bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical and Serological Insights from the Asian Lineage Chikungunya Outbreak in Grenada, 2014: An Observational Study
Authors: Macpherson Calum , Noël Trevor , Fields Paul , Jungkind Donald , Yearwood Katherine , Simmons Monika , Widjaja Susana , Mitchell George , Noel Dolland , Bidaisee Satesh , Myers Todd E. , LaBeaud A. Desiree
Published: August 2016

Chikungunya virus (CHIKV) spread rapidly throughout the Caribbean region in 2014, and the first serologically confirmed case was seen in Grenada in July. This study investigated the outbreak of CHIKV in Grenada to identify the distinguishing clinical manifestations and the symptoms that corresponded the closest with serological test results. Sera were tested by IgM enzyme-linked immunosorbent assay and polymerase chain reaction to distinguish between cases positive or negative for CHIKV. Of 493 cases, 426 (86%) tested positive for CHIKV. The diagnostic decision rule, “Define as CHIKV positive a patient presenting with joint pain and any combination of fever, body pain, or rash,” produced the closest agreement (85%) with the serological test results (Cohen's kappa, k = 0.289, P value < 0.001). When laboratory facilities are not available for diagnostic confirmation, syndromic surveillance using these four symptoms could be useful to define cases during a CHIKV outbreak when CHIKV is the predominant circulating arbovirus.
Incidence and Seasonality of Influenza-Like Illnesses Among Pregnant Women in Blantyre, Malawi
Authors: Divala Titus H. , Kalilani-Phiri Linda , Mawindo Patricia , Nyirenda Osward , Kapito-Tembo Atupele , Laufer Miriam K.
Published: August 2016

Pregnant women with influenza infection are at increased risk of developing complications compared with other adults. Information about burden of influenza in pregnant women in Africa is limited. To determine incidence and seasonality of influenza-like illness (ILI) in pregnant women in Blantyre, Malawi, we recruited a cohort of 450 pregnant women and conducted surveillance for ILI and malaria infection. We recorded gestational age and birthweight. We accrued 157 person-years of observation (PYO) and detected 37 episodes of ILI (24/100 PYO) and 83 episodes of malaria infection (including all new episodes of parasitemia) (53/100 PYO). ILI was the most common cause of fever, but was not associated with adverse pregnancy outcomes. ILI incidence peaked during the hot dry season. These results indicate that ILI is a significant burden among Malawian pregnant women and it is somewhat seasonal. Studies with molecular diagnostics are needed to establish influenza-specific burden and the potential role of vaccination.
Multiorgan Dysfunction Syndrome from Strongyloides stercoralis Hyperinfection in a Patient with Human T-Cell Lymphotropic Virus-1 Coinfection After Initiation of Ivermectin Treatment
Authors: Choksi Tatvam T. , Madison Gul , Dar Tawseef , Asif Mohammed , Fleming Kevin , Clarke Leon , Danilewitz Mervyn , Hennawy Randa
Published: August 2016

Strongyloides stercoralis is well known to cause hyperinfection syndrome during the period of immunosuppression; but dissemination, worsening hyperinfection, and development of multiorgan dysfunction syndrome after initiation of ivermectin has not been reported in the past. Herein, we describe the case of a 62-year-old man with chronic strongyloidiasis and human T-cell lymphotropic virus-1 coinfection, who developed significant clinical worsening after 24–48 hours of initiation of treatment with ivermectin (200 μg/kg daily). Oral albendazole (600 mg every 12 hours) was added to the regimen due to clinical deterioration. Notably, after a protracted clinical course with multiple complications, which included respiratory failure from gram-negative pneumonia and pulmonary alveolar hemorrhage, Klebsiella meningitis, Clostridium difficile colitis, and herpes labialis, the patient eventually recovered. Health-care providers should be aware that during the early days of antihelminthic treatment initiation, significant dissemination of S. stercoralis and worsening of the clinical scenario can occur.
Predictors of Inflammation in a Cohort of Bolivian Infants and Toddlers
Authors: Burke Rachel M. , Suchdev Parminder S. , Rebolledo Paulina A. , de Aceituno Anna M. Fabiszewski , Revollo Rita , Iñiguez Volga , Klein Mitchel , Drews-Botsch Carolyn , Leon Juan S.
Published: August 2016

Inflammation has been associated with cardiovascular disease and other health outcomes in children and adults, yet few longitudinal data are available on prevalence and predictors of inflammation in infants. We aimed to identify the prevalence of inflammation in a cohort of Bolivian infants and estimate its association with acute (recent illnesses) and chronic (overweight, stunting) morbidities and potential pathogen exposure (represented by water, sanitation, and hygiene [WASH] resources). We measured plasma concentrations of two acute phase proteins (C-reactive protein [CRP], marking acute inflammation, and alpha(1)-acid-glycoprotein [AGP], marking chronic inflammation) at three time points (target 2, 6–8, and 12–18 months). Of 451 singleton infants enrolled in the parent study, 272 had the first blood draw and complete data. Anthropometry and sociodemographic and recent illness data (2-week recall of cough, diarrhea, and fever) were collected at each visit. Inflammation was defined as CRP > 5 mg/L or AGP > 1 g/L. The prevalence of inflammation increased from early infancy (3% at first blood draw) to later infancy (15–22% at later blood draws). Recent cough, recent fever, and age in months were significantly associated with relative increases in CRP (7–44%) and AGP (5–23%), whereas recent diarrhea was only significantly associated with an increase in CRP (48%). Neither anthropometry nor WASH was significantly associated with inflammation. Results confirm the role of recent acute illness in inflammation in infants, and indicate that adiposity and WASH are not as important to inflammation in this age category.
Rapid Diagnostic Test Performance Assessed Using Latent Class Analysis for the Diagnosis of Plasmodium falciparum Placental Malaria
Authors: Liu Yunhao , Mwapasa Victor , Khairallah Carole , Thwai Kyaw L. , Kalilani-Phiri Linda , ter Kuile Feiko O. , Meshnick Steven R. , Taylor Steve M.
Published: August 2016

