bluuebunny/crossref_metadata_2025 huggingface dataset:
3D Mapping Reveals a Complex and Transient Interstitial Matrix During Murine Kidney Development
Authors: Lipp Sarah N. , Jacobson Kathryn R. , Hains David S. , Schwarderer Andrew L. , Calve Sarah
Published: April 2021

Significance Statement

ESKD is increasing in incidence and a limited number of organs are available for transplantation. Therefore, researchers have focused on understanding how cellular signaling influences kidney development to expand strategies to rebuild a kidney. However, the extracellular matrix (ECM), another critical component that biomechanically regulates nephrogenesis, has been largely neglected. Proteomics and 3D imaging of the murine kidney resolved previously undescribed dynamics of the interstitial matrix in the cortex and corticomedullary junction during development. Combined with cells and growth factors, scaffolds modeled after the composition and organization of the developmental ECM have the potential to improve engineered models of the kidney.

Background

The extracellular matrix (ECM) is a network of proteins and glycosaminoglycans that provides structural and biochemical cues to cells. In the kidney, the ECM is critical for nephrogenesis; however, the dynamics of ECM composition and how it relates to 3D structure during development is unknown.

Methods

Using embryonic day 14.5 (E14.5), E18.5, postnatal day 3 (P3), and adult kidneys, we fractionated proteins based on differential solubilities, performed liquid chromatography–tandem mass spectrometry, and identified changes in ECM protein content (matrisome). Decellularized kidneys were stained for ECM proteins and imaged in 3D using confocal microscopy.

Results

We observed an increase in interstitial ECM that connects the stromal mesenchyme to the basement membrane (TNXB, COL6A1, COL6A2, COL6A3) between the embryo and adult, and a transient elevation of interstitial matrix proteins (COL5A2, COL12A1, COL26A1, ELN, EMID1, FBN1, LTBP4, THSD4) at perinatal time points. Basement membrane proteins critical for metanephric induction (FRAS1, FREM2) were highest in abundance in the embryo, whereas proteins necessary for integrity of the glomerular basement membrane (COL4A3, COL4A4, COL4A5, LAMB2) were more abundant in the adult. 3D visualization revealed a complex interstitial matrix that dramatically changed over development, including the perinatal formation of fibrillar structures that appear to support the medullary rays.

Conclusion

By correlating 3D ECM spatiotemporal organization with global protein abundance, we revealed novel changes in the interstitial matrix during kidney development. This new information regarding the ECM in developing kidneys offers the potential to inform the design of regenerative scaffolds that can guide nephrogenesis in vitro.
Is Rural Kansas Prepared? An Assessment of Resources Related to the COVID-19 Pandemic
Authors: Berland Hannah , Hughes Dorothy
Published: April 2021

INTRODUCTION. This study investigated rural Kansas healthcare system capacity and critical care-related resources relevant to the care of COVID-19 patients in at the county level in the context of population characteristics.
METHODS. The federal Area Health Resource File was used to assess system capacity and critical care-related resources and COVID-19-related population risk factors at the county level. Data were described with summary statistics, cross-tabulations, and bivariate tests to discern differences across frontier, rural, and urban counties using 2013 Rural-Urban Continuum Code classifications.
RESULTS. Kansas has 105 counties. Urban counties had an average of 2 physicians per 1,000 people, while rural and frontier counties had 1. 63.5% of frontier counties had no anesthesia providers and 100.0% of frontier counties had no pulmonary disease physicians. While 96 counties have at least one hospital, nearly 90% frontier counties had no ICU services. The percent of the population estimated to be over 65 was higher among frontier counties (24.2%) than urban counties (19.3%). On average, frontier counties had approximately twice as many deaths per 1,000 people by cardiovascular diseases and COPD than urban and `rural counties.
CONCLUSIONS. Our findings showed that Kansas faces limited ICU capabilities and physician workforce shortages in frontier counties, both in primary care and specialties such as anesthesia and pulmonology. In addition, rural and frontier population age structures and mortality rates demonstrate an increased risk to potentially overwhelm local healthcare systems. This may have serious implications for rural health, particularly in the context of the COVID-19 pandemic.
SJS/TENN: A Mnemonic for Early Clinical Diagnosis of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis
Authors: Neill Brett , Seger Edward , Ferguson Jessica , Hooton Tyler , Rickstrew Jace J. , Rajpara Anand
Published: April 2021

Steven Johnson Syndrome (SJS) and toxic epidermal necrolysis (TEN) are dermatologic emergencies that are more likely to be encountered by primary care providers rather than dermatologists. Thus, it is essential for all clinicians to be familiar with common signs associated with SJS/TEN, so as not to miss or delay the diagnosis. We designed the simple mnemonic “SJS/TENN” which describes the most frequently seen clinical characteristics in these conditions to aid in the initial diagnosis.
Furuncle of the external auditory canal – a case study
Authors: Buksińska Małgorzata , Skarżyński Henryk , Cyra Kinga
Published: April 2021

Wprowadzenie

Czyrak jest ropnym zapaleniem okołomieszkowym z wytworzeniem martwiczego czopa. Towarzyszy mu silna bolesność okolicy objętej procesem zapalnym. Nieleczony czyrak może powodować przejście stanu zapalnego na okoliczne tkanki.

