bluuebunny/crossref_metadata_2025 huggingface dataset:
The psychological impact of the ongoing COVID-19 pandemic on health-care workers in primary health-care centers in resource-poor settings
Authors: Ahmed Sami Mustafa Jafar , Miskeen Elhadi , Awadelgeed Bashir Ali , Al Faifi Jaber Ahmed
Published: November 2023

Background:

Health-care workers' psychological status is essential to Preventive control measures in a weak and unstable health system with poor infrastructural constraints. This study examines the psychological impact of the ongoing coronavirus disease 2019 (COVID-19) pandemic on the health-care providers working in primary health-care settings in Sudan.

Materials and Methods:

This is a health facility–based cross-sectional study conducted in primary health-care units in White Nile State, Sudan. The psychological impact of stress and anxiety was determined using the Depression Anxiety Stress Scale 21 (DASS-21). A self-administered questionnaire measured depression, anxiety, and stress. The population of this study included health professionals working in health centers, including physicians, nurses, technicians, pharmacists, and other support staff.

Results:

A total of 167 health professionals were systematically recruited. The mean anxiety score in the study population was 8.26 & 9.0 (corresponding to mild anxiety). Participants without anxiety constituted 26.35% (n= 44) of the participants. Women were significantly more likely to be affected than men (P= 0.0). Age (21–40 years), female nurses, and other health-care workers (anesthesiology, public health, health education, occupational health, psychiatry, etc.) could be strong predictors of psychological disorders (P-value of 0.0).

Conclusion:

This study provided evidence for primary health care at its preparatory levels, as they are the first line of protection against the COVID-19 pandemic. Addressing the high-risk population is a high priority in the preliminary phase.
Radial nerve motor palsy after COVID vaccination: A case report
Authors: Radlberger Richard F. , Trinka Eugen , Leis Stefan
Published: November 2023

Vaccinations are one of the most effective ways in primary prevention of infectious diseases. Due to the SARS-CoV-2 vaccination, an extensive public discussion considering possible side effects has been started. In this report, we present a patient with a radial nerve motor palsy after a vaccination with tozinameran (Comirnaty®).
Role of creatine phosphokinase as a diagnostic marker in tubal ectopic pregnancy
Authors: Sharma Nalini , Kharkongor Dimple , Basu Ritisha , Sundaram Shanthosh Priyan , Singh Santa A. , Shullai Wansalan Karu , Sharma Aryan , Charaimuriya Birangana , Namita Gowda
Published: November 2023

Background and Aim:

Ectopic pregnancy (EP) is still one of the leading preventable causes of maternal morbidity and mortality in the first trimester. Amidst the use of sensitive assays for β-HCG and high-definition ultrasonography for the identification of EP, the search for a more reliable and sensitive marker remains a challenge till date. Our aim was to determine the validity of creatine phosphokinase (CPK) and its isoenzyme (CPK-MB) in the prediction of tubal EP.

Materials and Methods:

A prospective and comparative diagnostic accuracy study was conducted among 105 pregnant women in the first trimester who met the eligibility criteria in the Department of Obstetrics and Gynecology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS). The study included 35 patients each with tubal EP (EP), abortive intrauterine pregnancy (AP), and normal intrauterine pregnancy (NP). CPK, CPK-MB, and β-HCG were measured among all the participants, and the participants were followed up longitudinally.

Results:

A total of 105 pregnant women were included. The mean CPK and CPK-MB levels were significantly higher among the women with EP when compared to NP (P < 0.05) and AP (P < 0.05) women; however, there was no significant difference between the NP and AP groups (P > 0.05). Moreover, the receiver operating characteristic (ROC) curve showed that both CPK and CPK-MB were good predictors of EP, with CPK (area under the curve [AUC] = 0.764) being a better predictor than CPK-MB (AUC: 0.650) in the diagnosis of EP.

Conclusion:

Early diagnosis of EP allows appropriate and timely management, which would not only reduce mortality and morbidity associated with the condition but also enable preservation of fertility and improve future pregnancy outcome. Hence, the need of the hour is a reliable biochemical diagnostic marker for EP, such as CPK.
Role of colour Doppler in predicting foetal outcome in maternal anaemia
Authors: Agrawal Alka , Bhandari Gaurav , Taya Silky , Chaudhary Vinod
Published: November 2023

Context:

Anaemia is the most common nutritional deficiency in Indian pregnant females. It ensues foetal hypoxia resulting in different compensatory mechanisms in the foetus which may result in adverse perinatal outcomes. Colour Doppler can be used to measure these hemodynamic changes of the foetus ahead of the clinical manifestations, guiding the obstetrician for the appropriate management and circumventing any dire complication.

Aims:

The aim of this study is to detect foetal haemodynamic changes associated with maternal anaemia and assess the parameters which predict these changes accurately.

Settings and Design:

Prospective cohort study.

Materials and Methods:

Two hundred and forty pregnant females in the third trimester, divided into four groups based on their haemoglobin levels in the non-anaemic, mild, moderate and severe anaemic groups, were included in the study. These patients were followed up for foetal outcome in terms of effective foetal weight, APGAR score and neonatal intensive care unit admission.