Placental malaria causes low birth weight and neonatal mortality in malaria-endemic areas. The diagnosis of placental malaria is important for program evaluation and clinical care, but is compromised by the suboptimal performance of current diagnostics. Using placental and peripheral blood specimens collected from delivering women in Malawi, we compared estimation of the operating characteristics of microscopy, rapid diagnostic test (RDT), polymerase chain reaction, and histopathology using both a traditional contingency table and a latent class analysis (LCA) approach. The prevalence of placental malaria by histopathology was 13.8%; concordance between tests was generally poor. Relative to histopathology, RDT sensitivity was 79.5% in peripheral and 66.2% in placental blood; using LCA, RDT sensitivities increased to 93.7% and 80.2%, respectively. Our results, if replicated in other cohorts, indicate that RDT testing of peripheral or placental blood may be suitable approaches to detect placental malaria for surveillance programs, including areas where intermittent preventive therapy in pregnancy is not used.
A Prospective Study of Spectrum of Depressed Fractures of Skull and its Surgical Outcome
Authors: Sidram Vishwanath , Kumar PC Chandra , Raghavendra Bellara
Published: August 2016

Background

Depressed skull fracture is a very serious type of trauma occurring in 11% of severe head injuries, and there is a consistent association between the presence of cranial fracture and higher incidence of intracranial lesions, neurological deficit, and poor outcome. Depressed cranial fractures have to be treated aggressively because of their association with infection and late epilepsy.

Objectives

To study the clinical profile and surgical outcome of patients with depressed cranial fractures.

Materials and methods

A case series study of 44 patients with depressed fracture was conducted in a tertiary care hospital setting at the Department of Neurosurgery, Vijayanagara Institute of Medical Sciences, Bellary, Karnataka, during the period from June 2013 to January 2015. Among the selected patients, the clinical profile, radiological profile, and surgical interventions were undertaken and the outcomes were noted. Appropriate descriptive statistics were used to analyze the findings and to draw inferences.

Results

There were 30 males and 14 females. The mean age of the patients was 26.95 ± 14.87 years (6–65 years). The common cause of depressed fracture was road traffic accident (45%) and assault (40.9%); 63% of them had compound type and half of the fractures were located in the frontal region. Common associated injuries were extradural hematoma (50%) followed by dural tear (27.3%). Common complications were wound infection (9.1%) and cerebrospinal fluid leak (9.1%).

Conclusion

The management of depressed fractures should be individualized depending on factors like the degree of depression, communication with the exterior, neurological deficit and presence of associated injuries.

How to cite this article

Sidram V, Kumar PCC, Raghavendra B. A Prospective Study of Spectrum of Depressed Fractures
Intermediate Osteotomy and other Unique Techniques used in Reduction Rhinoplasty
Authors: Devasamudra Chidananda Ramappa , Devasamudra Chidananda R
Published: August 2016

Background

A 25-year-old male patient came with a history of nasal obstruction on the left side. He was also concerned about his nasal framework deformities, such as gross deviation of the nose to left, hump over the nose, asymmetrical nostril, and overall bulky nose.

Materials and methods

Detailed history was taken and examination done to rule out contraindication to septorhinoplasty. Expectations, requirements, and postoperative results of the patient were understood. Open approach reduction rhinoplasty was carried out. Unique techniques, such as intermediate and transverse osteotomies were done to achieve the required results.

Results

Bulky deviated nose was reduced to an esthetically good-looking nose by humpectomy, four types of osteotomies, extended spreader grafts, columellar strut, and Tipplasty.

Conclusion

Surgical steps must be undertaken in order to achieve good esthetic results. Surgeries, such as humpectomy must be done before osteotomies, intermediate osteotomies must be done before lateral osteotomies, and Tipplasty must be done after osteotomies.

How to cite this article

Sagar NJ, Devasamudra CR. Intermediate Osteotomy and other Unique Techniques used in Reduction Rhinoplasty. Clin Rhinol An Int J 2016;9(1):6-12.
Anatomic Variations of the Nose in Chronic Rhinosinusitis: Correlation between Nasal Endoscopic and Computerized Tomography Scan Findings and a Review of Literature
Authors: Chakraborty Priyanko , Jain Rajiv K , Joshi Purnima , Kumari Rakhi , Pradhan Sidharth
Published: August 2016

Background

Chronic rhinosinusitis (CRS) refers to a group of disorders characterized by inflammation of the mucosa of the paranasal sinuses. Nasal endoscopy and computed tomography (CT) scans are successfully used as diagnostic modalities of nose and paranasal sinus diseases. There have been many studies regarding the anatomic variations leading to pathogenesis of paranasal sinus diseases. Considerable progress has been made in the medical and surgical control of these conditions; however, a large number of questions relating to the diagnosis, evaluation, and treatment of the diseases remain unanswered.

Materials and methods

The study included 82 clinically diagnosed cases of CRS who underwent CT scan and were advised to undergo diagnostic endoscopy. The anatomical findings of the nose were compared to see correlation between nasal endoscopy and CT scan.