Opis przypadku

W pracy zawarto studium przypadku pacjenta z czyrakiem przewodu słuchowego zewnętrznego. Pacjent zgłosił się do Instytutu Fizjologii i Patologii Słuchu (IFPS) z powodu silnego bólu lewego ucha. W badaniu przedmiotowym stwierdzono obecność masywnego czyraka przewodu słuchowego zewnętrznego. Z uwagi na znaczne nasilenie dolegliwości czyraka nacięto i opróżniono z treści ropnej oraz wdrożono antybiotykoterapię ogólną. Po tygodniu podczas kontroli stwierdzono prawidłowe gojenie przewodu słuchowego oraz całkowite ustąpienie dolegliwości. Autorzy pracy dokonali przeglądu dostępnej literatury dotyczącej diagnostyki, leczenia oraz możliwych powikłań czyraków przewodu słuchowego zewnętrznego.

Wnioski

Czyraki przewodu słuchowego zewnętrznego nie są rzadkim stanem chorobowym. Charakterystyczny obraz kliniczny pozwala na szybkie rozpoznanie, natomiast rozlany naciek może być początkiem rozległego naciekania i wielu powikłań. Wdrożenie odpowiedniego leczenia miejscowego i ogólnego pozwala na skuteczną terapię. Konieczne jest zwrócenie uwagi na schorzenia ogólne, które mogą predysponować do nawrotu tego schorzenia.
Difficulties in diagnostics of non-organic hearing loss as a manifestation of a conversion disorder- a case report.
Authors: Kapustka Dorota , Szkiełkowska Agata , Domeracka-Kołodziej Anna
Published: April 2021

Wprowadzenie

Psychogenne zaburzenia słuchu są niejednorodną jednostką chorobową, charakteryzującą się obecnością rozbieżności pomiędzy faktycznym progiem słuchu pacjenta a progiem jaki on podaje. Mogą one być manifestacją zaburzeń konwersyjnych, w których nieuświadomione problemy ze sfery emocjonalnej zostają przekształcone w objawy somatyczne. Ten typ psychogennych zaburzeń słuchu stanowi największe trudności diagnostyczne, a większość autorów zgadza się, że jego częstość występowania jest niedoszacowana.

Opis przypadku

Opisywany przypadek dotyczy pacjentki, u której w 12 rż. po traumatycznym przeżyciu wystąpiły problemy ze słuchem. U dziewczynki rozpoznano wówczas obustronny niedosłuch odbiorczy głębokiego stopnia. Pacjentka nosiła aparaty słuchowe, jednak z powodu nawracających zapaleń przewodów słuchowych zewnętrznych, które wystąpiły po kilku latach użytkowania aparatów, zgłosiła się do innej poradni audiologiczno-foniatrycznej. Podczas badań diagnostycznych uwagę lekarza zwróciła zadziwiająco dobra komunikacja z pacjentką bez aparatów słuchowych oraz obustronna obecność odruchów z mięśnia strzemiączkowego. Z tego powodu wykonano badanie emisji otoakustycznych (TEOAE), którego wynik był prawidłowy, oraz badanie potencjałów wywołanych z pnia mózgu (ABR), które wykazało obustronnie progi słyszenia w zakresie normy. U pacjentki rozpoznano psychogenne zaburzenia słuchu. Dzięki szczegółowemu omówieniu diagnozy i wdrożeniu odpowiedniego postępowania, czyli terapii psychologicznej, u pacjentki nastąpiła remisja. Nie wymagała dalszego protezowania słuchu.

Wnioski

Psychogenne zaburzenia słuchu o typie zaburzeń konwersyjnych mogą stanowić trudności diagnostyczne. Nieprawidłowa diagnoza może narazić pacjenta na niepotrzebne cierpienia związane z inwazyjną diagnostyką i leczeniem, a także uniemożliwia wprowadzenie odpowiedniego postępowania jakim jest w tym wypadku psychoterapia. Celem pracy jest przedstawienie trudności diagnostycznych w przypadku psychogennych zaburzeń słuchu o typie zaburzeń konwersyjnych oraz podniesienie świadomości lekarzy na temat tego schorzenia, gdyż wiele doniesień wskazuje na jego niską rozpoznawalność. Autorzy pragną także podkreślić jak ważna dla pacjenta jest odpowiednia procedura audiologiczna umożliwiająca postawienie właściwej diagnozy.
Alternative Water Resources Quality Assessment during Flood Disaster in Kuala Krai, Kelantan, Malaysia
Authors: KOH LIEW SEE , NAYAN NASIR , HASHIM MOHMADISA , SALEH YAZID , MAHAT HANIFAH
Published: April 2021

Quality assessment of water resources is important to ensure the well-being of residents, especially the victims who are affected by floods and having difficulties in obtaining clean water supply when the floods hit. This paper seeks to discuss the quality assessment of water resources in the district of Kuala Krai, Kelantan. Field methods were used to collect water samples during the northeast monsoon season in the month of December 2016/January 2017 involving six well stations, four flood water stations and four rainfall stations. The quality assessment of water resources involved six key parameters, namely DO, pH, BOD, COD, NH3N and SS using the Water Quality Index (WQI) analysis. The results of the analysis showed that the WQI percentage of well and flood water stations accounted for 61.31 to 75.95% which is Class III of moderately contaminated status, except the T6 station that recorded 80.99% of WQI value which is Class II of good status. The findings also showed that all WQI values from the rainwater stations were at 87.85 to 89.10%, which is Class II of good status. This condition explains that the rainwater resources have better quality than the well and flood water resources. With the help of this research, the flood manager’s party can take systematic management measures in ensuring that flood victims receive water supplies during flood events. In this regard, infectious diseases resulted from the consumption of contaminated water among flood victims can be reduced.
Influence of the Oil Phase on the Wound Healing Activity of Sea Cucumber Extract-Based Cream Formulations
Authors: SUNMUGAM THIVIYA , AZHARI HANISAH , NG SHIOW-FERN , AZMI FAZREN
Published: April 2021

