bluuebunny/crossref_metadata_2025 huggingface dataset:
Un avenir post-nucléaire ? Les atermoiements des acteurs du territoire de Trino (Italie) en contexte de démantèlement
Authors: Gallimard Maude , Mattina Cesare
Published: February 2022

Malgré l’arrêt définitif des productions électronucléaires en 1990 et la décision, prise plus tard d’accélérer le processus vers un « démantèlement immédiat » de la centrale Enrico Fermi, les populations et les acteurs du territoire de Trino (plaine du Pô piémontaise) ont du mal à imaginer et à projeter un territoire post-nucléaire. Cette contribution essaye d’expliquer pourquoi l’après-nucléaire n’est pas si évident et quelles sont les raisons qui le freinent très largement. Dans une perspective diachronique, cet article montre comment les différents acteurs et groupes sociaux de ce territoire ont traversé la phase de déclin de la production nucléaire (référendum de 1987 décrétant un moratoire sur la construction de nouvelles centrales), la phase incertaine de l’arrêt des productions (1990), puis de la mise en sécurité passive (1990-2003) et du démantèlement (depuis 2003) ; pour s’installer dans l’incertitude durable des démantèlements et de la gestion des déchets dans l’attente d’un centre national de stockage des déchets radioactifs qui, en Italie, n’a toujours pas été réalisé. Malgré les projets et les initiatives pour imaginer et construire un après-nucléaire au travers du développement d’un tourisme vert et de qualité ou des énergies renouvelables, la plupart des acteurs agissant sur Trino demeure dans des rhétoriques et des actions tendant à confirmer la continuité et la légitimité du nucléaire sur le territoire, parfois à rebours de leurs discours ou convictions. À la vue du déclin démographique et du processus de désindustrialisation de son territoire, le nucléaire, avec d’une part ses emplois dans le démantèlement et, d’autre part, les fonds de compensation étatiques versés aux communes du fait de l’hébergement des déchets radioactifs, demeure un secteur important de ce territoire.
Matières à scandales ou matières recyclables ?Trois décennies de débats sur la libération des déchets nucléaires de très faible activité (TFA)
Authors: Martinais Emmanuel
Published: February 2022

Cet article s’intéresse aux déchets très faiblement actifs (TFA) produits en très gros volumes par le démantèlement des installations nucléaires. Très encombrants, mais considérés comme peu dangereux, ces matériaux divers (terres, métaux, gravats, et cetera) sont à l’origine de débats récurrents dans les milieux professionnels concernés, certains acteurs préconisant de les confiner en totalité dans des centres de stockage sécurisés, d’autres recommandant de les valoriser dans des filières de recyclage ou de les banaliser pour les évacuer à moindre coût vers des décharges conventionnelles. À partir d’une enquête de terrain sur le cas français, l’article se donne pour objectif de rendre compte de ces débats et de leurs effets sur la réglementation nationale. Trois périodes sont ainsi successivement examinées : la mise en filière de ces déchets TFA dans les années 1990 qui conduit à renoncer aux possibilités de recyclage et de banalisation ; la montée en puissance des démantèlements dans les années 2000 qui tend à remettre en cause le choix initial du stockage généralisé ; et enfin, la mise à l’étude de deux filières de valorisation dans les années 2010 qui témoigne des difficultés du recyclage à concurrencer la solution du stockage définitif.
Fin des infrastructures, mobilités et nouvelles dynamiques territoriales : le cas de la fermeture de la centrale électronucléaire Superphénix (Isère, France).
Authors: Garcier Romain , Pini Paul-Etienne
Published: February 2022

Cet article revient sur la fermeture de la centrale surgénératrice Superphénix de Creys-Malville, décidée en 1997, après 11 ans d’activité. Unique occurrence de fermeture complète d’un site électronucléaire de plein exercice en France, le cas de Superphénix renseigne sur les trajectoires territoriales post-fermeture, dans des zones où l’industrie électronucléaire fournissait de nombreux emplois bien rémunérés et des recettes fiscales locales importantes. Pour documenter les transformations territoriales consécutives à la fermeture, nous mobilisons l’entrée des mobilités, en nous fondant sur deux sources de données : d’une part, une étude quantitative des mobilités résidentielles et professionnelles qui utilise le recensement de population (1990, 1999, 2012) et permet de montrer la transformation du bassin d’emploi autour de Creys-Malville et l’évolution de la polarisation socio-économique du territoire; d’autre part, une étude qualitative de trente-et-un entretiens réalisés lors d’une enquête menée sur le terrain en 2012 auprès d’acteurs territoriaux (résidents, maires, industriels), qui permettent de rapporter les effets de la fermeture et les mobilités induites à des dires d’acteurs. L’article montre comment les effets de déréliction territoriale craints par les opposants à la fermeture ne se sont pas produits : la fermeture du site a été compensée par de nouvelles mobilités résidentielles et professionnelles, permises notamment par le développement de la zone industrielle de la plaine de l’Ain à l’est de Lyon.
Mosquito net as an environmental aid in the management of pemphigus
Authors: Ahmed Ghazal
Published: February 2022

Dear Editor

Pemphigus is often difficult to manage disease, which involves, apart from the pharmacological management, maintaining the environmental temperature and humidity within a narrow range as the loss of skin easily result in thermal and hydration imbalance.1 While this might be easy to do this in a well-equipped hospital with airconditioning, but turns out to be difficult in a low resource set-up.
Potential downside issues with telemedicine for individuals with chronic respiratory diseases
Authors: Paelet Lawrence , Raskin Jonathan , ZuWallack Richard
Published: February 2022

