunization through the Universal Immunization Programme (UIP) and Mission Indradhanush, issues remain in incomplete coverage and vaccine hesitancy. Other key challenges include high health expenditures, shortage of trained healthcare professionals, and lack of patient safety and irrational pharmacotherapy in remote areas. Community Pharmacology offers a multifaceted solution in community healthcare delivery through a well-designed integrated network equipped with skills in practical implications of pharmacology aimed at better medication supply, storage and dispensing, adherence to formularies according to the community needs, preparing Essential Medicine List and implementation of rational prescribing. Antimicrobial stewardship (AMS), adverse drug reaction (ADR) monitoring, and evidence-based usage of different drug formulations or drug delivery systems must be implemented beyond the tertiary level, involving both public and private stakeholders. Integrating Community Pharmacology into public health is crucial for fulfilling the global health initiatives to reach the Sustainable Development Goals (SDGs) as well as attaining India’s ambitious overall development targets.
Call for Reforms in the NEET-UG Examination (National Eligibility cum Entrance Test - Undergraduate): Addressing Human Resources in Health for India, the World’s Most Populous Country
Authors: Ranjan Piyush , Kain Sarthak , Kumar Raman
Published: December 2024

ABSTRACT

The National Eligibility cum Entrance Test for Undergraduate (NEET-UG) in India serves as a unified admission examination for undergraduate medical courses, aiming to standardize assessment across diverse educational backgrounds. Despite its goals, NEET-UG has faced criticism over fairness, excessive reliance on coaching, and its impact on students’ holistic development. The article reviews the limitations of the current NEET-UG format and proposes reforms, emphasizing the need to align the syllabus more closely with medical requirements by reducing physics and chemistry content and prioritizing biology. It suggests restructuring NEET-UG into a two-step examination to improve differentiation among candidates and reduce malpractice. Introducing a computer-based format, expanding the question pool, and adding interdisciplinary topics relevant to healthcare, such as Psychology, Nutrition, Physical Education, Cell biology, Genetics, public health and sociology, are also recommended. Additionally, the paper compares NEET-UG with global medical entrance exams, noting that broader subject assessments and critical thinking skills could enhance candidate evaluation. The Indian medical education system is the largest in the world. Given its vast capacities, it is crucial to reform the selection process to ensure that human resources in health can effectively address the pressing public health needs of India, the world’s most populated country. The proposed reforms aim to create a fairer, more comprehensive selection process that minimizes stress, encourages holistic education, and better meets medical education standards.
Doctors’ knowledge, practices, challenges, and limitations regarding disclosure of bad news: A multicentre study from Pakistan
Authors: Usman Asma , Shah Sameena , Zaki Samar , Nanji Kashmira , Sawani Sobiya , Uneeb Saher Naseeb , Bari Naseem , Ullah Obaid , Abid Sumera
Published: December 2024

ABSTRACT

Background:

Breaking bad news is one of the most difficult tasks for practicing doctors, especially for those working in health care specialties where life-threatening diseases are diagnosed and managed routinely. Our aim was to elicit the knowledge and practices of doctors and identify barriers faced by them in disclosure of bad news across the provinces of Pakistan.

Methods:

Cross-sectional, multi-centered study supported by an external grant in 15 Government and Private Hospitals across Pakistan. A total of 1185 doctors were surveyed. Responses were compared across provinces.

Results:

80% of doctors across all specialties considered life-threatening diagnoses like cancer and stroke as equivalent to bad news, whereas less than 50% perceived conditions like malaria and typhoid as bad news. Regarding the level of difficulty encountered in giving bad news on a scale of 0 to 6, over 57% doctors rated it 4 and above. The reasons identified were lack of confidentiality, lack of privacy, lack of time, lack of training, fear of patients’ and family reactions, not wanting to hurt the patient or causing more distress, concern of having failed the patient, and their own reactions among others.