Sea cucumbers are attractive marine natural sources as they are enriched with functional biomaterials that can contribute in accelerating wound healing. The present study was carried out to prepare cream formulations comprising extract of sea cucumber with different type of oil phase, namely F1 (olive oil), F2 (tea tree oil) and F3 (lemongrass oil) to assess the influence of the oil on the physicochemical properties and the wound healing efficacy of the creams. The formulated creams showed satisfactory physicochemical characteristics such as homogeneity, spreadability, rheology, pH, and showed no evidence of phase separation even when the creams were kept at extreme conditions. The ex vivorelease profile of sea cucumber extract from the formulated creams was determined by using a Franz diffusion cells. F3 demonstrated a constant and yield the highest release percentage of sea cucumber extract, followed by F2 and F1. Topical application of the formulated creams on the excision wound in rats showed a significant wound healing efficacy compared to the control group. Among the creams formulation, F1 demonstrated a significantly higher rate of wound closure compared to F2, F3, and positive control. The wound healing efficacy of the formulated creams were not dependent on the ability of the oils in promoting skin permeation for the release of sea cucumber extract. This study depicted that lemongrass oil acted as a good skin permeation enhancer for the release of sea cucumber extract while olive oil worked in a more synergistic manner with sea cucumber extract in promoting wound healing.
Simple and Fast Generalized - M (GM) Estimator and Its Application to Real Data Set
Authors: MIDI HABSHAH , ISMAEEL SHELAN SAIED , ARASAN JAYANTHI , MOHAMMED MOHAMMED A
Published: April 2021

It is now evident that some robust methods such as MM-estimator do not address the concept of bounded influence function, which means that their estimates still be affected by outliers in the X directions or high leverage points (HLPs), even though they have high efficiency and high breakdown point (BDP). The Generalized M(GM) estimator, such as the GM6 estimator is put forward with the main aim of making a bound for the influence of HLPs by some weight function. The limitation of GM6 is that it gives lower weight to both bad leverage points (BLPs) and good leverage points (GLPs) which make its efficiency decreases when more GLPs are present in a data set. Moreover, the GM6 takes longer computational time. In this paper, we develop a new version of GM-estimator which is based on simple and fast algorithm. The attractive feature of this method is that it only downs weights BLPs and vertical outliers (VOs) and increases its efficiency. The merit of our proposed GM estimator is studied by simulation study and well-known aircraft data set.
Knowledge representation in russian and european tradition
Authors: Dobrova Victoria V. , Antunes Tatiana Koryakina
Published: April 2021

Knowledge representation is a fundamental question in philosophy, pedagogy, linguistics, psychology and artificial intelligence. This paper examines the achievements in the field of creating knowledge-based systems that exist in Russian and European practice. We employed the methods of cross cultural content analysis and meta analysis to analyze various sources of information, to interpret definitions, and to increase the validity of the conclusions. The following problems are highlighted: the definition of knowledge and its types; the interplay between knowledge itself, its representation, and the physical world; approaches to knowledge representation; representation schemas for procedural and declarative knowledge types. The findings of the research illustrate that in Russian science, the problem of knowledge representation is associated with the problem of knowledge as such and its representation in our psyche, in contrast to European practice where the problem is considered to be purely applied. Theoretical contributions and practical implications discussed in the paper contribute to the problem of knowledge representation and prove the efficiency of combination of both discussed approaches.
Students‘ attitudes in the perception of broadcast advertising meanings
Authors: Belousova Ekaterina E.
Published: April 2021

The aim of the research presented in the paper is the empirical study of the semantic attitudes and life meanings of students in the perception of advertising posters. Advertising impact is viewed as a process of broadcasting the meanings concentrated in advertising posters. The study sample consisted of 80 students from two universities (Rostov-on-Don, Russia). To determine the severity of life meanings, the method of life meanings was used by V.Yu. Kotlyakov (V.Yu. Kotlyakov, 2003), the method of expert assessments was used to study advertising posters. The results were processed using the methods of mathematical statistics: descriptive statistics were used; as well as nonparametric tests for comparing several independent samples, the Kruskal-Wallis H-test, for studying the relationships between the scales of V.Yu. Kotlyakov and the assessment of advertising posters by the respondents used the Spearmans rank correlation coefficient. It was shown that in the process of broadcasting meanings in advertising posters, students semantic attitudes are actualized. The sample of students showed a tendency to evaluate advertising posters in accordance with the dominant meanings of life. It is shown that there is a relationship between the dominant life meanings of students and the ratings of advertising posters.
The technology of formation of teamwork skills in terms of project-based learning students
Authors: Lipatova Svetlana D. , Khokholeva Evgeniya A.
Published: April 2021

Each era has its own requirements for the level of competence formation of employees. The fourth industrial revolution focuses on the development of human potential. One of the forms that allow us to reveal the potential capabilities of the individual is project activity.

This paper presents the experience of developing team work skills among university students. The paper analyzes the possibility of using project activities for the development and improvement of team work skills in order to implement a modern competence-based approach in higher education. The paper describes the technology of forming team work skills. On the basis of the conducted research, promising opportunities for the implementation of teamwork in the educational environment were identified, as well as problematic aspects of this type of activity were identified.

The purpose of this paper is to describe the experience of implementing the technology of forming students teamwork skills in the format of project training.