Telemedicine refers to the use of communications technologies to provide or enhance medical care through mitigating the negative effects of patient-caregiver distance on medical evaluation and treatment. The general concept, telemedicine, can refer to a number of interventions, such as telemonitoring, tele-consultations, tele-education, tele-communication, and tele-rehabilitation. While telemedicine has seen steady growth its trajectory has increased during the COVID-19 pandemic. As a tool in health care delivery, telemedicine is often met with patient satisfaction often resulting from ease of use and accessibility.  Additionally, outcomes may improve, although the medical literature is not consistent in this regard.  However, enthusiasm over its beneficial effects should be tempered by negative aspects, including the decrease in direct patient-clinician interaction (such as loss of information from the physical examination) and potentially serious privacy risks. Finding a happy median between positive and negative features of telemedicine remains a work in progress.
A case of Klebsiella pneumoniae hypervirulent phenotype causing necrotizing fasciitis of chest wall
Authors: Dasgupta Rituparna , Das Arghya
Published: February 2022

Necrotizing fasciitis of the chest wall or upper torso is a rare clinical entity. Monomicrobial Klebsiella pneumoniae as a causative agent of necrotizing fasciitis is far less common than the polymicrobial etiology. Here, we report a case of community-onset pyogenic necrotizing fasciitis caused by Klebsiella pneumoniae in an immunocompetent male of tribal background from the rural area of Jharkhand, India. The hypermucoviscous phenotype of the bacterium causing necrotizing fasciitis has been infrequently reported from the Indian subcontinent to date. The existence of multidrug resistant trait in the hypervirulent pathotype poses a unique challenge in treatment in such a case and emerges as a critical community health problem requiring prompt attention of the public health stakeholders. Thus, there is a need for widespread awareness for proper protocols in antimicrobial usage, infection control, early diagnosis, and prompt treatment.
A unique case of uncorrected Fallot's tetralogy with nasal dermoid cyst and median cleft lip presenting during postpartum
Authors: Chatterjee Subhankar , Ojha Umesh K. , Chavan Suraj H. , Singh Diksha , Kumari Priyanshu , Kumar Kunal , Shafi Ramsha , Baskey Surendra , Dasgupta Rituparna , Benito-León Julián , Ghosh Ritwik
Published: February 2022

While tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease among children, its first presentation in the third decade of life just after successful pregnancy outcome is extremely rare. In fact, survival of both child and mother having uncorrected TOF after noninstitutional delivery is unheard of. Herein, authors report a case of previously undiagnosed TOF associated with other midline congenital abnormalities, that is, nasal dermoid cyst and cleft palate, who presented for the first time with postpartum hemorrhage after an unsupervised home birth. To the best of our knowledge, this unique association has never been described before.
Modified collision study to isolate and study small fibre neuropathy in patients with Type 2 diabetes
Authors: Hazeena Philo , Shanmugam Sundar , Ramesh Rithvik , Venkatasubramanian Shankar
Published: February 2022

Introduction:

Diabetic distal symmetrical polyneuropathy (DSPN) can be categorized as small fibre, large fibre, and mixed neuropathy. Even though small fibre neuropathy is the most prevalent, unfortunately it is usually not recognized by routine electrophysiologic studies. In this study, we intend to examine the slow velocity small fibres responsible for small fibre DSPN, by isolating them using collision technique principle in patients with diabetes.

Methods:

This is an observational case-control study designed to compare nerve conduction values with application of collision technique in 60 patients with T2D and in 60 age and sex matched controls.

Results:

The collision study in patients with Type 2 Diabetes showed mean Latency of 10.5 ± 1.7 ms and mean Amplitude of 3.4 ± 2.3 mV on the right side and mean Latency of 10.5 ± 1.7 ms and the mean Amplitude of 3.5 ± 2.2 mV on the left side. There was a statistically significant difference (P value < 0.001) in the amplitute and latency of CNAPs of small fibres in median nerve innervated APBs of both arms between those with T2D and controls.

Discussion and Conclusion:

Collision study helps to examine the slower conducting fibres of the larger nerves. Our study suggests that the Collision Technique can be used to identify early peripheral neuropathy regardless of the diabetes status, thus making it more practically feasible and cost-effective.
COVID-19 infection among health care workers in a tertiary care teaching hospital in Kerala – India
Authors: Chandran Priya , Lilabi M. P. , Thomas Bina , George Biju , Hafeez Nimin , George Ardra Merin , Cyriac Milu Elizabeth
Published: February 2022

Health care workers are at the frontline for management and containment of COVID-19 infection which has put them at additional risk of the disease. Infection and subsequent quarantine of contacts among HCW may produce considerable strain on the health care system. It is essential that we study the modes by which HCW may get infected in the work environment.

Methods:

All HCW testing positive for SARS COV 2 from 1st March 2020 to 31st Jan 2021 were included in the study. Data regarding possible source of infection, details of symptoms along with demographic details were collected.

