bluuebunny/crossref_metadata_2025 huggingface dataset:
A new approach to Maslach Burnout Inventory: Measuring burnout syndrome in health-care staff with fuzzy conjoint analysis
Authors: Gürsel Güney , Turunç Ömer
Published: June 2022

Background and Purpose:

Burnout syndrome (BOS), the popular phenomenon of our pandemic era, is examined in three dimensions: emotional exhaustion, depersonalization and cynicism, and personal inefficiency. One of the known and accepted ways of measuring BOS is Maslach Burnout Inventory (MBI), in which these three dimensions are measured by 22 items, using 5- or 7-point Likert scales. The aim of this study is to eliminate the loss of precision in BOS measurement and handle the subjectivity and uncertainty, as a result, to get rid of the bias caused by the classical way.

Methods:

To do this, fuzzy conjoint analysis (FCA) is used together with MBI. In the classical way, the calculations are made by assigning crisp values to the answers, which causes scientific bias and loss of precision because Likert scale type answers have subjectivity and uncertainty.

Results:

When the scores obtained with FCA are examined, all the scores and some BOS levels differ. When the position of the values according to the borders of the BOS levels is taken into account, it can be said that these tiny differences caused by the loss of precision make this difference.

Conclusion:

Findings show that the resulting scores changed significantly when calculations are made with FCA. Especially, when these scores are interpreted as intervals or grades, as in MBI, even tiny differences may result in significant scientific bias.
Forty-five Years of Faculty Development
Authors: Zayapragassarazan Zayabalaradjane , Dharanipragada Kadambari
Published: June 2022

In the last two decades, India has seen a massive rise in the number of medical schools. As a result, numerous issues, including the availability of qualified teachers, have made medical education in India challenging. Faculty development (FD) has gained significant attention because of its importance in educational capacity building. FD programs help faculty become more aware of their professional responsibilities. Medical education units can play a vital role in FD and thus improve the quality of medical training by training the teachers. The National Teacher Training Centre (NTTC), Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, was the first center established by the Ministry of Health and Family Welfare, Government of India in 1975, with the assistance of the World Health Organization, to promote the training of health professionals in educational science and technology, including educational planning and research. This article describes the profile of activities of NTTC, which is functioning under the aegis of the Department of Medical Education (DME), JIPMER, and lists the outcomes that contributed to the success of DME with particular reference to the last decade. The establishment of DME is seen to affect the medical school positively.
Psychological impact of disease outbreaks on healthcare workers
Authors: Sunil Shweta , Sharma Manoj Kumar
Published: June 2022

Disease outbreaks can have an impact on one's mental health. A comprehensive knowledge about the psychological state of healthcare workers (HCWs) during disease outbreak is limited. This review aims to present HCWs' psychological issues due to multiple outbreaks in the past and present, including SARS, MERS, Ebola, and COVID-19. The results indicated the presence of affective symptoms, paranoia, and decreased trust among HCWs. The review reveals the need of research to understand strategies and interventions that can enhance the well-being of HCWs.
What brings people to government urban primary care facilities? A community-based study from Delhi, India
Authors: Virmani Nitish , Mittal Ishaan , Lahariya Chandrakant
Published: June 2022

Introduction:

Mohalla or Community Clinics of Delhi, India, provides free primary care services to the general population, with special focus on the underserved and marginalized. This study was conducted to analyze the perception and experience of target beneficiaries and to understand and document the determinants of people visiting these clinics.

Material and Methods:

A community-based study was conducted from October 2019 to April 2020. A semi-structured questionnaire was used for data collection. Correlation and comparative analysis were used. Thirty-seven Mohalla Clinics and their catchment areas were visited. A total of 391 respondents (including 35 health staff and 356 community members) were included.

Results:

Proximity of clinics, waiting times, age, perceived quality of treatment, and cleanliness at facilities were the factors that influenced the usage of clinics. Lack of first-aid facilities and long waiting time (at a few facilities) were identified challenges. There is a need for wider publicity and awareness about the clinics and regular analysis of data to determine an appropriate mid-course action to further increase utilization.

Conclusion:

Community Clinics of Delhi, India, have brought people back to government primary healthcare (PHC) facilities. The popularity of these clinics has encouraged a number of Indian states to set up similar facilities. The factors behind their success need to be studied in detail to derive lessons for making urban PHC accessible in other low- and middle-income countries.
Study on occupational ventilatory defects among workers employed in cement factories of Darjeeling district, West Bengal, India
Authors: Sarkar Payel , Biswas Daliya , Gazi Eashin , Ishore Kaushik
Published: June 2022

Introduction:

Cement factory workers are at a high risk of exposure to crystalline silica-laden cement dusts and at a higher risk of developing chronic obstructive pulmonary disease (COPD), like chronic bronchitis, emphysema and restrictive lung disease like silicosis. This study was done to measure the extent of occupational ventilatory defect among workers employed inside cement factories.

Material and Methods:

A cross sectional study was conducted among cement factory workers using questionnaire on respiratory symptoms 1986 and spirometry was done after seeking permission from the concerned authority and Institutional Ethics Committee. Logistic regression analysis was done to test for statistical significance.