Methodology. The study was conducted using the test method of V. Stefanson Q-sorting, a formative experiment in the format of students project activities and the authors questionnaire Students attitude to teamwork in the conditions of project activities, mathematical methods of analysis.

Results. The technology of forming team work skills in the framework of project training of university students has been tested. As a result, it was revealed that project training has a complex impact on the formation of teamwork skills, this was noted by 83.5% of respondents.

Conclusion. Project activity in the educational environment not only forms the skills of teamwork, but also is a tool for creating positive attitudes of students to team activities, which indicates the wide resource possibilities of this form of work.
Ensino de Geología Ambiental no ambiente urbano
Authors: Alves Carlos
Published: April 2021

As restrições financeiras no ensino superior têm afetado diversas áreas de estudo e seus efeitos podem ser considerados particularmente perniciosos para os temas que precisam de trabalho de campo, como é o caso da Geologia. Nestas circunstâncias, a utilização de recursos locais merece especial atenção. Neste trabalho são apresentados alguns exemplos potencialmente interessantes para o ensino de Geologia Ambiental e que dizem respeito a observações de geologia local e de estruturas construídas. Os exemplos de observações da geologia local incluem afloramentos expostos por meteorização e erosão, bem como exposições resultantes de intervenções humanas. Estas últimas poderão permitir o estudo de porções não disponíveis de outra forma e, potencialmente, em uma perspetiva 4D (espaço + tempo) que inclui a criação de condições que favorecem a observação de situações dinâmicas como movimentos de massa ou variações do lençol freático. As observações de materiais geológicos e análogos de processos geológicos em estruturas construídas pode ajudar a superar algumas das limitações da geologia local e também pode ser considerado como parte dos estudos geológicos relevantes no contexto do Antropoceno.
Consideraciones previas sobre las formas del tipo tafone y otras estructuras menores en la vertiente Norte del Pão de Açúcar, Rio de Janeiro - Brasil
Authors: Rodrigues Waldherr Felipe , Vidal-Romani Juan Ramón , De Oliveira Rodrigues Sérgio Willians
Published: April 2021

Las cavidades tipo tafone en los afloramientos rocosos granítico-gnéisicos de Rio de Janeiro habían pasado inadvertidas hasta ahora para los investigadores a pesar de ser formas frecuentes tanto en las zonas costeras como en las montañosas adyacentes. Poco se ha discutido, hasta ahora, sobre el origen de estas formas en Brasil atribuidas habitualmente a la alteración subedáfica y subaérea. Este trabajo presenta una breve descripción de las cavidades del tipo tafone encontradas en la pared norte del domo Pão de Açúcar y discute otras hipótesis genéticas alternativas a las habituales para estos rasgos geomorfológicos característicos del basamento granítico-gnéisico del sureste brasileño.
Comparación de propiedades petrográficas y petrofísicas de tres fragmentos escultóricos para determinar su pertenencia al sepulcro de Nuno Freire de Andrade II (siglo XIV)
Authors: Freire-Lista David Martín
Published: April 2021

Tres fragmentos de piedra que representan una cabeza, un cuerpo y una tapa de sarcófago atribuidos a la lauda de Nuno Freire de Andrade II, Gran Maestre de la Orden de Cristo del siglo XIV, fueron analizados para determinar sus propiedades petrográficas, velocidad de propagación de ondas de ultrasonido y color. Los resultados indican que las piedras corresponden a tres tipos litológicos con distinta petrografía, velocidad de propagación de ondas P, color y variación de color entre secas y húmedas. El fragmento de la cabeza corresponde a un ortogneis, el del cuerpo a una granodiorita y el de la tapa de sarcófago a un leucogranito. A partir de estos datos se infiere que ninguno de los tres fragmentos ha formado parte de la misma lauda, ya que las tapas de sarcófagos medievales gallegas talladas en granito estaban hechas en un único bloque de piedra.
Recrear el selfie
Authors: Martínez Eiriz Sabela
Published: April 2021

Este artículo aborda la enseñanza de la fotografía contemporánea a través de la reflexión conceptual y de la creación fotográfica en un contexto capitaneado por las redes sociales rebosantes de imágenes, en el que la intimidad y la auto–representación tienen un papel fundamental. Se trata de una investigación educativa basada en las artes desarrollada a través de tres aciones artísticas en las que el alumnado reflexiona –con palabras y con imágenes– sobre los usos de las redes sociales y su influencia en las prácticas artísticas contemporáneas, la exhibición de la intimidad, el relato fotográfico y la proyección de la identidad a través de la fotografía.
The Motion of Out-of-Plane Equilibrium Points in the Elliptic Restricted Three-Body Problem at J4
Authors: Singh Jagadish , Richard Tyokyaa K.
Published: April 2021

We have investigated the motion of the out-of-plane equilibrium points within the framework of the Elliptic Restricted Three-Body Problem (ER3BP) at J4 of the smaller primary in the field of stellar binary systems: Xi- Bootis and Sirius around their common center of mass in elliptic orbits. The positions and stability of the out-of-plane equilibrium points are greatly affected on the premise of the oblateness at J4 of the smaller primary, semi-major axis and the eccentricity of their orbits. The positions L6, 7 of the infinitesimal body lie in the xz-plane almost directly above and below the center of each oblate primary. Numerically, we have computed the positions and stability of L6, 7 for the aforementioned binary systems and found that their positions are affected by the oblateness of the primaries, the semi-major axis and eccentricity of their orbits. It is observed that, for each set of values, there exist at least one complex root with positive real part and hence in Lyapunov sense, the stability of the out-of-plane equilibrium points are unstable.
Desigualdad de género en la participación laboral y remuneraciones en el grupo de países CID
Authors: Martínez André , Ugarte Fadel , Zentner Joaquín
Published: April 2021

