bluuebunny/crossref_metadata_2025 huggingface dataset:
A Case Report on Individualized Homeopathic Treatment of Psoriasis
Authors: Kumar Ratnesh , Panwar Anju , Nayak Chaturbhuja
Published: June 2023

Psoriasis is a chronic dermatosis characterized by an unpredictable course of remission and relapses and presence at a typical site of well-defined erythematous papules and plaques, which are surmounted with large, silvery loose scales. Psoriasis is an immune-mediated genetically determined common dermatological disorder which affects skin, nails, joints and has various systemic associations. One patient suffering from psoriasis was treated in the outpatient department of State National Homoeopathic Medical College and Hospital, Lucknow. Thorough case-taking was done, followed by analysis and evaluation of the case, was done. The patient was prescribed medicines as per homeopathic principles. The condition of the patient was assessed with the Psoriasis Area and Severity Index (PASI) score every month. Homeopathic medicine reduced the PASI score suggesting the utility of homeopathic treatment of a patient suffering from psoriasis.
Experimental Evaluation of Analgesics and Anti-Inflammatory Activity of Punarnavadi Guggulu and Panchavalkaladi Taila
Authors: Pandya Matangee , Donga Shilpa , Nariya Mukesh B.
Published: June 2023

Background:

Inflammation is a dynamic sequence as a protective response against various etiological agents either infectious or noninfectious by the body. Control of inflammation is necessary when inflammation becomes severe. Many herbs work as anti-inflammatory in ayurveda classics. Punarnavadi Guggulu and Panchavalkaladi Taila is said to be efferive in reducing inflammation. Present experimental traial was conducted to revalidate this claim. The study aimed to evaluate the anti-inflammatory and analgesics activity of Punarnavadi Guggulu and Panchavalkaladi Taila in experimental animals.

Materials and Methods:

In this trail, Wistar strain albino rats (weighing 200 ± 20 g) of either sex and pharmacologically validates model for analgesic and anti-inflammatory was used to evaluate activity. Punarnavadi Guggulu (270 mg/kg body weight) and Panchavalkaldi Taila (q.s.) locally were administered in the experimental group.

Results:

Punarnavadi Guggulu with Panchavalkaladi Taila was found significantly inhibited the inflammation on carrageenan-induced paw edema (P < 0.001) at 1, 3, and 5 h. In analgesic activity, Punarnavadi Guggulu with Panchavalkaladi Taila was not significantly inhibit the early and late phases of pain.

Conclusion:

The results revealed that Punarnavadi Guggulu with Panchavalkaladi Taila has anti-inflammatory activity but insignificant analgesic activity. Hence, Punarnavadi Guggulu with Panchavalkaladi Taila can be effective in reducing inflammatory conditions.
Evaluation of Clinical and Laboratory Findings in the Differential Diagnosis of Central Precocious Puberty and Premature Thelarche
Authors: Beştaş Aslı , Unal Edip , Aktar Karakaya Amine , Demiral Meliha , Haspolat Yusuf K.
Published: June 2023

Aim:

In this study, it was aimed to examine the clinical and laboratory findings that can be used to predict central precocious puberty (CPP) in cases whose breast development started before the age of 8.

Materials and Methods:

The chronological age, anthropometric measurements, bone age (BA), hormone test results and pelvic ultrasonography findings of the cases were recorded. Those with a peak luteinizing hormone (LH) level of ≥5 IU/L in the gonadotropin-releasing hormone (GnRH) stimulation test were classified as CPP and those with a peak LH level of <5 IU/L were classified as prepubertal cases. A receiver operating characteristic (ROC) analysis was performed to determine the diagnostic accuracy of laboratory variables.

Findings:

A total of 297 female cases were included in the study. The age at the time of admission, height-standard deviation score (SDS), BA, the long axis of the uterus and the volumes of the right and left ovaries of the cases diagnosed with CPP were found to be significantly higher than those of the prepubertal group. The cut-off value providing the best sensitivity (99%) and specificity (99%) for the peak LH was found to be 4.55; the cut-off value providing the best sensitivity (94%) and specificity (85%) for the peak LH/follicle-stimulating hormone (FSH) ratio was found to be 0.32 and the cut-off value providing the best sensitivity (47%) and specificity (93%) for the basal LH was found to be 0.13.

Conclusion:

We believe that in female cases with early breast development, a peak LH level of ≥4.55 may possibly indicate CPP and a basal LH level of <0.13 can significantly rule out CPP.
Inherited Lipid Disorders in Children: Experience from a Tertiary Care Centre
Authors: Syal Simran , Rao Sudha , Joshi Rajesh , Keshwani Rachna , Bodhanwala Minnie
Published: June 2023

Background:

Primary dyslipidaemia in children is a rare inherited disorder of lipoprotein metabolism with debilitating sequelae and poor outcomes. Lipid-lowering drugs have less often been used in children and long-term outcome studies are scarce. The purpose of this study was to understand the clinical and laboratory profile, response to treatment on follow up and outcome of primary dyslipidaemia in Indian children.

Methods:

Clinical records, including historical details, examination features and laboratory and radiological evaluation of children diagnosed with primary dyslipidaemia, presenting over the last 9 years were studied. Cascade screening was done for family members of the patients to detect dyslipidaemia in parents and siblings. All children were followed up 3 to 6 monthly for clinical and laboratory evaluation. Diet and drug therapy, initiated as appropriate, were modified as necessary.