Conclusions:

Technical proficiency, training, good patient-centered communication, and incorporating socio-cultural aspects are essential for effective disclosure of bad news.
Developmental delay and its associated factors among children of 9 months and of 18 months attending primary health facilities in an urban resettlement area of East Delhi
Authors: Verma Bhavana , Chhabra Pragti , Maroof Amir K. , Aggarwal Anju
Published: December 2024

ABSTRACT

Background:

Early identification of developmental delay in children can help in making early intervention for its management. Routine developmental screening is not being practised in India due to lack of trained field workers, lack of awareness among parents and lack of feasible assessment screening tool. There is lack of studies that focuses on home environment provided to the children as it is associated with developmental delay.

Methods:

A cross sectional study was conducted in immunization clinic of two Maternal and Child Welfare (MCW) centres of Nand Nagari, an urban resettlement colony in East Delhi among children of 9 months and 18 months of age. New Delhi Development Status Questionnaire (ND-DSQ) was used for assessment of developmental status. Data on socio-demographic profile, home stimulation of the child and anthropometric measurements including weight, height was collected. Chi-square test was used for univariate analysis and binary logistic regression was used to find out the predictors of developmental delay.

Results:

The prevalence of DD was found to be 17.7% in children 9 m of age, and 10% in 18 m. On univariate analysis preterm gestation, low-birth weight of the child, lower mother’s education status and presence of complications at birth were significantly associated with developmental delay. The independent predictors of DD were presence of complications at birth, preterm gestation, lower mother’s education status and underweight children.

Conclusion:

This study reports a higher prevalence of DD. More follow up studies on DD is needed to see the course of achievement of developmental milestones. Screening for developmental milestones can be done during visit for immunization.
Gastrointestinal stromal tumors mimicking as gynecological tumors-A case series
Authors: Trivedi Kiran , Toppo Shabnam , Sharma Apoorwa , Jha Rohit Kumar , Bharati Binit , Pushpanjali  , Sinha Tulika
Published: December 2024

ABSTRACT

Gastrointestinal stromal tumors (GISTs) are rare mesenchymal tumors that arise from interstitial cells of Cajal. Due to vague presentation, location and confusing imaging studies, they tend to mimic gynaecological tumors. They usually diagnosed intra-operative and histopathology followed by tumor specific receptors such as KIT, CD34, CD 117 and DOG 1 are mainstay of diagnosis of GIST. Prognosis of GISTs depends on mitotic rate, tumor size and organ of origin. Resection of mass with tumor free margins is the target of treatment. L ymphadenectomy is not routine. Chemotherapy with tyrosine kinase inhibitors such as Imatinib, Dasatinib, Sorafenib and follow- up depend upon risk category. In this case series, there were four cases with vague symptoms misdiagnosed as gynaecological tumors are reviewed. Preoperatively tumors assumed to be of gynaecological origin were found to be case of GISTs intra-operatively and confirmed by presence of cajal’s cells histopathology and mainly by DOG 1, CD117 and tyrosine kinase inhibitor receptors on immunohistochemistry. All belonged to high risk category of GISTs. Any abdomino-pelvic mass detected on ultrasonography and with unusual presentation presenting at primary health centre the possibility of non-gynecological tumors especially GISTs should be kept in mind and should be referred to higher centres for further investigation and proper management.
Distribution of extrapulmonary tuberculosis in CBNAAT samples received in a tertiary care hospital – A record-based study
Authors: Mondal Soumyya , Mandal Anwesha , Saha Sipra , Chakrabarty Partha Sarathi , Datta Piyali , Das Debalina
Published: December 2024

ABSTRACT

Background:

Pulmonary tuberculosis (PTB) accounts for 85% of all reported tuberculosis cases globally. Extrapulmonary involvement can occur in isolation or along with a pulmonary focus as in the case of patients with disseminated tuberculosis (TB). EPTB can occur through hematogenous, lymphatic, or localized bacillary dissemination from a primary source, such as PTB and affects the brain, eye, mouth, tongue, lymph nodes of neck, spine, bones, muscles, skin, pleura, pericardium, gastrointestinal, peritoneum and the genitourinary system as primary and/or disseminated disease. Although pulmonary TB is the most common presentation, EPTB is also an important problem clinically. Cartridge-based nucleic acid amplification (CBNAAT) test has a well-documented role in diagnosing pulmonary tuberculosis.

Aim:

To determine the distribution of EPTB in various samples received for CBNAAT testing in our Institution.