Results:

Ventilatory defect was present among one fourth of the factory workers. Obstructive type of lung disease was much higher (94.6%) than restrictive lung disease (5.4%). Almost half of the study subjects had presented with different types of respiratory symptoms. Breathlessness on exertion was commonest symptom, followed by cough day and night. Ventilatory defects were noted to be much higher (86.5%) among the workers working in the cement factories for more than 10 years and increasing trend was observed with increment in their age and years of working at the factory. Ventilatory defect were significantly high among smokers (29.5%), subjects who started smoking in early age (35.9%) and there is increasing trend of defects with a greater number of cigarettes intake.

Conclusion:

Periodically awareness generation and mandatory use of personal protective equipment should be practiced among workers in cement factories.
A clinico-epidemiological profile of scrub typhus cases admitted in a tertiary hospital in South India
Authors: Phukan Purabi
Published: June 2022

Scrub typhus (ST) is a consistently underreported disease. The disease is spreading to newer areas, and an understanding of disease epidemiology is needed in the local Indian and current context. This study describes the demographic characteristics, monthly distribution, clinical and laboratory presentations, and treatment outcome of the ST cases recently identified. Case sheets of 15 ST patients diagnosed from January 2019 to December 2020 were analyzed. The majority of the patients were male. Eighty percent of the patients were from rural or suburban areas. Higher admission was observed from September to December. Fever (100%), skin rash (73.3%), body ache (53.3%), and vomiting (53.3%) were the most common clinical features. The onset of fever till the appearance of skin rash was 3 ± 1.2 days. The mean day from onset of symptoms till diagnosis was 6.8 ± 3.9 days. Eschar was found in only two patients. Nine (60%) patients already had complications at the time of admission. Most patients presented a laboratory picture of thrombocytopenia, neutrophilic leukocytosis, and anemia. Complications such as septic shock, acute kidney injury, and hepatic involvement were observed. All responded to doxycycline within 48 h. No fatalities were observed. Early clinical suspicion of ST among those with high fever, skin rash and thrombocytopenia, and transaminitis showed positive clinical outcome.
Human Leukocyte Antigen-A, B, and DRB1 Diversity in Renal Transplant Patients and Donors
Authors: Mishra Vikash Chandra , Chandra Dinesh , Deshpande Trupti , Singh Parvind , Anthwal Archana , Raina Vimarsh
Published: June 2022

Background:

The understanding of transplant acceptance or rejection derives directly from knowing human leukocyte antigen (HLA) involved in the immune response. The HLA of the major histocompatibility complex contains a numerous family of genes located on the short arm of the chromosome number 6 and divided majorly into two classes, Class I (HLA-A, B, and C) and Class II (HLA-DR, DQ, and DP). The detection and detailed information of these histocompatibility genes are essential for the better outcome of organ transplants.

Aims and Objectives:

The aim of the present study is to analyze the frequencies of HLA-A, B, and DRB1 in chronic kidney disease (CKD) patients and their prospective donors as well as to see the prevalence of heterogenicity.

Materials and Methods:

A total of 264 patients diagnosed with CKD and 333 potential donors were studied retrospectively in the present study. All these cases were analyzed for HLA-A, B, and DRB1 loci typing by PCR-SSOP method based on the Luminex platform.

Results:

We identified 15 different alleles of HLA-A, 29 of HLA-B, and 13 of HLA-DRB1 amongst studied samples. Out of these identified HLA alleles, HLA-A*02, HLA-B*35, and HLA-DRB1*15 were more frequent as compared to others. The results showed significant heterogenicity in the identified HLA-A, B, and DRB1alleles.

Conclusion:

The result highlights the diversity of HLA-A, B, and DRB1 alleles and is valuable as a reference for organ transplantations. Further, these findings can also guide in better donor selection and hence improved transplant outcome. In addition, this information could be a starting point for the development of an indigenous transplant assay kit.
Liver Transplant during COVID-19 Pandemic
Authors: Rambhatla Anuhya , Kumar G. V. Prem , Swaroop Shakti , Kumar N. Sunil , Ramachandra Sumana , Reddy Raghuram , Kumaraswamy P. , Chaitanya Krishna , Menon Balachandran
Published: June 2022

Introduction:

Novel coronavirus affects different individuals in different ways, with most people recovering with mild to moderate illness not requiring hospitalization. Liver transplant for end-stage liver disease is a lifesaving procedure, and though living donor liver transplant (LDLT) is a well-planned elective surgery, it was considered a semi-emergency owing to the decompensation of the recipient posing a challenge to the transplant team owing to the situation of the pandemic. The availability of liver grafts from cadaveric donors in India was 0.65 per million population until 2019 as per the National Organ and Tissue Transplant Organization statistics which was sparse and further accentuated, leaving LDLT as the only option during the pandemic.

Aim:

This study aims to describe our experience and testing protocol for COVID-19 disease for the patients undergoing liver transplant during the pandemic at our hospital, which is a tertiary care referral hospital.

Materials and Methods:

This was a retrospective study done at AIG Hospitals, Hyderabad, India. Fifty adult patients who underwent LDLT and deceased donor liver transplant from May 2020 to December 2020 were included in the study.