Results:

Of nine children with primary dyslipidaemia, seen over the last 9 years, homozygous familial hypercholesterolaemia (HoFH) (n = 4/9), familial hypertriglyceridaemia (FHT) (n = 3/9), familial combined hyperlipidemia (FCH) (n = 1/9), mutation proven chylomicronaemia syndrome (n = 1/9) were the phenotypes seen. Multiple xanthomas (n = 4/9), recurrent pancreatitis (n = 2/9) and incidentally found biochemical abnormality (n = 3/9) were the chief presenting features. Medical nutrition therapy and lipid-lowering drugs, as appropriate, were instituted in all. Follow-up over 16 months (range 4 to 90 months) revealed no deaths and no new onset of symptoms. Atherosclerotic plaques in the carotid artery were seen in one child, who presented late, despite fair compliance to treatment. Interestingly, lipid levels decreased in all cases and were normalised in two.

Conclusion:

Primary dyslipidaemia when detected early and treated aggressively can improve short-term outcomes.
Adult Height in Indian Girls with Turner Syndrome Treated with Long-Term Growth Hormone Therapy — A Western India Tertiary Centre Experience
Authors: Khadilkar Vaman , Mondkar Shruti , Oza Chirantap , Gondhalekar Ketan , Khadilkar Anuradha
Published: June 2023

Background and Objectives:

Owing to paucity of data on adult height in Indian girls with Turner syndrome treated with growth hormone (GH), this study was conducted to assess improvement in height following GH therapy and adult height achieved with long-term GH therapy in Indian girls with Turner syndrome and to assess relationship between achieved and predicted height.

Methodology:

Retrospective analysis was performed on 12 girls with karyotype-proven Turner syndrome, who had attained adult height following mean duration of GH therapy of 4.8 years (range: 2.7-7.6). Adult height predictions were performed using index of responsiveness (IOR) and Ranke’s prediction model.

Results:

Mean age at starting GH was 10.2 ± 1.9 years; Pubertal induction was between 11 and 15 years. Mean height gain was 29.3 ± 9.8 cm (range: 14–39.5) from onset of treatment to adult height. Significant improvement in height Z scores (IAP 2015 and Indian Turner reference data) following GH therapy (p = 0.002 and 0.012, respectively) was noted. Using Indian Turner reference data, the height Z score improved from pre-treatment 0.8 ± 0.8 to 2.0 ± 0.9 on stopping GH and adult height Z score of 1.3 ± 0.7. Using Ranke’s equation for prediction of near adult height, predicted and achieved adult height showed a strong positive correlation (Spearman correlation coefficient = 0.827, significant at 0.01 level).

Conclusion:

At a dose in the lower range (40-50 mcg/kg/day) of recommendation and duration of 5 years, Indian girls with Turner syndrome can achieve adult height within the healthy Indian reference range. Dose individualization based on IOR would help in optimizing GH dosage and would turn out to be economically sustainable without compromising on height outcomes.
Zoledronic Acid Treatment in Infants and Toddlers with Osteogenesis Imperfecta is Safe and Effective: A Tertiary Care Centre Experience
Authors: Kumar Angad , Saikia Uma K. , Bhuyan Ashok K. , Baro Abhamoni , Prasad Surendra G.
Published: June 2023

Context:

Osteogenesis imperfecta (OI) is a genetic disorder of the extracellular matrix of bone characterized by low bone mass manifesting as frequent fractures, delayed motor development, pain, and impaired quality of life. The intravenous bisphosphonate, pamidronate is an established treatment for OI. Recently, zoledronic acid (ZA) has been used for the management of OI.

Aim:

To assess the efficacy and safety of ZA in children below five years of age with OI.

Settings and Design:

A hospital-based prospective observational study.

Methods and Material:

Patients with OI aged less than five years attending our centre were treated with intravenous ZA at a dose of 0.05 mg/kg every six months. Subjects were closely monitored for clinical and biochemical variables, adverse events, and new-onset fractures. The response to therapy was assessed by monitoring clinical variables including the degree of bony pains, number of fractures, height/length standard deviation score (SDS), and motor developmental milestones. All patients were analysed at baseline and at the end of two years for biochemical parameters and clinical severity score (CSS) as proposed by Aglan et al. with modifications.

Results:

After two years of treatment, OI patients showed a significant decline in the rate of fractures (p < 0.001), improvement in ambulation (p = 0.005), alleviation of pain (p < 0.001), and improvement in height SDS (p < 0.05). There was a significant improvement in CSS after two years of therapy. Apart from mild flu-like symptoms and mild asymptomatic hypocalcaemia immediately post-infusion, no other adverse effect was noted.

Conclusion:

ZA therapy in infants and children below five years of age with OI was effective and safe and a more convenient alternative to pamidronate.
An Observational Study on Response to Growth Hormone Therapy in Indian Patients of Short Stature with Special Emphasis on Biochemical Parameters and Bone Biomarkers
Authors: Roy Ritam , Hazra Avijit , Ghosh Sujoy
Published: June 2023

Introduction:

There is a lack of Indian data on short stature treatment using recombinant human growth hormone (rhGH). We explored the effects of such treatment in eastern Indian patients, with emphasis on biochemical parameters and bone biomarkers in addition to basic anthropometry.

Methods:

Our descriptive study covered 50 short stature patients of varied aetiology attending endocrine outpatient department (OPD) of a tertiary care teaching hospital. Patients were followed up for 1 year after the index visit, and prospective data were reconciled with past medical records. A dose of rhGH used was 0.18–0.375 mg/kg as standard, starting dose mostly being 0.2 mg/kg. Dosing was adjusted if the physician judged the clinical outcome to be less favourable than expected. Anthropometric parameters (height, weight, body mass index (BMI) and skeletal age) were recorded clinically, and various biochemical parameters and bone biomarkers were estimated from blood.