Results

The mean age (±standard error of the mean) of presentation was 34.11 (±1.42) years, while most patients were from the age group of 18 to 30 years. Males were predominating the study group with 62.2%, while 37.8% were females. The most common anatomic variation was deviated nasal septum with 92.68% CT reported patients. This was followed by inferior turbinate hypertrophy, septal spur, concha bullosa, and agger nasi cells.

Conclusion

Computed tomography scan is considered the gold standard for sinonasal imaging. Diagnostic endoscopy and CT scan are a must prior to any functional endoscopic sinus surgery. They help in assessing the extent of sinus disease and to know the variations and vital relations of the paranasal sinuses. Computed tomography scan assists the surgeon as a “road map” during endoscopic sinus surgery.

How to cite this article

Chakraborty P, Jain RK, Joshi P, Kumari R, Pradhan S. Anatomic Variations of the Nose in Chronic Rhinosinusitis: Correlation between Nasal Endoscopic and Computerized Tomography Scan Findings and a Review of Literature. Clin Rhinol An Int J 2016;9(1):13-17.
Epistaxis—Incidence, Etiology, and Management: A Hospital-based Study
Authors: Moran Niru , Das Debajit
Published: August 2016

Epistaxis is defined as bleeding from the nose. Though it is not serious, it causes anxiety both to the sufferer and to the attending physician. The objective of this study was to review the incidence, common etiological factors, and management modalities of epistaxis. It is a prospective study of 288 patients seen with epistaxis over 1.5 years at Assam Medical College and Hospital from January 2014 to July 2015. The age of patients ranged between 4 and 80 years. An incidence of 7.5% (38,400) was recorded and slight male preponderance with a male:female ratio of 25:9. Trauma and local nasal factor were the main etiological factors identified, but over 5.90% had no discernable cause. About 65% presented with active bleeding and 50% required admission. Patients were managed according to their cause. About 10.41% required blood transfusion. Epistaxis is a common rhinological emergency that requires prompt intervention to reduce morbidity and prevent mortality.

How to cite this article

M oran N, D as D . E pistaxis—Incidence, Etiology, and Management: A Hospital-based Study. Clin Rhinol An Int J 2016;9(1):18-20.
A Clinical Study of Relationship of Body Mass Index with Allergic Rhinitis
Authors: Bist SS , Bhagat Sanjeev , Kala Himanshu
Published: August 2016

Objectives

Although the association between obesity and bronchial asthma (BA) has been gaining more attention, few studies have been conducted concerning the relationship between body mass index (BMI) and other allergic diseases. The purpose of this study is to determine the relationship between allergic rhinitis (AR) and BMI.

Materials and methods

This was a retrospective study. Two hundred and ten patients of AR (138 males and 72 females) and 424 healthy controls were included in the study. The BMI of patients and controls were calculated and correlated.

Results

The percentage of AR patients with a low BMI was 9.5%, whereas 57.6% had a normal BMI; 21% were preobese and 9.5% were obese. In the control group, 48.6% subjects had normal BMI range followed by preobese 21.2%, underweight 20.3%, and obese 9.9%. Among the overweight (preobese+ obese) category, the maximum number of subjects belonged to cases, i.e., 32.8% with an odds ratio (OR) of 0.95 (95% confidence interval (CI) 0.91-1.07). Thus, AR was not associated with high BMI. Among the underweight, the maximum number of subjects belonged to the control group, i.e., 20.3% with an OR of 2.13 (95% CI 1.24-3.68). Thus, AR had no relationship with lower BMI also. It was also observed that more of the female patients (18, 29.1, and 12.5% were underweight, preobese, and obese respectively) had deranged BMI than male patients (5.3, 20.2, and 7.9% were underweight, preobese, and obese respectively). A relative risk of 1.124 (95% CI 1.01-1.23) and 1.04 (95% CI 0.95-1.13) was present in female patients with low and high BMI respectively, which is statistically significant (p = 0.0008).

Conclusion

It was concluded that BMI was not associated with increased prevalence of AR. Among the underweight and overweight, AR was more common in females than in males. Thus, BMI had a significant association with AR among female patients. Overall, BMI had no significant association with AR.

How to cite this article

Kala H, Bhagat S, Varshney S, Bist SS. A Clinical Study of Relationship of Body Mass Index with Allergic Rhinitis. Clin Rhinol An Int J 2016;9(1):33-36.
Mucociliary Clearance in Bronchiectasis
Authors: Gupta KB , Yadav Jyoti , Ranga Rupender K , Goel Anuj K
Published: August 2016

Bronchiectasis is a chronic lung disease, defined pathologically as irreversible dilatation of the bronchi. There is ineffective clearance of pulmonary secretions because of damage to the cilia. The nasal mucociliary clearance was studied using the saccharine method in 75 patients of bronchiectasis and the results were compared with those of 25 healthy controls. The nasal mucociliary clearance was significantly prolonged in patients with bronchiectasis.

How to cite this article

Yadav J, Ranga RK, Goel AK, Gupta KB. Mucociliary Clearance in Bronchiectasis. Clin Rhinol An Int J 2016;9(1):37-39.
Maxillary Sinus Hypoplasia—A Not-so-uncommon Clinical Entity: A Review
Authors: Srivastava Saurabh , Shakeel Mohd , Varshney Prasoon
Published: August 2016

Bilateral sinus maxillary sinus hypoplasia is a rare anomaly. Radiological diagnosis of maxillary sinus hypoplasia is important for diagnosis to prevent recurrent rhinosinusitis and complications during endoscopic sinus surgery. A high index of suspicion is required by outpatient department examination for proper clinical evaluation and further management of these patients.