La desigualdad en la participación laboral de las mujeres y su menor remuneración relativa, en comparación con los hombres, representa una de las principales fuentes de inequidad de género observada en los países de América Latina, y de los países del grupo CID en particular. Si bien es cierto, las brechas en participación laboral femenina se han reducido en las últimas tres décadas, dicha reducción ha sido apenas de 7 puntos porcentuales a nivel mundial, por lo que se vuelve necesario analizar cuáles son los factores que afectan la participación laboral femenina en la región para diseñar políticas públicas que ayuden a eliminar estos obstáculos. A partir de un modelo de Heckman para las mujeres en los países CID, encontramos evidencia que sugiere que la vida conyugal se asocia con reducciones de 19% en la probabilidad de estar ocupadas y de cerca de 17% en su remuneración real por hora trabajada. La maternidad también se asocia con reducciones en ambas variables, por 5.5% y 6.3%, respectivamente. En las parejas en las que la mujer tiene mayor número de años de escolaridad aprobados, el efecto negativo de la vida conyugal sobre su participación laboral se mitiga en 0.8%. El modelo también refleja la importancia de la educación, como indicador de capital humano, para incrementar las oportunidades de participación laboral de las mujeres y su ingreso salarial.
Dexamethasone as an Adjuvant to 0.5 % Ropivacaine for Ultrasound Guided Supraclavicular Brachial Plexus Block
Authors: Mehta Shweta Saurin , Patel Nidhiben Sureshbhai
Published: April 2021

BACKGROUND Supraclavicular brachial plexus block is a reliable, regional anaesthetic technique for upper limb surgeries. Also known as “spinal of upper limb”.1 The present study was conducted to assess the analgesic efficacy of dexamethasone as an adjuvant to 0.5 % ropivacaine for ultrasound sonography (USG) guided brachial plexus block. METHODS 50 adult patients of American Society of Anaesthesiologists (ASA) physical status I and II of both genders, aged 18 - 50 years scheduled for elective upper limb surgeries under brachial plexus block via supraclavicular approach were randomised into 2 groups of 25 patients each to receive either 20 ml of 0.5 % ropivacaine with 2 ml of normal saline (group A) or 20 ml of 0.5 % ropivacaine with 2 ml of dexamethasone (8 mg) (group B). RESULTS Use of ultrasound helps in better visualisation of nerves, needle & spread of local anaesthetic at brachial plexus block site. So, less amount of drug volume is required for the block. Time of onset of sensory and motor block was significantly lower in group B compared to group A. Mean duration of motor and sensory block was significantly longer in group B than group A. The duration of postoperative analgesia was 18.79 ± 2.31 hours in group B & 9.06 ± 0.35 hours in group A, with statistically highly significant difference (P < 0.05). There were no perioperative haemodynamic variations between the two groups and no complication of technique or adverse effects due to dexamethasone occurred. CONCLUSIONS Dexamethasone 8 mg has significantly extended duration of analgesia of brachial plexus block with no adverse effects. KEYWORDS Brachial Plexus Block, Ropivacaine, Dexamethasone, Supraclavicular Approach, Ultrasound Guidance
Diversity and Prevailing Antimicrobial Resistance in Blood Stream Pathogens at NICU of a Tertiary Care Institute in Kolkata
Authors: Pal Nandita , Dolui Sanat Kumar , Majhi Bhuban , Das Manisha
Published: April 2021

BACKGROUND Septicaemia is a leading cause of morbidity and mortality in neonates. Antimicrobial prescription for neonatal septicaemia (NS) should be wisely used depending on the regional spectra of infecting microbes and their antimicrobial resistance (AMR) patterns which vary over time, place and host factors. METHODS This was a descriptive cross-sectional study conducted from January 2017 to June 2017 among 102 cases of NS admitted in neonatal intensive care units (NICU). Demographic data of the concerned neonates was collected through a predesigned checklist. Blood collected from neonates was processed for culture and sepsis screen. Antimicrobial susceptibility testing was performed for the cultured isolates and phenotypic AMR patterns were observed. RESULTS Most of the studied neonates had subnormal birth weight (86). Blood culture showed predominance of gram-negative bacilli (GNB) among which Klebsiella pneumoniae was the most common followed by Burkholderia cepacia complex. Coagulase negative staphylococcus species (CoNS) was most numerous among the cultured gram-positive cocci (GPC). Candidemia of late onset was confirmed in 25 neonates. Early onset sepsis was predominantly caused by GNB (29 / 31) predominated by Klebsiella pneumoniae. Multi drug resistant (MDR) pathogens viz., extended spectrum beta-lactamase (ESBL) producing GNB, carbapenem resistant-GNB (CR-GNB) and methicillin resistant staphylococcus (MRS) phenotypes were notably prevalent. CONCLUSIONS Multidrug resistant microorganisms are notably prevalent in neonatal septicaemia. In clinically suspected very sick septicaemic neonates not showing much improvement with guideline-led empirical antimicrobial therapy, an early antibiogram guided change over to meropenem and amikacin or even to colistin in case of reported carbapenem resistance, is highly recommended. KEYWORDS Antimicrobial Resistance, Blood Culture, Multi Drug Resistance, Neonatal Septicaemia
Efficacy of Quantitative Troponin I in Predicting Cardiovascular Outcome in ST Segment Elevation Myocardial Infarction / Non-ST Segment Elevation Myocardial Infarction (STEMI / NSTEMI) Patients - A Retrospective Study from a Centre in South India
Authors: George Jisa , A.R Malathy
Published: April 2021