Results:

Among 50 subjects, 60% had idiopathic growth hormone (GH) deficiency and 26% had Turner’s syndrome. The median age at treatment start was 10 years, and the median treatment duration was 25.5 months. The height increased more in the first year of therapy. In the last 6 months, the height velocity was approximately 0.5 cm/month. Although the weight increased significantly, the increment slowed down in the last 6 months. Both remained less than age- and gender-matched references throughout. The skeletal age was on average 2 years behind chronological age (CA)—being 8.7, 9.6 and 11.3 years, respectively, at therapy start, after one year and at study end. Fasting blood glucose (FBG), total cholesterol and calcium level changes were not statistically significant. Serum cortisol and phosphate showed a modest but statistically significant rise, while thyroid-stimulating hormone (TSH) level declined. Insulin-like growth factor 1 (IGF-1) increase was relatively pronounced. Among bone biomarkers, a decrease in CTx and an increase in vitamin D were significant. Dual-energy X-ray absorptiometry (DEXA) data indicated that bone mineral density was less than that of age-matched controls despite treatment. The therapy was well tolerated.

Conclusions:

rhGH treatment leads to significant improvement in anthropometry in Indian children comparable with Western data. Bone biomarker changes indicate decreased bone resorption and increased bone formation although bone mineral density still lags behind age-matched controls.
One-Year follow-up of 50 Rural Underprivileged Type 1 Diabetes Children on Insulin Pump Therapy: Breaking Socio-Economic Barriers in Diabetes Technologies
Authors: Swaminathan Krishnan
Published: June 2023

Aims:

To audit the feasibility and clinical outcomes of fifty rural underprivileged children with Type 1 diabetes on insulin pump therapy for a one-year duration.

Material and Methods:

All patients were audited from the Type 1 database of Madhuram Diabetes and Thyroid Centre (Unit of Idhayangal Charitable Trust www.idhayangal.org, NGO focussed on Type 1 diabetes from poor socio-economic strata). Below Poverty Line (BPL) was defined as any family earning less than Rs 2 lacs per annum. All children acted as their own controls managed on MDI for at least six months before pump start. Data were tabulated in Microsoft Excel and analysed.

Results:

There were significant reductions in glycosylated haemoglobin at 6 months and one-year of insulin pump therapy compared to baseline pre-pump MDI values. In addition, significant reductions in diabetic ketoacidosis and severe hypoglycaemia admissions were seen.

Conclusion:

Insulin pump therapy without prejudice on indicated well-selected rural underprivileged children with Type 1 diabetes leads to clinically meaningful outcomes. NGO-Private-Industry partnership is vital to expand access of modern diabetes technologies to reach the most underprivileged.
A Pilot Study to Assess Effect of Metformin Therapy on Prevention of Double Diabetes in Indian Adolescents with Type-1 Diabetes
Authors: Oza Chirantap , Mondkar Shruti , Shah Nikhil , More Chidvilas , Khadilkar Vaman , Khadilkar Anuradha
Published: June 2023

Introduction:

Increased prevalence of metabolic syndrome in Indian adolescents owing to the obesity epidemic leads to double diabetes (DD), which is associated with an increased risk of complications in type-1 diabetes (T1D). Metformin may be a useful intervention for the prevention and treatment of insulin resistance in T1D. We conducted this pilot randomized controlled trial with the objective of investigating the effect of metformin on insulin sensitivity in Indian adolescents with T1D.

Method:

This pilot randomized controlled trial was performed on 59 participants with T1D aged 10–19 years distributed uniformly by gender and puberty across two groups with a 3-month intervention period. The intervention group received metformin (weight less than 60 kg received 500 mg twice daily and more than 60 kg received 1 gm twice daily) and non-metformin group received standard of care for diabetes. Anthropometric, clinical details, biochemistry and insulin sensitivity indices (ISI) were evaluated using standard protocols at baseline and endline.

Result:

22.2% of subjects from non-metformin group and 12.5% from metformin group were at the risk of the development of DD. The odds ratio and relative risk for the development of DD in non-metformin subjects were 2.0 and 1.4, respectively, as compared to participants in metformin group. The mean improvement in ISI ranged from 1.4% to 4.6% in participants on metformin as opposed to deterioration of -2% to -14.1% in non-metformin group. On performing the paired sample t-test, the reduction in ISI in non-metformin group was significant.

Conclusion:

Metformin may prevent deterioration in insulin sensitivity in Indian adolescents with T1D.
Pulmonary artery diameter correlates with echocardiographic parameters of right ventricular dysfunction in patients with acute pulmonary embolism
Authors: O’Corragain Oisin , Alashram Rami , Millio Gregory , Vanchiere Catherine , Hwang John Hojoon , Kumaran Maruti , Dass Chandra , Zhao Huaqing , Panero Joseph , Lakhter Vlad , Gupta Rohit , Bashir Riyaz , Cohen Gary , Jimenez David , Criner Gerard , Rali Parth
Published: June 2023

Introduction:

Right ventricular dysfunction (RVD) is a key component in the process of risk stratification in patients with acute pulmonary embolism (PE). Echocardiography remains the gold standard for RVD assessment, however, measures of RVD may be seen on CTPA imaging, including increased pulmonary artery diameter (PAD). The aim of our study was to evaluate the association between PAD and echocardiographic parameters of RVD in patients with acute PE.

