bluuebunny/crossref_metadata_2025 huggingface dataset:
Multimedia Information Time Balance Management in Mobile Cloud Environment Supported By Case Study
Authors: Hussein Karim Qassim
Published: October 2022

Mobile cloud computing is used to define and determine computing services with a structure model. The data and resource of any service will be retrieved from cloud computing through internet service, some tools, and user interface (web-based or application). Mobile Cloud Computing (MCC) is a hybrid of cloud computing and mobile computing. Multimedia Information is the core of Mobile Cloud information because of the sizable information of multimedia particularly video streaming. Mobile Cloud mostly handles and processes that information.  MCC is one of the business expressions with the real environment in the IT world. The concept of the MCC is still in the beginner stage of advancement. So, the handle of the innovation in a careful way especially in the bearing of future research should be provide.  In this paper, an algorithm is throttled load balancing for mobile clouds has been presented within an example of Multimedia information. The results has shown that the load balancing of cloud computing environment. In this scenario, load balancing techniques in mobile cloud computing can be employed and can successfully manage time through the cloud.
Noise Invariant Convolution Neural Network for Segmentation of Multiple Sclerosis Lesions from Brain Magnetic Resonance Imaging
Authors: M D Swetha , C R Aditya
Published: October 2022

The objective of the research work is to accurately segment multiple sclerosis (MS) lesions in brain Magnetic Resonance Imaging (MRI) of varying sizes and also to classify its types. Designing effective automatic segmentation and classification tool aid the doctors in better understanding MS lesion progressions. In meeting research challenges, this paper presents Noise Invariant Convolution Neural Network (NICNN). The NICNN model is efficient in the detection and segmentation of MS lesions of varying sizes in comparison with standard CNN-based segmentation methods. Further, this paper introduced a new cross-validation scheme to address the class imbalance issue by selecting effective features for classifying the type of MS lesion. The experiment outcome shows the proposed method provides improved Dice Similarity Coefficient (DSC), Positive Predicted Value (PPV), and True Positive Rate (TPR) value compared to the state-of-art CNN-based MS lesion segmentation method. Further, achieves better accuracy in classifying MS lesion types compared to standard MS lesion type classification models.
Usages du passé et rhétorique de la demande de pardon en politique
Authors: Vitale María Alejandra
Published: October 2022

A partir d’une approche rhétorique et d’analyse du discours, cet article a pour objectif de caractériser l’acte de demander pardon pour des faits traumatiques de l’Histoire comme un mode d’usage du passé dans le discours politique et, par conséquent, de proposer une manière d’analyser l’ancrage discursif de la mémoire. Comme cas de figure de cette problématique dans le contexte argentin, j’analyse la demande de pardon que l’ex-président Nestor Kirchner a adressée le 24 mars 2004, au nom de l’État national, dans l’ancienne l’École de Mécanique de l’Armée (ESMA), principal centre clandestin de détention, aux victimes du terrorisme d’État en vigueur en Argentine durant la dernière dictature militaire (1976-1983). J’examine aussi les tensions que sa demande de pardon et de construction de la mémoire a engendrées avec le premier président élu démocratiquement après la dictature, Raul Alfonsin (1983-1989) et avec le parti politique auquel il appartenait, l’Union Civique Radicale.
La rhétorique fondationnelle. Identité politique et usages du passé dans les discours politiques des gouvernements argentins du 21e siècle
Authors: Dagatti Mariano
Published: October 2022

Cet article présente les résultats d'une enquête plus large dans le domaine de l'analyse du discours politique, centrée sur l'étude de l'imaginaire et des identités politiques dans l'Argentine contemporaine. L'objectif spécifique est de décrire la rhétorique fondatrice des différents fronts et coalitions qui ont gouverné le pays depuis la reprise de la compétition électorale en 2003 : le Frente para Victoria [Front pour la Victoire] (2003-2015), Cambiemos [Changeons] (2015-2019) et le Frente de Todos [Front de Tous] (2019-). Différentes dans leur portée, dans leur orientation idéologique et dans leur recherche de consensus, notre hypothèse est que ces rhétoriques sont une voie d'accès privilégiée à l'analyse des identités politiques, car elles condensent le nœud du récit que chaque force organise pour définir son rapport au passé, décrire le présent et projeter ou imaginer l'avenir.
Second Phase Dissolution Influenced by Simultaneously Enhanced Mg, Cu Contents during Homogenization of As-cast Al-Zn-Mg-Cu Alloys
Authors: Ren Wei Cai , Wen Kai , Zhang Yong An , Liu Hong Lei , Zhang Tian You
Published: October 2022