Results:

A total of 390 health-care workers tested positive for SARS CoV-2 in the institution. The mean age of affected health-care workers was 32.82 (±10.6) years (range 20–65 years), and 61.3% were female 33% of the positive HCW were doctors and 19.5% nurses. 29% of the infections occurred during patient care of which majority were from the non-COVID areas of the hospital. Interactions with infected colleagues constituted 27.4% of the infections. Symptomatics constituted 67% and the predominant symptoms included Fever, myalgia and severe headache. 57.2% of those followed up reported persistence of symptoms, commonly fatigue (53%), dyspnea on exertion (48%) and myalgia (18%).

Conclusion and Recommendation:

Infection control practices in non-COVID areas of the hospital needs to be stepped up. Adherence to masking and personal protection during clinical interactions and with colleagues needs to be maintained. Physical distancing at workplace and during mealtimes needs to be ensured by the system.
Mobile technology
Authors: Sharma Sadhana , Kumari Bandana , Ali Asgar , Yadav Rajesh K. , Sharma Abhay K. , Sharma Krishan K. , Hajela Krishnan , Singh Girish K.
Published: February 2022

Healthcare systems deal with disease prevention, early detection, diagnosis, investigation, and timely, affordable, and safe treatment. For the delivery of services in the health sector, communication is the key to linking the service provider and the patients. Mobile technology in the recent past has rendered various platforms of communications for the healthcare system. Thus, in health, mobile technology has greatly contributed to time management and cost reduction for healthcare at every level including hospital visits to individual appointments with doctors, hence the convenience. With advancements in mobile technologies and the growing number of mobile users, newer opportunities have opened up for the use of mobiles for patient care. Emerging information and communication technologies with the help of the Internet of Things (IoT) have been instrumental in integrating different domains of the health sector with mobile technology. Thus, the technology may have the potential to become powerful medical tools to support the health sector at all levels of care. In this review, the concept, applications, and advantages of mobile technology for health and the present pandemic have been discussed. It also discusses mobile health technology, as a support system for convenient and safer healthcare for public health, and the opportunities to improve its applications for unseen future health crises.
Prevalence of presbyopia, spectacles coverage and barriers for unmet need among adult population of rural Jhajjar, Haryana
Authors: Malhotra Sumit , Vashist Praveen , Kalaivani Mani , Rath Rama Shankar , Gupta Noopur , Gupta Sanjeev Kumar , Prasad Manya , Sathiyamoorthy Ramadass
Published: February 2022

Background:

Presbyopia is a major cause for near visual impairment among adults. Presbyopia induced visual impairment can be corrected easily by spectacles. We aimed to study the prevalence of presbyopia among adults aged ≥35 years and spectacles coverage among them. We also studied the unmet need for presbyopia along with the barriers to uptake of services.

Methods:

This is a population-based cross-sectional study conducted among adults aged ≥35 years in a rural district of Haryana. Near vision assessment and semistructured interview schedule were administered by a team of trained ophthalmic assistant, social worker and health assistant.

Results:

A total of 3832 adults aged ≥35 years were enumerated, from which 3246 (84.7%) were examined. Prevalence of presbyopia was found to be 42.9% (95% confidence interval 41.2-44.6). Participants with increasing age, literacy and women had higher prevalence, and those that were employed and belonged to below poverty line economic status had lower prevalence of presbyopia. Spectacles coverage among presbyopes was found to be 25.8%. There was an inverse association between unmet need for presbyopia and women, increasing education status and office work. Lack of felt need and personal reasons were the most common barriers for unmet need due to presbyopia.

Conclusions:

There is high prevalence of presbyopia among adult population, with spectacles coverage being low. Awareness activities along with affordable, accessible and socially acceptable services for those affected with presbyopia would be one of the key components of management.
Acceptance Rate of Influenza Vaccination Among Patients with Type II Diabetes
Authors: Alsufyani Shahad Ali
Published: February 2022

Background:

It is well known that patients with diabetes are at increased risk of influenza infection and its serious complications. Our aim was to evaluate the attitude towards and prevalence of influenza vaccination among Saudi patients with diabetes.

Methodology:

Descriptive questionnaire-based cross-sectional survey of a sample of patients with diabetes attending a specialist diabetic centre in the Ministry of Health Hospital in Taif city in Saudi Arabia. We utilized a generalized logistic regression model analysis to evaluate the effect of background factors on influenza vaccine uptake.

Results:

The study included (n = 336) patients with diabetes. The prevalence of uptake of influenza vaccine was 43.5% (CI: 38.2% to 48.8%). Adjusted analysis of background effects revealed that uptake of influenza vaccine was improved with age, university education, and belief in the dangerousness of flu infection in patients with diabetes. Factors that deterred from the uptake of flu vaccines were longer in DM duration, getting health messages about flu vaccines, belief in vaccine effectiveness, health practitioner information, in addition to physician recommendation of the vaccine.

Conclusion:

The content of health messages about flu vaccine and the quality of practitioner-patient interaction requires considerable improvement and re-evaluation if the flu vaccine uptake rates among Saudi individuals with diabetes were to increase. Comprehensive therapeutic packages for patients with diabetes should include high quality education about influenza vaccine. Research into preventative measures among patients with diabetes should evaluate the effect of educational interventions using robust methodology.
Diurnal variation of fat oxidation rate and energy expenditure in an acute bout of endurance exercise by young healthy males
Authors: Sharma Priyanka , Agarwal Mayank
Published: February 2022

Background:

Few studies have reported that circadian rhythm affects fat oxidation (FOx) during exercise. Time-of-day causing greater FOx and energy expenditure (EE) during exercise would be beneficial in the prevention of physical inactivity-related health disorders such as metabolic syndrome. The study aims to compare EE and FOx rate after an endurance exercise session done in the morning and late-afternoon hours by apparently healthy young male participants.