Methods:

Retrospective analysis of patients diagnosed with acute PE was conducted at large academic center with an established pulmonary embolism response team (PERT). Patients with available clinical, imaging, and echocardiographic data were included. PAD was compared to echocardiographic markers of RVD. Statistical analysis was performed using the Student’s t test, Chi-square test, or one-way analysis of variance (ANOVA); P < 0.05 was considered statistically significant.

Results:

270 patients with acute PE were identified. Patients with a PAD >30 mm measured on CTPA had higher rates of RV dilation (73.1% vs 48.7%, P < 0.005), RV systolic dysfunction (65.4% vs 43.7%, P < 0.005), and RVSP >30 mmHg (90.2% vs 68%, P = 0.004), but not TAPSE ≤1.6 cm (39.1% vs 26.1%, P = 0.086). A weak increasing linear relationship between PAD and RVSP was noted (r = 0.379, P = 0.001).

Conclusions:

Increased PAD in patients with acute PE was significantly associated with echocardiographic markers of RVD. Increased PAD on CTPA in acute PE can serve as a rapid prognostic tool and assist with PE risk stratification at the time of diagnosis, allowing rapid mobilization of a PERT team and appropriate resource utilization.
Guidelines for endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA): Joint Indian Chest Society (ICS)/Indian Association for Bronchology (IAB) recommendations
Authors: Mohan Anant , Madan Karan , Hadda Vijay , Mittal Saurabh , Suri Tejas , Shekh Irfan , Guleria Randeep , Khader Abdul , Chhajed Prashant , Christopher Devasahayam J. , Swarnakar Rajesh ,   for the “EBUS Guidelines Working Group” Working group Members (in alphabetical order by surname), Agarwal Ritesh , Aggarwal Ashutosh Nath , Aggarwal Shubham , Agrawal Gyanendra , Ayub Irfan Ismail , Bai Muniza , Baldwa Bhvya , Chauhan Abhishek , Chawla Rakesh , Chopra Manu , Choudhry Dhruva , Dhar Raja , Dhooria Sahajal , Garg Rakesh , Goel Ayush , Goel Manoj , Goyal Rajiv , Gupta Nishkarsh , Manjunath BG , Iyer Hariharan , Jain Deepali , Khan Ajmal , Kumar Raj , Koul Parvaiz A. , Lall Ajay , Arunachalam M. , Madan Neha K. , Mehta Ravindra , Loganathan N , Nath Alok , Nangia Vivek , Nene Amita , Patel Dharmesh , Pattabhiraman V. R. , Raja Arun , Rajesh Benin , Rangarajan Amith , Rathi Vidushi , Sehgal Inderpaul Singh , Shankar Sujay H. , Sindhwani Girish , Singh Pawan K. , Srinivasan Arjun , Talwar Deepak , Thangakunam Balamugesh , Tiwari Pawan , Tyagi Rahul , Chandra Naren V. , Sharada V. , Vadala Rohit , Venkatnarayan Kavitha
Published: June 2023

Over the past decade, endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has become an indispensable tool in the diagnostic armamentarium of the pulmonologist. As the expertise with EBUS-TBNA has evolved and several innovations have occurred, the indications for its use have expanded. However, several aspects of EBUS-TBNA are still not standardized. Hence, evidence-based guidelines are needed to optimize the diagnostic yield and safety of EBUS-TBNA. For this purpose, a working group of experts from India was constituted. A detailed and systematic search was performed to extract relevant literature pertaining to various aspects of EBUS-TBNA. The modified GRADE system was used for evaluating the level of evidence and assigning the strength of recommendations. The final recommendations were framed with the consensus of the working group after several rounds of online discussions and a two-day in-person meeting. These guidelines provide evidence-based recommendations encompassing indications of EBUS-TBNA, pre-procedure evaluation, sedation and anesthesia, technical and procedural aspects, sample processing, EBUS-TBNA in special situations, and training for EBUS-TBNA.
An unusual, life-threatening complication of EBUS-TBNA: Pneumoperitoneum
Authors: Söyler Yasemin , Uzel Şener Melahat , Öztürk Ayperi
Published: June 2023

Endobronchial ultrasound-guided with transbronchial needle aspiration (EBUS-TBNA) is a safe procedure. We present an unusual life-threatening complication after EBUS-TBNA in a 43-year-old female. She underwent EBUS-TBNA for enlarged lymph nodes evaluation. After EBUS-TBNA, a progressively worsening abdominal distension was observed. In computed tomography, subcutaneous emphysema, bilateral pneumothorax, pneumomediastinum and pneumoperitoneum were detected. This complication was successfully treated with chest tube insertion and bedside abdominal decompression. Even though EBUS-TBNA is considered to bear a low risk, the possibility of complication occurrence must be taken into account and clinicians must be more cautious about pulmonary barotrauma, especially when EBUS-TBNA is performed.
Acute respiratory distress syndrome following breast augmentation managed by delayed veno-venous extracorporeal membrane oxygenation
Authors: Pirompanich Pattarin , Saisirivechakun Pannarat , Nithisatienchai Chichaya , Homvises Boonlawat , Sapankaew Tunlanut , Udomlap Natthawarang , Warnnissorn Naree
Published: June 2023