The dissolution of second phase with relatively high melting point in as-cast Al-Zn-Mg-Cu alloys was closely related to Mg and Cu contents. In present work, second phases in three Al-Zn-Mg-Cu alloys with simultaneously enhanced Mg and Cu contents (named by LMC alloy, MMC alloy and HMC alloy as Mg and Cu contents progressively enhanced) were analyzed and the correlated dissolution during homogenization was investigated. The results showed that both Mg(Zn,Cu,Al)2 phase and Cu-rich phase existed in as-cast alloys while HMC alloy possessed more eutectic phases. As homogenized by 470°C/24h, Mg(Zn,Cu,Al)2 phase had dissolved completely, LMC alloy contained little Al2CuMg phase and the amount of it for the three alloys was arranged as LMC alloy < MMC alloy < HMC alloy. As furtherly homogenized by a second stage at 480°C for 12h, no endothermic peak for Al2CuMg phase was observed for LMC alloy and only Fe-rich phase existed. Meanwhile, Al2CuMg phase still remained in MMC and HMC alloy. As the homogenization time prolonging to 36h, Al2CuMg phase in MMC alloy dissolved completely while that still existed in HMC alloy. Adding a third stage at 490°C for HMC alloy, no Al2CuMg phase could be observed for 24h. This gave rise to a method by incrementally grading homogenization temperature combined with prolonging soaking time to fulfill the dissolution of second phase for Al-Zn-Mg-Cu alloys with enhanced Mg and Cu contents
Exploration of Phase Dissolution during Solution Treatment for a New Al-3.86Cu-0.89Li-0.38Mg-0.28Ag Alloy
Authors: Wang Tao , Xiong Bai Qing , Lin Ben , Hu Zheng Gen , Li Xi Wu
Published: October 2022

The dissolution of the second phase during solution treatment was of great importance for achieving preferential properties via aging treatment for Aluminum-Lithium (Al-Li) alloys. The microstructure characteristics of an extruded Al-Li alloy and its second phase dissolution during solution treatment were studied, while related electrical conductivity and tensile properties after ageing were tested for verification. The results indicated that as the alloy solution was treated from 500°C to 520°C with a soaking time of 1.5h, the Cu-rich phase dissolved into the matrix continuously. The statistics of remained phase area fraction ascertained no obvious decrement from 510°C to 520°C and only Fe-containing phase with large size was detected. Meanwhile, tensile properties under the same aging regime declared a higher strength was obtained at 510°C. As the solution time varied from 0.5h to 5h at 510°C, the Cu-rich phase was detected in a soaking time of 0.5h while disappeared after 1.5h and only the Fe-containing phase was observed. Correspondingly, electrical conductivity exhibited a moderate growth while tensile strength obviously increased from 0.5h to 1.5h and then maintained a platform, which revealed a preferential solution regime of 510°C/1.5h. This gives a reference for the second phase dissolution during solution treatments and furtherly obtaining preferential solution regimes.
Corrosion Behavior of 3Cr Steel in Simulated Oilfield CO2 Environment
Authors: Ji Nan , Kuang Xian Ren , Ge Kai Qi , Wang Peng , Long Yan , Feng Chun
Published: October 2022

The corrosion behavior of 3Cr steel in simulated oilfield CO2 and formation water environment at different temperature and partial pressure of CO2 were investigated using dynamic immersion tests, scanning electron microscopy inspection and X-ray diffraction analysis. The result demonstrated that with an increasing of temperature, the corrosion rate of 3Cr steel decreased, and reached the maximum corrosion rate when the partial pressure of CO2 was 0.5MPa. The high content of Ca2+ in the formation water had also played an important role in the corrosion behavior of the 3Cr steel for it can lead to a deposition of the CaCO3 on the surface of the specimen.
A Systematic Literature Review on Financial Stress of Small and Medium Entrepreneurs
Authors: Jayasekara B. E. A. , Fernando P. N. D. , Ranjani R. P. C.
Published: October 2022