How to cite this article

Bhargava A, Khanduri S, Shakeel M, Srivastava S, Varshney P. Maxillary Sinus Hypoplasia-A Not-so-uncommon Clinical Entity: A Review. Clin Rhinol An Int J 2016;9(1):43-45.
Posaconazole: An Only Oral First-line Antifungal for Rhinocerebral Mucormycosis
Authors: Jalal Muhammed JA , Fernandez Shirley J , Thomas Renu M , Kandathil Julio C , Menon Murali K , Kuruttukulam Gigy
Published: August 2016

Introduction

Mucormycosis is a rare opportunistic invasive fungal infection. The most commonly reported form of the disease is rhinocerebral mucormycosis. Early diagnosis of the disease and aggressive medical and surgical intervention prevent the high morbidity and mortality associated with mucormycosis.

Case report

A 54-year-old diabetic and hypertensive male presented with severe frontal headache and retro-orbital pain of 4 days duration with high-grade fever. On examination, the patient was conscious and oriented with a blood pressure of 210/100 mm Hg. The pupils were anisocoric. Frontal sinus tenderness was present. Anterior rhinoscopy showed deviation of nasal septum to left without edema and nasal mucosal congestion. Eye examination revealed normal vision without any periorbital swelling and normal fundus. Plain axial computed tomography showed soft-tissue density material in sphenoid sinus with focal hyperdense component anteriorly. Cerebrospinal fluid study was negative for meningitis with a normal cerebrospinal fluid pressure. Axial T1-weighted image showed T1 intermediate to high signal soft tissue occluding the sphenoid sinus. Axial T2-weighted image showed T2 high signal soft tissue occluding the sphenoid sinus. Similar signal tissue was seen in the middle and posterior ethmoid air cells on both sides. Axial and coronal postcontrast T1-weighted fat-saturated images showed heterogeneously enhancing soft tissue in sphenoid and ethmoid sinuses. The patient underwent functional endoscopic sinus surgery and tissue sampling, following which antifungal therapy with posaconazole was initiated since biopsy from sinus mucosa was consistent with mucormycosis. The patient responded well to functional endoscopic sinus surgical evacuation of the fungal debris and posaconazole and is doing well on follow-up.

Conclusion

This report highlights the possibility of occurrence of this rapidly fatal condition even with normal-looking nasal mucosa. High index of suspicion is required to prevent the complications as the course of the disease is very rapid. This case report emphasizes the fact that posaconazole is the only available oral antifungal that can be used as a first-line agent in the management of mucormycosis, even in immunocompromised individuals.

How to cite this article

Jalal MJA, Fernandez SJ, Thomas RM, Kandathil JC, Menon MK, Kuruttukulam G. Posaconazole: An Only Oral First-line Antifungal for Rhinocerebral Mucormycosis. Clin Rhinol An Int J 2016;9(1):46-49.
Ectodermal Dysplasia presenting with Atrophic Rhinitis: A Report of Two Cases and a Review of the Literature
Authors: Pati Sampurna , Pal Sudipta , Biswas Surajit , Saha Somnath
Published: August 2016

Aims

To present two rare cases of ectodermal dysplasia presenting with maggot infestation due to atrophic rhinitis.

Study design

Case report.

Setting

A tertiary care referral hospital.

Presentation

Two male children aged about 5 and 8 years presented to the ear, nose, and throat emergency with a history of maggot infestation of the nose.

Results

Clinical examination was suggestive of ectodermal dysplasia. Intranasal examination was suggestive of atrophic rhinitis. Maggots were removed in the conventional manner. Following a conservative treatment, skin biopsy and nasal mucosal biopsy were done, which confirmed the diagnosis of ectodermal dysplasia.

Conclusion

Any ectodermal dysplasia patient should be suspected of having atrophic rhinitis and intranasal conservative therapy should be initiated at the earliest to prevent complications like maggots in the nose.

How to cite this article

Pati S, Pal S, Saha S, Biswas S. Ectodermal Dysplasia presenting with Atrophic Rhinitis: A Report of Two Cases and a Review of the Literature. Clin Rhinol An Int J 2016;9(1):53-55.
Changing Trends in Endoscopic Endonasal Medial Maxillectomy
Authors: Verma Hitesh , Arun TM , Kaur Amrinder
Published: August 2016

Medial maxillectomy is a surgical resection of the medial walls of the maxillary bone, medial part of the orbital floor, and ethmoid sinuses. Lateral rhinotomy or sublabial degloving is the traditional approach used for an open medial maxillectomy. Endoscopic medial maxillectomy is used as an alternative approach with similar cure rate with less morbidity. We report here a case of inverted papilloma of the medial wall of the right maxillary sinus where the disease clearance was done with preservative of nasolacrimal duct, inferior turbinate, and lateral nasal wall mucosa by the endoscopic medial maxillectomy approach.

How to cite this article

Verma H, Dass A, Singhal SK, Gupta N, Arun TM, Kaur A. Changing Trends in Endoscopic Endonasal Medial Maxillectomy. Clin Rhinol An Int J 2016;9(1):56-58.
Sensory and Knee Range of Motion Responses of Slump Test on Unaffected and Radiculopathy Affected Limb in Patients with Lumbar Disk Herniation
Authors: Singh Amarjeet , Aggarwal Amita , Jayakrishnan Sarvanan
Published: August 2016

Background

Disk herniation is common—it is seen in up to a quarter of magnetic resonance imaging (MRI) and can be detected even in asymptomatic adults. The slump test has become widely advocated as a neural tissue provocation test for clinical assessment of patients with spinal and lower limb pain. The purpose of this study was to determine the sensory and terminal knee extension limitation responses produced during slump test on radiculopathy affected and unaffected limb in patients with lumbar disk herniation.

