bluuebunny/crossref_metadata_2025 huggingface dataset:
Preemptive visceral analgesic effect of thoracic paravertebral block on postoperative opioid consumption in patients undergoing laparoscopic cholecystectomy: a prospective, randomized, assessor-blind study
Authors: Lee Jong-Hyuk , Kim Chan-Sik , Kim Hyungtae , Choi Jae Moon , Kim Youngmu , Jeong Sung-Moon , Choi Seong-Soo
Published: December 2022

Background: The preemptive visceral analgesic effect of regional nerve block has not been adequately investigated to date. We evaluated the preemptive visceral analgesic effect of thoracic paravertebral block (TPVB) in patients undergoing laparoscopic cholecystectomy (LC) in whom pre-incisional rectus sheath block (RSB) was used to minimize somatic surgical pain.Methods: In this prospective, randomized, assessor-blind study, 70 patients scheduled for elective LC were randomly assigned to the pre-TPVB (n = 35) or the post-TPVB (n = 35) group. Both groups received pre-incisional RSB, and patients in the pre-TPVB group received TPVB before skin incision while those in the post-TPVB group received TPVB after skin closure. The primary outcome was the total rescue analgesic consumption (morphine equianalgesic dose) during the 24 h post-surgery. The secondary outcomes were the cumulative analgesic consumption and pain intensity for 24 h after surgery, and adverse events.Results: Pre-TPVB significantly reduced total rescue analgesic consumption (estimated mean [95% CI]) during the 24 h after surgery than post-TPVB (16.9 [14.5, 19.3] vs. 25.3 [22.8, 27.7] mg, estimated difference: -8.3 [-11.8, -4.9], P < 0.001). The cumulative rescue analgesic consumption was significantly lower in the pre-TPVB group from 2–24 h after surgery (P < 0.001). The postoperative pain intensity was significantly lower in the pre-TPVB group as well at 0.5–6 h after surgery. There were no adverse events in both groups.Conclusions: Pre-incisional TPVB conferred a significant preemptive visceral analgesic effect in patients undergoing LC, and significantly reduced the amount of postoperative opioid consumption.
First molecular survey of Anaplasma phagocytophilum in hard ticks (Ixodidae) from Southwestern Iran
Authors: Hamidinejat Hossein , Jallali Mohammad HosseinRazi , Bahrami Somayeh , Bagheri Mohammad
Published: December 2022

Anaplasma phagocytophilum is a gram-negative obligate intracellular tick-borne rickettsia with veterinary and public health importance worldwide. This organism is an etiologic agent of tick-borne fever (TBF) in domesticated animals and human granulocytic anaplasmosis (HGA) as well. Hard ticks (Ixodida: Ixodidae) are incriminated as the main biologic vectors for Anaplasma spp. Studies represent that Ixodes spp. are the main vectors for A. phago-cytophilum and few reports hinted that other tick species may play this role. So, the goal of the presented work was to investigate the A. phagocytophilum in 2000 hard ticks in Khuzestan province of Iran by specific nested-PCR performing two consecutive amplifications of 16SrRNA gene fragment with highly variable nucleotide region. Each reaction included 10 salivary glands of distinct tick species. Specific nested-PCR on accumulated salivary glands detected specific bands in 15.5% of reactions (31 of 200) in electrophoresis only in Rhipicephalus sanguineous and Hyalomma marginatum ticks. We concluded that the broad distribution of A. phagocytophilum infection is not only is due to the existence of Ixodes spp. but other hard ticks may also play a role in this issue.
Systematic review
Authors: Mubarak  , Satoto Tri Baskoro Tunggul , Hartini Sri , Tontowi Alva Edy
Published: December 2022

Background & objectives: This study aimed to review the effectiveness of lactic acid when combined with other types of attractants for Aedes spp.

Methods: A systematic review was conducted according to the protocol for a systematic review and meta-analysis (PRISMA). Literature search used Cinahl, Medline/PubMed, ScienceDirect, ProQuest and Ebsco electronic databases. Research articles used in the systematic review were experimental articles that reported the effectiveness of mosquito traps using lactic acid or a combination of lactic acid with other attractants.

Results: From a total of 42 articles reviewed, there were 6 articles fulfilling the inclusion criteria. The highest synergistic combination of lactic acid in the ketone group was shown in the acetone compound, in the sulfides class, dimethyl sulfides, and in the chloroalkanes group, chloroform. The combination of lactic acid with two effective attractants can be seen in the incorporation of ammonia + caproic acid, and for the incorporation of lactic acid with three other effective attractants illustrated by combining ammonia + caproic acid + CO2.

Interpretation & conclusion: Lactic acid as an attractant can be combined with other various compounds (ketone compounds, sulfides and chloroalkanes). Lactic acid increases its effectiveness in trapping Ae. aegypti and/or Ae. albopictus if combined with acetone, dimethyl sulfides, and/or chloroform.
Assessment of effectiveness of Japanese encephalitis vaccination in West Bengal, India using sample positivity rate as an alternate measure
Authors: Chakraborty Debjit , Banerjee Surajita , Maji Dipankar , Dey Tushar Kanti , Vaitheeswaran Kulothungan , Mondal Palash , Biswas Prashanta , Debnath Falguni , Chatterjee Pranab
Published: December 2022

Background & objectives: Japanese encephalitis (JE), is a vaccine preventable mosquito borne arboviral disease. The State Health Department of West Bengal, India started a vaccination programme using live attenuated, single dose JE vaccine (SA-14-14-2) in children aged 1-below15 years since 2006 in five districts. The objectives were to compare Sample Positivity Rates (SPR) of Acute Encephalitis Syndrome (AES) cases for JE between vaccinated & unvaccinated districts and observe trend of SPR & Cumulative Incidence in vaccinated districts for three years.

