bluuebunny/crossref_metadata_2025 huggingface dataset:
Apremilast in Erythema Nodosum Leprosum: A Case Series
Authors: Mandloi Usha , Gogia Neha , Sonare Durgesh , Waghmare Swagat
Published: July 2024

Erythema nodosum leprosum (ENL) is an immune-mediated inflammatory reaction (antigen-antibody reaction involving complement) of leprosy. Available standard treatment in the form of steroids or thalidomide does not work in all ENL patients. Apremilast is an oral phosphodiesterase-4 inhibitor with potent immunomodulatory action. At present, apremilast is approved for chronic plaque psoriasis and psoriatic arthritis, however, not in ENL. The aim of this study was to assess the effectiveness of apremilast in chronic recalcitrant ENL. It was a case series, in which apremilast was started in 10 consecutive patients with recalcitrant ENL with 10 mg morning dose with a daily increment of 10 mg until day 6, when the recommended dose of 30 mg twice daily for adults is reached. Follow-up was done every 1 month till 6 months. Three patients showed good responses. The drug was well tolerated with few side effects. The most common adverse effect reported was headache (n = 5), followed by nausea (n = 4) and diarrhea (n = 4). Apremilast has lower cost and better safety profile compared to thalidomide and may be an option with limited effectiveness for ENL.
Tildrakizumab in Psoriasis and Beyond
Authors: Bubna Aditya K. , Patil Nitin
Published: July 2024

Background:

Tildrakizumab is an interleukin-23p19 inhibitor, approved by the Food and Drug Administration for the management of moderate-to-severe plaque psoriasis.

Purpose:

This review aims to describe the dermatological implications and applications of tildrakizumab.

Methods:

PubMed and Google Scholar were searched for scholarly articles related to tildrakizumab and its utility in dermatology using the search terms “Tildrakizumab” AND “Psoriasis” AND “other dermatological disorders.”

Results:

Tildrakizumab is a valuable biologic agent for the management of psoriasis. It has also been successfully used for other dermatologic disorders such as hidradenitis suppurativa, lichen planus, pityriasis rubra pilaris, lupus erythematosus tumidus, and pyoderma gangrenosum.

Conclusion:

Tildrakizumab’s usage is not limited to psoriasis. Its benefit extends to many more dermatologic conditions. Besides, it has an acceptable safety profile.
Outcomes in Older Inpatients with Hyperkalemia: A Follow-up Observational Study
Authors: Ramesh Bharathi , Felix Reuben Jerrald , Viggeswarpu Surekha , Belavendra Antonisamy
Published: July 2024

Objectives:

Hyperkalemia is a common electrolyte disturbance encountered in hospitalized older patients secondary to age-related physiological changes in the kidneys, multiple comorbidities, and the burden of multiple medication usage. Metabolic acidosis, rhabdomyolysis, and tumor lysis syndrome cause the shift of potassium into the extracellular space. This contributes to hyperkalemia. This study aims to determine the outcomes in patients with hyperkalemia admitted to a tertiary care center and to list the factors contributing to the development of hyperkalemia in these patients.

Methods:

This was a prospective observational study conducted among older inpatients (≥60 years of age) admitted to the geriatric and medical wards in a tertiary care hospital. The patients with hyperkalemia were followed up till discharge or death.

Results:

Among the 225 study participants who presented with hyperkalemia, the mortality rate was found to be 22.2%. In the multivariate analysis, older people aged more than 70 years (P = 0.007) and those who were male had a significantly higher mortality (P = 0.009). The use of angiotensin-converting enzyme inhibitors (ACEIs) (P = 0.049) and beta-blockers (P = 0.02) was significantly associated with the development of hyperkalemia.

Conclusions:

ACEIs and beta-blockers increased the risk of developing hyperkalemia in the study population. Hyperkalemia was found to be associated with an increase in mortality, especially in the very old (>70 years) and in males.
Frailty and Associated Factors in the Elderly: A Cross-sectional Study from a Tertiary Care Hospital of Northeast India
Authors: Modi Tanmoy , Devi Th. Shanti , Deb Abhik , Das Abhijit , Majumder Abhishek Paul
Published: July 2024

Background:

Despite the unfavorable impact of frailty on the health of the elderly, research on frailty in Northeast India remains scarce. This study aimed to assess the prevalence of frailty among elderly inpatients and identify associated factors.

Subjects and Methods:

This cross-sectional study was conducted among 200 elderly (above 60 years of age) inpatients at a tertiary care hospital. A semistructured pro forma was used to collect data on sociodemographic details and other laboratory parameters. The Fried frailty phenotype was used to assess frailty. Quantitative data were presented as means ± standard deviation, whereas qualitative data were presented as frequency and percentages. The Chi-square/Fisher’s exact test was applied to determine the association, and P < 0.05 was considered statistically significant.

Results:

The majority of the study participants were male, <70 years, and had a caretaker at home. The proportion of frail among the hospitalized elderly was 50% (95% confidence interval = 42.87%–57.13%). The rest 49.5% were categorized as robust and 0.5% were categorized as prefrail. Frailty was significantly associated with increased age, status of presence of caretaker, addiction, and higher body mass index. Comorbidities such as hypertension, chronic kidney disease, stroke, anemia, diabetes, chronic pulmonary disease, ischemic heart disease, and malignancy were also significantly associated.