Objectives

To compare the sensory and knee range of motion (ROM) responses produced during slump test on affected and unaffected limb.

Materials and methods

Fifty patients, 25 to 45 years of age chronic disk herniation patients with unilateral radiculopathy with/without lower backache. Patient underwent standardized history and physical examination followed by slump test. Outcomes included terminal knee extension limitations and sensory response produced in terms of intensity numeric rating scale (NRS), nature and location (pain drawings).

Results

During slump test end position, NRS score and restricted terminal knee ROM comparative results were highly significant (p < 0.001). Based on nature and location of sensory response, maximum number of subjects in affected limb had pain in center of lower back radiating to whole lower limb and for unaffected limb stretch at back of knee.

Conclusion

In this study, it was suggested that though sensory and knee ROM responses are present in both affected and unaffected limb but the radiculopathy affected limb was more affected in terms of intensity of pain and limitation of motion.

How to cite this article

Aggarwal A, Jayakrishnan S, Singh A. Sensory and Knee Range of Motion Responses of Slump Test on Unaffected and Radiculopathy Affected Limb in Patients with Lumbar Disk Herniation. J Postgrad Med Edu Res 2016;50(1): 1-4.
Effectiveness of Isokinetic Exercises in Preoperative Anterior Cruciate Ligament Tears Rehabilitation
Authors: Dhillon Mandeep , Adhya Bibek , Aggarwal Amita
Published: August 2016

The present study compared the effectiveness of adding isokinetic exercise program to conventional rehabilitation protocol in preoperated patients with anterior cruciate ligament (ACL) tear. The subjects were randomly assigned into two groups (n = 10 each). Group A followed conventional rehabilitation protocol. In group B, isokinetic exercise for quadriceps and hamstring were advised. These consisted of 3 set of 10 repetitions at velocity of 60 and 120° sec. with 1 minute rest interval between the sets. The exercise protocol was performed 6 days a week for 4 weeks. Student t-test was used for analysis. Also subjects were evaluated for pain using visual analog scale (VAS). For the assessment of symptoms and functions Cincinnati knee rating system and Lysholm scoring scale were used. The effectiveness of isokinetic exercise was significantly better only with knee extension peak torque and peak work in case of quadriceps (p < 0.05). Hamstring testing showed no significant difference with isokinetic training in intragroup as well as intergroup comparison for any measured parameters. Also no significant differences were found with use of functional scales.

Conclusion

Isokinetic exercises are effective in improving quadriceps peak torque and peak work in patients with ACL tear.

How to cite this article

Aggarwal A, Adhya B, Dhillon MS. Effectiveness of Isokinetic Exercises in Preoperative Anterior Cruciate Ligament Tears Rehabilitation. J Postgrad Med Edu Res 2016;50(1):5-8.
Stress, Stress Reactions, Job Stressors and Coping among Nurses Working in Intensive Care Units and General Wards of a Tertiary Care Hospital: A Comparative Study
Authors: Kaur Sukhpal , Das Karobi , Saini Ruchi
Published: August 2016

Literature has presented nursing as a stressful profession. The present study was conducted to compare stress level and job stressors operating in two different units, i.e. intensive care units (ICU) and general wards of a tertiary care hospital of North India. This is a cross-sectional study involving 285 nurses (general wards = 176; ICU = 109). The nurses were selected conveniently. Demographic profile sheet, modified workplace stress scale (WSS), workplace stress symptom scale (WSSS) and coping checklist (CCL) of Rao, Subbakrishna and Prabhu (1989) was used in the study. Findings of the study revealed moderate to high stress level among general wards and ICU nurses with young female nurses experiencing more stress. Further, workload, role ambiguity and lesser social support accounted for significant amount stress among nurses working on both the units while external factors, such as physical environment and resources hardly contributed to stress. It was also found that the ICU nurses experienced stress more in the form of exhaustion (11.9%); irritation (11.9%) and reduced self-confidence (0.9%) that those working in general wards. However, the nurses on both the units use distraction, positive coping, problem-solving and religious strategies to manage and handle their stress. The findings of the study give insight into stress and stressors related to job which can be buffered using various stress management strategies by the nurse managers.

How to cite this article

Saini R, Kaur S, Das K. Stress, Stress Reactions, Job Stressors and Coping among Nurses Working in Intensive Care Units and General Wards of a Tertiary Care Hospital: A Comparative Study. J Postgrad Med Edu Res 2016; 50(1):9-17.
Risk Factors of Congenital Malformations in North India: A Case Control Study
Authors: Singh Amarjeet , Sinha Smita
Published: August 2016

An increasing incidence of congenital malformations (CMF) has been reported in India.

Objective

To ascertain the determinants of CMF.

Methodology

This hospital based age-sex matched pair case control study was done at advanced pediatric center (APC), obstetrics and gynecology department (ANC clinic, maternity ward, labor room, etc.) and special clinics, PGIMER, Chandigarh, India in 2008. The mothers were interviewed to collect information about risk factors.

Results

Two hundred three CMF (under five children and gestational CMF) cases and same number of controls were studied. Significant association of CMF was observed with the use of sex selection drugs by mothers (OR = 4.35), habits of fathers like taking alcohol (OR = 3), smoking (OR = 4.5) and using tobacco (OR = 2.7). Mother's age at marriage < 18 years and history of abortion were also important predictors of CMF.

Conclusion

Most of the risk factors for CMF were avoidable viz. addiction, early marriage and use of sex selection drugs. People need to be educated about this.