Methods:

In this retrospective cross-sectional study, data of suspected EPTB patients were retrieved and analyzed from January 2020 to December 2022.

Statistical Analysis:

All the statistical analyses were carried out using the Excel spreadsheet and Open-epi version 3.01 platform.

Results:

A total number of 1118(n) extrapulmonary samples were processed using GeneXpert MTB/RIF assay. Out of the 1118 received samples, (22%) were positive. Among the 249 positive samples, 55% samples were received from the female patients and 45% samples received from the male patients. We found that most MTB positive samples were from this age group (i.e. 21-30). Most common sample received for processing was Lymph node aspirate accounting to 37% followed by pleural fluid (30%), pus (8%) and gastric lavage amounting for 4% along with other miscellaneous samples making up the others to 21%. Out of 249 MTB detected samples, 47% were from lymph node aspirate, 13% from pleural fluid, 12% from pus, 3% from gastric lavage and 25% from other samples. We noted that the majority of the positive cases were rifampicin sensitive (97.68%).

Conclusion:

Results of our study suggest that younger age (third decade of life) and female gender may be independent risk factors for EPTB. In developing countries, the prevalence of EPTB is relatively lower than PTB but still it is an important cause of morbidity and mortality. Thus, early diagnosis and initiation of appropriate treatment are important for reducing the case load. Women especially should be investigated thoroughly for EPTB and BCG vaccination should be encouraged.
Association of anemia with poor housing quality among older Indian adults: Multilevel modeling analysis of nationally representative cross-sectional study in India
Authors: Halder Pritam , Tiwari Jaya , Rathor Shivani , Pal Saumyarup , Mamgai Anshul , Biswas Riya , Rajan Abin K , Soni Anamika , Prabhakar Manish Chandra
Published: December 2024

ABSTRACT

Introduction:

Anemia is an important public health disorder. There is a significant chunk of India’s population residing in poor housing quality with inadequate sanitation and hygiene, which might lead to higher anemia prevalence. The objective was to determine the association between anemia with poor housing quality among the older Indian adult population (≥45 years) as per residence.

Methods:

This study analyzed the nationally representative dataset of the Longitudinal Ageing Study in India (LASI 2017–18, Wave-1). Bivariate analysis and logistic regression were conducted to show the association of anemia (outcome variable) with poor housing quality (explanatory variable). Multivariable logistic regression was conducted by adjusting for covariates as per their models. P value <0.05 was considered statistically significant. STATA version 17 was used for analysis.

Results:

Our study found that higher adjusted odds of having anemia among older Indian adults were observed among participants with overcrowding (AOR 1.30, 95%CI 1.19–1.42), having access to open/nonsanitary toilet facility (AOR 1.56, 95%CI 1.41–1.72), no electric supply (AOR 1.31, 95%CI 1.12–1.53), and overall poor housing quality (AOR 1.34, 95%CI 1.21–1.48). All of these associations were even higher in urban areas except for having access to open/nonsanitary toilet facilities, which was much higher in rural areas (AOR 1.61, 95%CI 1.45–1.79).

Conclusion:

Through a nationally representative large dataset, this study generated compelling evidence despite several obstacles indicating a positive association between anemia and poor housing quality among older Indian adults. It might raise awareness and assist individuals in steering clear of the negative effects of overcrowding, using open/nonsanitary toilet facilities, lack of electric supply, and overall housing quality on anemia status. It is advised to conduct additional research to determine temporality and causation.
Comparison of single-point insulin sensitivity estimator (SPISE) index and cognitive performance in vitamin B12-deficient young adults: An analytical cross-sectional study
Authors: Suri Himanshi , Senghor K. A. Arul , Vinodhini V. M. , Sai Koneru T. , Charles Jonathan , Rooban S.
Published: December 2024

ABSTRACT

Background:

Vitamin B12 is an essential micronutrient, aids in synthesis of neurotransmitters, and vital for cognitive function. In the current younger population with more of electronic gadgets and scientific world seems to slow down critical thinking and impairs the trick of comprehensive subjective learning. Vitamin B12 deficiency has been linked to insulin-resistant state and future cardiovascular risk.