The initiation of veno-venous extracorporeal membrane oxygenation (VV-ECMO) has been opposed in late-phase acute respiratory distress syndrome (ARDS) due to an increase in mortality. Herewith an individual case of a 20-year-old female who survived severe ARDS after breast augmentation is reported, whose delayed transfer to our tertiary referral center led to a late initiation of VV-ECMO and multiple mechanical ventilation-associated complications. Nonetheless, her VV-ECMO was decannulated after 45 days of ARDS onset, considering an awake ECMO strategy possibly contributing to her positive outcome. We also provided spirometry results and chest radiography findings over the three years of follow-up. Intensive care specialists need to consider the potential use of ECMO in late-phase ARDS with selected patients.
Using Digital Technologies to Strengthen Routine Immunization Data in Enugu, Nigeria: A Qualitative Study of Stakeholders’ Perceptions of Open Data Kit
Authors: Odii A , Ezema GU , Ugwu GO , Bisi-Onyemaechi A , Enebe NO , Onyishi CN , Ugwu JI , Okeke C , Uzochukwu BSC , Onwujekwe O
Published: June 2023

ABSTRACT

Background:

Stakeholders have had a long-standing concern about the quality of Routine Immunisation (RI) data in Nigeria. Digital technology tools like Open Data Kit (ODK) can address this challenge by reducing errors and discrepancies in RI data. However, despite its use in various health promotion programs, ODK is yet to be implemented for RI data capture and transmission.

Aim:

The purpose of this study is to explore stakeholders’ views regarding the use of ODK for RI data capture and transmission.

Methods:

The study was conducted in Enugu State, using a qualitative research approach. Stakeholders in RI from Primary health facilities, local government quarters and Enugu state primary health care development agencies (ENS-PHCDA) were purposefully selected and interviewed. The analyses followed a thematic approach.

Results:

The study found that the current method of RI data capture is challenged by delays, incomplete and inaccurate reporting. Stakeholders had a positive reception of a switch to ODK for RI data capture and transmission because they think it can address the challenges associated with the current method, which is partly paper-based. The desire to switch to ODK was based on the belief that it guarantees data safety, timely submission, and reduced error or inaccurate data; these views were informed by previous experience with ODK in other health promotion programs. Stakeholders also perceived that to effectively implement ODK for RI data capture and transmission, training must be properly organized and resources put in place.

Conclusion:

The study provides new knowledge to pave the way for pilot implementation and integration of ODK for RI data capture and transmission in Enugu State, Nigeria.
Perspectives of Immunization Data users on Quality and use of Immunization Data in the Federal Capital Territory, Nigeria: A Qualitative Study
Authors: Tor S , Onyeneho N , Okolie N , Aronu NI , Atumah O , Okwuosa LN , Igwe I , Ebenezer OT , Ezenwaka U , Mbachu C , Onwujekwe O
Published: June 2023

ABSTRACT

Background:

Despite the benefits of immunization in saving the life of children, about one in every five children in the African region did not receive an initial dose of Diphtheria, Pertussis, and Tetanus. This has been attributed to the inefficient use of data in planning immunization service delivery in many African countries, including Nigeria.

Aim:

To explore barriers to efficient use of good quality data in planning immunization service delivery in Nigeria.

Methods:

A total of 31 in-depth interviews were conducted among key stakeholders in immunization data in the immunization program of the Federal Capital Territory (FCT), Nigeria. Questions were asked on their perceived use of immunization data; archiving of immunization data; major challenges in keeping and using immunization data among others. Thematic content analysis was performed on the data using the Atlas.ti software.

Results:

There was a consensus on the importance of data for efficient delivery of immunization services. However, oftentimes the immunization data were not used because of the poor quality and late submission attributed to the poor tools, poor facilities, and data capture materials. Some of the staff were not well trained and when trained, the staff rotation did not allow them to stay on the job for a long time. There was also the predominance of private for-profit health facilities that rarely submit reports and data.

Conclusion:

Several capacity-related factors affect the efficient use of immunization data in the FCT immunization program. Some of these include the unavailability of the right tools and facilities for data generation, storage, and use. Inadequate training of the staff was also mentioned.
Digital Technology Tool for Routine Immunization: Lessons Learned from Open Data Kit Intervention and Way Forward
Authors: Ugwu GO , Odii A , Bisi-Onyemaechi A , Ezema GU , Okeke C , Uzochukwu BSC , Onwujekwe O , Mbachu C
Published: June 2023

ABSTRACT

Background:

Digital technology tools like open data kit (ODK) can improve the quality of routine immunization (RI) data, yet we know very little about how well it performs.

Aim:

This study evaluated the implementation of ODK for RI data capture and transmission. We also discussed the way forward for the uptake of ODK for RI data capture and transmission.

Methods:

Sixty focal persons were recruited from 60 PHCs and trained for two days on the use of ODK. The DHIS2 tools that include daily immunization register, daily vaccine utilization summary, and daily TT immunization register were loaded into ODK. The participants collected RI data and transmitted same via ODK to a secure server for 3 months. At the end of the exercise, we conducted six (ten per group) focus group discussions with them. They were interviewed to share their experiences. The implementation was evaluated using Proctor’s outcomes with a specific focus on acceptability, adoption, and appropriateness.

Results:

Findings show that users were satisfied with the use of ODK for RI data capture and transmission. It was reported that ODK removed the need to transport data from the facilities to the local government headquarters for entry into the DHIS2 platform. It was also learned that it reduced errors and inconsistencies commonly reported in RI data.