Exclusion Criteria:

All recipients and donors with reverse transcription polymerase chain reaction (RT-PCR) positive for SARS CoV2; and COVID-19 disease reporting and data system (CO-RADS) score of 4 or 5 on high-resolution computed tomography (HRCT) chest.

Results:

The mean age of the recipients was 46 years, and the donors was 36 years; the most common indication being acute-on-chronic liver failure with failed medical therapies and the second common being hepatocellular carcinoma. All the 50 recipients were RT-PCR negative for SARS CoV2; 8 out of whom had a CO-RADS score of 3; and 4 out of the 8 were post-COVID-19 infection who had IgG positive and IgM negative; and the other 4 were both IgG and IgM negative, similarly 4 out of 8 donors were IgG positive. Intraoperative and postoperative period was uneventful. None of the donors or recipients were infected with COVID-19 disease during the hospital stay and up to 1 month postoperative. One patient died within 1 month due to sudden cardiac arrest.

Conclusion:

In our experience, with meticulous testing and proper care, there is a favorable outcome for liver transplant even during the pandemic.
Analysis of Hemorrhagic Cystitis and BK Viremia in Children after Hematopoietic Stem Cell Transplantation
Authors: Yozgat Ayça Koca , Bozkaya Ikbal Ok , Aksu Tekin , Isik Pamir , Kanbur Mehtap , Tiryaki Tugrul , Yarali Nese , Özbek Namik Yasar
Published: June 2022

Purpose:

Hemorrhagic cystitis (HC) which occurs in 9%–31% of recipients after hematopoietic stem cell transplantation (HSCT) is an important cause of morbidity and mortality. Various treatment approaches have been applied for such as conservative treatments (hydration, analgesic agents, antibiotics), intravesical treatments (bladder irrigation, hyaluronic acid, and prostaglandin E), intravenous or intravesical antiviral agents, hyperbaric oxygen, and surgical treatments.

Materials and Methods:

This retrospective study included two hundred thirty-three children who underwent HSCT in Pediatric Bone Marrow Transplantation unit between April 2010 and June 2017.

Results:

Ten patients (4.2%) developed HC. The mean age of patients was 12.8 years and the mean duration of the onset of HC was 20 days. Urine and blood BK polyomavirus were positive in nine and four patients, respectively. Six patients received intravesical hyaluronic acid, three patients received intravesical prostaglandin E, three patients received intravenous ganciclovir, two patients received intravenous and/or intravesical cidofovir and hyperbaric oxygen treatment. The mean time of recovery from hematuria was 43 days. This study showed that the BK polyomavirus has an important role in the development of HC in HSCT patients, as in harmony with the literature. HC has been successfully treated in eight patients with supportive measures and/or intravesical hyaluronic acid.

Conclusions:

BK polyomavirus plays an important role in the development of HC pediatric patients. Intravesical hyaluronic acid, besides supportive measures, was effective for the treatment of HC and hyperbaric oxygen may be reserved for refractory cases.
Public Perception and Willingness to Undergo Cosmetic Procedures During the COVID-19 Pandemic
Authors: Alreshidi Ibrahim , Albrekeit Assil , Alharithy Ruaa
Published: June 2022

Background:

As a result of the spread of coronavirus disease (COVID-19) at the beginning of 2020, many governments, including Saudi Arabia, have suspended operations in many agencies. Most of the dermatologists have restricted their practice, including cosmetic procedures, to ensure social distancing. On May 7, 2020, Saudi authorities have reduced the restriction of COVID-19 virus preventative measures, allowing clinics to start accepting patients with following the ministry of health protocols.

Purpose:

To evaluate the public's perception and willingness to undergo cosmetic procedures during the COVID-19 outbreaks in Saudi Arabia.

Methods:

A descriptive, cross-sectional, questionnaire-based study was carried out among the individuals who lack typical symptoms of COVID-19 infection in Saudi Arabia. A self-designed web-based questionnaire was developed; content face validity and a pilot study were done. The questionnaire was distributed electronically from May 8 to May 31, 2020.

Results:

A total of 656 individuals who lack typical symptoms of COVID-19 infection were included in this analysis. Only 10.5% of participants expressed their will to do cosmetic procedures during the COVID-19 pandemic. More than 90% of the participants believed that the COVID-19 pandemic was either somewhat serious (52.9%) or very serious (38.7%). The willingness to do cosmetic procedures during the COVID-19 pandemic remained unaltered when the price was discounted (P < 0.001), and when infection control measures were ensured (P < 0.001).

Conclusion:

The COVID-19 pandemic had a negative impact on the practice of cosmetic dermatology. Fear of transferring the infection to a beloved home member is the main reason to avoid these procedures. Generating well-structured safety guidelines to decrease the risk of this unusual virus transmission in dermatology practice and creating financial incentives may help increase the public willingness to do these cosmetic procedures during this pandemic.
Trichoscopic Findings in Various Alopecias at Tertiary Referral Center
Authors: Mamatha P. , Neha V. , Jartarkar Shishira R. , Sampath Shalini , Madireddy Rakesh R.
Published: June 2022

Background:

Hair disorders are a common complaint that baffles dermatologists due to multiple causes. Trichoscopy is a noninvasive technique used to diagnose and monitor the progression of various hair disorders.