Statistical Analysis Used:

Analysis of Variance Appearance, Pulse, Grimace, Activity and Respiration (ANOVA) test was used to compare the quantitative variables. SPSS software was used.

Results:

The middle cerebral artery (MCA) Doppler indices and cerebroplacental ratio (CPR) values were increasing while umbilical Doppler indices were decreasing with the increasing severity of anaemia. CPR was found to be the most sensitive predictor for foetal outcome.

Conclusions:

Maternal anaemia results in foetal hypoxia which can be measured in terms of foetal Doppler indices. CPR was found to be more sensitive than the umbilical or MCA in predicting foetal hypoxia and in turn the perinatal outcome of foetuses of anaemic pregnant females. The foetuses with low CPR values will require urgent intervention to improve the outcomes.
Study of neuregulin-4 levels in newly diagnosed type 2 diabetes mellitus
Authors: Akshay D , Chauhan Ajay , Goyal Parul , Pranesh V
Published: November 2023

Background:

Neuregulin-4 is a recently recognized adipokine acting as ligands to tyrosine kinases receptor of the Erb B family. This adipose tissue augmented endocrine factor participates in the modulation of lipid and glucose metabolism and energy homeostasis. This novel adipokine is associated with insulin resistance, dyslipidemia, obesity, oxidative stress, and inflammation.

Objective:

The study aimed to compare plasma levels of neuregulin-4 in newly diagnosed type 2 diabetes mellitus as compared to matched controls and to correlate with glycemic and lipid parameters.

Materials and Methods:

100 newly diagnosed T2DM patients and 100 age, sex, and BMI-matched controls after fulfilling all exclusion and inclusion criteria were included in the study. Fasting and postprandial blood glucose levels, glycated hemoglobin (HbA1c), and fasting plasma insulin levels were measured in both cases and controls. HOMA-IR values in both groups were calculated using fasting glucose and insulin levels.

Results:

Mean levels of plasma neuregulin-4(pg/mL) in newly diagnosed T2DM were 7949.76 ± 949.76) pg/ml, which was significantly lower as compared to 9143 ±949.76) pg/ml in the control group (P-value <.0001). In the present study, a significant negative correlation was seen between plasma neuregulin-4 (pg/mL) with fasting blood sugar, postprandial blood sugar, HbA1C, and HOMA-IR with a correlation coefficient of -0.303, -0.416, -0.433, and -0.514, respectively. Moreover, a significant positive correlation was seen between plasma neuregulin-4 (pg/mL) with HDL with a correlation coefficient of 0.216. A significant negative correlation was seen between plasma neuregulin-4 (pg/mL) and LDL, with a correlation coefficient -0.208.

Conclusion:

Neuregulin levels are significantly lower in diabetics as compared to controls. There levels correlated inversely with HbA1C and HOMA IR.
Methylphenidate for neurological improvement post-TBI
Authors: Mohammed Denelle , Verma Sadhika
Published: November 2023

Traumatic brain injuries (TBIs) can have numerous neurologic and cognitive sequelae. The road to recovery can be long and arduous for many patients. Improving cognition can assist in a shorter recovery time as patients may be more in tune with their plan of care. Family physicians may be helpful in assisting with the recovery process post-hospital discharge. This case report seeks to educate family physicians on the use of methylphenidate in the ambulatory setting after TBI. Here, a case of a 51-year-old man on methylphenidate after a traumatic brain injury is presented.
Rare case of chronic naphthalene ball ingestion in a young Indian woman
Authors: Meena Pratibha , Narayanan Gitanjali , Murthy Pratima
Published: November 2023

Chronic oral abuse of naphthalene balls is extremely rare. It is associated with different types of metabolic toxicity, neurological deficits and multiple organ failure. However, the psychological implication of naphthalene abuse is poorly understood. This is a unique case report of a 29-year-old lady who presented with a 17 year history of naphthalene ball consumption. Historically, there have been self-harm behaviors, fire setting, cleaning compulsions, and involuntary motor movements associated with naphthalene. A series of assessments were conducted to assess her personality, psychiatric symptoms and cognitive functions. Additionally, blood tests, CT scan and MRI were done. The patient's profile indicated no apparent medical, neurological or cognitive impairments. Her psychological profile revealed significant co-morbidities and marked personality pathology. The case study provides useful insights into the presentation of chronic naphthalene ball ingestion in an Indian woman, thereby indicating the need to identify psychosocial and biological markers longitudinally. It also highlights recognition of common household items that can be abused, suggesting better understanding of protecting vulnerable individuals from the same.
Factors associated with the knowledge of obstetric danger signs among pregnant women attending primary health care antenatal care clinics in Abha city
Authors: Alshaikh Ayoub Ali , Assiri Ahmed Shubayli , Riaz Fatima , Alshaikhi Saleh Ahmed , Alarrafi Abdullah Ali , Bharti Rishi K. , Mahmood Syed Esam , Farag Shehata
Published: November 2023

Introduction:

Knowledge of obstetric danger signs would equip women to make the right decisions and appropriate actions timely to have better health care assistance which will impose a significant impact on maternal mortality and morbidity. Hence, this study aimed to know the factors associated with the knowledge of obstetric danger signs among pregnant women who attend the primary health care clinics, which is considered as the first gate to seek health care for pregnant women during antenatal checkups.