Financial stress, which has become a contemporary issue in the globe, directly and indirectly affects individual’s behavior and disorders their physical and mental health. The main purpose of this study is to evaluate critically, the literature on financial stress of small and medium entrepreneurs and to build a financial stress-mitigating framework. The objectives of this study are to find the different aspects, measures and the level of financial stress of small and medium entrepreneurs to determine the consequences and methods of improving the financial stress to help policy makers to actively fill this missing gap and ultimately achieve economic development. The methodology used in this study was to review literature systematically using a sample of 151 most relevant studies published from 1936-2017 and critically appraise and synthesized findings qualitatively. The study revealed financial stress is less with those who are employed; elderly, having a lower debt load as a percentage of income, and possess better health and family relationships. Further, the financial stress is a cause of depression, anxiety, poor academic performance, unscheduled absence from work and negatively affects individual health, self-esteem, marriage satisfaction, parenting role and family functions. Hence, the study recommends overcoming financial stress as necessary to develop problem solving and financial management skills, develop effective handling of economic hardships, introduce more flexible repayment plans for loans; improve positive financial behaviors and budgets.
Impact of perceived authenticity in micro-influencer marketing on purchasing intention in fitness sector: The mediation role of trust
Authors: Wijerathna D. N. M. N. , Wijesundara T. R.
Published: October 2022

The purpose of the current study is to examine the impact of perceived authenticity in Micro-influencer marketing on purchasing intention with the mediation role of trust in the fitness sector. This is an explanatory study and the primary data were collected through an online self-administered questionnaire. The sample consisted of 150 respondents who are already following micro-influencers in the fitness sector on social media platforms. Partial Least Square Structural Equation Modelling was performed with Smart-PLS to estimate the path coefficients and to test the hypotheses developed in the study. The study discovered that there is a direct impact of perceived authenticity on purchasing intention and the relationship is partially mediated by trust. Subsequently, the theoretical and practical implications of the study are discussed.
Can Infectious Disease Control Be Achieved without Antibiotics by Exploiting Mechanisms of Disease Tolerance?
Authors: Lopez Brina S
Published: October 2022

Antimicrobial use in animal agriculture may be contributing to the emerging public health crisis of antimicrobial resistance. The sustained prevalence of infectious diseases driving antimicrobial use industry-wide suggests that traditional methods of bolstering disease resistance are, for some diseases, ineffective. A paradigm shift in our approach to infectious disease control is needed to reduce antimicrobial use and sustain animal and human health and the global economy. Targeting the defensive mechanisms that promote the health of an infected host without impacting pathogen fitness, termed “disease tolerance,” is a novel disease control approach ripe for discovery. This article presents examples of disease tolerance dictating clinical outcomes for several infectious diseases in humans, reveals evidence suggesting a similarly critical role of disease tolerance in the progression of infectious diseases plaguing animal agriculture, and thus substantiates the assertion that exploiting disease tolerance mechanisms can positively impact animal and human health.
ALL ABOUT THE SURGERY OF THE HOURORBITAL EXENTERATION!
Authors: Sinha Prerna , Saha Bhawesh Chandra , Nishant Prateek , Tiwari Pragati
Published: October 2022

Mucormycosis epidemic in the second wave of the coronavirus pandemic has led to the increase in the most disfiguring and mutilating of the orbital surgeries- orbital exenterations. This article deals with the details of orbital exenteration along with a detailed review of literature. One of the most radical surgeries of the eye, orbital exenterations prove to have a toll on the functional and psychological aspect of the patient's life. The post-operative disfigurement is stressful but various methods of reconstructions available have helped such patients with a better rehabilitation. With advances in the technology, better reconstruction options are now in plate for the patients undergoing this radical procedure. This article will help the readers understand the basics of the surgical procedure along with its post-operative management and rehabilitation.
POLYETHYLENE GLYCOL VERSUS CARBOXYMETHYLCELLULOSE SODIUM IN SENILE DRY EYE - RESULTS FROM A PROSPECTIVE RANDOMIZED STUDY IN NORTH INDIA
Authors: Nishant Prateek , Sinha Sony , Sinha Ranjeet Kumar
Published: October 2022

Purpose:

To evaluate patient-reported outcomes with Polyethylene glycol 0.4% + Propylene glycol 0.3% (PEG) eye drops and Carboxymethylcellulose Sodium 1% (CMC) eye drops in uncomplicated senile dry eye.