BACKGROUND Cardiac biomarkers like troponin play a very important role in the diagnosis of acute myocardial infarction. In a developing country like India, though the burden of cardiovascular diseases is on the rise, majority of the patients with acute coronary syndrome do not have access to primary percutaneous coronary intervention (PCI) facilities. Few Indian studies have looked into the utility of the quantitative troponin levels in predicting the cardiovascular outcome of non-ST segment elevation myocardial infarction / ST segment elevation myocardial infarction STEMI / NSTEMI patients; this study was conducted to find out the same. METHODS A retrospective analysis of the medical records of intensive care units (ICU) patients more than 18 years of age admitted with diagnosis of STEMI / NSTEMI for a duration of 12 months was done. The comorbidities, treatment, coronary artery disease (CAD) risk factors, cardiovascular complications and quantitative troponin levels were noted. RESULTS Retrospective analysis of 124 patient records was done which revealed that 74.8 % presented with STEMI and the rest were diagnosed to have NSTEMI. 39.5 % were hypertensive and 47 % were diabetic. The mean troponin values were higher in the patients who died and developed cardiac complications like left ventricular failure and cardiogenic shock. However, statistical significance was seen only for troponin values and left ventricular failure (LVF). CONCLUSIONS The quantitative levels of a simple biomarker like troponin I used for the diagnosis of acute myocardial infarction could also be used to predict the cardiovascular outcome and prognosis of the patient. A higher baseline troponin value during the diagnosis could possibly alert the treating primary physician for a referral to a specialised cardiac centre and likely need for early revascularisation, which is of importance in a developing country like India with compromised resources. KEYWORDS Quantitative Troponin I, STEMI, NSTEMI
Bacteriological Profile and Antibiogram of Blood Culture Isolates from Septicaemic Neonates and Children up to 10 Years of Age, in a Tertiary Care Centre of Eastern Bihar in India
Authors: Biswas Priyanka Paul , Akhter Kahkashan , Sen Aninda , Umesh Umesh , Chand Mohammad Intekhab Alam
Published: April 2021

BACKGROUND This study was an attempt to find the association of physical parameters, risk factors, common signs & symptoms of septicaemia, analyse the distribution of microorganisms isolated from clinically suspected cases of septicaemia, and collect their antibiogram. We also wanted to evaluate the haematological findings in conventional culture, correlate them to the sensitivity and specificity, and quantitatively identify the relevance of these haematological tests through their positive and negative predictive values. METHODS A total of 350 blood samples were received from patients with clinically suspected cases of blood stream infections (BSI) at the Department of Microbiology for routine culture & sensitivity and were processed using standard microbiological techniques to determine the percentage distribution of bacterial pathogens causing BSI and their antibiotic susceptibility patterns. Mueller-Hinton agar (MHA) with 4 % NaCl was used to detect methicillin resistance. RESULTS Of the 350 septicaemic cases, 58.8 % were from neonatal ICU and 41.2 % were from paediatric wards. Maximum culture positivity (45.3 %) was seen in < 28 days age group. Bacterial growth was seen in 62.0 % preterm babies. Probability of sepsis was more with leukopenia (85.4 %) as compared to leucocytosis (68.9 %); positive C-reactive protein (CRP) findings (63.8 %) were more likely to be associated with sepsis as compared to negative CRP findings (2.1 %). Leukopenia (97.5 %) and leucocytosis (96.3 %) had the highest specificity values. CONCLUSIONS Low birth weight (LBW) neonates, preterm birth and Caesarean section deliveries are risk factors that predispose neonates to septicaemia. Meropenem can be used in septaemia, but it should be reserved for critical cases, particularly those with multidrug resistant (MDR) bacteria, rather than on routine basis to prevent inadvertent promotion of bacterial resistance. This study showed that leukopenia and CRP are good indicators of sepsis, when used in combination. KEYWORDS Blood Stream Infection, Early Onset Septicemia, Late Onset Septicemia
Reticulocyte Parameters in Microcytic Hypochromic Anaemias Using Beckman Coulter DxH800 – A Study from Kerala, India
Authors: Thomas Blessy Mary , Das Sheila , Antony Sunil , David Alice
Published: April 2021

BACKGROUND Microcytic hypochromic anaemia is commonly due to iron deficiency, anaemia of chronic disorder [ACD] and thalassaemic syndromes. Reticulocyte count reflects the erythropoietic activity of bone marrow and is thus useful in both diagnosing anaemias and monitoring bone marrow response to therapy METHODS All samples were selected from routine blood counts, and sent for investigation of anaemia, over a period of two years. These samples were run on the DxH800 (Beckman Coulter). 385 cases were selected for the study. Blood analysis for all these cases had been requested by general practitioners to investigate anaemia. These blood samples had been collected in ethylenediaminetetraacetic acid (EDTA) anticoagulant vacutainers and processed within 2 hours of collection. Determination of red cell and reticulocyte parameters in all blood samples, was performed using the Beckman Coulter 7-part analyser [Unicell DxH 800]. RESULTS Of the 156 cases of microcytic hypochromic anaemia studied, iron deficiency anaemia (IDA) was present in 91 cases, anaemia of chronic disorder (ACD) in 50 cases, beta thalassemia trait (BTT) in 15 cases. Of the 50 ACD cases, 37 were associated with IDA. The control group comprised of 229 adult medical students (143 women and 103 men) with a median age of 18.84 ± 0.98 years. We also had 4 cases of other haemoglobinopathies, which were microcytic hypochromic, but were not included in our study as the number of cases was too less to be analysed. CONCLUSIONS New reticulocyte parameters are useful for evaluation of iron status and diagnosing iron deficiency anaemias. They also are reliable parameters for recognising subsets of anaemic patients thereby improving the management of anaemia. KEYWORDS Reticulocyte, Microcytic, Hypochromic, Anaemia, Beckman Coulter
A Prospective Observational Study on Efficacy of Ilizarov External Fixation in Infected Non-Union Tibial Fractures
Authors: Gundavarapu Avinash , Singh Vishal , Mishra Prashant Kumar , M Santhosh Kumar
Published: April 2021