Conclusions:

Frailty is a significant concern among hospitalized elderly individuals. Further research is needed to identify effective interventions to alleviate its impact. Community-level studies should elucidate the relationship between modifiable risk factors and frailty, aiming to enhance the quality of life for our aging population.
Fever in Older Persons
Authors: Maini Aseem , Singh Amanpreet , Kaur Baldeep , Goel Ashish
Published: July 2024

Fever in older adults poses unique challenges due to atypical symptoms, weakened immune responses, and comorbidities. This chapter explores the diverse presentations of fever in the elderly, emphasizing the importance of vigilant monitoring and tailored interventions by healthcare providers and caregivers. Challenges in temperature measurement, communication barriers, and polypharmacy further complicate fever management. The chapter discusses the differences between fever presentations in young and older individuals and addresses the complexities of managing fever in long-term care facilities. In addition, it highlights fever of unknown origin in older persons, stressing the need for timely diagnosis and tailored investigations. Finally, preventive strategies, including vaccination campaigns and infection control measures, are proposed to mitigate fever occurrences in older adults.
Inferior alveolar nerve block anesthesia in children: The effect of ibuprofen and phentolamine mesylate on pain perception
Authors: Nayak Ullal Anand , Ramasamy Saravanan , Marusamy Kavitha Odathurai , Nayak Prathibha Anand , Vanka Amit
Published: July 2024

Context:

For successfully managing pediatric dental patients, local anesthesia is essential to eliminate pain during or after the operative period. An early recovery from soft-tissue anesthesia after an inferior alveolar nerve block (IANB) should benefit a young child patient by avoiding the risk of inadvertently biting the soft tissues.

Aims:

Hence, the purpose of the study was to (1) evaluate and compare the efficacy of pre- and postoperative ibuprofen on pain perception in children who undergo IANB anesthesia with or without the use of PM and (2) evaluate the average time required for reversal of anesthesia symptoms using phentolamine mesylate.

Methods:

The present study was a randomized, clinical trial performed among 60 children between 6 and 8 years of age using a convenient sampling method. The children were randomly assigned into four equal groups of 15 each using the computer-generated randomization sequence. IANB anesthesia was performed using 2% lignocaine with 1:100,000 epinephrine, and a mandibular primary molar pulpotomy was performed on each group. Group 1: the ibuprofen tablet was taken 1 h before the onset of the procedure. Group 2: ibuprofen tablet 30 min after the pulpotomy procedure. Group 3: the ibuprofen tablet was taken 1 h before the onset of the procedure, and the Phentolamine mesylate (PM) injection was administered. Group 4: immediately after the pulpotomy, the PM injection was administered, and an ibuprofen tablet was taken 30 min after the pulpotomy procedure. All children were assessed for the duration of soft-tissue anesthesia, their behavior scores and pain rating, as well as the incidence of postoperative self-inflicted injuries.

Statistical Analysis Used:

A one-way ANOVA was used to compare the average time needed for the reversal of anesthetic symptoms between groups. The effects of phentolamine, local anesthetics, and ibuprofen on the child’s behavior and pain scores were compared using the Student’s t-test. For the study, P < 0.05 was accepted as statistically significant.

Results:

The time needed for the full reversal of anesthetic symptoms to manifest on the tongue and lip was substantially reduced by the injection of phentolamine (P < 0.001). The use of phentolamine for reversal or the intake of ibuprofen pre- or postoperatively did not exhibit any significant variation in the behavior, pain experience, or incidence of self-inflicted injuries in the child.

Conclusion:

It is evident that although phentolamine injections shorten the duration of anesthesia, the adjunctive use of pre- or postoperative ibuprofen did not significantly alter pain scores.
Custom-made versus prefabricated zirconia crowns for primary molars: A 12-month follow-up
Authors: Alassar Roqia Mohammad , Metwally Noha Ibrahim , Abdelgawad Asmaa Mohammad , Elsherbeny Selwan Hassan , Mohamed Eman Abdelraouf
Published: July 2024

Background:

Many practitioners have questioned whether the construction method of pediatric zirconia crowns impacts the periodontal health and clinical performance of severely decayed primary molars. The objective of this study was to compare the periodontal health and clinical performance of primary molars restored with custom-made zirconia crowns (CZCs) and prefabricated zirconia crowns.

Methods:

Twenty primary molars indicated for crown restorations were selected from ten patients (5–9 years old) randomly. Each patient received two pediatric zirconia crowns constructed by two different methods: one custom-made and one prefabricated. The primary molars were divided into two groups: Group 1: primary molars received CZCs and Group 2: primary molars received prefabricated zirconia crowns (PZCs).

Results:

After a 12-month follow-up, there was no statistically significant difference between the periodontal health of primary molars restored with custom-made and prefabricated zirconia crowns. The clinical performance of primary molars restored with CZCs was statistically significantly higher than those restored with PZCs in terms of retention and fracture resistance (P ≤ 0.05).

Conclusions:

The construction method of pediatric zirconia crowns does not significantly affect the periodontal health of primary molars; however, clinical performance is significantly affected in terms of retention and fracture resistance.