Aim:

This study compared single-point insulin sensitivity estimator (SPISE) index, cognitive performance, and CVS risk in vitamin B12-adequate and -deficient young adults.

Materials and Methods:

Study participants were 60 young female participants, 18 to 35 years with the inclusion criteria of BMI more than 22.9 and waist circumference >85 cm. Anthropometric variables were measured. Lipid profile analytes were analyzed in an integrated Beckman Coulter AU series autoanalyzer. Based on SPISE index categorized as insulin resistant Group A <5.82 and non-insulin resistant Group B ≥5.82. Cognitive function was assessed based on Mini-Mental State Examination screening tool.

Settings and Design:

Analytical cross-sectional study.

Results:

Individuals with low vitamin B12 levels had a low SPISE index of less than 5.82 and low HDL-C levels, which indicates abnormal lipidemia and reduced insulin sensitivity. Mini-Mental State Examination was low in B12-deficient. B12 revealed positive correlation with MMSE, SPISE Index, and HDLc, whereas negative correlation with TGL and TGL/HDLc ratio.

Conclusion:

Individuals with low vitamin B12 levels express low SPISE index, and low performance on MMSE confirms risk of impairment of cognitive function and cardiovascular risk.
Algorithm-informed treatment from EEG patterns improves outcomes for patients with major depressive disorder
Authors: Solhkhah Ramon , Feintuch Justin , Vasquez Mabel , Thomasson Eamon S. , Halari Vijay , Palmer Kathleen , Peltier Morgan R.
Published: December 2024

ABSTRACT

Objective:

Selecting the right medication for major depressive disorder (MDD) is challenging, and patients are often on several medications before an effective one is found. Using patient EEG patterns with computer models to select medications is a potential solution, however, it is not widely performed. Therefore, we evaluated a commercially available EEG data analysis system to help guide medication selection in a clinical setting.

Methods:

Patients with MDD were recruited, and their physicians used their own judgment to select medications (Control; n = 115) or relied on computer-guided selection (PEER n = 165) of medications. Quick Inventory of Depressive Symptomatology (QIDS SR-16) scores were obtained from patients, before the start of the study (day 0) and again at ~90 and ~180 d. Patients in the PEER arm were classified into one of 4 groups depending on if the report was followed throughout (RF/RF), the first 90 days only (RF/RNF), the second 90 days only (RNF/RF), or not at all (RNF/RNF). Outcomes were then compared with controls whose physician performed the EEG and submitted data but did not receive the PEER report.

Results:

Patients in the controls, RF/RF and RNF/RNF groups had fewer depressive symptoms at 90 and 180 days, but the response was significantly stronger for patients in the RF/RF group. Lower rates of suicidal ideation were also noted in the RF/RF group than the control group at 90 and 180 days of treatment.

Conclusion:

Computational analysis of EEG patterns may augment physicians’ skills at selecting medications for the patients.
The elderly population’s social networks and HIV perceptions: Evidence from China
Authors: Shen Jie , Xu Junfang
Published: December 2024

ABSTRACT

Background:

Previous studies have found that people with low participation in social activities and living alone were prone to have risky sexual behaviors, while people with high participation in social activities were less prone to have risky sexual behaviors. Based on the above assumptions, we conducted an analysis on elderly population’s social networks and human immunodeficiency virus (HIV) risky behaviors in China. In the survey study, considering the sensitivity of sexual behavior, HIV risk behavior of the elderly population is more difficult to measure, so the intermediate variable of HIV perceptions was used instead of the sexual behavioral variable.

Methods:

A cross-sectional study was conducted in July to September 2023 among the elderly aged ≥ 50 years in China to measure the social networks with the Social Support Rate Scale (SSRS) and to measure the HIV perceptions of the elderly with the degree of knowledge of acquired immunodeficiency syndrome (AIDS) prevention and treatment and the degree of discrimination of HIV/AIDS patients, and the data were statistically analyzed with SPSS 27.0 software. Statistical analysis methods included descriptive analyses such as frequency, percentage, mean ± standard deviation, and median, two independent samples t-test analysis, and multivariate logistic regression model analysis.