How to cite this article

Singh A, Sinha S. Risk Factors of Congenital Malformations in North India: A Case Control Study. J Postgrad Med Edu Res 2016;50(1):22-27.
Sutureless Vitrectomy for Repositioning of in-the-Bag Single Piece Acrylic Dislocated Intraocular Lens
Authors: Singh Ramandeep , Parchand Swapnil Madhukar , Singh Rishiraj , Kumari Neha
Published: August 2016

We report a successful outcome in a case of dropped in-thebag single piece intraocular lens (IOL), which was retrieved and refixated to sclera using 23-gauge transconjunctival sutureless vitrectomy (TSV). This technique of scleral refixation of same IOL using sutureless vitrectomy shows the versatility of the 23-gauge TSV in managing the difficult and cumbersome situations like above.

How to cite this article

Singh R, Parchand SM, Singh R, Kumari N. Sutureless Vitrectomy for Repositioning of in-the-Bag Single Piece Acrylic Dislocated Intraocular Lens. J Postgrad Med Edu Res 2016;50(1):28-29.
Staphylococcal Scalded Skin Syndrome in an Extremely Premature Neonate
Authors: Saini Shiv Sajan , Kulkarni Vinay Vamdev , Gautam Vikas
Published: August 2016

Staphylococcal scalded skin syndrome is a rare diagnosis in neonates. We present an extremely premature neonate presenting with bullous lesions all over the body on day 20 of life. The lesions ruptured leaving erythematous, tender raw areas. Nikolsky's sign was positive and clinical diagnosis of staphylococcal scalded skin syndrome was made. His blood culture grew Staphylococcus aureus and Klebsiella pneumoniae. His umbilical swab culture grew S. aureus. The baby was treated with by cloxacillin, piperacillin/tazobactum and clindamycin. The lesions healed in 7 days. The baby was discharged with normal skin and normal neurological condition.
Prevention of Sudden Cardiac Death in Cricketers
Authors: Kountouris Alex , Orchard John W , Puranik Rajesh , Semsarian Christopher , Orchard Jessica J , Samra David , Duflou Johan , Groenestein Patrick , Young Mark , Brukner Peter
Published: August 2016

Aims

Sudden death in cricketers is rare, with the most common causes being cardiac, neurological (head/neck trauma, mainly from ball impact) and environmental (e.g., lightning strike and heat stroke, the former which usually involves cardiac arrest). The aim of this study was to review possible prevention of sudden cardiac death and make recommendations.

Materials and methods

A literature review of possible causes of sudden cardiac death (SCD) among cricketers was performed, along with evaluation of evidence for existing preventative measures. The method for evaluation was expert panel (cardiology and sports medicine) consensus recommendations based on the published evidence base.

Results

Potential cardiac causes of sudden death while playing cricket can be divided into the following categories: (1) atraumatic-origin preexisting arrhythmias, cardiomyopathies and valve disorders (2) traumatic-origin arrhythmia (commotio cordis) (3) acquired coronary or valvular disease (4) viral myocarditis (5) Lightning strike. Preventive measures can be divided into pre-season (e.g., cardiovascular screening), prematch (e.g., assessment of viral illness), protective equipment (e.g., chest guards) and post-event (presence of first aid response including defibrillators). Our panel agreed that there was strong evidence that (1) trained and planned emergency response particularly with a defibrillator is effective at preventing SCD and (2) ceasing play in the presence of lightning strikes prevents lightning-related death (3) players with symptoms, risk factors or history suggestive of possible cardiac disease should undertake specific individual workup. There are other potential methods to prevent SCD, with expert level recommendations made in the absence of strong evidence.

Discussion and conclusion

The most controversial aspect of prevention of SCD is electrocardiogram (ECG) screening of asymptomatic players and this paper outlines the arguments both in favor and against without fully resolving the debate. The possible increase in early diagnosis of potentially life-threatening cases needs to be balanced against the risk of false positive results which may lead to discussion of exclusion from cricket. Cardiac workup is clearly of net benefit to symptomatic individuals (e.g. history of syncope, chest pain) or any player at higher than usual baseline risk (e.g., positive family history). Basic life support including access to defibrillators should be available with trained personnel wherever they can be afforded, which has strong evidence in favor of improving survival at the time of cardiac arrest.

How to cite this article

Orchard JW, Puranik R, Semsarian C, Orchard JJ, Samra D, Duflou J, Groenestein P, Young M, Brukner P, Kountouris A. Prevention of Sudden Cardiac Death in Cricketers. J Postgrad Med Edu Res 2016;50(2):49-58.
Feasibility of Using Mobile Smartphone Camera as an Imaging Device for Screening of Cervical Cancer in a Low-resource Setting
Authors: Bagga Rashmi , Keswarpu Payal , Naik Sarif Kumar , Chandrasekhar Vidya , Gupta Lovi , Paul Soubhik
Published: August 2016

Objective

The aim of this study is to determine the feasibility of a screening method for cervical cancer using an application developed on smartphone to aid visual inspection with acetic acid.

Materials and methods

A prospective study was carried out in 230 women in the Department of Gynaecology, PGIMER, Chandigarh, India. These women were divided into two groups. Among the first group, screen positive women (n = 28) were examined by two gynecologists. In the second group (n = 202), health care workers screened women in a mobile van. The two groups were examined using the smartphone and digital colposcope. Abnormal findings were confirmed by liquid-based cytology and histopathology. The image quality of ColpPhon® was compared with colposcopic images as the gold standard. Kappa was used for comparison of ColpPhon® and colposcopic findings for final diagnosis.