BACKGROUND Open fractures and fractures caused by high-energy trauma are likely to get infected and result in non-union. Infected non-union of long bones is a problem in developing countries like India. Ilizarov external fixator was employed to correct all the complications associated with non-union such as bone gap, infection, shortening, and deformities. Stable fixation, corticotomy and bone transport was employed to reduce or eliminate infection at the same time achieving bone union and correction of limb length discrepancy. Our study assesses the efficacy and safety of Ilizarov external fixation in patients with infected non-union tibial fractures. METHODS A series of 30 patients with infected non-union of tibia were treated with Ilizarov external fixation in Yashoda super speciality hospital and regularly followed-up between May 2014 and April 2016 (2 years). Bony and functional results were estimated and correlated with existing studies. RESULTS Out of thirty patients treated, bony results were excellent in 17 patients, good in 8 patients, fair in 4 patients and poor in 1 patient. Functional results were excellent in 17 patients, good in 5 patients, fair in 5 patients, and poor in 3 patients. Average duration of the fixator period was 8.1 months (min - 3 months, max - 14 months). Average length of regenerate was 3.64 cm (min - 2 cm, max - 6 cm). Average lengthening index in the study was 2.09 months / cm. Our study in all 4 categories of Association for the Study and Application of Methods of Ilizarov (ASAMI) criteria had approached Dror Paley’s Bony results and functional results. CONCLUSIONS In our study results have been encouraging in addressing all the complex problems by Ilizarov principle. Ilizarov external fixator system is the best device to treat infected non-union of tibia. Distal third of tibia is more prone for infection and non-union. Corticotomy or bone grafting is required for augmentation of the healing process. Almost all patients had varying degrees of oedema and pin track infections. Infection was controlled in all the cases and bony union was achieved, no patient had persistence of non-union and infection at the end of 2 years. KEYWORDS Ilizarov External Ring Fixator, Infected Non-Union, ASAMI Criteria, Bony Results, Functional Results, Bony Union
Comparison of Three Different Doses of Nalbuphine as Adjuvant to Intrathecal Hyperbaric Bupivacaine in Knee Joint Surgeries
Authors: Pradhan Amit , Kusumanchi Ranjitha , Padhi Pulak Priyadarshi , Das Saswati
Published: April 2021

BACKGROUND Postoperative pain is the most challenging task in patients undergoing knee joint surgeries under spinal anaesthesia. Spinal anaesthesia with bupivacaine provides adequate intraoperative conditions but falls short in providing prolonged postoperative pain relief. Intrathecal opioids are synergistic with local anaesthetics and intensify the sensory block without affecting the sympathetic block. This study intends to compare three different doses of intrathecal nalbuphine as an adjuvant to 0.5 % hyperbaric bupivacaine and determine the optimal dose in knee joint surgeries. METHODS A double-blind comparative study was conducted in one hundred and twenty American Society of Anaesthesiologists (ASA) I and II patients undergoing knee joint surgeries in a randomised prospective way. The patients were randomly allocated to A, B, and C groups who received 0.4, 0.8 and 1.2 mg nalbuphine respectively added to 12.5 mg of 0.5 % hyperbaric bupivacaine. The onset, duration of block, duration of effective analgesia, Visual Analogue Scale (VAS) score, and the incidence of adverse effects were studied and compared between the groups. RESULTS The mean onset time of sensory and motor block of group B and C was significantly faster as compared to the onset in group A. The duration of sensory, motor blockade and duration of analgesia were highest with 1.2 mg of nalbuphine followed by 0.8 and 0.4 mg (P < 0.05). VAS readings were comparable in all the groups. Hemodynamic variability among the three groups was comparable. Incidence of adverse effects was highest in group C when compared with others, although it was statistically insignificant (P > 0.05). CONCLUSIONS Nalbuphine in a dose of 0.8 mg when added to 0.5 % hyperbaric bupivacaine for subarachnoid block in patients undergoing knee joint surgeries provides excellent analgesia, prolonged duration of sensory block and motor block, with minimal adverse effects. KEYWORDS Local Anaesthesia, Opioid, Postoperative Pain, Orthopaedic Surgeries
Role of MRI in the Evaluation of Adnexal Masses - A Prospective Study
Authors: Subramanyam Aswini Jyothi Jayam , Cheedalla Surya Prakash , Bulkapuram Vanaja , Madireddy Veena , Kumari Vijaya
Published: April 2021