Results:

Among the 1022 elderly people surveyed, the proportion of those with weak and strong levels of social support was 46.9% and 53.1%, respectively; the proportion of those with low, medium, and high levels of HIV knowledge perceptions was 4.8%, 5.9%, and 89.3%, respectively; and the proportion of those with low, medium, and high levels of attitudinal perceptions was 24.7%, 35.0%, and 40.3%, respectively. Based on the Goodman–Kruskal Gamma test, it was found that there was a positive correlation between social support and HIV knowledge perceptions in the elderly population, and there was a negative correlation between social support and HIV attitudinal perceptions in the elderly population. Ethnicity, current occupation or pre-retirement occupation, personal average after-tax monthly income, attitudinal perceptions, and social support were the influencing factors for the knowledge perceptions in the elderly population (P < 0.05); literacy, number of children, mode of residence, personal average monthly income after tax, knowledge perceptions, and social support were the influencing factors of attitudinal perceptions in the elderly population (P < 0.05).

Conclusions:

There is a correlation between social networks and HIV perceptions in China’s elderly population, which is positively correlated with HIV knowledge perceptions and negatively correlated with HIV attitudinal perceptions, and it is important to improve the HIV prevention and knowledge of the elderly population and reduce their HIV-related discrimination.
Case report: Kabuki syndrome and persistent hypoglycemia in neonates
Authors: Safdar Osama Y , Abddulghfar Miral M , Saaty Renad N , Bernawi Zahrah , Babteen Reem , Felemban Osama M
Published: December 2024

ABSTRACT

The Kabuki syndrome (KS) is a rare congenital disease that has two different types, KS1 and KS2, with variant in epigenetic gene KMT2D and KDM6A, respectively. It is associated with multiple abnormalities such as (developmental delay, atypical facial features, cardiac anomalies, minor skeleton anomalies, genitourinary anomalies, and mild to moderate intellectual disability). This syndrome can lead to neonatal hypoglycemia that results from hyperinsulinemia and electrolyte abnormalities. We described 18-month-old Egyptian girl with Kabuki syndrome type 2 presented with persistent hypoglycemia since birth and accompanied by an abnormality in urine concentration, and blood gases showed academia. She was treated medically. The diagnosis was made at the age of five months. Growth failure and developmental delay were noted during the patient’s growth. We found that KS2 with heterozygous gene mutation KDM6A, which had related with severe hypoglycemia in neonates. Mostly due to congenital hyperinsulinism for further investigations. We aim to increase the awareness of different genetic diseases that are related to neonatal hypoglycemia and early recognition and treatment to prevent the neurodevelopmental complication and improve the outcome.
Assessment of services provided by urban ASHAs to mothers of urban slums in Lucknow district – A cross-sectional study
Authors: Kumar Santosh , Agarwal Monika , Kumar H Dinesh
Published: December 2024

ABSTRACT

Context:

Maternal and child health is an important public health issue which indicates the level of socioeconomic development in any country. Urban accredited social health activist (U-ASHA) workers in India are the main front-line urban health workers in primary health care delivery for slum and urban poor.

Aims:

To assess the services provided by U-ASHA workers to mothers of urban slums for antenatal and postnatal care.

Settings and Design:

Cross-sectional study in urban slums of Lucknow where recently delivered women (up to 2 years) were selected.

Methods and Material:

To include the desired sample size of 320 recently delivered women (RDW), the U-ASHAs of the selected slums were contacted and a list of RDWs was made for each slum. By simple random sampling, 20 RDWs were selected from each slum. A predesigned and pretested interview schedule was used for data collection.

Statistical Analysis Used:

SPSS-version-26 was used. P <0.05 was considered statistically significant.

Results:

The registered pregnancies were 95%. Only 43.1% of RDW had at least four ANC visits. The institutional delivery was 84.7%. Only 27.7% of RDW visited health facilities for PNC services. About 39.4% received Janani Suraksha Yojana incentives. Contraceptive users were only 41.9%. Counseling by U-ASHA workers regarding all the ANC and PNC services had better utilization among counseled RDW except for child-care counseling.

Conclusions:

Counseling services regarding ANC and PNC services have a significant impact on their utilization. Better results can be achieved if the counseling by U-ASHA is enhanced to reach out more beneficiaries.