Purpose:

To observe the trichoscopic patterns of various hair disorders to assist with differentiation.

Methods:

This was a cross-sectional observational study done in 256 patients with alopecia. After a detailed history, clinical examination, and relevant investigations, trichoscopy was performed using a Dermlite (3Gen LLC, Sanjuan Capistrano, CA, USA) dermoscope.

Results:

Out of 256 patients, 154 were male and 102 were female. Most of the cases were in the age group of 21–40 years (66.4%). Nonscarring alopecias (93.35%) were common compared to scarring alopecias (5.8%). The most common alopecia noted in our study was Androgenetic alopecia 125 patients (48.82%), followed by telogen effluvium 48 patients (19.1%), the common trichoscopic follicular features noted were short vellus hair 161 (62.8%), yellow dots (61%), hair diameter variation 125 (48.82%), and black dots (21.87%). The commo interfollicular features are seen were arborizing vessels 109 (42.6%) and pigmentation in 12 patients (4.68%). Significant findings observed in each group were hair diameter diversity in androgenetic alopecia, exclamatory mark in Alopecia Areata, comma hair in tinea capitis. Cicatricial alopecias are characterized by loss of follicular ostia along with inflammatory signs such as perifollicular scales and casts.

Conclusion:

Trichoscopy is a very valuable and useful tool to diagnose various hair disorders by understanding the various trichoscopic patterns specific for each disease.
Recurrent Papulonecrotic Tuberculid in an Adolescent Male
Authors: Shankaralingappa Arundhathi , Anthony Michael L. , Santosh Tummidi , Josephain Kanakapudi , Nagendran Prabhakaran , Gopinath Hima
Published: June 2022

Tuberculids are considered to be a hypersensitivity reaction to endogenous tuberculosis (TB). Papulonecrotic tuberculid (PNT) is a rare tuberculid occurring in <5% of active TB. An 18-year-old male presented with recurrent necrotic papules for 6 years on limbs, trunk, and neck which healed with scars. Biopsy from lesion revealed caseating granulomas with lymphohistiocytic vasculitis. Ziehl–Neelsen stain was negative for acid-fast bacilli, but Mantoux was strongly positive. The polymerase chain reaction was not done due to monetary constraints. The final diagnosis of PNT was confirmed and he was started on anti-tubercular treatment (ATT) for which he responded. PNT should be treated as a sentinel lesion and a meticulous search for systemic involvement of TB should be carried out. Awareness about PNT is essential for its diagnosis and to institute ATT at appropriate time.
DRESS syndrome due to first-line antitubercular therapy – A diagnostic imbroglio!
Authors: Patra Pratap K. , Banday Aaqib Z. , Jindal Ankur K. , Bhattarai Dharmagat , Patra Nilamani , Saikia Uma N. , Gupta Anju , Suri Deepti
Published: June 2022

ABSTRACT

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome after the use of first-line antitubercular drugs (ATDs) is rare and literature regarding DRESS syndrome due to ATDs is scarce in children. We report a young boy with tuberculosis who developed DRESS syndrome after exposure to isoniazid. A 9-year-old boy, diagnosed clinically as pulmonary tuberculosis, presented with fever, fast breathing, maculopapular rash, and one episode of gross hematuria. He had been on 4-drug ATD therapy (isoniazid, rifampicin, ethambutol, and pyrazinamide) for the past 4 weeks. In view of multiorgan involvement and absence of a microbiological diagnosis of tuberculosis, vasculitis was considered and he was treated with steroids. As the child recovered, both corticosteroids and ATD therapy were stopped. At 6 months of follow-up, he was presented with pneumonia. Microbiological diagnosis of tuberculosis was made and 4-drug ATD therapy was reinitiated. After 15 days, he again developed a high-grade fever and rash. On evaluation, isoniazid-induced DRESS syndrome was diagnosed. Subsequently, he received a modified regimen of ethambutol, pyrazinamide, levofloxacin, and linezolid. DRESS syndrome did not recur on these ATDs and the child became asymptomatic. Linezolid was stopped after 3 months of therapy and ethambutol, pyrazinamide, and levofloxacin are being continued. Currently, he has completed 15 months of modified ATD therapy. As a high index of suspicion is required for early diagnosis and management that are crucial to reducing morbidity and mortality, DRESS syndrome should be among the differentials in children with unexplained febrile illnesses.
Cross-sectional osteoporotic risk prediction with the FRAX without BMD in male and female patients attending OPD in a community health center of Bihar
Authors: Bhujade Rashmi , Srivastava Anupama , Chinchodkar Kishor N. , Pathak Pawan , Ibrahim Tarique
Published: June 2022

ABSTRACT

Background:

Bone health is an important requirement for healthy aging. Osteoporosis is an important cause of both mortality and morbidity among older adults. If we can predict the risk of future osteoporosis by cost-effective methods, we can prevent it up to certain level and plan intervention accordingly. That’s why the present study aims to estimate the likelihood of osteoporosis in patients attending the outpatient department (OPD) in a selected community health center (CHC).