Conclusion:

Digital technologies like ODK can improve the quality of RI data in Nigeria. Policymakers and implementers must, however, consider contextual issues relating to the incentivization of staff.
Evaluating an Intervention to Improve the Quality of Routine Immunization Data and Monitoring System in Enugu State, Nigeria: A Pre-and Post-Study
Authors: Ogbuabor D , Ghasi N , Nwangwu C , Okenwa U , Ezenwaka U , Onwujekwe O
Published: June 2023

ABSTRACT

Background:

Studies evaluating what interventions might improve the quality of routine immunization (RI) data and use in decision-making are scarce in Sub-Saharan Africa. This study assessed the effect of a data-focused intervention on the accuracy of RI data and the quality of the data monitoring system (DMS).

Methods:

A ”before and after” study was conducted in randomly selected health facilities (n = 60) in Enugu State, Nigeria. Data on three routine vaccinations in tallied registers, facility reports, and District Heath Information System II, and the quality of the DMS were compared before and after the intervention. The DMS covered recording, reporting, archiving, demographic information, core output and analysis, and data use. The intervention included monthly data review meetings and supervision of facility RI staff. We compared mean differences (MD) of log-transformed data accuracy and quality scores between baseline and end-line using paired samples t-test. Additionally, interviews were conducted with purposively selected RI stakeholders (n = 21) on the interventions and self-selected changes in RI data management practices. Data were coded and analyzed thematically using NVivo software version 11.

Results:

The accuracy of Measles2 facility reports improved post-intervention (MD = -0.62, t = 2.70, ρ = 0.009). The overall quality of the DMS (MD = -10.1, t = -4.4, ρ = 0.001), recording (MD = -6.5, t = -3.0, ρ = 0.048), demographic information (MD = -24.1, t = -6.1, ρ = 0.001), core output and analysis (MD = -14.2, t = -3.9, ρ = 0.004), and data use (MD = -17.05, t = -4.3, ρ = 0.001) improved post-intervention. Regarding the qualitative findings, adopting “tally as you vaccinate,” timely reporting, use of demographic information, archiving paper records, updating the monitoring charts regularly, and data-informed decisions improved the RI data monitoring system. However, resistance to changes in recording practices, staff shortage, use of inappropriate denominators, interrupted supply of monitoring charts, and lack of funds constrained the data monitoring system.

Conclusion:

Supervision and data review meetings improve the accuracy of Measles2 and the quality of the RI DMS. The feasibility of sustaining the data management practices requires RI stakeholders to address contextual limitations identified in this study.
Acceptability of Peer Learning and Support for Strengthening Routine Immunization Data in Nasarawa State, Nigeria
Authors: Sasetu SI , Mbachu CO , Addulkarim DI , Iliya S , Ezumah N , Odonye CE , Adis MU , Onwujekwe OE
Published: June 2023

ABSTRACT

Background:

Peer learning and support network (PLSN) has been shown to improve real-time accountability processes in data management, foster a supportive learning environment, and contribute to improved quality of immunization data.

Aim:

This study was conducted to assess the acceptability of PLSN and the intervention-related enabling factors among primary healthcare workers and routine immunization programme managers in Nasarawa state.

Materials and Methods:

Monthly PLSN sessions were conducted at facility and LGA levels over a three-month period. The acceptability of the intervention was evaluated using six constructs of Theoretical Framework for Acceptability. Data were collected through 26 key informant interviews and survey of 111 primary healthcare workers. Acceptability was measured on a five-point Likert scale using a 32-item composite scale with six subscales for affective attitude, experienced burden, ethicality, opportunity cost, perceived coherence and experienced effectiveness on RI data quality. Median scores were estimated and these were used to generate the rates and levels of acceptability. Qualitative data was analyzed manually using thematic approach.

Results:

The composite score for acceptability was 4.02 (IQR: 2.89 - 4.90) Affective attitude had a score of 4.17 (3.17 – 4.67); experienced burden was 3.57 (2.43 – 5); ethicality was 4 (1 – 5); opportunity cost was 4 (2.25 – 5); intervention coherence was 4 (2.75 – 5); and experienced effectiveness was 4.4 (2.6 – 5). The overall rate of acceptability was 50.91% and the level of acceptability was 74.55%. There was no significant relationship between acceptability and participants’ age, gender and years in service. The intervention-related enablers of the PLSN were, (i) its participatory and inclusive nature; (ii) the flexibility in scheduling of PLSN activities; (iii) integration of activities with existing data review processes. Although PLSN was perceived as burdensome, participants had a positive attitude and perceived it to be effective and ethical.

Conclusion:

Enablers of acceptability should be harnessed to reduce the burden of PLSN on health workers.
Data Quality and use in Primary Health Care: A Case Study of the Immunization Program in Ebonyi State, Nigeria
Authors: Eze II , Ogbu M , Ossai EN , Ekenna A , Okoronkwo I , Onwujekwe O
Published: June 2023

ABSTRACT

Background:

Reliable immunization data are vital for optimal coverage, informed decision-making, and efficient program implementation.

Aim:

This study assessed the quality of immunization data generation and use in primary healthcare centers (PHCs) in Ebonyi State, Nigeria.

Methods:

A cross-sectional study was conducted in 244 health facilities (HFs), selected through cluster sampling, across six local government areas (LGAs) in Ebonyi State. Information on the accuracy, completeness, timeliness, and monitoring system of the immunization program was collected using a validated Data Quality Self-Assessment (DQS) questionnaire and analyzed with IBM Statistical Package for the Social Sciences (SPSS) statistical software, version 25. The quality index was determined by the proportion of scores for all questions answered, “Yes,” divided by the maximum scores that could be obtained and converted into percentages. The quality index was defined as good for a score of ≥80%. The Chi-square and multivariate logistic regression analyses were conducted. The statistical significance level was set at a P value of <0.05.