Methods:

A prospective randomised double-blinded two-arm study was conducted in a secondary and a tertiary hospital in Bihar, amongst >60 year old patients (N=60) with uncomplicated senile dry eye using IDEEL Treatment Satisfaction and Symptom Bother Questionnaire after 2 weeks of treatment, followed by comparison of reported scores between the two arms.

Result:

Patients on PEG reported significantly better outcomes (n=30, p<0.01) compared to those on CMC (n=30) as regards treatment satisfaction. Patients with high symptom bother scores (severe dry eye) started on PEG appeared to be more benefited than those with comparable symptom bother scores started on CMC, while such a difference was less marked in patients reporting lower initial symptom bother scores (mild or moderate dry eye).

Conclusion:

Polyethylene glycol 400 0.4% + Propylene glycol 0.3% eye drops appear to be a better prescription option compared to Carboxymethylcellulose Sodium 1% in the initial management of uncomplicated senile dry eye.
A COMPARATIVE CLINICAL STUDY REGARDING EFFICACY OF OLOPATADINE (0.1%) VERSUS TACROLIMUS (0.03%) IN VERNAL KERATOCONJUNCTIVITIS (VKC)
Authors: Singh Rajesh Kumar
Published: October 2022

Vernal keratoconjunctivitis (VKC) is a relatively rare, chronic form of ocular allergy that can potentially cause severe visual complications. Affecting mainly children and young adults, it is an IgE- and T cell-mediated disease, leading to a chronic inflammation in which eosinophil, lymphocyte and structural cell activation are involved. Treatment of VKC requires a multiple approach that includes conservative measures and pharmacologic treatment. Patients and parents should be made aware of the long duration of disease, its chronic evolution and possible complications. Treatment should be based on the duration and frequency of symptoms and the severity of corneal involvement. Mast cell stabilizers and antihistamines have been proven to be effective for the treatment of mild to moderate forms of VKC. In the most severe cases, topical steroids can be used as rescue medication to reduce conjunctival and corneal inflammation.
CLINICO-SOCIAL STUDY OF LOW VISION AID TREATMENT AND ITS BENEFITS IN IMPROVING QUALITY OF LIFE AMONG PATIENTS IN PATNA
Authors: Kumar Ashwini
Published: October 2022

Aim:

The aim of this study was to determine whether visual acuity of low vision aid patients could be corrected using low vision aids and rehabilitation techniques and to understand to what extent this would affect quality of their daily living.

Methods:

In Mahavir Netralaya Kankarbagh and Renu Eye Center Patna, 36 patients with low vision were examined, investigated and treated by the author in the period between Dec 2018 to April 2019, using a variety of new instruments and rehabilitation techniques. Details related to their visual acuity pre and post interventions were determined through in person interviews and clinical examination.

Results:

There was improvement in visual acuity in 32 patients as well as improvement in quality of living where patients were able to undertake several household and profession related tasks and activities

Conclusion:

Through this study, the author concludes that for low vision patients, following proper diagnosis, and treatment, proper rehabilitation tools and techniques are needed to bring improvement the quality of life.
DELAYED CENTRAL RETINAL VENOUS OCCLUSION IN YOUNG MALE ON CLOMIPHENE CITRATE
Authors: Kumar Nilesh , Parachuri Nikulaa , Sharma Ashish
Published: October 2022