Methodology:

This is a cross-sectional study conducted among 400 pregnant women selected by simple random sampling technique who were attending antenatal clinics at primary health care centers at Abha City by using an interview-based questionnaire.cores of <50%, 50–75%, and >75% were considered to be poor, intermediate, and good scores. Frequencies and percentages were used for descriptive variables, whereas for association, tests of significance (Chi square, t-test, and F-test) were applied.

Results:

Almost 70.8% of participants received health information on obstetric danger signs. The main sources of information were the Internet (23%), family, relatives or friends (17%), and health care providers. The highest participants' correct responses regarding obstetric danger signs were related to severe vaginal bleeding (93.5%), convulsions (76.8%), and decreased fetal movements (76.5%). Proportions of participants with poor knowledge showed an inverse and significant increase with their educational levels (P < 0.001). The highest percentage of poor knowledge grade was observed among participants with no children (54.6%). Participants who received previous information on danger signs had significantly better knowledge grades than those who have not received previous information (P < 0.001).

Conclusions:

Women's knowledge was suboptimal regarding obstetric danger signs. 30% of women did not receive information about danger signs. Health education provided on obstetric danger signs to pregnant women should be enforced to those who are illiterate, are unemployed, have a low family income, and are with no or less previous pregnancies.
A cross-sectional study on the prevalence and determinants of various neonatal dermatoses
Authors: Quazi Sabiha , Choudhary Sanjiv , Singh Adarshlata , Madke Bhushan , Khan Khalid , Singh Sudhir
Published: November 2023

Background:

During the neonatal life cycle, various dermatological conditions are common. In comparison to the skin of adults, neonates' skins are more susceptible to infections in the first week of their lives. These infections often lead to many dermatological skin complications and create worrisome among parents. Hence, it is crucial to diagnose and manage such affected neonates at the earliest. This study aimed to highlight and estimate the occurrence of numerous dermatoses and assess various skin changes that occurred physiologically and pathologically in neonates.

Methodology:

In this cross-sectional observational study, 474 neonates were enrolled in the neonatal intensive care unit. The whole newborn skin surface, comprising the palms and soles, scalp, mucous membranes, genitalia, hair, and nails, was scrutinized under adequate light, and all changes that occurred over the skin were observed and recorded. The sample size estimation was undertaken from the references that have the least prevalent cutaneous dermatosis: hypertrichosis desquamation and napkin dermatosis. A statistical analysis like the Chi-square test was performed to associate the type of dermatosis with the parameters of age, gender, delivery type, and birth weight.

Results:

Of the total 474 cases, 90 (18.98%) had single dermatosis, while the remaining 384 (81.01%) had more than one form of dermatosis. Among the 384 cases, sebaceous gland hyperplasia (SGH) in 105 (22.15%), Epstein pearls in 50 (10.54%), erythema toxicum neonatorum (ETN) in 40 (8.43%), physiological desquamation in 25 (5.27%), lanugo hair in 20 (4.21%), miliaria in 22 (4.64%), salmon patch in 13 (2.74%), cradle cap/seborrheic dermatitis in 6 (1.26%), vernix caseosa in 12 (2.53%), transient neonatal pustular melanosis in 13 (2.74%), congenital melanocytic nevus in 20 (4.21%), hemangioma in 15 (3.16%), neonatal acne in 5 (1.05%), napkin dermatitis in 10 (2.10%), cutis marmorata in 6 (1.26%), milia in 2 (0.42%) intertrigo 3 (0.63%), collodion baby in 2 (0.42%), and neonatal occipital alopecia in 2 (0.42%) neonates each and others, respectively.

Conclusion:

The findings from the present study were representative of a specific racial/geographic distribution and will assist in adding or comparing the prevalence of neonatal dermatosis with other geographic regions as the array of dermatological characterizations in neonates varies as per time and place. This study aims to provide insight into the future implications in the neonatal dermatology domain and avoid further skin complications.
Prevalence and risk factor of anemia among pregnant women admitted in antenatal ward in PBMH Bhubaneswar, Odisha
Authors: Pradhan Sobhna , Karna Tanupama , Singha Debaleena , Bhatta Piyali , Rath Kalyani , Behera Anasuya
Published: November 2023

Background:

Anemia is one of the contributing factors for morbidity and mortality during pregnancy in developing country including India, which eventually leads to fetal and maternal consequences. Growing fetus depends completely on mothers for all its growth and maturity. Anemia is one of the nutritional deficiency disorders and around 56% of women are suffering from anemia in India. It is one of the reasons for maternal deaths and fetal complication during pregnancy.

Aim:

The aim of the study was to assess the prevalence of anemia and to determine the risk factors of anemia among pregnant women in PBMH hospital, Bhubaneswar, Odisha.

Materials and Methods:

A descriptive cross-sectional study was conducted over a period of 1 month from October 11, 2022, to November 11, 2022, from the Department of Obstetrics and Gynecology of Pradyumna Bal Memorial Hospital KIMS, Bhubaneswar. A total sample comprised of 52 pregnant women who were interviewed by using self-structured questionnaire for data collection and classification of anemia was performed according to the Indian Council of Medical Research (ICMR) criteria.