Methods: The study was based on the analysis of surveillance data from all tested AES cases including confirmed JE (IgM ELISA) from all JE testing facilities existent in the state during the study period (2011–13). Calculation of Cumulative Incidence, Odds Ratio (OR) with 95% CI, Preventive Fraction and Chi Square for trend (for SPR) was done. Trend of incidence was assessed by linear regression.

Results: In three years, 5 vaccinated districts contributed 945 AES and 88 JE cases (SPR - 9.3%) compared to 1807 and 254 (SPR - 14.1%) JE cases in 14 unvaccinated districts. Effectiveness of vaccination was evident by gradual decline of Odds Ratio in favour of vaccinated districts. Vaccination effectiveness of 68% overall and 80% [OR = 0.20 (0.10 - 0.41)] in below 15 years were observed. Trend of SPR was found significantly declining in most of the vaccinated districts.

Interpretation & conclusion: Significant reduction in sample positivity rate over three years in most of the vaccinated districts indicated that the vaccination programme had been gradually effective.
A comparative study to evaluate wonder and Sherman traps for the surveillance of ectoparasitic chigger vector mites of the scrub typhus
Authors: Paulraj Philip Samuel , Renu Govindarajan , Ranganathan Krishnamoorthi , Veeramanoharan Rajamannar
Published: December 2022

Background & objectives: Scrub typhus is caused by Orientia tsutsugamushi and transmitted by larval trombiculid chigger mites. Rodents and shrews are hosts for chigger mites in the transmission to humans. Wonder and Sherman traps are widely used for trapping rodents and shrews for the collection of ectoparasitic chigger mites. A comparative trapping study was undertaken in different villages in Vellore district, Tamil Nadu and Thiruvananthapuram district, Kerala, India to evaluate the efficiency of traps for trapping rodents & shrews.

Methods: Wonder and Sherman traps were set in outdoors and indoors to capture the rodents. Wonder Traps, large wired cage, and Sherman Traps are foldable. These traps were employed for the rodents/ shrew surveillance to gather chigger vector mites. Identification of rodents, chigger mites and Trap index were observed.

Results: Z Test comparing the capture rates showed wonder trap (P<0.001) to be significantly more efficient than the Sherman traps. The number of rodents /shrews collected in a Sherman trap was always one. But the number of rodents /shrews collected in a positive wonder tap was 2.83 in both states, 2.25 and 1.24 in Tamil Nadu and Kerala, respectively. Wonder traps (77%) were found more attractive in collecting more rodents in Tamil Nadu compared to Sherman traps (23%). But the Sherman trap (60.9%) was found efficient in collecting more shrews in Kerala compared to wonder traps (39.1%). Shrew’s collection was more in Sherman collections from both Tamil Nadu and Kerala. In Tamil Nadu and Kerala sex-wise collection of Male & female rodent/shrew was uniformly found in both the wonder (85% &75%) and Sherman traps (86% & 83%) with a maximum proportion of females.

Interpretation & conclusion: Sherman traps can be used as single-capture live traps and on the other hand wonder traps can be used as multiple-capture live-traps. The geographical distribution pattern of various rodents trapped can be determined to identify the target areas for control of a particular species and also for the control of selected species. Mostly females were captured abundantly in both wonder and Sherman traps. In wonder traps, female rodents were trapped as family members in large numbers. Wonder traps are more attractive for trapping more rodents. This study addressed the careful choice of wonder traps for ectoparasitic chigger vector surveillance.
Dengue induced reversible blindness
Authors: Dinkar Anju , Singh Jitendra , Atam Virendra
Published: December 2022

Dengue is spread by the bite of infected Aedes aegypti mosquito. It is usually a self-limiting viral infection but sometimes complicates to mortality. In the last few decades, literature has shown that clinical and biochemical profile of dengue is expanding due to the addition of unusual manifestation day by day. Hereby, we report a young male student suffering from dengue complicated to retinal hemorrhage and severe pancytopenia who recovered near fully on treatment.
Effective Common Chinese Herbal Medicines Used in Treating Chronic Cholecystitis with Liver-Gallbladder Dampness-Heat Syndrome
Authors: Tee Desmond Wei , Wong Hon Foong
Published: December 2022