Methods:

A cross-sectional study was conducted in a CNC in Siwan, Bihar, India. An equal number of male and female patients were recruited by quota sampling. A semi-structured proforma was prepared for data collection using the Fracture Risk Assessment (FRAX) tool without performing a bone mineral density (BMD) test in order to assess major osteoporotic fractures and risk for hip fractures with other requisite information

Results:

The collected data were organized using Microsoft Excel and analyzed using the statistical software SPSS Statistics 20. As data were gleaned and put under different categories, a statistical analysis based on the Chi-square test was carried out, and an ROC (receiver operating characteristic) curve was also drawn for statistical inference of the data gathered. The main findings of our analyses include the following: Approximately 15% males and 30% females in the study sample had a higher risk of osteoporosis and about 9% males and 36% females had a higher risk of hip fracture. Overall, the findings showed a statistically significant association (p < 0.05) between the gender of the participants and the FRAX risk scores for osteoporosis and hip fracture.

Conclusion:

Previously osteoporosis was thought of as a disease that affected only women; nevertheless, emerging findings show that osteoporosis is not unusual in men. The FRAX tool can be used as a screening tool before going for a BMD test.
Indian tubercular belly: A prospective study of 140 patients of abdominal tuberculosis and their outcomes
Authors: Keena Monika , Chawla Gopal , Sonika Ujjwal , Abrol Nupur , Hiremath Shrikant , Meena Virender Kumar
Published: June 2022

ABSTRACT

Background:

Abdominal tuberculosis is an important yet ignored entity in the spectrum of tuberculosis which has been dominated by pulmonary tuberculosis. Diagnosis and treatment are often delayed due to nonspecific symptoms. In this study, we aimed to highlight the clinical features, diagnostic methods and outcomes of abdominal tuberculosis.

Methods:

A prospective study was conducted in tertiary referral centre where all patients referred to drug distribution centres (DOTS centre) for abdominal tuberculosis were identified. Their demographic clinical and radiological profile was evaluated. These patients were followed-up for their treatment course for complications and outcomes.

Results:

A total of 140 patients who were labelled abdominal tuberculosis over a period of 2 years were reviewed at tuberculosis drug distribution centre (DOTS). Mean age of study population was 35.42 ± 12.53 years and majority of the population were males, 58.6% (82). The most common presenting symptom was abdominal pain which was seen in 82.8% (n = 116) of the patients, followed by feverin 65.6% (n = 92); 22.8% (n = 32) were seropositive for HIV and 44.2% (n = 62) had luminal tuberculosis of which ileocecal was the most common site. Peritoneum was second most common site which was involved in 26.4% (n = 37) of the patients followed by mixed tuberculosis involving more than one type. Confirmed diagnosis was achieved in 74 patients (52.8%), while the remaining 66 patients (47.14%) were diagnosed clinically. During follow-up, 12 patients were lost to follow-up; 113 (80.7%) had complete response, while 3 (2.14%) patients died during treatment.

Conclusion:

Abdominal tuberculosis usually presents with nonspecific complaints which require high index of suspicion. Most patients require only medical therapy which has good results.
Haematuria from early pregnancy in a morbidly adherent placenta: Case report and a short review
Authors: Pushpalatha K , Patel Shweta , Singh Bharti , Jain Himanshi
Published: June 2022

ABSTRACT

The morbidly adherent placenta has evolved into one of the potentially life-threatening conditions in obstetrics. Vaginal bleeding is the most common presentation of placenta percreta. Other symptoms include unusual dull, prolonged lower abdominal pain. Although haematuria is rare, it may be a presentation of the morbidly adherent placenta in early pregnancy. We report a case of placenta percreta with a very uncommon presentation of gross haematuria early in the second trimester managed successfully. It is emphasized that a high index of suspicion, ultrasound, and/or MRI can establish a preoperative diagnosis of the invasive placenta earlier. However, the diagnostic accuracy of cystoscopy is still under debate. With timely diagnosis, preparedness, and multidisciplinary care, it is possible to minimize catastrophic complications.
Electrocardiographic and echocardiographic findings in children with dengue infection
Authors: Nerella Santoshi , Sarkar Uttam K. , Namdeo Hema
Published: June 2022

ABSTRACT

Background:

The mechanism of myocardial damage in dengue could be the release of inflammatory mediators or the direct action of the dengue virus on myocytes leading to myocarditis. The release of inflammatory mediators is more in a severe form of the disease that correlates to the higher incidence of cardiac manifestations in patients with severe dengue.

Aim:

To determine the electrocardiographic and two-dimensional (2D)-echocardiographic findings in children with dengue infection and to find a correlation with disease severity.

Materials and Methods:

A total of 150 children between 1 month and 12 years of age seropositive for dengue Non-specific antigen 1 (NS1) Enzyme linked immunosorbent assay (ELISA) or dengue Immunoglobulin M (IgM) ELISA were studied in the Department of Pediatric Medicine of a tertiary care government hospital. The patients were undertaken for 12 lead electrocardiograms (ECGs) and echocardiograms.

Results:

Out of the 150 dengue seropositive cases, 61 cases were of mild dengue, 67 cases were of dengue with warning signs (DWSS), and 22 cases were severe dengue cases. Abnormal ECG was found in 78 cases (52%) in a total of 150 cases in terms of rate, prolonged PR interval (interval between atrial depolarization and ventricular activation), ST (ventricular repolarisation)-segment depression, and low-voltage complexes. Abnormal 2D- echocardiography (ECHO) was found in 70 (46.6%) out of 150 in terms of the ejection fraction (EF) <55%, Early diastole/atrial contraction (E/A) ratio <1, and the presence of pericardial effusion.