Central retinal vein occlusion is the second most common cause of retinal vasculopathy, with multiple local and systemic associations. Clomiphene citrate is the first line drug in infertility treatment regimen in females and is increasingly used in males for oligospermia. Association of CRVO in clomiphene therapy in male is rare to be reported. We report a 37-year-old male who developed CRVO after 40 days of stopping clomiphene therapy, in absence of any other identifiable risk factors, and recovered visual acuity on medical management.
A TYPICAL CASE OF PIGMENTARY GLAUCOMA
Authors: Dhand Prashant , Mishra Atul , Makhmoor  , Alam Aftab
Published: October 2022

Pigment dispersion syndrome and pigmentary glaucoma are conditions characterized by pigment dispersion originating from the posterior part of the iris and its accumulation on the trabecular meshwork, corneal endothelium, and anterior surface of the lens. The pigment on the trabecular meshwork can cause chronic inflammation with a secondary reduction of its function and an increase in intraocular pressure. The case presented represents a typical example of pigmentary glaucoma in a myopic patient in which signs, symptoms, and complications typical of these pathologies were present. We report and describe a case in which the patient presented with complaints of progressive decrease in vision of two year duration. The patient also had myopia with classical signs of PDS like Krukenberg's spindle on the posterior corneal surface were evident on slit lamp examination; transillumination defects in the iris could not be elicited by retroillumination as the iris was heavily pigmented. Gonioscopy revealed heavy and uniform pigmentation of trabecular meshwork. Patient was follow-up for a period of 6 months with clinical and instrumental examinations.
Demographic and clinical profiles of patients with β-thalassemia major treated at Dubai Thalassemia Centre
Authors: Almahmoud Rabah , Hussein Amal , Al Khaja Fatheya , Soliman Ahmed Farrag , Dewedar Hany , Mathai Sarah
Published: October 2022

Background:

β-thalassemia major (BTM) is one of the hereditary anemias that is inherited as autosomal recessive. It is complicated by iron overload in different organs including the heart, liver, and endocrine glands. This study aimed to look at the demographic of patients with BTM treated at Dubai Thalassemia Centre.

Methods

Demography and clinical data for all thalassemia patients between 2 and 45 years of age were collected. Data such as age, gender, nationality, frequency of blood transfusion, and ferritin level among different groups were calculated.

Results

A total of 351 patients were studied; men constituted 50.7% (n = 178) compared with women 49.3% (n = 173). Young children (2–9 years) made up 11.1% (n = 39) of the total population studied, whereas older children and adolescents (10–18 years) made 20.2% (n = 71), and adults (19–45 years) made 67.7% (241). UAE nationals constituted 38% of the total population compared with 44% in previously published studies. Also, the percentage of Emirati children has dropped significantly from prior years (46.3% to 19.9%). The mean pre-transfusion hemoglobin ranged between 9.69–10.2 g/dL in all age groups indicating a successful hyper-transfusion policy. The median Ferritin level was significantly higher among women aged 19–45 years (3255 µg/L) as compared with men (2160 µg/L; U = 5488, P = 0.034) in the same group, and this was not observed in the other groups.

Conclusion

The success of the premarital screening program implemented by the UAE government was evident in the drop in the percentage of Emirati children affected by BTM in our study.
ABC of Gaze and Ocular Oscillations
Authors: Madhusudanan Mohan
Published: October 2022

The chief goal of all eye movements is to maintain the image of an object steady on the retina especially the macula to preserve visual acuity. Gaze palsy refers to lack of the conjugate movements due to a failure of supranuclear control mechanisms. Supranuclear control is maintained by not one, but multiple eye movement systems and gaze mechanisms. Supranuclear gaze palsies can be associated with a myriad of aetiologies- from trauma or metabolic abnormalities to stroke, demyelinating disorders and space occupying lesions like tumours. Culprit lesions may be in frontal motor centres, brainstem gaze centres gaze or interconnecting segments. While the brainstem network for horizontal gaze lies in pons, that for vertical gaze is situated in midbrain. Further, ocular oscillations and nystagmus are abnormal eye movements that disrupt a steady fixation of gaze. It is prudent to be aware of various gaze pathways and their anatomical corelates in order to establish a topographic relationship of clinical findings. A systematic clinical examination may provide deep insights on the patho-physiological mechanisms along with aiding in localizing the lesion accurately. This review deals with systematic clinical approach to various gaze control systems.
Clinical Profile of Patients with Leber Hereditary Optic Neuropathy (LHON)
Authors: Wilson Vinny , Kaur Prabhjit , Singh Sofia , Ramachandran Radhika P. , Jyothi Vislavath , Mahesh Karthik V. , Takkar Aastha , Chandak Giriraj , Singh Ramandeep
Published: October 2022