Results:

A total of 52 antenatal mothers were admitted during this study period (October 11, 2022, to November 11, 2022), and all were selected as study sample. The incidence of anemia among antenatal mother in PBM hospital was found as follows: 17 (33%) mild, 04 (07%) moderate, and 02 (04%) were severe in this present study. The most common indication of anemia among antenatal mother as per the present study was found to be H/O infection (21%), chronic malaria (15%), hook worm (27%), and birth interval (42%).

Conclusion:

The study implies that the prevalence rate of Anemia is high, that is, 44.2%. Spacing between pregnancy and H/O infection plays a significant role in considering anemia in pregnant women, which eventually affects both maternal and fetal condition.
Water vapor therapy and polymyalgia rheumatica: Coincidental?
Authors: Lee Joshua , Lee Sandy , Nguyen-Oghalai Tracy U.
Published: November 2023

Polymyalgia rheumatica (PMR) is an inflammatory rheumatic condition characterized by pain and stiffness around the shoulders and hip girdles, an elevated erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) and a dramatic response to corticosteroids. It is usually seen in adults aged over 50 years; about 30% also have giant cell arteritis. Its etiology is unknown. A 72-year-old male received water vapor therapy, a novel, minimally invasive therapy for benign prostate hypertrophy (BPH). On postoperative day 1, he developed severe shoulder pain and weakness, with difficulty with lifting his arms above his head, and hip pain and weakness, with difficulty getting out of a bed or chair. Laboratory results showed elevated ESR and CRP, but a normal creatine kinase level. The patient received low-dose prednisone and had prompt symptom relief. This case illustrates that a diagnosis of PMR after water vapor therapy can be easily overlooked.
Prevalence of intestinal parasites in HIV/AIDS-infected patients with correlation to CD4+ T-cell count at hospital in Eastern India
Authors: Seema Kumari , Kumar Abhay , Boipai Manju , Kumar Manoj , Sharma Ashok Kumar
Published: November 2023

Introduction:

In developing nations, one of the most common reasons for death and illness is due to infections that are brought on by intestinal parasites. People who have HIV are more likely to contract parasites that are either well-established intestinal pathogens, like Entamoeba histolytica, Giardia lamblia and Strongyloidesstercoralis, or an opportunistic pathogen like Cryptosporidium, Isospora, Cyclospora and Microsporidia. Higher prevalence of intestinal parasitic infections occurs in patients with low CD4+ cell counts. Hence, this study had been performed to know the correlation of intestinal parasitic infection in HIV/AIDS patients with reference to CD4+ cell count.

Materials and Methods:

The study comprised 1477 HIV-positive patients who were treated at ART Centre of Rajendra Institute of Medical Sciences (RIMS), Ranchi. All participants provided verbal informed consent before specimens were collected. Blood and stool sample were used for the identification of parasite and CD4+ T-Cell count.

Results:

In patients living with HIV, the prevalence of intestinal parasite infection was 12.59 per cent. In a manner parallel, the prevalence of parasitic infections was found to be 10.29% among male HIV-positive patients and 2.31% among female HIV-positive patients.

Conclusions:

This study has shed light that low CD4+ T-cell count appears to be a factor for intestinal parasitic infections and development of diarrhoea. Regular screening and treatment of intestinal parasitic infections is very important in overall improvement in quality of life of HIV/AIDS patients. Nevertheless, sanitary hygiene practices and deworming are needed to enhance the control of infection in the affected areas.
Characteristics, glycemic control and outcomes of adults with type-2 diabetes mellitus attending specialized clinics in primary healthcare centers in Bahrain—A cross-sectional study
Authors: Alawainati Mahmood A. , Ayoob Zahra A. , Naser Huda S.
Published: November 2023

Introduction:

Diabetes mellitus is a global health challenge that requires continuous and multidisciplinary management. Suboptimal diabetes management results in serious complications that impose a huge burden on patients and the healthcare system. This study aimed to assess the characteristics, glycemic control and outcomes of patients with type-2 diabetes attending primary healthcare centers in Bahrain according to the new American Diabetes Association (ADA) guidelines.

Materials and Methods:

A cross-sectional study was conducted among adult patients with type-2 diabetes mellitus attending diabetic clinics in Bahrain. A multi-stage sampling technique was adopted. The data collection tool consisted of three parts: baseline and sociodemographic data, the physical measures of the patients and the most recent laboratory results. An A1C of less than 7% was indicative of good glycemic control.

Results:

A total of 721 patients with type-2 diabetes mellitus were included with an average age of 58.4 years. Most patients were hypertensive (n= 457, 63.4%), and half of them were hyperlipidemic (n= 373, 51.7%). Around 57% (n= 402) of the patients adopted lifestyle modifications, 14.8% adopted diet control measures and around half performed weekly regular exercises. More than 92% of the cohort were on metformin, 52.0% (n= 375) were on Sulphonylurea medications and 41% (n= 298) were on insulin formulations. While only 40% of the patients had controlled diabetes (n= 283, 39.3%) and hypertension (n= 298, 41.3%), most patients achieved adequate cholesterol and low-density lipoprotein levels (83.2% and 76.6%, respectively). Non-Bahraini (P≤ 0.001), young (P= 0.027) and obese patients (P= 0.003) had lower glycemic control measures. Adequate cholesterol levels were seen more in patients with a controlled glycemic index (P= 0.015).