Clinical Significance:

A CZC is an excellent alternative option, especially for primary molars whose permanent successors still have a long time to erupt. The PZC is a quick and easy restoration, but the technique is sensitive.
Comparative evaluation of the efficacy of the Pro AF Baby Gold and Kedo-S pediatric endodontic files for canal instrumentation, transportation, and centering ratio – A systematic review and meta-analysis
Authors: Shroff Yashshwini , Dutta Brahmananda N. , Verma Rajnish Kumar , Sharma Varsha
Published: July 2024

Background:

Traditionally, pediatric endodontics lacked access to the full potential of rotary instruments. These instruments, designed for the permanent root canal system, often presented limitations when used in primary teeth. To address this, exclusive pediatric rotary files with regular improvements have been introduced, featuring superior cutting efficiency with a focus on precise alignment. This design offers the advantage of reduced risk of ledges, perforations, instrument separation, and canal transportation. This study aimed to compare and evaluate the effectiveness of Pro AF Baby Gold and Kedo-S rotary files in preparing primary tooth root canals during pulpectomy procedures through a meta-analysis.

Methodology:

The review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. The review searched electronic databases from 2000 to February 2024 for studies evaluating the efficacy of Pro AF Baby Gold and Kedo-S files in terms of canal instrumentation, transportation, and centering ratio. The Cochrane risk of bias (ROB)-2 tool assessed quality, with analyses conducted using RevMan software version 5.3. The standardized mean difference (SMD) served as the summary with a random effects model (P < 0.05).

Results:

Out of the five studies identified through the eligibility criteria, three were deemed suitable for a meta-analysis, while all five were included in a qualitative synthesis. The quality assessment revealed a presence of moderate-to-low ROB. The pooled analysis using SMD did not show any statistically significant differences between the files, except for the centering ratio in the mesiobuccal canal, where the Kedo-S file performed slightly better. In addition, the absence of any significant asymmetry in the funnel plot suggests that there is likely no publication bias present in the data.

Conclusion:

Pro AF Baby Gold files can be used as an alternative adjunct in pediatric endodontics to Kedo-S files and manual files.

Prospero Registration: CRD42023469406.
A comparative evaluation of the efficiency of warm local anesthetic solution delivered on precooled injection sites with the conventional local anesthetic technique in 7–9-year-old children: A randomized split-mouth cross-over trial
Authors: Chittora Megha , Rao Dinesh , Panwar Sunil , Samaddar Krittika , Remi R. V.
Published: July 2024

Background:

Both precooling the site and injecting a warm anesthetic solution have proven to be efficient in reducing pain individually. However, there is insufficient data on evaluating the efficiency of precooling the site of injection along with the simultaneous administration of a warm local anesthetic solution on the same site in a single patient.

Aim:

The aim of this study was to evaluate and compare the efficacy, pain perception, hemodynamic changes, and adverse effects of a warm local anesthetic solution injected on precooled injection sites using 2% lignocaine with the conventional local anesthetic technique during inferior alveolar nerve block in 7–9-year-old children.

Methods:

A split-mouth, double-blinded, randomized clinical trial was conducted on 70 children who received 2% lignocaine with either technique A or B during the first or second appointment of the treatment procedure. The pain perception, anesthetic efficacy, pulse rate, oxygen saturation levels, and adverse events were evaluated.

Results:

Pain during injection and treatment after administration of the warm local anesthesia (LA) technique was less as compared to the conventional block technique. Anesthetic success was observed with a faster onset of action (212.57 ± 32.51 s) and shorter duration of LA (165.16 ± 33.09 min) in the warm local technique as compared to the conventional technique. No significant differences were found with regard to heart rate and oxygen saturation levels between the two techniques. Administrating warm LA solutions at precooled injection sites revealed fewer adverse events.

Conclusion:

Injecting warm LA solution on precooled injection sites causes less discomfort and anxiety in children, which makes it more suitable for the child as well as the pediatric dentist.
Impact of Knack Manoeuvre Among Women with Urinary Incontinence: A Quasi Experimental Study
Authors: Jagadeeswari J , Kalabarathi S. , Bhuvaneswari G.
Published: July 2024

ABSTRACT

Objective:

The Objective of the study is to assess the effectiveness of Knack manoeuvre among women with urinary incontinence.

Methods:

A quasi-experimental study with a repeated measures design was used to conduct study at Saveetha Medical College Hospital. Experimental group received Knack manoeuvre for 6 months and control group received routine care. The sample size was 100, which was recruited by purposive sampling technique. The data were collected with structured questionnaire, and questionnaire for urinary incontinence diagnosis and biophysiological parameters were assessed by abdominal leak peak pressure (ALPP).

Results:

The study results depict that frequency and percentage distribution of pretest and post-test level of ALPP. Between group comparison of post-test at 6 months of control and experimental showed significance (P < 0.001). There was a progressive decrease in ALPP of control and experimental groups.

Conclusion:

To our knowledge, this is the first prospective nonrandomized study that assesses the efficacy of the Knack manoeuvre on urine incontinence by assessing biophysiological parameters.
Maternal food insecurity and low birth weight: A hospital-based case–control study in Eastern India
Authors: Saha Roopsa , Kumar Navin , Patua Bijan , Bandyopadhyay Alapan
Published: July 2024

Background:

As household food insecurity is directly connected with the amount and quality of nutrition available to a person, maternal food insecurity, therefore, might have a role to play in poor pregnancy outcomes such as low birth weight (LBW).