The objective of the study is to identify the effective common Chinese herbal medicines used in treating chronic cholecystitis with liver-gallbladder dampness-heat syndrome (CCLGDHS) through reviewing relevant clinical studies published in the past 10 years. Data were collected from ScienceDirect and Chinese National Knowledge Infrastructure. Data screening was carried out for the abstracts and full texts of the data. The top 15 Chinese herbal medicines with the highest occurring frequency were selected, statistically analyzed, and classified by their medicinal properties, actions, and indications according to the Chinese Pharmacopoeia 2015 edition. The top 15 effective common Chinese herbal medicines comprise Chai Hu, Huang Qin, Jin Qian Cao, Bai Shao, Yin Chen, Yu Jin, Chuan Lian Zi, Yan Hu Suo, Zhi Shi, Ban Xia, Bai Zhu, Pu Gong Ying, Gan Cao, Zhi Zi, and Qing Pi. The predominant natures were cold, cool, and warm. This combination can clear stagnant heat, warm Yang, and regulate Qi dynamics. In addition, bitter, pungent, and sweet were the predominant flavors. They can clear dampness-heat, regulate Qi dynamics to relieve cramps and pain, as well as tonify the deficiency. Along with entering the liver and gallbladder meridians, these herbal medicines also entered the spleen, stomach, and lung meridians to prevent potential disease transmission. The combinatorial medicinal actions of the effective common Chinese herbal medicine highlight the importance of the holistic concept of traditional Chinese medicine when treating CCLGDHS. In addition, the inclusion of activating blood to promote blood circulation, relieving cramps and alleviating pain, and tonifying the spleen and stomach represents a new finding in the treatment principle for CCLGDHS.
Developing a Novel Single-Marker-Based Method for the Quantitative Evaluation of the Multiple Active Components in Corydalis yanhusuo W. T. Wang
Authors: Yang Xin-Rong , Jiang Shuang , Gan Chun-Li , Huang Jing , Wei Fan-Shu , Wang Zheng-Yang , Peng He-Song , Yang Jing , Yang Chun-Juan
Published: December 2022

Objective:

This study was designed to develop a method for detecting differences in the chemical composition of Corydalis yanhusuo W. T. Wang using high-performance liquid chromatography with a diode array detector technology.

Materials and Methods:

We established a novel quantitative evaluation method for identifying multiple components in natural extracts using a single-marker method quantitative analysis of multi-components by single marker (QAMS). This method was then validated using eight alkaloid phytochemical markers designed to evaluate C. yanhusuo quality.

Results:

Our evaluations revealed good linearity (R
2 ≥ 0.9991) within the range of tested concentrations for all eight alkaloids, with recovery ranging from 95.5% to 101.5%. The evaluations also returned stability results that fell within the acceptable range. Cluster analysis and Heatmap analyses were applied to classify and evaluate alkaloids across 21 different production areas. These results revealed a significant difference in the component profiles between samples from different origins.

Conclusions:

Thus, these data suggest that in the absence of a material reference, QAMS may help facilitate the stable production of C. yanhusuo. In addition, our data suggest that this method may have value as a promising alternative to common quality evaluations for controlling C. yanhusuo composition.
A chronic alcoholic with central pontine myelinolysis
Authors: Pratapa Sreekarthik , Spoorthy Mamidipalli Sai , Gupta Parul
Published: December 2022

Central pontine myelinolysis (CPM), is a potentially fatal neurological disorder identified by demyelination at the bottom of the pons. Osmotic stress, endothelial dysfunction, blood–brain barrier damage, and rapid correction of hyponatremia believed to be the main causes. Chronic alcoholism may influence the CPM. We report a case of chronic alcoholism and normonatremia, who presented with sudden onset of drowsiness and quadriparesis, after sudden abstinence from alcohol who was eventually diagnosed with CPM. Evidence of elevated serum ammonia level indicated encephalopathy. Our case emphasizes that CPM can manifest in patients with chronic alcoholism. CPM must be distinguished from the natural course of alcohol withdrawal delirium and Wernicke's encephalopathy, which necessitates clinical astuteness and a high level of suspicion on the part of the physician.
Colposcopic evaluation of cervix in patients with bacterial vaginosis
Authors: El-Deen El-Darwesh Abdel Aziz Galal , Halim Abdel Halim Mohammed Abdel , Sayed Mahmoud Abbas Mahmoud
Published: December 2022

Background and aim

Bacterial vaginosis (BV) is a clinical syndrome emerging from changing of the bacteria Lactobacillus species that produce hydrogen peroxide in the vagina with many population of anaerobic bacteria. A lot of researchers have agreed with the relation between BV and cervical intra-epithelial lesions. However, other researchers have not accepted this relation between cervical neoplasia and BV. The study aim was to evaluate the abnormal colposcopic findings associated with BV and to study the relation between BV and cervical lesions.

Patients and methods

This study is a cross-sectional observational one that included 246 women diagnosed as having BV using Amsle’s criteria. All participants underwent proper history taking, general and abdominal examination, local vaginal examination, and colposcopic examination. Finally, Swede score was applied to abnormal colposcopic findings.

Results

By naked-eye examination, there were 163 patients with normal findings and 83 patients had abnormal cervical appearance, colposcopic examination of patients revealed 14 patients with unsatisfactory findings, and 196 patients had normal findings and 36 patients had abnormal cervix. The abnormal colposcopic findings were significantly associated with urban (55.6%) than rural women (44.4%) (P=0.039), educated (72.2%) than noneducated women (27.8%) (P=0.033), nonemployed (72.2%) than employed women (27.8%) (P=0.011), and women using oral contraceptive pills (OCP) (38.9%) than other contraceptive methods (P=0.024).

Conclusion

Most cervical lesions associated with BV in our study were of low grade and although use of colposcopy allowed early detection and management of cervical precancerous lesions associated with BV.
Cognitive impairment after first-ever ischemic stroke
Authors: Omran Mosaab S.L. , Ibrahim Nabil H.M. , Zaki Mohammed A.
Published: December 2022

Background and aim

Ischemic stroke has a good outcome because these patients usually have a good motor recovery. The aim of this work was to assess the prognostic value of the neurocognitive status to detect early cognitive dysfunction in stroke phases, evaluate outcome after first-ever ischemic stroke, and to choose proper preventive management of stroke cognitive dysfunction.