Conclusion:

Considering the new glycemic targets, glycemic and hypertension control was poor among diabetic patients, especially non-Bahraini, obese and young patients. Urgent interventions by policymakers, physicians and caregivers are needed to improve the outcomes of diabetes.
Serum uric acid level in chronic liver disease and its correlation with Child–Pugh score in a tertiary care hospital from South India
Authors: Noklang Samuel , Noklang Imjungba , Chirumamilla Sri Sai Kaumudi , Kannauje Pankaj K.
Published: November 2023

Background:

Chronic liver disease (CLD) is one of the important causes of morbidity and mortality in our country, and since the damage to the liver is irreversible, we have to look for many severity markers or predictors for the prognosis of the patient. In this study, we have tried to correlate the level of serum uric acid (UA) with the severity of CLD presented as a Child–Pugh score.

Methods:

A cross-sectional observational study was conducted at Vijayanagar Institute of Medical Science (VIMS), Ballari, Karnataka, from October 2015 to June 2017 in the Department of General Medicine. Fifty patients diagnosed with CLD, aged between 18 and 65 years, of either gender, were enrolled in the study. Serum UA levels were measured, and liver function and coagulation parameters were assessed. A statistical analysis was performed to evaluate the association between serum UA levels, liver function test, and coagulation parameters.

Results:

In our study, the mean serum UA level was 6.52 mg/dl and was raised in patients with CLD in correlation to its severity. Alcoholic liver disease (ALD) was the most common etiology for CLD (80%) followed by hepatitis B (Hep B) virus infection (12%) and hepatitis C (Hep C) virus infection (6%). Serum UA levels increased as the Child–Turcotte–Pugh (CTP) score increased. The mean UA level in CTP class C was 8.29 mg/dl. Various parameters such as serum aspartate aminotransferase (AST), alanine transaminase (ALT), alkaline phosphatase, total bilirubin, international normalized ratio (INR), calcium, and albumin were significantly associated with serum UA levels in CLD patients.

Conclusion:

The correlation between rising blood UA levels and the Child–Pugh score shows that UA estimate may be a valid and affordable indicator for assessing the extent of liver cirrhosis in CLD.
Correlation of perceived stress with monthly cyclical changes in the female body
Authors: Jain Prashant , Chauhan Anil Kumar , Singh Kavita , Garg Rinku , Jain Nidhi , Singh Randhir
Published: November 2023

Background:

Women are liable to stress-related disorders as female sex hormone, estrogen has been indicated to be protective against stress disorders. The hormone level varies with different phases of menstrual cycle. Moreover, postmenopausal women are at risk for stress-related disorders. So this study was done to correlate the different phases of menstrual cycle with the perceived stress in different phases of monthly cycle.

Methods:

This study was conducted in the Department of Physiology, Shri Guru Ram Rai Institute of Medical and Health Sciences (SGRRIMHS), Dehradun. Four hundred girls in the age group of 18–26 years were selected for the study. The Perceived Stress Scale (PSS) questionnaire was circulated via Google forms after briefing them about the study. Informed consent was also taken. The menstrual history of the subjects was enquired by one-to-one interaction. The participants completed the PSS questionnaire twice in the same cycle. Data collected were statistically analyzed, using Independent t-test and Chi-square test and point biserial correlation test.

Result:

The analysis showed strong statistical association of PSS with two phases of menstrual cycle. The PSS score was higher in the late luteal and menstrual phase, while it was less in the late follicular phase (P < 0.05). Conclusion: The decreased oestrogen levels in the late luteal & menstrual phase are strongly associated with perceived stress in our study. Hormonal changes in the monthly cycles are related with stress, behavioral shift and many other physical changes in females. This information to the family physicians would be beneficial in counseling the females regarding various changes occurring during the menstrual cycle.
Prospective review of 188 cases of epistaxis presenting to the emergency department: Etiology and outcome
Authors: Raaj Prethesh , Hazra Darpanarayan , Chandy Gina M. , Jacob Christna R. , Ganesan Priya
Published: November 2023

Background:

Due to a myriad of risk factors, epistaxis is a very frequent presentation to the emergency room (ER). This study aims to ascertain the prevalence of epistaxis in our population, risk factors, effectiveness of ER treatment, complications, and ER outcome.

Materials and Methods:

This was a prospective observational study performed in the ER of a referral tertiary care center in south India. Data were categorized, coded, and analyzed to determine the objective of the study.

Results:

During the study's six-month duration, 188 (0.6%) patients presented with epistaxis. The mean age was 42.9 (SD: 16.49) years, with a male preponderance of 143 (76.1%). A majority of these patients (n: 156; 82.9%) were triaged as priority II, with hypertension (n: 53, 28.2%) as the commonest comorbidities. Trauma-related epistaxis (n: 107, 56.9%) was the most frequent cause. Anterior nasal packing was carried out for 85 (45.2%) patients, posterior nasal packing was carried out for one (0.5%) patient, and bleeding had spontaneously resolved in the majority (n: 102; 54.3%) patients. Seven (3.7%; p-value: 0.001) patients had recurrent epistaxis, and of those, three (1.6%) required urgent resuscitation with crystalloid fluid and blood products. Two of these patients had bleeding dyscrasias, four had history of trauma, and one patient presented with uncontrolled hypertension. Two (1.1%) patients came back to us with recurrent bleeding within 12 h of discharge. Majority (69.2%; 130) were discharged stable, (23.9%; 45) were admitted for observation and (6.9%; 13) were discharged against medical advice. There was no mortality among these study populations.