Objectives:

To find out whether maternal food insecurity was associated with LBW among infants born between May and June of 2020 in a tertiary care hospital of Eastern India.

Materials and Methods:

The study was a case–control design, conducted among a set of sex-matched cases and controls. 105 LBW infants were taken as cases and 105 infants with birth weight ≥2500 g were taken as controls. Multivariable logistic regression analysis was done to ascertain the relationship between the independent and dependent variables and crude and adjusted odds ratios (AOR) were calculated to find out the association between the exposure and the outcome.

Results:

The cases and controls were statistically comparable with respect to baseline characteristics. Univariable analysis showed that the odds of LBW were 7.77 (95% confidence interval [CI]: 3.73–16.16) times more in food-insecure households. After adjusting for other variables included in the analysis, the AOR for food insecurity was 8.04 (95% CI: 3.81–16.94).

Conclusion:

The odds of giving birth to a LBW infant were higher in mothers belonging to food-insecure households. Addressing the prevalent barriers to accessibility, affordability, and adequacy of nutrition can be effective in mitigating this problem.
A study on menstrual hygiene practices and school absenteeism during menstruation among high school girls from an urban area of Hyderabad, Telangana
Authors: Alenur Rajitha , Koteswaramma Ch. , Maktha Vijay Kumar , Dayyala Sridhar
Published: July 2024

Background:

Menstrual hygiene is an important risk factor for reproductive tract infections among adolescent girls. Unhygienic practices during menstruation have a significant impact on health. Fear of blood leaking, fatigue, dysmenorrhea, and lack of cleanliness in schools during menstruation contribute to absenteeism. Frequent episodes of absenteeism result in poor school performance.

Objectives:

The objectives of the study were to assess menstrual hygiene practices among the study population and estimate the proportion of school absenteeism among girls during menstruation and evaluate the associated factors.

Materials and Methods:

A cross-sectional study was conducted among 231 high schools (8th, 9th, and 10th standards) girls in Narayanguda, Hyderabad. A semi-structured questionnaire was used to interview the subjects after taking permission from the principal, and confidentiality was ensured for the students. Adolescent girls who have attained menarche and who were present on the day of the survey were included in the study. Adolescent girls who have not attained menarche were excluded from the study.

Results:

The mean age of menarche was 12.19 ± 1.17 years. The majority (93%) were using sanitary pads. Disposal of material used for menstruation was majorly (95.6%) by throwing in dustbins. Almost 92.2% of them were following good hygienic practices. The proportion of school absenteeism during menstruation was 53%, and the reasons were dysmenorrhea and fear of leaking menstrual blood while transiting.

Conclusions:

The majority of the girls were following good hygienic practices and used sanitary pads. About half of them remained absent from school during menstruation.
Perceptions and awareness of snakebite envenoming in hilly areas of Madikeri: A cross sectional study
Authors: Sinha Sweta , Udayar Eshwar Sharvanan , Narasimha B. C. , Madeshan Ashwini , Marella Krishnaveni
Published: July 2024

Background:

Snake bite is one of the neglected public health problems in many tropical and subtropical countries. Wrong perception and practice of unproven traditional methods about snakes and snakebites may increase mortality due to snakebite envenoming.

Objective:

The objective is to assess the knowledge, attitude and practice regarding snakes and snakebites among the rural population in the Kodagu district.

Materials and Methods:

A community-based cross-sectional study was conducted between August-2021 and October-2021 in the rural field-practice area of Bhagamandala Primary Health Centre. Systematic random sampling was incorporated into the study to select the study participants. Data were collected using a predesigned and pretested questionnaire. Data entry was done in Microsoft Excel and was analyzed using STATA (16.1), StataCorp, College Station, Texas, USA.

Results:

Out of 1284 participants, the majority 964 (75.07%) of participants identified spectacled cobra correctly and 1142 (88.94%) correctly identified it as venomous. About 1228 (95.64%) participants had correct knowledge regarding Anti-Snake venom being an effective treatment for snake bites and the overall knowledge regarding snake bites was adequate among only 380 (29.60%) of the study population. Whereas, 188 (14.64%) of them even considered visiting a local quack or faith healer after a Snakebite.

Conclusions:

In our study, the overall knowledge regarding snake bites was adequate among 29.60% of the study population. The knowledge regarding the venemosity of snakes was good, but identification was poor. The participants had correct knowledge about ASV and its availability. The harmful practices such as visiting traditional healers and applying native medicine are still seen in 14.64% of participants.
Study of copper and ceruloplasmin in hypothyroidism and Grave’s hyperthyroidism as compared to euthyroidism: Hospital-based case–control study
Authors: Bhat Vinayak Ganesh , Patra Rajkumar , Raju D. S. S. K. , Mohandas G. V. , Rao N. Lakshmana
Published: July 2024

Background:

Hypothyroidism was highly prevalent in India, with 10.95% affected patients as compared with only 2% in the United Kingdom and 4·6% in the USA. The prevalence of Hyperthyroidism was found to be 1.6%. Copper has an essential role in thyroid metabolism, thyroid hormone production, and absorption. Copper is an essential part of thyroxine (T4) hormone and thyroid-stimulating hormone (TSH) synthesis.

Objectives:

This study evaluated the status of serum copper and ceruloplasmin levels in hypothyroidism and Grave’s hyperthyroidism in comparison with euthyroid participants.