Conclusion:

Nearly 50% of the patients have abnormal ECG and ECHO findings, more so in the severe dengue group. There is a statistically significant association of the EF between mild dengue, DWWS with severe dengue (P =0.001).
Bacterial meningitis or cobalamin deficiency: A diagnostic conundrum
Authors: Tripathi Anchal K. , Swarnkar Keerti , Malik Shikha
Published: June 2022

ABSTRACT

Studies show nearly half to two-thirds of the children in India to be deficient in vitamin B12. Meningitis is a major disease in Indian children with studies attributing up to 22% of under-five deaths to meningitis and pneumonia. India is one of the countries with the highest mortality in absolute numbers due to meningitis. Usually, the diagnosis of each of these entities is straightforward. The presence of meningeal signs, papilledema, seizures, and altered sensorium often suggests meningitis. And vitamin B12 deficiency has a myriad of clinical presentations. At times, encephalopathy secondary to cobalamin deficiency may be confused with infection. Here, we present a case that presented with signs and symptoms suggestive of central nervous system infection but turned out to be cobalamin deficiency eventually. To our knowledge, this is the first presentation of cobalamin deficiency presented with features suggestive of meningitis.
Maternal early pregnancy body mass index, gestational weight gain and pregnancy outcomes among urban slum dwellers in Pune, India–A retrospective analysis
Authors: Deshpande Swapna S. , Kajale Neha A. , Unni Jyothi , Khanijo Vandana , Khadilkar Anuradha V.
Published: June 2022

ABSTRACT

Context:

Studies on prepregnancy body mass index (BMI), gestational weight gain (GWG), and pregnancy outcomes among urban Indian slums are sparse.

Aims:

To study BMI during early pregnancy, GWG, and maternal and neonatal outcomes among slum-dwelling women in Pune, India.

Design:

A retrospective study among pregnant women attending antenatal care (ANC) facility.

Methods and Material:

Anthropometric and clinical data throughout pregnancy and pregnancy outcomes postdelivery were collected during hospitalization for delivery using ANC cards. Asian BMI cut-offs were used to define underweight (UW), normal weight (NW), overweight (OW), and obesity (OB). GWG was classified into insufficient, adequate, and excessive categories (2009 Institute of Medicine). Statistical analysis was performed using R (v 4.0).

Results:

Slum-dwelling pregnant women (n = 509, mean age 24 (3.6) years) were studied. Seventy-five percent of the women visited ANC clinics at least thrice during pregnancy. Only 17.5% (n = 89) of the women registered before 12 weeks of gestation, and higher education and being primiparous were the correlates. A total of 28% of the women were UW, whereas 25% of the women were OW/OB as per early pregnancy BMI. The highest percentage of preterm deliveries and cesarean/instrumental deliveries were observed in OW/OB categories. A total of 27% gained appropriate gestational weight. This cohort had 508 live births (mean BW- 2.8 kgs) and one stillbirth. One baby had macrosomia (BW >4 Kg), whereas 19% were low birth weight (LBW) (BW <2.5 Kg).

Conclusions:

Double burden of malnutrition (UW and OW) was observed among young slum-dwelling women. The proportion of slum-dwelling women attending ANC clinics during early pregnancy is still low. Increased uptake of government programs is required to enhance maternal and child health.
An Epidemiological Investigation to evaluate the link between hypovitaminosis D and COVID-19
Authors: Singh Shruti , Nimavat Nirav , Singh Chandramani , Ranjan Alok , Mahto Mala , Singh Sunil Kumar , Kumar Amarjeet , Pradhan Swetalina
Published: June 2022

ABSTRACT

Background:

The COVID-19 pandemic has become a global threat, with an inexplicable course of action and suboptimal response to the multitudes of therapies being tried. Vitamin D’s pleiotropic effects (immunomodulatory, anti-inflammatory, and antiviral) have lately received considerable attention in the scientific community, and it has been shown to be helpful in the defense against viral respiratory infections.

Aim:

To find out the association between vitamin D and COVID-19.

Methods:

Overall, 360 (156 COVID-19 +ve and 204 COVID-19 −ve) subjects were investigated in this hospital-based case-control study. The study participants were taken from the COVID-19 wards and Flu clinic of a dedicated COVID hospital between August 1 and September 15, 2020. The demographics and clinical data including alcohol and smoking history along with serum vitamin D levels were recorded. Binary logistic regression analysis was performed to assess the association between age, gender, alcohol intake, smoking history, vitamin D status, and COVID-19.

Results:

There was no significant difference in the mean vitamin D levels between cases and controls. Bivariate analysis of predictors and COVID-19 revealed that predictors such as advanced age, BMI, alcohol intake, smoking habit, diabetes, hypertension, and vitamin D deficiency were significantly associated with COVID-19.