Material and Methods:

The present crossover quasi-experimental study involved 10 moderately active but physically untrained male participants of age 18–25 years with normal body mass index. Participants did a steady-state exercise on a motorized treadmill for 30 minutes at a moderate-intensity (50 ± 2% of their heart rate reserve) on two separate occasions at 9:00–10:00 and 15:00–16:00. A similar meal followed by 2 hours of fasting was done before each trial session. During the last 2 minutes of the exercise session, the respiratory gas analysis estimated volume of oxygen (VO2) and volume of carbon dioxide (VCO2) consumed in L/min. Indirect calorimetry equations assessed FOx (mg/min), EE (Kcal/min) and respiratory exchange ratio (RER). Data of one participant were removed to adjust for extreme chronotype. Paired t-test was applied, and P ≤ 0.05 was considered significant.

Results:

Morning versus late-afternoon variations in FOx (269 ± 110 vs 290 ± 110, P = 0.016), RER (0.86 ± 0.05 vs 0.85 ± 0.05, P = 0.040), EE (5.454 ± 0.987 vs 5.494 ± 0.959, P = 0.079) and VO2 (1.104 ± 0.201 vs 1.113 ± 0.196, P = 0.035) were present after adjustment for chronotype.

Conclusion:

In an acute bout of endurance, exercise done by young and healthy male individuals, FOx was significantly higher, while EE tends to be higher in late-afternoon than in the morning.
Risks of khat chewing on the cardiovascular, nervous, gastrointestinal, and genitourinary systems
Authors: Alshoabi Sultan Abdulwadoud , Hamid Abdullgabbar M. , Gameraddin Moawia B. , Suliman Awadia G. , Omer Awatif M. , Alsultan Kamal D. , Binmodied Abdul-Rub A. , Alhamadi Mohammed A.
Published: February 2022

Khat is an evergreen plant and its fresh green leaves and buds are chewed for several hours a day for its psychostimulant response. This study aimed to review the effects of khat chewing on the body. PubMed was searched for literature on the different aspects of khat chewing to summarize its effects on different body systems. The major effects of khat chewing are those on the cardiovascular system including increased blood pressure, increased heart rate, and increased risk of myocardial infarction. It causes insomnia, stress, depression, hallucination, and increased risk of brain stroke. It causes dental caries, bad oral hygiene, periodontitis, increased oral mucosal ulcers, and increased gingival bleeding and recession. Khat chewing causes loss of appetite, gastritis, constipation, and hemorrhoids, and increased risk of hepatotoxicity and liver cirrhosis. Ultimately, it causes weak micturition, decreased sperm motility and count, and low birth-weight offspring in khat chewing mothers. The published articles about khat chewing in journals indexed in the PubMed was reviewed. Inclusion criteria involved each article available with English language and have a reported new effect of khat chewing.
Beliefs, barriers, and acceptance associated with COVID-19 vaccination among Taif University students in Saudi Arabia
Authors: Mubarak Ali S. , Baabbad Ameera S. , Almalki Nada A. , Alrbaiai Ghaida T. , Alsufyani Ghadi A. , Kabrah Danah K.
Published: February 2022

Background:

COVID-19 was declared a public health emergency of global concern by the World Health Organization (WHO) on January 30, 2020. Vaccination is one of the most effective methods for halting the pandemic and preventing complications. Vaccine hesitancy is a possible threat to global public health. Understanding the key determinants that influence the community's preferences and demands for a future vaccine may aid in the development of strategies to improve the global vaccination program. The aim of this study was to assess the beliefs, barriers, and acceptance of COVID-19 vaccination among Taif University students in Saudi Arabia.

Materials and Method:

This was a descriptive cross-sectional study, based study in Taif University, Saudi Arabia. Data was collected using a designed self-administered questionnaire that was shared as a link through social media. 332 students were considered eligible to participate voluntarily. Data were analyzed using the (SPSS) program version 25.

Results:

Out of 332 participants, 278 (83.7%) were accepting to take the covid vaccine, while 54 (16.3%) refused. Believes in vaccine safety and effectiveness and trust in the ability of the vaccine to prevent the complication, were all associated with high acceptance rate. Fear about side effects is considered a major factor for vaccination refusal.

Conclusion:

Most of the participants have the willingness to be vaccinated. The majority of students who agreed to take the vaccine were in the medical field, and that is mostly due to their high knowledge exposure. This indicates the importance of raising the awareness of the non-medical students.
RAPD as a clinical alert for early evidence of dysthyroid optic neuropathy
Authors: Gupta Vinita , Das Sucharita , Mohan Shalini , Chauhan Udit
Published: February 2022