Materials and Methods:

This was a hospital-based case–control study that involved 100 cases of hypothyroidism and 60 cases of Grave’s hyperthyroidism compared with 100 euthyroid participants aged 15–60 years. After detailed case history and examination, the blood sample was collected and analyzed the same day for FreeT3, FreeT4, TSH, serum copper, and ceruloplasmin levels.

Results:

Compared to euthyroid participants, patients with clinical hypothyroidism had statistically significant (P < 0.05) lower levels of serum copper and ceruloplasmin. The scenario was the opposite in the case of Grave’s hyperthyroidism patients. Our study found statistically significant (P < 0.05) higher serum copper and ceruloplasmin levels in Grave’s hyperthyroidism patients.

Conclusion:

Our study found serum copper levels directly affected the thyroid profile and vice versa. The deficiency of one parameter affected the other. Patients with hypothyroidism and hyperthyroidism should be routinely screened for serum copper and ceruloplasmin levels for more effective thyroid treatment.
Functional assessment and depression among geriatric population of rural Patancheru: A community-based cross-sectional study
Authors: Batchu Naga Gayathri , Lavanya C. , Kumar G. Vinod , Sadipirala Anila , Bolla Chandrasekhar Reddy
Published: July 2024

Background:

Indian aged population is currently the second largest globally. The proportion of 60 years and above population in India is 8%. It is growing faster than any other age group. However, it also challenges society to adapt, in order to maximize the health and functional capacity of older people as well as their social participation and security.

Objective:

The objective was to study functional assessment and depression among rural geriatric population.

Materials and Methods:

This was a community-based cross-sectional study among 1020 persons aged >60 from eight villages of three subcenters. Functional assessment was done using the Katz Index of Independence in Activities of Daily Living (ADL) and the Lawton Instrumental Activities of Daily Living Scale (IADL). Depression was measured using the Geriatric Depression Scale (GDS).

Results:

81.6% belonged to 60–75 years. Females were almost double compared to males. Majority (65.4%) were having normal body mass index. Majority 759 (74.41%) have no disturbance in sleep pattern. Majority 867 (85%) were functionally independent according to Katz ADL. Majority 745 (73.04%) were partially dependent according to the Lawton IADL. Majority of the respondents 954 (93.53%) were with no depression according to GDS. Sleep disturbance was seen highest in the age group of 60–75 years, and it reduced significantly as the age increased by a decade to 16.09%–7.3% in those aged 85 years and more (P < 0.05). Among study participants with disturbed sleep, majority 176 (67.43%) were alcoholics (P < 0.05). There is an association between ADL and depression (P < 0.05).

Conclusion:

Majority were functionally independent. Majority were partially dependent, Lawton IADL. Majority were with no depression according to GDS.
A comparative study of prophylactic nebulized dexamethasone versus intravenous dexamethasone for prevention of postoperative sore throat in prone-position surgeries
Authors: Ramamurthy Sarayu , Bettaswamy Guruprasad
Published: July 2024

Background:

Whenever endotracheal intubation is carried out during surgeries, patients commonly complain of sore throat after surgery. For its prevention, dexamethasone has been studied and found useful. However, there are limited data on comparing the efficacy of different routes of prophylactic dexamethasone for sore throat postoperatively after lumbar spine surgery in the prone position.

Objective:

The objective of the study was to compare the efficacy of nebulized dexamethasone with intravenous dexamethasone for the prevention of postoperative sore throat after lumbar spine surgery in the prone position.

Materials and Methods:

Hospital based randomized comparative study carried out among 70 patients of the American Society of Anesthesiologists (ASA) 1 and 2 aged between 20 and 60 years. They were randomly allocated into one of the two groups. Group N received 8 mg dexamethasone in 2 ml of normal saline as nebulization 30 min before induction. Group I received 8 mg dexamethasone intravenously 5 min before induction. Postoperatively, looked for symptoms of sore throat and hoarseness of voice at 2, 6, 12, and 24 h.

Results:

Both groups were comparable for age, sex, ASA grades, Mallampati grades, duration of surgery, and size of the endotracheal tube. At 2, 6, 12, and 24 h after surgery, the incidence of sore throat was higher in Group I compared to Group N. These differences at each time interval were statistically significant (P < 0.05). At 6 h, the incidence in Group I patients was 65.7% compared to Group N patients (42.9%) (P < 0.05). At 12 and 24 h, the incidence of sore throat in Group I patients (60% and 37.1%, respectively) compared to Group N patients (28.6% and 17.1%, respectively) (P < 0.05).

Conclusion:

Eight milligram of dexamethasone in 2 ml of normal saline as nebulization 30 min before induction was found to be more effective in reducing the incidence of sore throat compared to 8 mg dexamethasone intravenously 5 min before induction.
Quality of life and vision assessment with scleral lenses in keratoconus
Authors: Hadimani Shivanand R. , Kaur Hardeep , Shinde Amit J. , Chottopadhyay Tonmoy
Published: July 2024

PURPOSE:

The purpose of the study is to evaluate the visual outcomes and improvement in quality of life (QOL) of patients with keratoconus with scleral lenses.