Patients and methods

Patients with ischemic stroke were prospectively evaluated using Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) individually and in combination with National Institutes of Health Stroke Scale (NIHSS), either at the subacute stroke phase or within 2 weeks (baseline), and modified Rankin scale (mRS) scores, for functional outcome 3 and 6 months later.

Results

Cognitive impairment was diagnosed at baseline in 37.5% of patients with median NIHSS=4 and median mRS=2 (P<0.001). Baseline NIHSS, MMSE, and MoCA can individually predict mRS scores at 3 and 6 months, and NIHSS is the strongest predictor. However, patients with more disability at baseline (NIHSS>2), baseline MoCA, and MMSE had a moderately large significant predictive value to the baseline NIHSS for mRS scores at 3 and 6 months.

Conclusion

Screening of cognitive state at the subacute stroke phase can predict functional outcome independently and improve the predictive value of stroke severity scores. And it is important to evaluate what cognition is, and the brief cognitive test may facilitate assessment in the early phases.
Relation Between the Facial Injury Severity Scale Score and Length of Stay in Maxillofacial Fracture Patients at General Hospital in Surabaya
Authors: Ariobimo Bonfilio Neltio , Dita Muhammad Rafif Alfian , Nujum Nurun
Published: December 2022

Introduction:

Fractures on maxillofacial not only give physical impact but also cause economic burden to the patients from hospitalization. The Facial Injury Severity Score (FISS) could be used as a predictor of treatment costs and length of hospital stay for certain injury severity. This study evaluated the relation between FISS score and length of stay at General Hospital in Surabaya.

Methods:

This is an observational analytic cross-sectional study involving 63 patients with maxillofacial fracture treated at General Hospital in Surabaya. Data collected were gender, age, etiology, site of fracture, FISS score, concomitant trauma, treatment given, and duration of hospitalization. Univariate analysis of sociodemographic data and multivariate analysis for comparative and correlative between FISS score and length of stay were done.

Results:

The characteristics of patients in this study were highest in the male sex (81%), age group 26–45 years old (47.6%), traffic light accident event (95.2%), lower face site (63.5%), mild FISS (63.5%), with concomitant trauma (60.3%), and get operative treatment (79.4%). The mean length of stay on participants with FISS >3 was longer than FISS ≤3 with 19.04 days and 10.98 days, respectively. There was a significant correlation between length of stay and FISS with the correlation coefficient (r value) was 0.536. Patients with FISS score >3 have a longer length of stay.

Conclusion:

This research establishes a relationship between FISS and length of stay. The findings may aid in providing counseling to patients regarding the cost and time required for treatment. Patients with FISS score >3 have a longer length of stay but need to be concerned about the condition of the patient in the treatment process such as the presence of comorbidities that may make the length of hospital stay longer.
Completeness of Prescription Contributes to Prescribing Errors in Hospitals: Is this the Doctor’s Negligence?
Authors: Ningrum Shely Oktavia Puspita , Prabasari Mardhina Ratna , Chalidyanto Djazuly
Published: December 2022

Introduction:

Incident reporting is the primary key to implement patient safety. One indicator of patient safety is to reduce prescription errors. Errors in writing prescriptions can cause the treatment process to be disrupted and even lead to malpractice and ethical violations. This study aimed to know the effect of individual and organizational factors on prescribing errors in the Outpatient Unit of Nganjuk Public Hospital.

Methods:

This research was a cross-sectional observational study in the Outpatient Clinic of Nganjuk State General Hospital. This study used a questionnaire and prescriptions with a total sample of 362 prescriptions from 24 doctors, with exclusion criteria: doctors with an expired license at the time of the study and doctors with <2 years of service. Prescriptions were also used as a sample to assess the incidence of prescribing errors. This research used descriptive analysis with cross-tabulations.

Results:

A doctor’s knowledge about writing complete prescriptions is the most related factor to prescribing errors (n = 0.159) in individual factors. Likewise, the doctor’s perception variable related to prescribing policy has the most substantial relationship compared to other variables on organizational factors (n = 0.235).

Conclusions:

Several factors influence prescribing errors, such as the physician’s skill and knowledge. Doctors with high subjective and objective workloads, doctors’ perceptions regarding the incident reporting system, prescribing policies, and medication management also affect prescribing errors. Training and reduction of doctors’ workload could be the solution to reduce prescribing errors.
Postoperative Pain after Total Joint Arthroplasty: Pathophysiology and Current Pharmacological Pain Management
Authors: Soetjahjo Bintang , Nefihancoro Udi Heru , Ermawan Rieva , Saputra Rhyan Darma , Pranandaru Herlambang
Published: December 2022

This review is a literature review based on articles gathered over the previous 10 years from scientific search engines. To divide pain management following total joint arthroplasty into segments. The pain is frequently connected with incision pain induced by surgical damage to a major peripheral nerve and differs in quality and location from pain experienced before surgery. Acetaminophen, nonsteroidal anti-inflammatory drugs, and opioid analgesia are the three categories of medicines used to manage postsurgical pain. These medications can be used as pre-emptive analgesia or as part of a multimodal analgesia regimen. Multimodal analgesia is the most common therapy for postoperative pain following joint replacement. This medication is meant to lessen the risk of negative effects that may arise after taking opioids.
Conservative Management of Internal Bleeding Following Trauma in an Immune Thrombocytopenic Purpura Child with COVID-19 Infection
Authors: Wati Mita Erna , Yudistio Alvin Fajri , Dewi Hidayati Utami , Rahadi Damian Dwi
Published: December 2022