Dysthyroid optic neuropathy (DON) is a serious manifestation of thyroid eye disease (TED) resulting in permanent visual loss. There is controversy regarding the diagnostic features of DON. Relative afferent pupil defect (RAPD) in TED is highly specific for DON. Our first patient, a 42-year-old male presented with proptosis and intermittent blurring of vision with best corrected visual acuity of 6/6 in both eyes and right RAPD as an early sign of DON. Our second patient, a 54-year-old female presented with proptosis and clinical activity score <3 at the time of presentation. She developed intermittent blurring of vision with left RAPD on her second presentation as clue of bilateral asymmetric DON in her eyes, though BCVA was 6/6 both eyes. Both cases of bilateral asymmetric DON had RAPD as early specific sign of DON, which prompted us to do detailed radio-imaging to confirm DON, hence highlighting the importance of RAPD.
We love orthodox medicine but still use our ‘Elewe omo’
Authors: Goodman Olayinka O. , Adejoh Samuel O. , Adeniran Adeyinka , Emechebe Angela C. , Kuyinu Yetunde A.
Published: February 2022

Background:

Traditional Medicine refers to knowledge, skills and practices based on the theories, beliefs and experiences indigenous to different cultures. Women have been reported to utilize orthodox health care facilities more hence this study in an urban center.

Objective:

To determine the utilization of traditional healers, preference of healthcare and co-utilization of traditional and orthodox medicine among women in an urban community in Lagos, Nigeria.

Method:

A cross sectional design using a multistage sampling to select 270 women in Mosan Okunola, Lagos, Nigeria in 2019. A pretested semi-structured intervieweradministered questionnaire and an in-depth interview were used to obtain data from participants. Utilization of traditional healers was referenced within the last 12 months.

Result:

Sixty three percent (63.2%) of the study population utilized traditional healers and 80.6% of respondents that accessed healthcare utilized traditional healers. The Traditional Medicine ingredient dealer was the most patronized (74.6% of respondents). Eighty three percent (83.3%) of study participants indicated preference for orthodox medicine and 53.1% of the study respondents co-utilized both traditional healers and orthodox medicine. Concurrent use of both traditional and orthodox medicine was not a common practice among the women. Level of education, monthly income and means of payment for treatment had a statistical significant association (P < 0.05) with utilization of traditional healers but means of payment for treatment was the singular predictive factor of utilization of traditional healers.

Conclusion:

Utilization of traditional healers among women in this community was high with majority indicating a preference for orthodox medicine. It is recommended that an in-depth history of remedies used by patients should be delved into by orthodox health practitioners.
Covid-19 and leptospirosis, pulmonary involvement and response to steroids
Authors: Xavier Vinod , Baby Binitha , George Joemon M. , Ittyachen Abraham M.
Published: February 2022

Background:

COVID-19 is an emerging infectious disease with a global outreach. Leptospirosis is a zoonotic disease mainly confined to tropical areas. In both cases, most of those affected are asymptomatic or have only mild respiratory disease. Those who turn critical develop acute respiratory distress syndrome (ARDS) and/or multiple-organ failure occurs rapidly, with high fatality.

Methodology:

This is a retrospective observational study from 2020 involving COVID-19 and leptospirosis patients. The data were collected using a semi-structured proforma, and analysis was performed using Easy R (EZR) software.

Results:

There were five patients with COVIDC-19 and four patients with leptospirosis; with pulmonary involvement. All the patients were males. There was no significant difference in age, the onset of pulmonary involvement, time of initiation of steroids, duration of steroids, and outcome between the two groups. However, in the case of COVID-19, it took a longer period for clearing of infiltrates.

Conclusion:

Though COVID-19 and leptospirosis are two different diseases, both of them show a similar life-saving response to steroids, the common factor in the pathogenesis being cytokine storm. Primary care physicians in tropical areas of the world should be aware of the similarities between these two diseases, especially the initial clinical presentation, the pathogenesis, and the response to steroids.
Study of clinico- epidemiological profile of COVID-19 positive pregnant females in a tertiary care hospital of Kumaon region
Authors: Rani Mahima , Khan Mohd Najmul Aqib , Ahmad Shahzad , Maroof Mohd , Pant Prabhat , Awasthi Sadhana
Published: February 2022

Introduction:

Pregnant females are considered as a high-risk group for the prevention and control of various communicable diseases. Therefore, this research was undertaken to study the clinic-epidemiological profile and biochemical parameters of COVID-19-positive pregnant females in a tertiary care hospital.

Methods:

This hospital-based retrospective study was done on COVID-19-positive pregnant females admitted during April 2020–March 2021. A total of 139 patients were included in the study. Clinical, epidemiological, hematological, and biochemical profiles were described using frequency, percentages, mean, standard deviation using Microsoft Excel software.

Results:

The mean age of study participants was 25.36 ± 3.79 years, mean duration of pregnancy was 37.53 ± 3.31 weeks. The majority of the patients were asymptomatic (89.2%). Abdominal pain was the most common symptom (66.7%) among symptomatic. All patients were managed conservatively.

Conclusion:

The study showed the mild nature of COVID-19 among pregnant females as the majority of them pregnant were asymptomatic and few presented with mild symptoms.
Implementation, effectiveness and monitoring of telemedicine program in Bhutanese refugees camp in Eastern Nepal
Authors: Gupta Pramendra Prasad , Khatoon Salina , Khatiwada Neemesh , Mishra Abishekh , Bhatta Narendra , Geissbuhler Antoine
Published: February 2022

Background:

Telemedicine, a part of Medical Informatics used to consult patients from remote places either via videoconferencing or transferring data and resources via the Store and Forward method, makes the quality of healthcare in low-and middle-income countries more efficient, cost-effective, and accessible. The objectives of this study were to determine its effects on the health of refugees and its efficacy in terms of referrals and cost reduction for healthcare service providers among Bhutanese refugees in eastern Nepal.