Conclusion:

Middle-young, aged males most commonly presented with epistaxis. Most of them were secondary to trauma. Anterior nasal bleeding was the most common source and hemostasis could be obtained by anterior nasal packing. Majority could be discharged stable from the ER. However, this cohort had seen patients in life-threatening conditions, so the severity cannot be overlooked.
Effects of examination-induced stress on memory and blood pressure
Authors: Ahmed Firoz , Dubey Dinesh K. , Garg Rinku , Srivastava Rani
Published: November 2023

Stress has been defined in many ways as a state of psychological arousal that results when the external demand is beyond what one can cope with. Stress is caused by various factors called stressors. Medical students are subjected to different kinds of stressors, such as pressure of academics with obligation to succeed, an uncertain future and difficulties of integrating into the system and different teaching protocols, which may affect their learning ability and performance. Stress has a great impact on brain mainly in the form of impaired memory and on cardiovascular function in the form of increased heart rate and blood pressure. The study was planned to assess the effects of examination induced stress on memory and blood pressure. The study was longitudinal in nature conducted at Department of Physiology, Santosh Medical College, Ghaziabad, India. Initially 100 subjects were selected from 17-24 years of age group then all the subjects were divided into two groups of ‘slow-learners’ and ‘fast-learners’ based upon their past academic performances. Readings were taken at two stages of academic year, 05 months before pre-prof examination and 03 days before pre-prof examination. Blood Pressure were measured and the memory assessments were done by using 10 subtests of PGI memory scale. We found a significant increase in stress level 3 days before the examination, compared to 5 months before the examination which in turn affected both blood pressure and memory functions. But, slow-learners were affected more compared to fast-learners.
Impact of COVID-19 pandemic on global economy
Authors: Katole Ashwini
Published: November 2023

COVID-19 is an emerging global health concern. It is rapidly spreading all over the world. The transmission of COVID-19 is faster as compared to the SARS-CoV infection, and this has created a global emergency-like situation. To overcome the situation, many countries had locked down the states and sealed the country's borders. This resulted in reduced transmission of COVID-19 infection but deteriorated the world's economy. The lockdown effect can be very well seen in various sectors like education, industries, food, tourism, health, and jobs. Poor production levels, lack of connectivity, lack of import and export facilities, break in school education, and overstretched healthcare facilities placed an economic burden on the countries. This economic burden pulled back many countries in the crisis that will require several years to normalise. To overcome the situation, governments must take precautionary majors by focusing on healthcare facilities and providing financial support to reopen small businesses and industries.
Awareness and perceptions regarding autism among school teachers in Jazan region, Kingdom of Saudi Arabia
Authors: Otaif Eman A. , Salih Sarah M. A. , Mahfouz Mohammed S.
Published: November 2023

Background:

Identification of Autism Spectrum Disorder (ASD) especially at early stages is highly important to improve the quality of life and help to decrease the disease burden. This study was performed to assess the school teachers' level of knowledge and perception regarding Autism.

Materials and Methods:

An observational cross-sectional study was carried out in the Jazan region among a random sample of school teachers (males and females) who are working at the governmental primary Schools, throughout the scholastic year 2019–2020. A structured validated self-administered questionnaire was used for data collection. It includes three sections: sociodemographic information of the participants, the Autism Knowledge Questionnaire (AKQ), and statements exploring the teachers' attitudes toward children with autism.

Results:

The study included 403 primary school teachers. The age of 47.1% of them ranged between 35 and 44 years. Slightly more than half (50.9%) were males. Overall, the total autism knowledge score ranged between 2 and 26, out of a possible 30 with a median (interquartile range “IQR”) of 15 (12-18). Teachers who ever encountered a child with autism had higher significant knowledge scores about autism compared to their counterparts (mean ranks were 263.95 and 179.32, respectively), P < 0.001. Female compared to male teachers more significantly agreed that teachers not trained in special education should not be expected to deal with a child with autism, P = 0.018. Teachers aged between 35 and 44 years are more willing to have an autistic child in their class in compare to those ages ≥55 years that they would not want children with autism in their class, P = 0.036 and more interested in attending training in the area of childhood developmental and behavioral disorders, P = 0.010. Postgraduate teachers were more agreed than Bachelor holders that teachers not trained in special education should not be expected to deal with a child with autism, P = 0.001. Diploma-holder teachers were more agreed than postgraduates that children with autism are too impaired to benefit from activities of a general school, P = 0.019 and students with Autism should be given every opportunity to function in the regular education classroom whenever possible, P = 0.028.