Immune thrombocytopenic purpura (ITP) usually presents with minor bleeding such as petechiae and purpura. Rarely, life-threatening events such as intracranial and intra-abdominal bleeding can be occurred. Here, we present a case of a 9-year-old patient who presented to the emergency department after being hit by a motorcycle with a decrease of consciousness and symptoms of shock. On physical examination, a large abdominal bruise was seen, and it was proved by FAST to confirm abdominal bleeding. Sign of shock, decrease of hemoglobin, and a free fluid in Morison’s pouch were found by the FAST examination and led to establish abdominal bleeding diagnosis. The presence of bleeding in ITP patient, especially children, can be safely managed with observation alone. This case highlights the life-threatening condition, abdominal bleeding in severe thrombocytopenia, successfully treated with a conservative treatment strategy.
Screening of oral tamoxifen ocular toxicity in patients with breast cancer
Authors: Tharwat Ahmed , Salman Abdelrahman G. , Said Azza M.A. , Fawzy Samah M. , Abdelmotal Ahmed S. , Ahmed Mai M.A. , Abdelgawad Randa H.A.
Published: December 2022

Background

Carcinoma of the breast is considered as one of the main cancer types among women. Its prevalence is reported to be the second most common type. Several treatment lines have been used in breast cancer besides surgical and radiological interventions. Tamoxifen is one of the medical treatments used in postsurgical prophylaxis of breast cancer. Various visual problems were reported with tamoxifen therapy. These include posterior subcapsular cataracts, color vision affection, intraretinal crystals, and optic neuritis.

Aim

The aim of this work was to screen for ocular toxicity of tamoxifen used for breast cancer treatment in patients having no ophthalmic complaints and treated with tamoxifen for at least 2 years with a dose of 20 mg per day.

Patients and methods

We included 50 women with breast carcinoma on tamoxifen therapy for at least 2 years, and then we divided them into two groups regarding duration of tamoxifen intake from 2 to 4 years (group 1) and from 5 to 8 years (group 2). All participants underwent complete careful history taking and full ophthalmological examination. Best-corrected visual acuity was measured using Snellen chart with conversion to logMAR notation for statistical analysis. We assessed the retinal structural changes by optical coherence tomography (OCT) and correlated these changes with the function affection (color vision testing and electrophysiological studies).

Results

There was a statistically significant correlation between duration of tamoxifen intake and Retinal Pigment Epithelium (RPE) mottling. No other significant correlations were detected. There was no significant difference between the two groups in mean best-corrected visual acuity; intraocular pressure; cup values; disc parameters; ganglion cell complex thickness; retinal nerve fiber layer zones, except for in the inferior quadrant; and macular thickness, except for in the superior quadrant. OCT layer thinning shows retinal nerve fiber layer affection in 34% of cases, ganglion cell complex affection in 48% of cases, and macula affection in 64% of cases. Color vision defects were found in 12%, and electrophysiological test changes were found in a few cases.

Conclusion

Tamoxifen therapy causes minimal affection on the ocular structure and function. OCT layer thinning (34–64% of cases) precedes the clinical changes. This highlights the importance of OCT examination in those patients to evaluate tamoxifen toxicity, and further studies will be needed to evaluate the reversibility of these changes after stoppage of therapy. The main ocular complications associated with tamoxifen therapy were correlated with duration of treatment.
Distribution of Ciprofloxacin- and Azithromycin-Resistant Genes among Salmonella Typhi Isolated from Human Blood
Authors: Dola Nigha Zannat , Shamsuzzaman S. M. , Islam Saiful , Rahman Asma , Mishu Nafisa Jabin , Nabonee Modina Ansaree
Published: December 2022

Context:

Salmonella Typhi has developed resistance to different groups of antibiotics.

Aims:

The purpose of the present study was to assess the distribution of ciprofloxacin- and azithromycin-resistant genes among Salmonella Typhi isolated from human blood.

Settings and Design:

This cross-sectional study was conducted in the Department of Microbiology of a tertiary care hospital in Bangladesh from July 2019–June 2020.

Subjects and Methods:

Clinically suspected enteric fever patients, irrespective of age and gender, who attended the laboratory of the Department of Microbiology and outpatient department of Medicine of tertiary care hospital. Blood culture and sensitivity tests were done. The positive growth of Salmonella Typhi was identified by Gram staining, colony morphology, and biochemical test. Then, Salmonella Typhi was identified by using Salmonella-specific antisera. Final identification was made by using 16s rRNA by polymerase chain reaction (PCR). PCR was also done to detect quinolone and azithromycin resistance genes.

Results:

A total number of 83 samples yielded positive cultures, of which 50 isolated organisms were identified as Salmonella species; however, among these isolates, Salmonella Typhi was detected in 40 (48.2%) isolates. Among 12 ciprofloxacin-resistant isolates, 8 (66.67%) were positive for the gyrA gene, 1 (8.33%) was positive for the qnrB gene and qnrS gene, 2 (16.67%) were positive for aac (6´)-Ib-cr. Among 12 azithromycin-resistant isolates, 2 (16.66%) were positive for mphA and mefA genes, respectively.