Methods:

This was a cross-sectional study done retrospectively from the records of patient data of Bhutanese refugees from AMDA, Damak, and prospectively by asking the questionnaire to the healthcare providers of Beldangi PHC of AMDA, Damak.

Results:

The total percentage of patients that were seen via teleconsultation in the primary center was 58% male and 42% females, whereas from the secondary center, males were 43% and females constituted 57%. The referral rate from those primary centers and secondary centers were decreased to 31% and 39%, respectively, from 72% and 61% from previous records. The budget expenditure was also decreased to 13.65% from 29.41%.

Conclusions:

Telemedicine is beneficial in those types of refugee camps where there are chains of referring patients from primary health centers to tertiary care centers via secondary healthcare centers. As it not only decreased the referral rate but also save the budget expenditure, which are needed when referring those patients to other centers.
Effect of melatonin in children with neurodevelopmental disabilities and sleep disorders
Authors: Al Twaijri Waleed A. , Ba Armah Dua'a , Bin Sabbar Najla , Aldebasi Tariq , Shaheen Naila , Al Bekairy Abdul Kareem S. , Al-Jeraisy Majed
Published: February 2022

Objectives:

The aim of this study is to assess the efficacy and side effects of melatonin use in a population of children with neurodevelopmental disabilities who had sleep disorders.

Methods:

This is a cross-sectional study conducted in the pediatric neurology clinic at King Abdulaziz Medical City. A designed questionnaire was given to the parents to inquire about the sleep characteristics of their children before and after using melatonin. The patients' demographic data were collected and different parameters before and after starting melatonin were compared. Categorical variables were summarized and reported in terms of frequency and percent (n%). Continuous variables were reported in terms of mean and standard deviation.

Results:

A total of 23 patients were enrolled in our study, of which 15 (65.22%) were male. The mean age was 5.83 ± 3.07 years. For melatonin dose, 9 (39.13%) received 1 mg, 8 (34.78%) received 2 mg, and 6 (26.09%) received over 3 mg. Regarding melatonin duration of use, 7 (30.43%) received melatonin for 0 to 6 months, 7 (30.43%) received it for 7 to 12 months, and 9 (39.13%) received it for over a year. Significant differences were observed in time taken to fall asleep (P =0.046), the number of times the child woke up at night (P =0.071), total sleep time within 24 hours (P =.011), and time taken to wake up (P =.007), while no significant difference was observed in the number of naps taken during the daytime (P =.801). There were no major side effects reported.

Conclusion:

Melatonin had a significant impact on total sleep time and quality during the pre and post assessment of children with neurodevelopmental disabilities and sleep disorders.
To assess the feasibility and diagnostic accuracy of preoperative ultrasound and ultrasound-guided fine needle aspiration cytology of axillary lymph nodes in patients of breast carcinoma
Authors: Singh Somendra P. , Mishra Shashi P. , Gupta Vipin , Singh Shailendra P. , Gupta Poonam , Verma Ram L. , Akram Nadeem
Published: February 2022

Background:

Metastasis of the lymph node is one of the most significant prognostic factors for breast cancer (BC).

Aim:

To predict positivity of the lymph node in BC patients with help of USG and USG-guided FNAC and thus to prevent unnecessary morbidity.

Methods:

50 patients of incisional/true cut biopsy-proven BC patients were included. All were subjected to mammography, USG and FNAC of the lump breast. USG-guided FNAC of the axillary lymph node was done in 25 of these patients. These findings were assessed by histological examination following dissection of the axillary lymph node.

Results:

Axillary lymph node (ALN) metastasis was present in 42 patients on histopathology; 21 patients suspicious of malignancy on preoperative USG were confirmed by HPE. Out of 88 confirmed lymph nodes evaluated on ultrasonography, 4 were benign, 18 were indeterminate and 66 were suspicious. The most promising features were tumour length/depth ratio of <1.5 in 81, absent fatty hilum in 73% and hypoechoic cortex in 74%. Assessment of axilla with USG had a sensitivity of 50%, a specificity of 100%, a PPV of 100%, an NPV of 27.59% and a diagnostic accuracy of 58%. Preoperative USG-guided FNAC had a sensitivity of 91.67%, a specificity of 100%, a PPV of 100%, an NPV of 33.33% and a diagnostic accuracy of 92%.

Conclusion:

USG can detect non-palpable axillary lymph nodes and FNAC can increase the sensitivity and specificity of this technique, which makes this procedure very promising in detecting axillary metastases in BC patients.
An observational study to find association between Hypertension and severe and fatal COVID-19 infection in COVID dedicated hospital, Mumbai
Authors: Kinge Kirti V. , Chavhan Smita S. , Adsul Balkrishna B. , Kumbhar Maharudra A. , Gokhale Chinmay N. , Ingale Aniket R.
Published: February 2022

Introduction:

World Health Organization (WHO) has declared COVID-19 outbreak as a “public health emergency of international concern” on January 31, 2020. After that the epidemic spread rapidly around the world. Chronic non-communicable diseases were identified as risk factors for SARS-CoV-2. Hypertension (HTN) is one of the most common cardiovascular diseases with a prevalence ranging from 10% to 20% among adult population. After COVID-19 outbreak, identification of risk factors for severe or fatal disease is necessary to allocate limited resources. For primary care physicians, this is of vital importance to know the association between hypertension and severe and fatal COVID-19 infection as hypertension is affecting millions of people all over the world and primary health care is of immense importance in a country like India. Duration of stay in hospital which will be taken as proxy measure of duration of illness, symptomatic status, need of ICU care and death will be taken as indicators of severe and fatal COVID-19 infection. There are few researches to find an association between Hypertension and severe and fatal COVID-19 infection. There is a need to assess the same.