METHODS:

In this prospective study, 14 patients (28 eyes) with bilateral keratoconus were fitted with scleral lenses (McAsfeer 16.00 mm) in Pune city, Maharashtra, India. Uncorrected visual acuity (VA), best spectacle-corrected VA, and VA with scleral lenses were evaluated. The patients were given the National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25) for judging the QOL, before and after using scleral lenses for 3 months.

RESULTS:

The mean uncorrected VA of the 14 patients with a mean age of 28.64 ± 6.57 years was 1.18 ± 0.19 logMAR. Best spectacle-corrected high-contrast VA improved from 0.47 ± 0.25 logMAR to 0.03 ± 0.07 logMAR with scleral lenses (P < 0.001). Best spectacle-corrected low-contrast VA improved from 0.68 ± 0.22 logMAR to 00.47 ± 0.10 logMAR with scleral lenses (P < 0.001). Along with the increase in overall median scores on the NEI VFQ-25 from 1735 to 2930 points (P < 0.001), the distance and near activities (P < 0.001), vision-specific mental health (P < 0.002), social functioning (P < 0.004), and driving (P < 0.005) improved after using scleral lenses for 3 months.

CONCLUSION:

Scleral lenses can be an effective and safe management option for patients with keratoconus leading to an improved vision and QOL.
The effect of age on lens parameters and axial length among wide age range of Saudis: A prospective, cross-sectional study
Authors: Alotaibi Wafa M. , Alqahtani Kholoud H.
Published: July 2024

PURPOSE:

The purpose of the study is to establish normative values of eye parameters such as lens thickness (LT), lens diameter (LD), and axial length (AXL) among wide age range of Saudis using Pentacam AXL and compare these values between gender, in addition to that, to find the correlation between the age and those parameters.

METHODS:

In this prospective cross-sectional study, we measured LT, LD, and AXL in 125 healthy Saudi controls aged between 8 and 60 years using OCULUS Pentacam AXL. The screening tests were performed for each subject to exclude any ocular abnormalities using slit lamp (Haag-Streit BQ 900), refractive error measured using auto refractometer (Topcon KR-1 Autorefractor/Keratometer), and subject who has spherical equivalent more than ± 4.00D and astigmatism more than 1.00DC was excluded from the study. The mean of three readings of LT, LD, and AXL was taken. All examination was applied on one eye (right eye).

RESULTS:

The overall mean and standard deviation of LT, LD, and AXL was 2.2 mm ± 0.5, 2.7 mm ± 0.6, and 23.8 mm ± 1.0, respectively. There was no statistically significant difference between males and females in these parameters in all age groups, except in Group 2 (age: 19–30 years), there was a statistically significant difference between males and females in AXL, mean difference (M = 0.48), and P = 0.015. The mean of LT and LD was negatively associated with age. However, there was no significant correlation between AXL and age.

CONCLUSION:

Normative values of LT, LD, and AXL have been established in wide age group of healthy Saudis; the findings of the present study can highlight not only the normal range of the different ocular parameters, namely LT, LD, and AXL, but also their variation with age and gender.
Factor analysis of traditional Chinese medicine symptoms for identification of syndrome patterns associated with idiopathic short stature in children
Authors: Liao Tzu-Shien , Tsai Li-Ping , Tzeng I-Shiang , Hsu Ya-Ting , Hsieh Po-Chun , Wu Hsien-Chang
Published: July 2024

ABSTRACT

Objectives:

Diagnosing idiopathic short stature (ISS) in Traditional Chinese Medicine (TCM) remains challenging partly because the symptoms and syndrome patterns vary among ISS patients and studies. We aimed to use factor analysis of TCM symptoms to identify syndrome patterns associated with ISS in children on the basis of TCM theory.

Materials and Methods:

A cross-sectional study was conducted at Taipei Tzu Chi Hospital, New Taipei City, Taiwan, from October 1, 2014, to February 28, 2016. The study included 957 individuals who were newly diagnosed with ISS through simple random sampling. The outcome measures comprised 34 TCM symptoms related to children’s growth, and these symptoms were assessed using a five-level self-report questionnaire, which was completed by children and their parents. A factor analysis was conducted for the extraction of underlying factors.

Results:

A total of 26 symptoms had factor loadings higher than the exact threshold value (0.4), and five factors were extracted. Factor 1, comprising seven symptoms, was interpreted as “yin deficiency and fire hyperactivity of kidney syndrome.” Factor 2, which included eight symptoms, was interpreted as “phlegm dampness stagnation of spleen syndrome.” Factor 4, which included five symptoms, was interpreted as “liver qi invading the spleen syndrome.” Factor 5, which included four symptoms, was interpreted as “spleen-stomach weakness syndrome.” Factor 3, which included four symptoms, was uninterpretable. Factors 1–5 accounted for 10%, 9%, 8%, 7%, and 6% of the total variance.