Conclusion:

In conclusion, the gyrA, aac (6´)-Ib-cr, mphA, and mefA genes are found for the first time in tertiary care hospitals from the quinolones and azithromycin-resistant Salmonella Typhi.
When Clinico-Morphological and Molecular Studies Tell Different Stories: A Case of Myelodysplastic Syndrome
Authors: Jain Niharika , Gautam Parul , Tiwari Atul , Mittal Anjana , Gupta Naveen , Yadav Mohan Lal
Published: December 2022

Myelodysplastic syndromes (MDSs) are clonal hematopoietic stem cell disorders characterized by cytopenias, dysplasia in one or more of the major myeloid cell lines, ineffective hematopoiesis, with cellular marrow, and risk for leukemic transformation. We present a case of a 66-year-old male with a history of multiple packed red blood cell (PRBC) transfusions. Routine investigations, bone marrow aspiration, and biopsy were done. The clinical and morphological findings raised suspicion of MDS with isolated del (5q), so cytogenetics was done. When cytogenetics was done, there was a big mismatch in finding between clinical, morphological, and molecular findings which brought a major change in prognosis as well as treatment. It is, therefore, very essential to not rely only on the clinical and morphological findings to reach a diagnosis. Molecular findings play a pivotal role to come to a final conclusion.
Fulminant acute fatty liver of pregnancy presenting with multi-organ failure
Authors: Saran Sai , Misra Saumitra , Siddiqui Suhail Sarwar , Agrawal Avinash , Gurjar Mohan , Patwa Ajay Kumar , Muzaffar Syed Nabeel
Published: December 2022

Liver disease in pregnancy can be classified into pregnancy-related, liver disease coincident with pregnancy or preexisting liver disease. Acute fatty liver of pregnancy (AFLP) is a rare liver disorder that is caused by defects in mitochondrial beta (β) oxidation of fatty acids. In view of its fulminant presentation and rapid progression to multiple organ failure (MOF), AFLP carries high maternal and fetal mortality. These patients are commonly present in the third trimester of pregnancy with gastrointestinal symptoms and complications such as hypoglycemia, lactic acidosis, hyperammonemia, leukocytosis, liver dysfunction, coagulopathy, and renal dysfunction. Diagnosis is mostly based on the Swansea diagnostic criteria and by excluding other etiologies of liver dysfunction. Liver biopsy is rarely performed owing to underlying coagulopathy and thrombocytopenia. In this case series, we intend to share our experience of managing four cases of AFLP that were admitted to the intensive care unit with fetal demise and MOF.
Long Term Lifestyle Modifications on Submaximal Exercise Tolerance Test in Overweight Children, Tamil Nadu, India
Authors: Malarvizhi Devadhason , Pasupathy Sekar
Published: December 2022

Background: The ability of the body to maintain continuous rhythmical exercise is referred to as cardio-vascular endurance. Based on previous longitudinal studies, obese children have a higher chance of becoming overweight adults in future. So this study was examining the impact of a school-based lifestyle modifications intervention on overweight and health outcomes among school children for a period of one and a half years. Methodology: The study design was randomized control trial 145 overweight children randomly recruited from 1300 healthy children. Seventy three overweight children from first school was Group A Experimental group and 72 overweight children from second school was Group B Control group. Participants in the study had an average BMI of 85 to 95 percentiles for their age and sex range, and they had to be 11 to 15 years old. Group A was treated with Lifestyle modifications like exercises, nutritional guidelines, and active lifestyle methods along with pamphlet. Group B was given oral instructions and given pamphlet with all instructions. 6MWT was used as an outcome measure to test submaximal exercise tolerance. Results: Group A showed significant improvement in all parameters like distance walked, VO2 Max, resting heart rate, blood pressure than Group B at P < 0.05. Conclusion: The study concluded that 18 months of lifestyle modifications are effective in improving the submaximal exercise tolerance in overweight school going children. Government policy makers and school authorities should take extreme steps to encourage physical activity
The Effect of Sleep Quality and Mental Fatigue on the Learning Rate of Shift Workers with Fast Shift Work Rotation
Authors: Naeini Seyedeh A. B. , Habibi Ehsanollah , Shokrolahi Ismail
Published: December 2022

Background:

Modern industrial societies are always prone to errors and accidents due to complex devices, multitasking, and shift work jobs. Therefore, behavioral tests in learning and memory are necessary to evaluate employees' perceptions to examine the brain's information processing and the physiological and psychological aspects of memory disorders.

Materials and Methods:

In this study, the effect of fast shift rotation, sleep quality, and mental fatigue on individuals' learning and memory was investigated using a maze device. Participants were divided into two groups (regular daytime workers and shift workers). The quality of sleep was assessed using the Pittsburgh Sleep Quality Index (PSQI), and the rate of mental fatigue was evaluated using a checklist published by the Japan Industrial Safety and Health Association.

Results:

Learning time and the number of learning errors at the beginning and end of the morning shifts and night shifts had a significant relationship (P value <0.0001). However, there was no meaningful relationship between sleep quality and time and the number of learning errors in day workers and shift workers.