Results:

Accurate, complete, and timely data were recorded in 137 (56.1%), 133 (56.6%), and 81 (33.3%) HFs, respectively. Overall, quality data were observed in a minor proportion, 14 (5.7%) of HFs. The HFs with good-quality data on specific monitoring indices include archiving (109 (44.7%)), reporting (106 (43.4%)), demographic information (58 (23.8%)), evidence of use of data (45 (18.4%)), recording (40 (16.4%)), and core output (14 (6.7%)). Accuracy was predicted by good reporting (AOR = 35.714, CI = 13.260–96.196); completeness was predicted by good archiving (OR = 26.749, CI = 11.514–62.144).

Conclusion:

Data quality and use in PHC are suboptimal. Integrating the quality self-assessment concept into staff training and supportive performance supervision could improve immunization data quality and use.
What’s new in hematopathology 2023: updates on mature T-cell neoplasms in the 5th edition of the WHO classification
Authors: Marques-Piubelli Mario L. , Miranda Roberto N.
Published: June 2023

The overview of the upcoming Blue Book of the 5th edition of the World Health Organization Classification of Hematolymphoid Tumors was published in Leukemia in June 2022. The updates on mature T-/NK-cell lymphomas and leukemias are organized in nine groups based on cell of origin, morphology, clinical scenario, and localization, and are highlighted in this newsletter.
Assessing Medication Use Quality in Older Outpatients Using the Beers Criteria: Findings from a Single-Center Retrospective Study
Authors: Jenghua Kittipak , Wutthi Kanchira , Wannakrachang Chanisorn , Chathongyos Sitanan , Ngamsom Panadda
Published: June 2023

Background: No comprehensive assessment of the quality of medications used in older outpatients has been conducted in Thailand. This study aimed to ascertain the prevalence of and factors contributing to older outpatients' use of potentially inappropriate medications (PIMs).Methods: This cross-sectional study retrospectively assessed the prescriptions of older (≥60 years) outpatients at a secondary-care hospital. For PIM identification, the 2019 American Geriatric Society (AGS) Beers criteria were applied, considering all five PIM categories: PIM category I (medications that are potentially inappropriate in most older adults), II (disease-/syndrome-exacerbating drugs), III (medications that should be used with caution), IV (clinically important drug–drug interactions), and V (medications that should be avoided or have their dosage reduced based on renal function).Results: This study included 22,099 patients (mean age, 68.86±7.64 years). Nearly three-fourths of patients were prescribed PIMs, with 68.90%, 7.68%, 44.23%, 15.66%, and 3.05%, respectively, receiving category I–V medications. The positive factors associated with PIM use included female sex (odds ratio [OR]=1.08; 95% confidence interval [CI], 1.01–1.16), age ≥75 years (OR=1.10; 95% CI, 1.01–1.21), polypharmacy (OR=10.21; 95% CI, 9.31–11.21), ≥3 diagnostic categories (OR=2.31; 95% CI, 2.14–2.50), and ≥3 chronic morbidities (OR=1.46; 95% CI, 1.26–1.68). The negative factor associated with PIM use was a comorbidity score of ≥1 (OR=0.78; 95% CI, 0.71–0.86).Conclusion: PIM use among older outpatients remains highly prevalent in clinical practice. The results of this study identified polypharmacy as the strongest factor affecting PIM use.
Case Report: Duodenal Papillary Stenosis Secondary to Strongyloides stercoralis Infection in a Non-Immunocompromised Host
Authors: Vera Torres Alonso , González Laura Peña , Mususú William Cruz , Vásquez Sergio Valencia , Cortés Mejía Nicolás Andrés , López Panqueva Rocío del Pilar
Published: June 2023

Strongyloides stercoralis infection is a common infection in tropical and subtropical regions and is considered one of the “neglected tropical diseases.” Owing to its life cycle, this infection can remain undetectable for years, preventing an early diagnosis and prompt treatment. We report the case of a 65-year-old woman who presented to us with a history of nausea, abdominal pain, bloating, and weight loss and, after initial radiologic and laboratory workup, was diagnosed with a periampullary mass with no secondary spread. She underwent an uneventful pylorus-preserving pancreatoduodenectomy, and on histopathological study of the lesion, a diagnosis of S. stercoralis infection was confirmed. This case stands out because of the importance of keeping S. stercoralis infections as a differential diagnosis of periampullary masses, particularly when the patient comes from regions where S. stercoralis is prevalent.
Distributed Co-Simulation for Effective Development of Battery Management Functions
Authors: Hrvanovic Dino , Haberl Hannes , Krammer Martin , Scharrer Matthias K.
Published: June 2023

Electrification calls for a range of system components, that need to be developed and tested. Execution of tests on real batteries is typically time- and cost-intense, and includes considerable risks, leading to safety hazards. In this paper, we introduce a novel development and test approach for battery systems, that is driven by a unified, standardized interface between hardware- and software components and physical devices alike. Whereas established Hardware-in-the-Loop (HiL) systems are built on proprietary systems and environments, our approach is based on both open-source and industrial simulation software solutions. The Distributed Co-Simulation Protocol (DCP) is used to encapsulate and virtualize these components, as shown in a demonstrator use case. A "DCP master" is used for effective configuration and re-configuration of so-called "DCP slaves". It allows to seamlessly exchange real hardware components of the system (e.g., Battery modules, vehicle power train, Balancing circuits) with software components (e.g., Simulation models, Vehicle behaviour/electric motors) and vice versa. The test setup can be installed in an office environment without additional safety requirements and validated using a continuous integration approach for automatic Battery Management System (BMS) software deployment and testing, as the simulation models may replace the battery cells and electric loads. Using these models streamlines the testing of BMS functions, as it eliminates the test preparation times by up to 90%. The concept is promising to simplify the distributed development of components in many different cases.
A Holistic Approach For Near Zero Emission Diesel Vehicles Using A Pre-Turbo-Catalyst-System – Ready For EU 7
Authors: Conin Michael , Knaf Daniel , Fiore Luis , Keck Mathias , Beidl Christian , Kreuz Joachim , Hohenberg Günter
Published: June 2023