Conclusion:

Four major TCM syndrome patterns, namely, “yin deficiency and fire hyperactivity of kidney syndrome,” “phlegm dampness stagnation of spleen syndrome,” “Liver qi invading the spleen syndrome,” and “spleen–stomach weakness syndrome” were identified and accounted for 40% of the total variance of the 34 TCM symptoms surveyed in children with ISS. Our findings may facilitate the diagnosis of ISS and the optimization of treatment strategies.
Race-modified estimated glomerular filtration rate underestimates chronic kidney disease prevalence in Black patients undergoing partial and radical nephrectomy: Implications for surgical planning
Authors: Hasley Hunter L. , Iarajuli Teona , Nguyen Jennifer , Thiemann Daniel , Malik Martin , Roth Jacquelyn , Raver Michael , Stifelman Michael , Munver Ravi , Ahmed Mutahar , Yerram Nitin
Published: July 2024

Introduction:

In estimated glomerular filtration rate equations (eGFR), the race multiplier (RM) yields greater eGFR values and may assign less severe chronic kidney disease (CKD) stages to black individuals. When deciding on appropriateness for partial nephrectomy (PN), patients with CKD are often considered a relative or absolute indication. We hypothesize that the eGFR RM may have ramifications for patients being counseled for radical nephrectomy (RN) versus PN to manage their renal tumor.

Methods:

We utilized prospective and retrospective, IRB-approved single-center databases to select patients who underwent PN or RN between 2016 and 2022. Demographics, preoperative risk factors, preoperative eGFR, and surgical management were collected. Descriptive statistics and two-tailed difference of proportion tests compared the percentage of patients with CKD who underwent nephrectomy.

Results:

This cohort included 1137 patients who underwent RN or PN, including 74 (6.5%) Black patients and 93.5% (n = 1063) non-Black patients. There was no statistically significant difference between the eGFR of Black and non-Black individuals using the Modification of Diet in Renal Disease equation (P = 0.24) or Chronic Kidney Disease Epidemiology Collaboration 2009 (CKD-EPI 2009) (P = 0.45); however, there was statistically significant difference in eGFR between sample populations when using CKD-EPI 2021 (P = 0.0055). Of the Black patient cohort, 16.2% of patients reclassified to a worse CKD class using CKD-EPI 2021, including 9.5% of Black patients reclassified to CKD3a or worse, and 14.6% of all patients (Black and non-Black) reclassified to a different CKD class under the CKD-EPI 2021 equation.

Conclusions:

There are quantitative differences in the evaluation of eGFR when utilizing different equations that may impact clinical considerations and health equity outcomes for nephrectomy across racial groups.
Resource-Efficient Deep Learning: Fast Hand Gestures on Microcontrollers
Authors: Tran Mach Tuan Kiet , Nguyen Van Khai , Le Minhhuy
Published: July 2024

Hand gesture recognition using a camera provides an intuitive and promising means of human-computer interaction and allows operators to execute commands and control machines with simple gestures. Research in hand gesture recognition-based control systems has garnered significant attention, yet the deploying of microcontrollers into this domain remains relatively insignificant. In this study, we propose a novel approach utilizing micro-hand gesture recognition built on micro-bottleneck Residual and micro-bottleneck Conv blocks. Our proposed model, comprises only 42K parameters, is optimized for size to facilitate seamless operation on resource-constrained hardware. Benchmarking conducted on STM32 microcontrollers showcases remarkable efficiency, with the model achieving an average prediction time of just 269ms, marking a 7× faster over the state-of-art model. Notably, despite its compact size and enhanced speed, our model maintains competitive performance result, achieving an accuracy of 99.6% on the ASL dataset and 92% on OUHANDS dataset. These findings underscore the potential for deploying advanced control methods on compact, cost-effective devices, presenting promising avenues for future research and industrial applications.
On Multilinear Inequalities of Ho ̈lder-Brascamp-Lieb Type for Torsion-Free Discrete Abelian Groups
Authors: Christ Michael , Christ Michael , Demmel James , Knight Nicholas , Scanlon Thomas , Yelick Katherine
Published: July 2024

Holder-Brascamp-Lieb inequalities provide upper bounds for a class of multilinear expressions, in terms of L^p norms of the functions involved. They have been extensively studied for functions defined on Euclidean spaces. Bennett-Carbery-Christ-Tao have initiated the study of these inequalities for discrete Abelian groups and, in terms of suitable data, have characterized the set of all tuples of exponents for which such an inequality holds for specified data, as the convex polyhedron defined by a particular finite set of affine inequalities. In this paper we advance the theory of such inequalities for torsion-free discrete Abelian groups in three respects.The optimal constant in any such inequality is shown to equal 1 whenever it is finite.An algorithm that computes the admissible polyhedron of exponents is developed. It is shown that nonetheless, existence of an algorithm that computes the full list of inequalitiesin the Bennett-Carbery-Christ-Tao description of the admissible polyhedron for all data,is equivalent to an affirmative solution of Hilbert's Tenth Problem over the rationals.That problem remains open.
Projections of totally disconnected thin fractals with very thick shadows on ${\mathbb{R}}^{d}$
Authors: Lai Chun-Kit , Patil Lekha Priya
Published: July 2024

We study an extreme scenario of the Marstrand projection theorem for which a fractal has the property that its orthogonal projection is the same as the orthogonal projection of its convex hull. We extend results in current literature and establish checkable criteria for self-affine sets to have this property. Using this, we show that every convex polytope on

\R^{d}

contains a totally disconnected compact set, which is a union of self-affine sets, of dimension as close to 1 as possible, as well as a rectifiable 1-set, such that the fractal projects to an interval in every 1-dimensional subspace and its convex hull is the given polytope. Other convex sets and projections onto higher dimensional subspaces are also discussed.
Endoscopic dacryocystorhinostomy with and without bicanalicular silicone tube in patients with a small lacrimal sac: a comparative study
Authors: Yu B , Mao B , Tu Y , Wang M , Wu W
Published: July 2024