Conclusions:

This study showed that serum vitamin D status might be able to reduce the impact of COVID-19, although more studies are required to establish clear causality.
Factors related to clinical breast examination: A cross-sectional study
Authors: Rabiei Maryam , Hoseini Seyyed Hamid , Khodarahmi Shiva , Sepahvand Elham , Shirali Elham
Published: June 2022

ABSTRACT

Background and Aim:

Breast cancer is one of the most common types of cancer among women as well as one of the most serious and important public health issues in developing countries. The aim of the present study was to evaluate the factors related to clinical breast examination in women in Tehran.

Method:

This cross-sectional study was conducted on 859 women in Tehran, Iran in 2020. Logistic regression was applied to identify determinant factors that related to clinical breast examination.

Result:

The prevalence of clinical breast examination was 52.6%. Results indicated significant differences between those who underwent clinical breast examination and those who had a nonclinical breast examination in terms of age, housing conditions, marital status, problem in the breast, perceived susceptibility, perceived barriers, fatalism, and self-care.

Conclusion:

It is essential to inform and educate women about breast cancer and associated complications and problems after being diagnosed with breast cancer as well as about the screening and diagnostic methods, including the need for clinical breast examination by a specialist.
Sero-prevalence of Nipah antibodies among close contacts of the index case during 2019 Ernakulam outbreak
Authors: Ramachandran Reshmi , Jose Merin S. , Sahay Rima R. , Shete Anita
Published: June 2022

ABSTRACT

Introduction:

Nipah virus (NiV) infection is a fatal emerging zoonotic disease. Infection with NiV has a wide range of clinical spectrum which can range from asymptomatic cases to acute respiratory distress syndrome (ARDS). The index case of NiV infection of 2019 outbreak in Ernakulam district was a 23-year-old male who presented with features of encephalitis. This study was undertaken to address the subclinical or asymptomatic NiV infection amongst the close contacts of this index case by using NiV-specific Immunoglobulin IgM and IgG antibodies. The index case was first treated in a primary care center. He survived the infection and was discharged after a period of 108 days from the tertiary care facility where he was treated eventually.

Methods:

Serum samples from 49 close contacts of the index case were collected and tested for anti-NiVIgM and anti-NiVIgG antibodies. The contacts included health care workers including those from the primary care facility, family members, and his friends.

Results:

Most common type of exposure included physical contact (59.2%), followed by exposure to body fluids (22.4%).

Conclusion:

None of the 49 contacts tested positive for anti-NiV human IgM and anti-NiVIgG antibodies. There were no subclinical cases amongst the close contacts of Nipah index case during the 2019 Kerala outbreak.
Knowledge, perceptions and practices of medical students towards climate change and global warming: A cross sectional study
Authors: Reddy Gudelli Prashanth , Rajamouli J , Arora K Dilzith , Jothula Kishore Yadav , Amaravadi Sreedeep , Boda Abhilash
Published: June 2022

ABSTRACT

Context:

Climate change is the biggest global health threat and also the greatest health opportunity of the 21st century. Five warmest years among the last 140 years occurred between 2015 and 2019. Limited information is available regarding the knowledge and practices of medical students towards climate change, especially in India.

Settings and Design:

A cross-sectional survey was conducted in two medical colleges of Karimnagar city from January 2021 to July 2021 involving MBBS and Post-graduate students as study participants.

Methods and Material:

903 undergraduate and post-graduate medical students who consented for the study were included. A pre-structured questionnaire was used.

Statistical Analysis Used:

Data is presented in frequencies and proportions with 95% confidence interval and Chi-square test is used as test of significance.

Results:

Poor knowledge regarding Sustainable Developmental Goal for climate action, Organisations dealing climate change and Government actions towards climate change were observed among study participants. Cardiovascular and respiratory diseases (84%) were answered as the major health impacts of climate change. Majority (97.4%) of the participants agreed that ‘human actions are also the cause for global warming’. Environment-friendly practices were observed significantly high among participants with adequate knowledge. Major (72%) source of learning about climate change was via internet.

Conclusions:

Our study found that major proportion of participants doesn’t have environment-friendly practices. However, the participants with adequate knowledge about climate change were observed to have more eco-friendly practices compared to participants with inadequate knowledge.
The role of Schedule H1 and Red Line campaign in improving antibiotic use in India
Authors: Mathew Philip , Thomas Shruthi Anna , Chandy Sujith J
Published: June 2022

ABSTRACT

Purpose:

Over-the-counter (OTC) sale of antibiotics have contributed to the growing threat of antibiotic resistance. The Government of India has instituted regulatory measures, such as Schedule H1 and public campaigns such as Red Line Campaign, to limit such sales. This study was conducted to assess the perceptions of stakeholders regarding their effectiveness.

Methods:

To assess Schedule H1, pharmacists who own retail pharmacies in the state of Kerala, India, were interviewed using a pre-prepared question guide. In the next phase, healthcare professionals and patients in a hospital were shown the Red Line on an antibiotic blister pack and asked about its significance. Finally, 100 patients were shown a blister pack of Amoxicillin, and asked to identify the medicine or its use.

Results:

It was observed that there is poor awareness about antibiotic regulations and a perception of laxity in enforcement. Regarding the Red Line, only 7% of healthcare professionals could describe its significance and none among patients. Among the 100 patients who were shown Amoxicillin, only 42 could identify it as an antibiotic or describe its use.