Results

Among the 230 women screened, cervical intraepithelial neoplasia (CIN) was diagnosed in six cases by histopathology (CIN 2/3 in five and CIN 1 in one). These six women belonged to the group of 28 women examined in the colposcopy clinic. Both colposcope and ColpPhon® were able to identify these six women. The individual image quality parameters for ColpPhon® were slightly inferior to the colposcope. The overall image clarity had an agreement in 82% (184/225) as being either good or excellent. The diagnosis made on images acquired from each device had an agreement in 90% (208/230) of the cases.

Conclusion

This study demonstrates feasibility of incorporating a smartphone device to capture images of the cervix for improving cervical cancer screening in resource-poor countries.

How to cite this article

Bagga R, Suri V, Srinivasan R, Khandelwal N, Keswarpu P, Naik SK, Chandrasekhar V, Gupta L, Paul S. Feasibility of Using Mobile Smartphone Camera as an Imaging Device for Screening of Cervical Cancer in a Lowresource Setting. J Postgrad Med Edu Res 2016;50(2):69-74.
Bisphosphonates in Orthopedics: Evidence-based Review of Indications and Adverse Effects
Authors: Dhillon Mandeep , Aggarwal Sameer , Gahlot Nitesh , Saini Uttam Chand
Published: August 2016

Bisphosphonates (BPs) are clinically the most important class of antiresorptive agents available to treat diseases characterized by osteoclast-mediated bone resorption. These agents have a potent effect on the skeleton and are in common use for treatment of osteoporosis, Paget's disease, and metastatic bone disease in adults as well as in the treatment of pediatric disorders, such as osteogenesis imperfecta, Perthes’ disease, and fibrous dysplasia. Although initial investigations had demonstrated an acceptable safety profile of bisphosphonate drugs, but recently this has been questioned by some authors. In this article, we review the chemistry, pharmacokinetics, and pharmacodynamics of these agents in brief and the orthopedic applications as well as adverse effects in detail.

How to cite this article

Aggarwal S, Gahlot N, Saini UC, Dhillon MS. Bisphosphonates in Orthopedics: Evidencebased Review of Indications and Adverse Effects. J Postgrad Med Edu Res 2016;50(2):75-85.
Vitamin D reduces Exacerbation in Children with Asthma: A Systematic Review and Meta-analysis
Authors: Agarwal Amit , Chauhan Anil , Jaiswal Nishant , Singh Manvi , Thumburu Kiran Kumar , Chauhan Shailender Singh , Dhatwalia Sunil , Bhende Mananda S , Singh Meenu
Published: August 2016

Aim

The question whether treatment with vitamin D improves asthma exacerbations in children and adults still needs to be addressed.

Background

Recent studies in children and adults found a higher prevalence of hypovitaminosis D associated with a higher severity of asthma and impaired pulmonary function. In asthmatic children, patients with vitamin D deficiency demonstrated increased airway hyperresponsiveness and corticosteroid requirements.

Results

Of 469 records/studies identified through database searching, 5 studies were included in this systematic review. The overall pooled effect showed a significant reduction in acute asthma exacerbation in the vitamin D group (odds ratio 0.45, 95% confidence interval 0.22—0.93). There were no studies that focus on the quality of life.

Conclusion

This systematic review supports the role of vitamin D in reducing the number of asthma exacerbations in children but not in adults.

Clinical significance

The present systematic review demonstrates reduction in asthma exacerbations in children. Most of the asthma children are on inhaled corticosteroid, which poses a threat for its side effects. However, vitamin D having multiple functions in body could be used as an alternative therapy in asthmatic children. In adults, more trials are needed wherein the deficient individuals are supplemented with vitamin D and further assessed for asthma exacerbations. There is no harm in supplementation of vitamin D to deficient and insufficient asthmatic individuals.

How to cite this article

Chauhan A, Singh M, Jaiswal N, Thumburu KK, Agarwal A, Chauhan SS, Dhatwalia S, Bhende MS, Singh M. Vitamin D reduces Exacerbation in Children with Asthma: A Systematic Review and Meta-analysis. J Postgrad Med Edu Res 2016;50(2):86-92.
Can Physiotherapists be trained to work in Critical Care utilizing Clinical Simulation?
Authors: Dennis Diane , Marsh Lisa
Published: August 2016

Aims

The intensive care unit (ICU) is an acute area requiring significant expertise and training. This study aimed to see if a novel package of simulation training of physiotherapists in ICU physiotherapy competencies would promote confidence and be less stressful compared to traditional training. The secondary aim was to see if simulation training was less costly in terms of training time and whether additional support staff hours required.

Materials and methods

Fifteen physiotherapists participated in the study, with two trainee cohorts (traditional, n = 5; simulation, n = 5) and supervising staff (n = 5). A simulation training program was implemented over 6 half days during 2013/2014. All participants then completed follow-up questionnaires. Data were also collected relating to training costs and cost of support provided to the trainee on commencement of independent work in the ICU.

Results

Respondents reported that simulation was extremely useful (> 4.75) and likely to reduce stress and improve confidence (> 3.8). All training components were useful (> 3.4) with simulation trainees perceiving the highest usefulness (4—4.8). Simulation training took less time per trainee (mean 3 vs 4.4 days), and less trainer time (total 9 vs 22 days). Costs incurred during 1st week of independent work were similar.

Discussion

This study has demonstrated that the delivery of a novel package of simulation scenarios was successful in improving the confidence of inexperienced physiotherapists moving into the ICU setting. The mode of up-skilling was also less expensive compared to the existing training model. Simulation may be useful for other health professionals in the critical care environment.