BACKGROUND Among all the disorders of female reproductive system, adnexal masses are one of the most common disorders. The main purpose of the study was to evaluate an adnexal mass and to differentiate the mass as benign or malignant and facilitate selection of appropriate treatment algorithm. For few benign lesions, radiological follow-up is very suitable for further management and additional follow-up may not be useful when an imaging abnormality is not found. METHODS Our study was conducted in Osmania General Hospital and its allied hospital named Government Maternity Hospital, Hyderabad, on about 150 patients. This is an institution-based, multicentric, cross-sectional, prospective, analytical study. All clinically suspected female patients with adnexal masses referred to the Department of Radiodiagnosis were evaluated. These patients were first subjected to ultrasonography, followed by magnetic resonance imaging (MRI) (plain and contrast wherever required). MRI findings were compared with ultrasonography. These findings were compared with operative findings and histopathological findings, wherever performed. RESULTS In the present study, females in the age group of 21 – 40 years showed majority of pelvic lesions - 81 (54 %). Most of the pelvic masses were arising from the ovary - 102 (68 %). Majority of the adnexal lesions on MRI were benign in nature - 132 (88 %). MRI showed a sensitivity of 100 %, specificity of 97.7 %, and a positive predictive value of 83 %, & a negative predictive value of 100 %. CONCLUSIONS In practice, ultrasonography (USG) is the primary modality for diagnosing the pelvic mass. MRI is superior to ultrasound and can be used as problem solving technique in the assessment of pelvic mass. The multiplanar imaging capability allows accurate identification of origin of mass and characterisation of mass. This is helpful to the preoperative planning of sonographically detected mass and avoids surgery in possible cases. MRI is the technique of choice for staging, treatment planning and post treatment follow-up of pelvic malignancies. KEYWORDS MRI, USG, Adnexal Masses, Ovarian Masses, Board Ligament Lesions, Fallopian Tube Lesions, Cysts
Prevalence of Soil Transmitted Helminthic Infections among Adolescent Girls in a Residential School of North Coastal Andhra Pradesh
Authors: Venkata Siva Priya Jalakam , Bhimarasetty Devi Madhavi , Kajana Phani Madhavi
Published: April 2021

BACKGROUND Intestinal helminthic infections are endemic worldwide. In developing countries like India these contribute to a major morbidity among children. Factors like poverty, lack of proper sanitation, hygiene, illiteracy, hot and humid tropical climate play a role in the transmission of these infections. Under RMNCH + A (child health) school children were receiving biannual albendazole in the months of February and August. We wanted to assess the prevalence of soil transmitted helminthic infections (STHI) among adolescent school children in a residential welfare school. METHODS A cross-sectional study was conducted in the month of October 2018 in rural field practice area of the Department of Community Medicine, Andhra Medical College, Visakhapatnam. The study was done in a residential welfare school for girls in peri urban areas of Visakhapatnam. The study was done among 96 girls who were present in the school during the days of survey by using systematic random sampling after obtaining informed consent. A pretested interview schedule was used to collect data. Microscopic stool examination for ova / cyst and haemoglobin estimation was done for all the study subjects. Data was entered in Microsoft Excel and analysis was done by Statistical Package for Social Sciences (SPSS version 21). RESULTS The mean age of the subjects was 13.41 ± 1.07 years, with age ranging from 12 to 15 years. About 19 % (19.8 %) of the study subjects were found to have STHI on microscopic stool examination. Among them about 68 % of the study subjects were found to have Ascaris lumbricoides followed by Trichuris trichiura (32 %). Mean haemoglobin level was 9.73 + 1.06 (g / dl). On statistical analysis, no significant difference was found between presence of infection and variables like anaemia (P = 1), open air defecation (P = 0.51), nail biting (P = 1), presence of symptoms (P = 1) and pica (P = 0.75). CONCLUSIONS Helminthic infections burden is still high in the school children KEYWORDS Adolescent School Girls, Anaemia, Soil Transmitted Helminthic Infections (STHI’s), Residential School, Visakhapatnam
Clinical Profile and Prediction of Response to Treatment in Childhood Epilepsy - A Single-Centre Experience from Eastern India
Authors: Ghosh Prakash Chandra , Bera Mitali , Barma Punyabrata , Roy Arijit , Majumder Sananda , Guin Debshankar , Pandit Alak , Ganguly Gautam
Published: April 2021

BACKGROUND Though epilepsy remains a significant problem for children and adolescents in our country, studies delineating the clinical profile and response to treatment in childhood epilepsy are lacking. The current study was carried out for obtaining a baseline profile and to predict the response to treatment in childhood epilepsy in India that may be helpful in planning management strategies from a public health point of view. METHODS Patients with clinical suggestion of active epilepsy (N = 141) from one month to 12 years, were enrolled into the study over a period of 1 year (February 2010 to January 2011) from the out-patient department and epilepsy clinic of Bangur Institute of Neurology. Detailed history was taken along with neurological examination. Electroencephalography (EEG) and neuroimaging (MRI / CT scan) were done on all patients. Each patient included in the study was kept in followup for a period of 6 months and their response to the treatment was recorded. RESULTS About 48.9 % (N = 69) patients had localisation related epilepsy while the rest had generalised epilepsy. Of those with generalised epilepsy, generalised tonicclonic seizures (GTCS) was by far the most common type. Of those with focal EEG activity, the highest proportion (50 %), were localised to the temporal lobe. Symptomatic aetiology accounted for 59.6 % (N = 84) of the patients. 20.6 % (N = 29) had poor response to treatment at 6 months follow-up. Abnormal neuroimaging (OR = 6.708) and abnormal EEG (OR = 6.357) were effective factors in predicting poor response to treatment. CONCLUSIONS Our study highlights the need to link specialised epilepsy services with primary health centres for early detection and treatment. EEG is an essential cost-effective modality in determining seizure localisation and response to treatment. KEYWORDS Paediatric, Epilepsy, Clinical Profile, Response to Treatment