Conclusion:

The knowledge about autism among primary school teachers is average in general, however, they expressed mostly positive attitudes towards autistic children.
Subacute invasive pulmonary aspergillosis in a nondiabetic immunocompetent female suffering from allergic broncho pulmonary aspergillosis
Authors: Kumar Subodh , Singh Devesh Pratap , Ansari Sana , Hada Vivek
Published: November 2023

A 55-year-old female presented with recent exacerbation of the chronic cough, dyspnea, and copious expectoration. The symptoms worsened during the winter months. In the past, she was misdiagnosed with pulmonary tuberculosis. A computed tomography scan revealed bronchiectasis changes, high attenuated mucus, and hypereosinophilia. The diagnosis of Allergic Bronchopulmonary Aspergillosis (ABPA) with subacute invasion was confirmed through bronchoscopy and fungal culture. Treatment with oral voriconazole significantly improved lung function and quality of life. This case highlights the importance of considering invasive pulmonary aspergillosis in patients with exacerbations of asthma and bronchiectasis. Early diagnosis and appropriate treatment are essential for improved outcomes in such cases.
Effect of COVID-19 pandemic on utilization of maternal healthcare services in a rural area of Haryana – A record-based comparative study
Authors: Singh Tejbeer , Kaur Ravneet , Kant Shashi , Mani Kalaivani , Yadav Kapil , Gupta Sanjeev Kumar
Published: November 2023

Background:

The COVID-19 pandemic posed a challenge for the public health system, as all the health facilities and manpower were diverted for the delivery of COVID-19-related services. This affected the provision of routine health services, including maternal healthcare services. There is a paucity of data from rural and primary healthcare settings, as the earlier studies were either modelling-based or from tertiary care centres.

Materials and Methods:

This record-based study was conducted in 12 subcentres in the district Faridabad of Haryana. Data of pregnant women registered during 1 April to 30 September in the years 2017–2020 were retrieved. The utilization of maternal healthcare services among women registered during 1 April 2020 to 30 September 2020 was compared with those registered in the same period during the preceding 3 years (2017–2019).

Results:

There was a significant decline in utilization of maternal healthcare services. Services like minimum four antenatal visits declined from 67.8% to 48.3% (P < 0.0001), at least 100 iron-folic acid tablets (45.4–20.9%; P < 0.001), and examination at each visit (90.8–72.3%; P < 0.001). The proportion of pregnant women who received full antenatal care decreased from 26.0% to 10.7% (P < 0.001). There was a significant increase in delivery in private health facilities (40.9–49.9%) and delivery by caesarean section (21.6–27.3%; P = 0.002).

Conclusion:

COVID-19 pandemic had an adverse effect on utilization of maternal healthcare services. Effective planning and coordination between different levels of government health facilities and primary care providers, including family physicians, can ensure uninterrupted provision of essential services during similar emergencies in future.
Raised Hematocrit at High Altitude: Its Relation to Sensorineural Hearing Loss
Authors: Gupta Atul , Raj Poonam
Published: November 2023

Background:

Military troops deployed in high altitude areas (HAAs) may suffer from illnesses peculiar to the terrain which are usually due to hypoxia. The physiological dynamics at high altitude (HA) are different from those in the plains and hence environmental factors play an important role at HA. The effect, if any, of hemodynamic changes in terms of raised hemoglobin (Hb) levels in HA on otological disorders is not very well researched and needs to be explored further. This study was undertaken to study the clinical manifestations, if any, of the hemodynamic alterations in the inner ear and their correlation with the Hb levels after 1 year deployment at HA.

Methods:

A longitudinal descriptive study was conducted over 1 year duration at a Military Hospital located at HAA on 99 soldiers who were <40 years of age with no history of prior ear complaints/ear surgery and with normal pure tone audiometry (PTA) thresholds and Hb levels at initial evaluation. Each soldier underwent PTA and Hb estimation twice: initially, at the time of induction, and later after completion of 1 year deployment at HAA. Statistical analysis was done using simple paired t-test.

Results:

On data analysis, no hearing loss was found in any participant of the study cohort at frequencies 500 Hz and 1 kHz in either ear on second evaluation. At 2 kHz, for left ear, the mean Hb level for the group with hearing thresholds greater than 25 dB was 17.07 g% with a standard deviation of 0.66, and for right ear, it was 16.95 g% with standard deviation of 0.64. At 4 kHz, the mean Hb level was 16.50 g% and 16.49 g% for hearing thresholds below and up to 25 dB for left and right ear, respectively. It was 16.99 g% and 16.96 g% for hearing thresholds above 25 dB. The results were statistically significant for both right and left ear at 4 kHz.

Conclusion:

A statistically significant deterioration of hearing thresholds for 4 kHz frequency with corresponding increase in Hb levels was observed in our study. Hb levels can therefore be used as a marker to ensure no further exposure to other risk factors like loud noise exposure, further deployment at higher altitudes to prevent deterioration, and progression of hearing loss.
Distribution of COVID-19 Cases According to Environmental Pollutants and Meteorological Factors in Districts of Maharashtra
Authors: Madhu B. , Biswas Brototi , Karegam Dhivya , Yadav Arun Kumar
Published: November 2023

Introduction:

Environmental factors such as temperature, precipitation, and various other pollutants in the air like nitrogen dioxide (NO2), CO2, etc., have been studied for sustenance and transmission of Coronavirus disease-19 (COVID-19). Studies from India are lacking about the distribution of COVID-19 cases according to air pollutants and meteorological factors. Hence, the present study was conducted to study the relationship between COVID-19 and environmental factors with the objectives of Cluster mapping of the COVID-19 cases district-wise for the state of Maharashtra.