Objectives:

To find an association of hypertension and severe and fatal COVID-19 infection.

Methodology:

A hospital-based cross-sectional study was carried out at a COVID dedicated hospital, Mumbai in 9 months from 1 April 2020 to 31 December 2020. All patients admitted in hospital were included in the study by universal sampling.

Ethical Approval:

The permission to conduct the study was taken by Institutional Ethics Committee.

Results:

There was a significant association between hypertension and severe and fatal COVID-19 infection defined by more duration of stay in hospital, admission to ICU and mortality.

Conclusions:

It is concluded from this study that hypertension is associated with severe and fatal COVID-19 infection. It gives a clear idea for primary care physicians to give more focus towards patients with hypertension with COVID-19 infection. Blood pressure monitoring should be strictly practiced during COVID-like illnesses. Special attention is to be given as far as treatment and early referral to higher centre with ICU is concerned for better outcome. Hypertensive patients should be protected more by adopting COVID appropriate behaviour.
A comparative study on psychiatric morbidity among elderly population residing in old-age homes and community
Authors: Saritha C. Venkata Naga , Sudha Sree T. Y.Y. , Rao Ramana G. V. , Sasanka K. S. B. S. Krishna , Thangaraju Pugazhenthan
Published: February 2022

Aims and Objectives:

The objective of this study is to study, assess and compare the socio-demographic profile, psychiatric morbidity, cognitive functioning, quality of life and social support of senior citizens in care homes as well as in the communities.

Material and Methods:

Hundred subjects (50 were from old-age home and the rest were from the community) were assessed using intake pro forma details and an interview questionnaire. The Geriatric Mental Status questionnaire, Mini-Mental Status Examination, Quality of Life Support, and Multidimensional Scale of Perceived Social Support scales were then performed on each subject from the two groups in that order, and they were rated on all scales.

Results:

Individuals with lack of spouse and lack of children were higher and common attitude was death in old-age homes. Past history of psychiatric illnesses was more in the inmates of old-age homes. Memory disturbances, concentration problems, hypochondriasis, somatic dysfunction, error behaviour, thought disturbances, perceptual disturbances, persecution, expressed happiness and satisfaction were greater in the inmates of old-age care homes. The quality of life was poor in community group than in old-age home group.

Conclusion:

There is a need to increase community and health-care professional awareness of mental health problems in later life, as well as improve access to appropriate geriatric and mental healthcare.
Factors influencing the acquisition of COVID infection among high-risk contacts of COVID-19 patients in Madurai district-A case control study
Authors: Meena M. Selva , Priya S. , Thirukumaran R. , Gowrilakshmi M. , Essakiraja K. , Madhumitha M. S.
Published: February 2022

Introduction:

COVID is a new disease; understanding the transmission dynamics and epidemiological characteristics may help in developing the effective control measures. The study is done 1. To determine the various factors influencing the acquisition of COVID-19 infection among high-risk contacts 2. To estimate the secondary attack rate among high-risk contacts 3. To determine the factors in COVID index cases influencing their secondary attack rate.

Methodology:

Unmatched case control study was conducted from March to August 2020 among 139 COVID index cases in Madurai district from March–May (Reference period) and their 50 COVID positive (cases), 551 COVID negative (controls) high-risk contacts. Case investigation form* and contact tracing Proforma*were used to collect data. Chi-square test and independent sample t test were used to find out the association. Univariate* and Multivariate logistic regression* were used to predict the risk of various factors in acquisition of COVID infection with the help of adjusted and unadjusted odds ratio. P value < 0.05 was considered statistically significant.

Results:

Male contacts (P = 0.005, OR = 2.520), overcrowding (P = 0.007, OR = 3.810), and duration of exposure to index case (for 4-7 days P = 0.014, OR = 2.902, for >7 days P = 0.001, OR = 6.748 and for > 12 hours/day P = 0.000, OR = 5.543) were significant factors predicted to be associated with acquisition of COVID infection among high-risk contacts. Reproductive number (R0)* estimated was 1.3. Secondary attack rate (SAR)* estimated among high-risk contacts was 8.32%. Index cases whose outcome was death (P = 0.026); symptomatic index cases (P = 0.000), cases with fever (P = 0.001); sorethroat (P = 0.019); breathlessness (P = 0.010); cough (P = 0.006) and running nose (P = 0.002) had significantly higher mean SAR than their counterparts.

Conclusion:

Contacts with above said risk factors who were found to be more prone to infection could be given special focus to prevent the transmission in them.
COVID-19
Authors: Kuriakose Serin , Rohini C , Krishnan Aarati , Sreedevi S
Published: February 2022

Context:

Corona Virus Disease 2019 (COVID-19) has become a pandemic causing millions of deaths and causing a devastating blow to the global economy. Like all other countries and territories, the Ernakulam district (Kerala, India) is affected by COVID-19. When the number of COVID-19 cases reported in the other states started coming down, the Ernakulam district continued to record a large number of cases.