This study shows the newest results of a near-series pre-turbo-catalyst (PTC) system reaching lowest emissions for electrified diesel passenger cars to address future emission legislation. The PTC system is developed using a state-of-the-art tool chain containing 1D & 3D simulation approaches and testing near-series exhaust gas aftertreatment systems under real-driving boundary conditions. The innovative concept of a selective catalytic reduction (SCR) PTC and a PTC bypass path solve the challenge of a thermal handshake between PTC and underfloor SCR System as well as the challenge of a particular filter regeneration. The development of adaptive PTC bypass path operation strategies based on exhaust gas and catalyst conditions enables lowest NOx and NH3. Using this concept, zero-impact NOx emissions, that don’t impact cities air quality, can be reached in a wide range of operating scenarios while sustaining full drivability and highest efficiency. Advanced catalyst technologies enable a high emission conversion and lowest secondary emissions. These results have been achieved in the context of the “INES” (“Intelligentes Niedrigstemissionssystem für die Diesel PKW Anwendung”) project, funded by the Bundesministerium für Wirtschaft und Klimaschutz, Ministry for Economic Affairs and Climate Action (BMWK) and addresses research of future mobility requirements.
Machine-Learning-Based Fault Detection in Electric Vehicle Powertrains Using a Digital Twin
Authors: Dettinger Falk , Jazdi Nasser , Weyrich Michael , Brandl Lukas , Reuss Hans-Christian , Pecha Urs , Parspour Nejila , Li Shiqing , Frey Michael , Gauterin Frank , Nägele Ann-Therese , Lüntzel Vitus Alexander , Sax Eric
Published: June 2023

Electric Vehicles are subject to effects that lead to more or less rapid degradation of functions. This can cause hazards for the drivers and uninvolved road participants. For this reason, the must be detected and mitigated, to maintain the vehicle function even in critical situations until a safe operating mode can be established. This publication presents an intelligent digital twin, located in the edge and connected with an electric vehicle via 5G. That can improve the operation of electrified vehicles by enabling the online detection of abnormal situations in the electrified powertrain and vehicle dynamics. Its core component is the fault detection system, which is implemented based on a 1-Nearest Neighbor algorithm. It is initially trained on synthetic data, generated in CarMaker for real-world powertrain issues such as demagnetization and open-/short-switch failures, using detailed mathematical models. In this context 139 simulations were performed with three different velocities (10 km/h, 18 km/h and unlimited) in sum. Thereby 36 variables were recorded in each simulation. This leads to a total number of 953,534 data points. Out of this, 77 % are used for training and 23 % are used for validation. Based on the detected fault, a self-healing strategy is applied. Therefore, a look-up table, also located in the edge, is used to limit the motor torque to predefined levels. During the evaluation two major results are shown. The fault is well detected after a short detection time, but situations like accelerating or braking shows a similar signal behavior like the considered faults, leading to false positives. The effect of a fault can be mitigated by an online self-healing approach located in the edge in nearly real time. For connected vehicles, it seems realistic to apply an online digital twin enabling the fault detection and mitigation to the edge.
Categorizing Simulation Models Using Convolutional Neural Networks
Authors: Grbavac Andrija , Angerbauer Martin , Grill Michael , Itzen Dirk , Milojevic Sasa , Hagenbucher Timo , Kulzer André
Published: June 2023

Whether as an optimization problem or a development tool, neural networks help engineers to work more efficiently. This paper’s central aspect is to add metadata to the core files of the project simulation data. To understand the project and its simulation models, a pre-processing methodology and convolutional neural network architecture are presented. With the added labels, it is possible to access the content of the model files of an engine performance simulation tool without examining them. At first, a pre-processing approach and its design are introduced to extract and filter the desired data from the XML data structure. Then, the data is split into sequences and paired with labels. Expert knowledge is used to label the models. These labels are further paired with the extracted sequences. In addition, a convolutional neural network design with a single convolutional layer and three dense layers is presented to add the defined labels that characterize the powertrain architecture to these sequences. Furthermore, this paper shows the advantages and disadvantages of the pre-processing methodology and the architecture of the convolutional neural network. The results show that the model can categorize the extracted sequences with a very good accuracy. At last, suggestions for improvement for the pre-processing and additional studies are presented.
Analysis of Current Challenges of Automotive Software in the View of Manufacturing
Authors: Zhai Yi , Vetter Andreas , Sax Eric
Published: June 2023

The rapidly growing amount of software in cars reshapes the automotive industry. The software has a significant influence on the production lines, due to the time required to flash it onto the vehicle and its capabilities to test vehicle functions during production. In this paper we identify the main pain points regarding software in the manufacturing process by performing a structured analysis on the experiences made at a major car manufacturer over last two years. Consequently, the paper analyses the possible approaches to address the challenges.