Conclusion:

The results indicated that although shift workers experience rapid shift rotation, they are still exposed to this circadian sleep change's side effects such as general physical fatigue, sensory-neurological fatigue, poor perceived sleep quality, daily dysfunction, difficulty in learning, and memory. They show a significant difference compared to people working on a regular workday.
Effect of Full-Face and Half-Face Helmet on Functional Vision and Visual Reaction Time
Authors: Kazi Farhatbee N. , Korani Hiral , Chande Prema
Published: December 2022

Background:

Motorcycle helmets are one of the most important protective gears in the automotive industry. However, some riders think they hinder their vision, which leads to helmet non-compliance. Hence, thorough research is required to evaluate the same.

Aim and Objective:

To assess the effect of full-face and half-face helmets on functional vision and visual reaction time (VRT).

Setting and Study Design:

Comparative experimental crossover study.

Methods:

The subjects aged between 18 and 35 years and who gave written consent to participate were included. Functional vision and VRT were assessed with and without the helmets. Helmets tested included a full-face helmet and a half-face helmet.

Results:

A total of 52 subjects aged 20 ± 1.5 years, participated in the study. Of those, 16 were males and 36 were females. The mean stereopsis without any helmet was 44.42 ± 6.3 arcs of second that reduced to 60.57 ± 13.34 arcs of second with a full-face helmet and to 60.38 ± 14.27 arcs of second with a half-face helmet. Repeated-measure analysis of variance showed a significant reduction in stereopsis in both types of helmets (P < 0.05) as compared to without a helmet. However, contrast sensitivity, VRT, and visual field did not show any significant difference (p > 0.05) when compared to the baseline or within the helmet types.

Conclusion:

The visor significantly affects the stereopsis while viewing through it. The study did not find the exact cause of this reduction, and hence, further evaluation is recommended.
The Mental Health of Health Care Workers in the UK During COVID-19
Authors: Chotalia Ravi , Abbas Mohammed J. , Aggarwal Alisha
Published: December 2022

Introduction:

The COVID-19 pandemic had a significant impact on the mental health of health care workers (HCWs).

Aim:

This study investigated the mental health of HCWs working in Leicester, UK during COVID-19.

Settings:

Two hospital trusts in Leicester, UK.

Methods:

An online survey was sent to HCWs in two trusts in July 2020. The Generalized Anxiety Disorder-7 scale (GAD-7) and the Patient Health Questionnaire-9 scale (PHQ-9) were used to measure the prevalence rates of anxiety and depression. The Perceived Stress Scale-14 (PSS-14) was used to measure levels of perceived stress. Other questions were used to identify the prevalence of increased alcohol intake and possible risk factors.

Statistical Analysis Used:

Chi-square test, independent sample t-test, ANOVA, and logistic regression.

Results:

A total of 1009 HCWs completed the survey. Using a cutoff score of 5 (mild symptoms), for both GAD-7 and PHQ-9, 80.2% of participants had at least one condition and 71.5% had both. Using the cutoff score of 10 (moderate/severe symptoms), 27.2% had at least one condition and 27.25% had both conditions. In addition, 37.5% of those who did not report pre-existing mental health conditions now have at least one condition. About 33.6% of participants reported an increase in alcohol consumption. A number of risk factors were identified: having less social support, not feeling supported at work, and poor pre-existing mental health.

Conclusions:

The pandemic had a significant impact on mental health of HCWs. Health organizations need to monitor and address these emerging effects.
Prescription analysis of rheumatology and endocrinology departments of a teaching hospital in Western India
Authors: Yadav Vikas , Jaiswal Sanjay , Shyam Sharan
Published: December 2022

Background:

Prescription analysis is the simplest method to observe the current treatment practice in any health-care setting. Biopharmaceuticals are a class of drugs that hold great promise in treating diseases. In recent years, there has been an increase in their consumption. The present analysis was carried out to obtain data on the prescribing patterns and the prevalence of the use of biologics in two departments of a tertiary care hospital through a cross-sectional study.

Methodology:

The study was conducted as an observational study in the departments of rheumatology and endocrinology of a tertiary care hospital in western India. Data were collected from the prescription notebooks or medical case sheets of patients on treatment in the outpatient departments (OPDs) or wards by the rheumatologists or endocrinologists of the hospital. The World Health Organization core drug use indicators for drug prescription analysis were calculated.

Results:

A total of 4684 drugs had been prescribed in the 874 patient encounters analyzed with the average number of drugs per prescription being 5.36. While 13.3% of prescriptions in the rheumatology department contained a biologic, more than 55% of prescriptions in the endocrinology department contained a biologic. The commonly used biologics were infliximab and etanercept in the rheumatology department and insulin analogs in the endocrinology department.

Conclusion:

The use of eight types of biologics in rheumatoid arthritis patients in this study is an indicator of active monitoring of the disease and early intervention. The present study has brought out the rational use of biologics such as infliximab and etanercept in rheumatology and insulin analogs in the endocrinology departments of the hospital.
The role of lipid profile as an early indicator of preeclampsia
Authors: Gupta Jeevika , Soni Monica , Charaya Harsha , Nayak Asmita
Published: December 2022

Background:

Preeclampsia is called the “disease of theories” because its direct cause is still debated. Among all maternal deaths worldwide, 19% of deaths are due to hypertension during pregnancy (World Health Organization 2014). Early diagnosis and management remain the cornerstone in the management of preeclampsia. Estimation of serum lipid profile early in pregnancy could help to identify high-risk cases prone to preeclampsia, thereby reducing morbidity and mortality associated with preeclampsia. The study aimed to determine the role of serum lipid profile in the early prediction of preeclampsia.