Conclusions:

There is a general perception that regulations are poorly enforced and all are not aware of the Red Line campaign including healthcare professionals. Greater awareness at all levels about appropriate antibiotic use through prescriptions followed by greater efforts towards regulatory implementation and compliance should form parts of a multi-modal strategy to contain OTC sales of antibiotics. This will greatly help to aid physicians in improving overall healthcare through safe and effective prescribing.
Psychological impact of Covid-19 pandemic among the Healthcare workers in a North-Eastern state of India
Authors: Visi Vizovonuo , Dutta Gitashree , Medhi Gajendra Kumar , Bhattacharyya Himashree , Sundaram Shanthosh Priyan , Pala Star , Ghatani Ruben
Published: June 2022

ABSTRACT

Background:

Previous studies done during SARS 2003 outbreak and early reports related to COVID-19 show that healthcare workers experience considerable anxiety, stress and fear. Although similar studies were done in other parts of India, there is dearth of data on this topic in the Northeastern region.

Aim:

This study aimed to assess the mental health status of Healthcare Workers during Covid-19 pandemic in the region.

Methods:

The study was conducted among the doctors and nurses of a Northeastern state of India through an online survey. PHQ-9, GAD-7 and ISI scales were used to assess depression, anxiety and insomnia among the participants.

Results:

The prevalence of depression, anxiety and insomnia among the HCWs was 74.5%, 42% and 32%, respectively. Moderate to Severe form of depression, anxiety and insomnia was experienced by 15.5%, 20.5% and 8.5%, respectively. Females and those who directly cared for Covid-19 patients were more prone to suffer from depression. Participants who reported having previous history of any psychological problems reported eight-fold, seven-fold and three-fold increased odds of developing depression, anxiety and insomnia, respectively, during the pandemic.

Conclusions:

A large proportion of HCWs reported symptoms of depression, anxiety and insomnia among the healthcare workers. Protecting the mental health of these health workers is paramount to ensure psychological wellbeing, which in turn will ensure a healthy and robust workforce.

Relevance for Patients:

Improves the productivity of Healthcare workers in terms of Patient care and Management.
Persisting, unilateral tinnitus 22 days after first dose of an mRNA-based SARS-CoV-2 vaccine
Authors: Finsterer Josef , Edmonds Robert
Published: June 2022

ABSTRACT

Objectives:

Although vaccination with vector-based or mRNA-based SARS-CoV-2 vaccines is usually well tolerated, they are not free of side effects. Some of these side effects can be severe and concern the primary care physician, otorhinolaryngologist, and the neurologist. Persisting, unilateral tinnitus time-linked to the first dose and worsening after the second dose of an mRNA-based SARS-CoV-2 vaccine has not been reported.

Study Design:

Case report.

Methods:

Routine tests were applied to investigate the patient.

Results:

A 35-year-old male experienced sudden onset of right-sided tinnitus, diffuse headache, and ear respectively facial pressure 22 days after the first dose of an mRNA-based SARS-CoV-2 vaccine. Since symptoms worsened after the second dose, 28 days later, the patient started a self-medication with non-steroidal anti-inflammatory drugs, without benefit. After an otolaryngologist suspected Meniere’s disease, prednisone was given for 5 days with significant improvement. After discontinuation of steroids, however, previous symptoms recurred with similar intensity as before. Cetirizin and loratadin were started resulting in complete resolution of headache and pressures but persistence of tinnitus. After exclusion of various differentials, a causal relation between clinical presentation and vaccination was suspected.

Conclusions:

SARS-CoV-2 vaccination can be followed by unilateral persisting tinnitus, headache, and ear respectively facial pressure. Since steroids and anti-histamines had a beneficial effect, an immunological pathophysiology is quite likely.
A systematic review of mucormycosis cases in COVID-19: Is it an unholy trilogy of COVID-19, diabetes mellitus, and corticosteroids?
Authors: Kumar Rajesh , Misra Arup Kumar , Dutta Siddhartha , Gupta Ajay , Kumar Bharat , Charan Jaykaran
Published: June 2022

ABSTRACT

Background:

A significant surge of cases of mucormycosis is seen in individuals with COVID-19 with presence of diabetes mellitus (DM) and usage of corticosteroids. We aim to conduct a systematic analysis of the cases involving presence of mucormycosis and to find out its association with COVID-19, diabetes mellitus, and corticosteroids.

Method:

The electronic records of PubMed, Google Scholar, and Science Direct were searched for the case reports and case series that reported mucormycosis in association of COVID-19. The particulars of each case report and case series were retrieved, stored and analyzed.

Results:

In this study, 476 cases of mucormycosis were reported. In 346 cases of mucormycosis, the patients were found to be COVID-19 positive. The incidence of diabetes Mellitus (DM) was 67.01%. Corticosteroid was administered in 57.77% of the cases. Mortality was reported in 36.34% of the cases.

Conclusion:

An immunosuppressive environment created due to the COVID-19, diabetes mellitus, and extensive use of corticosteroid provide a suitable background for the increased incidence of mucormycosis. The COVID task force should adopt an aggressive multidisciplinary approach to optimize the use of corticosteroids and maintain glucose in the optimal range.