How to cite this article

Dennis D, Marsh L. Can Physiotherapists be trained to Work in Critical Care utilizing Clinical Simulation? J Postgrad Med Edu Res 2016;50(3):136-140.
Problems of Injury Surveillance and Documentation in Cricket: Indian Experience
Authors: Prabhakar Sharad , Dhillon Mandeep , Garg Bhavuk , Dhillon Sidak
Published: August 2016

Cricket is the most prevalent and popular sport in India. Its expansion, including recent inclusion of T20 format over the last decade, has placed greater demands on cricketers and led to an increased incidence of injuries worldwide. Worldwide, in all forms of sport, successful injury prevention requires ongoing injury surveillance as a fundamental process. Unfortunately, injury surveillance is not the norm in Indian sports. We do not have any specific documentation protocol for documenting injury patterns, causative mechanisms, and analyzing the incidence of different cricket-related injuries in players of different ages except the Aclass test players. Despite being the most popular team sport in India, there is just a single publication in the medical literature reporting cricket injuries from India. This article reviews the burden of cricket injuries in both national and international perspective and emphasizes the potential and need of an injury surveillance program to improve cricket sport in India.

How to cite this article

Dhillon M, Garg B, Dhillon S, Prabhakar S. Problems of Injury Surveillance and Documentation in Cricket: Indian Experience. J Postgrad Med Edu Res 2016;50(3):148-150.
Molecular cloning, sequence characterization, and tissue expression analysis of three water buffalo (Bubalus bubalis) genes – ST6GAL1, ST8SIA4, and SLC35C1
Authors: Song Shen , Ou-Yang Yina , Huo Jinlong , Zhang Yongyun , Yu Changlin , Liu Minhui , Teng Xiaohong , Miao Yongwang
Published: August 2016

Abstract. Recent studies have shown that ST6 beta-galactosamide alpha-2,6-sialyltransferase 1 (ST6GAL1), ST8 alpha-N-acetyl-neuraminide alpha-2,8-sialyltransferase 4 (ST8SIA4), and solute carrier family 35, member C1 (SLC35C1) play essential roles in the metabolism of milk glycoconjugates in mammals. However, studies on their coding genes in water buffalo have not been reported. In the present study, cloning and sequencing showed that the coding sequences (CDSs) of buffalo ST6GAL1, ST8SIA4, and SLC35C1 were 1218, 1080, and 1095 bp in length, which encoded a precursor protein composed of 405, 359, and 364 amino acids, respectively. The deduced sequences of these three proteins in turn showed 97.6–98.5, 98.6–99.7, and 97.8–99.2 % similarities with other bovine species. Both buffalo ST6GAL1 and ST8SIA4 were predicted to be a member of glycosyltransferase family 29 and were all hydrophilicity proteins functioning in the Golgi apparatus. Buffalo SLC35C1 was a hydrophobic membrane protein located in the Golgi membrane, containing a TPT domain that is found in a number of sugar phosphate transporters. In addition, semi-quantitative RT-PCR analysis in 13 lactating buffalo tissues revealed that the ST6GAL1 and ST8SIA4 were expressed in 9 tissues, while SLC35C1 was expressed in 11 tissues. The expression levels of these three genes in the mammary gland were significantly higher in lactating than in non-lactating stage. Collectively, our data indicate that ST6GAL1, ST8SIA4, and SLC35C1 are potentially involved in the process of buffalo lactation.
Evaluation of European air quality modelled by CAMx including the volatility
basis set scheme
Authors: Ciarelli Giancarlo , Aksoyoglu Sebnem , Crippa Monica , Jimenez Jose-Luis , Nemitz Eriko , Sellegri Karine , Äijälä Mikko , Carbone Samara , Mohr Claudia , O'Dowd Colin , Poulain Laurent , Baltensperger Urs , Prévôt André S. H.
Published: August 2016

Abstract. Four periods of EMEP (European Monitoring and Evaluation Programme) intensive measurement campaigns (June 2006, January 2007, September–October 2008 and February–March 2009) were modelled using the regional air quality model CAMx with VBS (volatility basis set) approach for the first time in Europe within the framework of the EURODELTA-III model intercomparison exercise. More detailed analysis and sensitivity tests were performed for the period of February–March 2009 and June 2006 to investigate the uncertainties in emissions as well as to improve the modelling of organic aerosol (OA). Model performance for selected gas phase species and PM2.5 was evaluated using the European air quality database AirBase. Sulfur dioxide (SO2) and ozone (O3) were found to be overestimated for all the four periods, with O3 having the largest mean bias during June 2006 and January–February 2007 periods (8.9 pbb and 12.3 ppb mean biases respectively). In contrast, nitrogen dioxide (NO2) and carbon monoxide (CO) were found to be underestimated for all the four periods. CAMx reproduced both total concentrations and monthly variations of PM2.5 for all the four periods with average biases ranging from −2.1 to 1.0 µg m−3. Comparisons with AMS (aerosol mass spectrometer) measurements at different sites in Europe during February–March 2009 showed that in general the model overpredicts the inorganic aerosol fraction and underpredicts the organic one, such that the good agreement for PM2.5 is partly due to compensation of errors. The effect of the choice of VBS scheme on OA was investigated as well. Two sensitivity tests with volatility distributions based on previous chamber and ambient measurements data were performed. For February–March 2009 the chamber case reduced the total OA concentrations by about 42 % on average. In contrast, a test based on ambient measurement data increased OA concentrations by about 42 % for the same period bringing model and observations into better agreement. Comparison with the AMS data at the rural Swiss site Payerne in June 2006 shows no significant improvement in modelled OA concentration. Further sensitivity tests with increased biogenic and anthropogenic emissions suggest that OA in Payerne was affected by changes in emissions from residential heating during the February–March 2009 whereas it was more sensitive to biogenic precursors in June 2006.