Methodology:

The air pollution variables NO2 column density (mol/m2), sulfur dioxide column density (mol/m2), Aerosol absorbing index (Ai), Carbon monoxide (CO) column density (mol/m2), and Ozone column density (mol/m2) were extracted from Sentinel-5P datasets available in Google Earth Engine (GEE) (https://code.earthengine.google.com/). The meteorological variables precipitation (m), temperature (t), and humidity (k) were extracted from the European Environmental Agency 5-Land reanalysis dataset in GEE, which provides data at a resolution of 1113.2 m. The preprocessing and retrieval of data were carried out in GEE. These values were correlated with daily cases, density, and other demographic factors.

Results:

The study identified a cluster of cases in few districts of Maharashtra. These districts were Pune, Ahmednagar, Mumbai, Nashik, and Nagpur. Population density and NO2 were important factors in most of the monthly data.

Conclusion:

The present study used data available on public platforms to assess the association between COVID-19 and environmental factors. The study found that various environmental factors such as NO2, CO, and Ai may be associated with increase cases of COVID-19 in the district. However, ecological bias may be kept in mind.
Risk Factors and Functional Outcome of Ischemic Stroke Vis-à-vis Hemorrhagic Stroke at a Tertiary Care Hospital in North India
Authors: Gupta Anirban , Mukherjee Arindam , Gupta Aditya , Shashikala Tirulapati Padmavathi , Barki Satish , Dhull Pawan
Published: November 2023

Background:

Worldwide, stroke is the most common cause of death after coronary artery disease (CAD). The risk factor stratification and prognostication of stroke patients are vital in planning and allocating health-care resources.

Methods:

We conducted a prospective, comparative observational study. Fifty age- and sex-matched cases each of ischemic stroke (IS) and intracerebral hemorrhage (ICH) stroke were enrolled, and baseline demographic, risk factor profile, Glasgow Coma Scale, modified Rankin scale (mRS), and Barthel Index (BI) were recorded, and the cases were followed up for 90 days or till death. We looked at the risk factors associated with IS and ICH and functional outcome of IS vis-à-vis ICH using mRS and BI at 90 days postenrollment. We also compared the mortality of IS vis-à-vis ICH.

Results:

The presence of hypertension (100% vs. 88%) and smoking (50% vs. 26%) was significantly higher in ICH (P < 0.05). The presence of diabetes mellitus (40% vs. 18%) and CAD (12% vs. 2%) was significantly more in IS cases (P < 0.05). Consumption of alcohol was more prevalent in ICH patients compared to IS patients (30% vs. 24%). Based on mRS and BI at 90 days, ICH cases had significantly poorer functional outcome compared to IS cases (P < 0.0001). Mortality of IS cases (4%) was also significantly less compared to ICH cases (30%).

Conclusions:

A combination of hypertension, smoking, and history of alcohol consumption had a higher predilection for the occurrence of ICH, whereas a combination of hypertension, diabetes mellitus, and CAD favored the occurrence of IS. The functional outcome of cases of ICH 90 days poststroke was significantly poorer compared to IS cases. The most important factors for poor outcome of ICH cases were more stroke severity at baseline compared to IS cases and the presence of intraventricular hemorrhages in some cases. Mortality was also found to be more in patients with ICH compared to IS.
A Clinicoradiological Profile of H3N2 Outbreak in Western India
Authors: Harikrishnan P. , Duche Suraj Gautam , Vashisht Rohit , Mishra Yogendra , Kumar Abhinav , Samadarshi Samir
Published: November 2023

Introduction:

Although H3N2 outbreaks were once rare, they have become more common in recent years. With a significant toll on health-care resources and the ability to cripple any society, the epidemiological significance of this disease is paramount. While most of the previous studies on influenza outbreaks have reported H1N1 disease, there is a scarcity of literature regarding the H3N2 clinicoradiological profile. Hereby, we present the clinicoradiological profile of a series of H3N2 cases from western India.

Materials and Methods:

This is a retrospective chart-based review of clinicoradiological profile of a series of cases that were reported to a tertiary care center in western India between February 2023 and March 2023.

Results:

A total of 10 patients had tested positive for H3N2. All patients had a history of fever lasting an average of 4.7 days, and six had varying degrees of dyspnea. One patient had gastrointestinal symptoms, and six developed tachypnea with hypoxemia requiring oxygen supplementation. One patient with multiple comorbidities required invasive mechanical ventilation and had a complicated course with a superadded bacterial infection. Out of the four patients with radiographic findings, two had atypical pneumonia/acute infective etiology.

Conclusion:

This study provides valuable insights into the clinical presentation and management of H3N2 infections. The findings highlight the importance of influenza vaccination and early detection of H3N2 infections to prevent severe complications. The successful outcomes of the patients in this study demonstrate the effectiveness of prompt intervention and appropriate treatment in managing H3N2 infections.