Background: To establish whether bicanalicular silicone tube intubation is required during endoscopic dacryocystorhinostomy (En-DCR) for treating chronic dacryocystitis with a small lacrimal sac. Methods: In total, this study enrolled 264 patients diagnosed with unilateral chronic dacryocystitis with small lacrimal sacs via computed tomography-dacryocystography that underwent En-DCR from March 2016-September 2020. Patients were randomized into two treatment groups, with those in group A undergoing tubes intubation and those in group B not undergoing this procedure. The tubes were removed 3 months post-operation in group A. Surgical outcomes and related complication rates were then compared. Results: This study included 242 patients, including124 and 118 in groups A and B, respectively. At the three-month follow-up time point, 12.90% of patients in group A exhibited ostial granulation tissue, with this frequency with no differences observed in group B (11.86%). At 6 months post-surgery, 80.65% of patients in group A and 72.88% of patients in group B exhibited successful surgical outcomes, with no significant differences between groups. At 9 months postoperatively, the overall effective success rate was 60.74%, and the success rate was significantlyhigher in group A relative to group B (group A: 75.81%; group B: 44.92%). There were no failed patient outcomes observed as of the 12-month follow-up time point. Conclusions: While En-DCR-based treatment of chronic dacryocystitis in those with smalllacrimal sacs did not yield satisfactory outcomes with respect to the overall effective success rate, these results suggest that intraoperative intubation may improve success rates in long-term follow-up.
COVID-19 olfactory dysfunction: associations between coping, quality of life, and mental health
Authors: Jacobson P T , Vilarello B J , Snyder C , Choo T-H , Caruana F F , Gallagher L M , Tervo J P , Gary J B , Saak T M , Gudis D A , Joseph P V , Goldberg T E , Devanand D P , Overdevest J B
Published: July 2024

Background: Persistent olfactory dysfunction (OD) is a common symptom following SARS-CoV-2 infection that can greatly impact quality of life (QoL). Because coping strategies have been shown to moderate the effect of disease symptoms on functional and affective outcomes, this study aims to determine whether specific coping strategies are associated with and moderate QoL outcomes. Methodology: Participants with prior SARS-CoV-2 infection underwent psychophysical olfactory testing with Sniffin’ Sticks and completed questionnaires to elicit subjective olfactory function, coping strategies, olfactory-specific QoL, general QoL, and mental health. Results: There were 93 participants included in the study. Olfactory specific QoL scores were significantly worse among individuals with subjective and psychophysically measured OD compared to those with subjective and psychophysically confirmed normosmia. Olfactory-specific QoL, general QoL, and anxiety symptom scores were positively correlated with avoidant and disengagement coping among individuals with subjective and psychophysically measured OD. Depression symptom scores were positively correlated with avoidant and disengagement coping and negatively correlated with approach and engagement coping. There were no significant moderating effects on the association between olfactory performance and QoL or mental health screening assessment. Conclusions: Approach and engagement coping mechanisms are associated with improved depression, whereas avoidant and disengagement coping tracks with worse QoL and mental health screening assessment, offering an opportunity to counsel patients accordingly.
Cybersecurity Approval Criteria: Application of UN R155
Authors: Hellstern Mona , Langhanki Stefan , Grün Florian , Kriesten Reiner , Sax Eric
Published: July 2024

The UN R155 regulation is the first automotive cybersecurity regulation and has made security a mandatory approval criterion for new vehicle types. This establishes internationally harmonized security requirements for market approval, presenting a challenge for manufacturers and suppliers to demonstrate compliance throughout the product life cycle. An issued type approval is internationally recognized by the member states of the UN 1958 Agreement. International recognition implies that uniform assessment criteria are applied to demonstrate compliance and to decide whether security efforts are sufficient. Independent accredited assessors assess the security engineering results during type approval. Considering the risk-based approach of ISO/SAE 21434 to security engineering, assessing whether threats have been appropriately addressed is a challenge. While there are currently no uniform assessment criteria at product level, the question arises as to which development artifacts serve as indicators for determining the efficacy of mitigation strategies. In response to this challenge, the paper conducts an analysis of existing security concepts of the automotive security standard ISO/SAE 21434 and the Information Technology Security Evaluation Standard ISO 15408 (Common Criteria) and therefore provides an insight into the state-of-the-art of security evaluation methods. The overall objective is to derive applicable assessment criteria and recommendations for the UN R155 approval while taking into account relevant security properties that help to decide on the sufficiency of security measures. These recommendations aim to enhance the comprehensiveness of the security assessment associated with UN R155, fostering a more uniform approach to evaluating cybersecurity in the context of vehicle type approvals.
Ominous Creatures: Foreshadowing and Intertextuality in Joseph Conrad’s Shorter Fiction
Authors: Murphy Royse
Published: July 2024

In a number of short stories and novellas during one period of his writing Joseph Conrad specifically used apparently unrelated but dramatic animal imagery, detached from but foreshadowing the development of the subsequent events in each narrative. There may be a number of reasons for this type of foreshadowing and for its effect in his shorter fiction which are explored. Intertextuality has been noted between the stories of Joseph Conrad and H. G. Wells. Here additional examples are found between the works of these authors, men who were good friends but later had conflicting views about writing and life, and between their own and other authors’ works.