Aims:

To analyse the situation of the COVID-19 pandemic in the district of Ernakulam, Kerala.

Material and Methods:

The authors were part of the COVID-19 surveillance unit of Ernakulam district, and hence, had access to the data collected. The available data were analysed in the following phases of the pandemic: First phase: From the reporting of the first case in Kerala in January to the reporting of the first case in the Ernakulam district. Second phase: Cases reported mostly in those with a travel history and their contacts to the period of community spread. Third phase: From the start of community spread.

Results and Discussion:

As of July 5, 2021, the Ernakulam district reported 3,60,345 cases of the COVID-19 infection with 1,317 deaths and the recovery rate being 96.45%. Despite factors like high human development index (HDI), access to the Internet and social media, access to affordable healthcare, etc., factors like high population density, airports, seaports, railway stations, container terminals, IT parks, major highways, tourist spots, beaches, large shopping malls, large floating population, a huge number of migrant labourers, a large proportion of the elderly population, high prevalence of non-communicable diseases, etc., are the some of the major challenges. The preparedness of the fight against COVID-19 included the training of all healthcare workers, ward level rapid response teams (RRT), upgradation of health facilities, district-level patient management system, provisions to manage biomedical waste, etc., The containment zone strategy is currently based on the local self-government area-wise weekly test positivity rate (TPR). The cluster containment is focused on the early identification of clusters. Currently, the Ernakulam district reports one of the highest numbers of COVID-19 cases in India. This is mainly because of the high number of tests (five to six times to national average) and targeted testing strategy. This is scientifically proven by the very low case fatality rate (0.35%), low-bed occupancy rate of the COVID treatment facilities and the latest seroprevalence study by Indian Council for Medical Research (ICMR).

Conclusions:

So far, the Ernakulam district could excel in its efforts to fight against COVID-19. But even now, when we are moving forward with the immunisation of the healthcare workers, front-line workers, elderly population, our main strategies to prevent COVID-19 remain the same—proper social distancing, hand hygiene, use of masks, avoiding unnecessary travels and gathering, early identification of cases and treatment.
Diabetic peripheral neuropathy in diabetic patients attending an urban health and training centre
Authors: Kamalarathnam Sangeetha R. , Varadarajan Suresh
Published: February 2022

Introduction:

Diabetic neuropathy is a complication affecting almost 50% of the diabetic patients. Diabetic Peripheral Neuropathy (DPN) predominantly affects the hands and lower limbs. It leads to loss of protective sensation resulting in continuous injury to insensitive feet. The early detection of DPN using an objective screening test followed by its appropriate management is important as up to 50% of the patients may be asymptomatic.

Objectives:

To screen Diabetic patients attending an Urban Health and Training Centre of a medical college in Tamilnadu for Diabetic Peripheral Neuropathy. To assess the association between DPN and selected variables such as socio-demographic factors, glycaemic control, duration of diabetes, physical activity, body mass index, smoking and consumption of alcohol. Methods: The study was conducted among 204 diabetic patients attending an Urban Health and Training Centre. Participants were assessed using Michigan Neuropathy Screening Instrument (MNSI), which involves using a questionnaire followed by a physical examination.

Results:

Of the 204 patients, 58.8% were male. The mean age was 54.8 years (SD = 8.8 years). About 79.9% were employed of which 29.4% were skilled labourers. Mean duration of diabetes was 6.2 years (SD = 5.3 years). The proportion of diabetics who screened positive for Peripheral Neuropathy was 23% and 45.6% using MNSI questionnaire and examination, respectively. An age of 60 years and above was significantly associated with DPN (OR = 2.505, P value = 0.003). A duration of more than 4 years of diabetes was also significantly associated with DPN (OR = 1.872, P value = 0.02820).

Conclusion:

A high proportion of diabetics with peripheral neuropathy did not express symptoms specific for diabetics. Thus, a simple tool like MNSI would be useful in primary care settings to screen for peripheral neuropathy, and hence prevent disability”.
Experience of discomfort and its self-management strategies in ICU patients
Authors: Tavakoli Pouran , Cheraghi Mohammad Ali , Jahani Simin , Asadizaker Marziyeh
Published: February 2022

Introduction:

Discomfort in patients admitted to the ICU occurs due to various reasons and leads to a stressful situation in these patients. Discomfort significantly affects the ability to cope psychologically, the process, and results of treatment. The aim of this study was to investigate the experiences of discomfort and its self-management strategies in patients admitted to the ICU.

Methods:

This qualitative study was conducted in the period of September 2019 to December 2020 through in-depth interviews with 13 patients admitted to the ICU who were selected by purposive sampling. Interviews continued until data saturation. All interviews were recorded, transcribed, and analyzed using MAXQDA18 software by the conventional Lundman and Graneheim content analysis method.

Results:

The two main themes including “hospitalization with anxiety” and “coping with the horror of ICU” emerged from the uncomfortable experiences of patients admitted to the intensive care unit. “Hospitalization with anxiety” included five subthemes: “fear of disability and possible death,” “separation from family,” “understanding ambiguity and contradiction in treatment,” “environmental disruptors,” and “painful and unfamiliar devices and treatments.” “Coping with the horror of ICU” included three subthemes: “recourse to spirituality,” “benefiting from psychosocial coping,” and “information search.”