Methodology:

This was a hospital-based prospective study done among pregnant women with a period of gestation of 20 ± 1 week enrolled after screening for inclusion and exclusion criteria and informed consent and institutional ethical committee approval, samples for lipid profile were taken. Patients were divided into two groups (100 each) based on lipid profile – Group A: normal lipid profile and Group B: abnormal lipid profile. Both groups were followed and closely observed for the development of hypertension, albuminuria, and signs and symptoms of preeclampsia. Data were collected and systematically analyzed.

Results:

In Group A, eight participants developed preeclampsia, whereas in Group B, 27 participants developed preeclampsia during the study period. The difference was found statistically significant (P = 0.003).

Conclusion:

In our study, it was observed that dyslipidemia in pregnancy is positively associated with an increased risk of preeclampsia.
Comparison of forearm muscle fatigue among apparently healthy young adults with and without diabetogenic genes
Authors: Pradeep Leander , Jyothish U Karthika , Fernando Rajesh Jeniton , Ravichandran Kandasamy , Das Subhasis
Published: December 2022

Background:

Diabetes is primarily a genetic disorder. Whether the forearm muscle fatigue, handgrip strength (HGS), and phase angle difference between young adults with diabetic genes and their counterparts are not known. We designed a cross-sectional study to compare these variables among young healthy adults with diabetic parents in one group and nondiabetic parents in the other.

Methodology:

Forearm muscle fatigue, HGS, and phase angle were measured in 60 young healthy adults aged 18 to 23 years with body mass index between 18 and 23.4. Among them, 30 had at least one parent who had been a diabetic for more than 3 years and the other thirty had nondiabetic parents (both parents having fasting blood sugar <100 mg/dl).

Results:

The continuous variables between the groups, which were normally distributed, were analyzed using the independent sample t-test. Data that were nonnormally distributed were analyzed using the Mann–Whitney U test. Forearm muscle fatigue of young adults with diabetic parents increased significantly compared to their counterparts (P = 0.005). HGS was greater among adults with nondiabetic parents compared to adults with diabetic parents, although this was not statistically significant. Phase angle did not show any significant difference between the two groups.

Conclusion:

A simple noninvasive measurement like forearm muscle fatigue is found to be increased among young healthy adults with diabetogenic genes when compared to their counterparts without diabetogenic genes. Prospective studies need to be performed to show increased muscle fatigue as a predictor of future incidence of diabetes.
Exploring the discrimination and stigma faced by transgender in Chennai city–A community-based qualitative study
Authors: Kumar Gayathri , Suguna A , Suryawanshi Deodatt M. , Surekha A , Rajaseharan Divya , Gunasekaran Kalaipriya
Published: December 2022

ABSTRACT

Background:

Transgender people experience widespread prejudice discrimination, violence and other harms of stigma and trans-phobia (dislike of or prejudice against trans-sexual or transgender people). To study various modes in which transgenders experience the stigma and discrimination and to understand situations and circumstances under which they are vulnerable toward stigma and discrimination.

Materials and Methods:

The present study was a mixed-method study which was conducted during the months of January to June 2019 among 43 study participants. Focus group discussion and in-depth interview was conducted with these participants with subsequent transcription. Interpretative phenomenological analysis (IPA) was used for analysis.

Results:

Transgenders face discrimination and stigma in various setting including education, employment, healthcare, and various public setting. Difficulties in getting government identity cards (ID), facing difficulties in changing ID cards after transition, discrimination in getting bank loan, homelessness, travelling rejections were considered as major obstacles and discrimination by the study participants.

Conclusion:

Multilevel interventions are needed for transgender populations, including legal protections, improvement of various settings. Inclusive measures should be taken to improve their status focusing on social stigma coupled with psychological pain and economic hardship.
Unwelcomed and devalued: Preachers of exclusion plagiarize from documents of inclusion
Authors: Philip Sharad , Gangwani Nonita , Singh Satendra
Published: December 2022

ABSTRACT

The All India Institute of Medical Sciences (AIIMS), New Delhi published guidelines, titled “Report of the Expert Group for framing Guidelines for admission of candidates with benchmark disabilities in postgraduate courses at AIIMS, New Delhi”, for doctors with disabilities seeking postgraduate admissions to the Institutions of National Importance. The expert group, which lacked representation of people with disabilities, in general, and doctors with disabilities, in particular, puts immense effort into justifying why trainees with disabilities must not join AIIMS, at times in bold and/or capital letters, and at other places, in an outright ableist language. In addition, there is blatant plagiarism from well-known advisories and guidelines which are known for promoting the inclusion of trainees with disabilities. Attitudinal barriers and biases remained incorrigible as sections of these documents were selectively abridged to justify prevailing exclusion practises. We link the connection of these members to the controversial National Medical Council guidelines for undergraduate admission of persons with specified disabilities, which were successfully challenged in courts, as well as to the identification of posts for employment at AIIMS. We justify disability accommodations by citing inclusive court interventions from India to emphasise that the notion of inclusive equality includes the provision for reasonable accommodations. It is high time that the motto “Nothing about us, without us” becomes a locus classicus for immediate change of these discriminatory guidelines, as well as the prescribing powers of such experts.