Background:

Leber hereditary optic neuropathy (LHON) is a maternally inherited disease resulting in irreversible visual loss usually in patients belonging to the age group of 15–35 years. Clinically, the patients present with sequential or bilateral, painless, progressive visual loss with central (or ceco-central) scotomas. Although the three mutations, namely, G11778A, T14484C, and G3460A contribute to >95% of LHON cases globally, the relative frequency of each mutation varies.

Aims and Objectives:

We aimed to assess the clinical and genetic profile of patients with mutation-positive LHON at a north Indian tertiary care center.

Materials and Methodology:

One hundred sixty-one patients (61 prospective and 100 retrospective) presenting with the clinical diagnosis of LHON were screened for the three known mitochondrial mutations (G1178A, G3460A, T14448C). Patients were assessed for detailed clinical, ophthalmological, and neurological examinations. Five milliliter of blood sample was taken to assess the three known mutations using DNA isolation and Sanger sequencing.

Results and Discussion:

Clinical profile of 83 patients with both positive and negative mutations was analyzed. Twenty-three out of 161 patients (14.3%) tested positive for either of the three mutations. The majority of the patients harbored G11778A mutation (56.52%) followed by T14484C (34.78%) and G3460A (8.69%). No statistical difference could be noted between the clinical profiles of mutation-negative and -positive patients.
Early Lactate Clearance in Predicting In-hospital Mortality in Patients with Sepsis Admitted in the Paediatric Intensive Care Unit
Authors: Dinakaran Janani , Yadav Shabd Singh , Patel Saurabh Kumar
Published: October 2022

Introduction:

Mortality due to sepsis is increasing in the PICUs of India. This study was conducted with the aim to investigate the prognostic value of lactate level at the time of admission and lactate clearance for mortality in sepsis and estimate its cut-off value of predicting mortality. This study also aimed to estimate the correlation between lactate clearance with PRISM III score (Pediatric Risk of Mortality score) and duration of stay.

Materials and Methods:

This was a prospective study on 150 patients admitted with severe inflammatory response syndrome with a probable infection in the paediatric intensive care unit with an estimation of serial lactate levels in the blood at 0–3 h, 24 h and 48 h of admission. Lactate clearance was calculated, and patients were followed up till discharge/death.

Results:

Out of 150 patients, there were 94 survivors and 56 non-survivors; the mean lactate clearance at 24 h was 6.16% in non-survivors, which was lower than survivors at 28.41%. The cut-off value of lactate clearance for predicting mortality was estimated to be 17.6%. PRISM III score and lactate clearance were inversely related. The duration of intensive care unit stay was more in non-survivors with low lactate clearance.

Conclusion:

Lactate clearance can be used as a prognostic measure for mortality in patients with sepsis and can be used as a guide for treatment.
Implementing Foundation Course for the First Time-Qualitative Analysis of Medical Students' Feedback and Lessons Learned
Authors: Bhatnagar Kavita , Oberoi Aroma , Ketkar Mrunal
Published: October 2022

Introduction:

Medical education aims at training an individual with respect to the knowledge, clinical skills, communication skills, and soft skills and building the highest standards of morale. While majority of training programs offer considerable technical skills only a few incorporate the remaining assets.

Methods:

A curriculum innovation project “Foundation Course” aiming to achieve the above goals, designed for the students entering a medical college was conducted for 74 students joining M. B. B. S. course in a Government Medical College in Port Blair in the year 2015. The feedback from students and teachers was collected at the end of entire activity in the form of a specially designed structured questionnaire with open as well as close-ended questions. Qualitative analysis was performed for students' and teachers' feedback on the open-ended questions.

Results:

The response rate was 100%. Students perceived foundation course as an excellent opportunity to acquire basic knowledge, attitude, and skills required for subsequent phases in MBBS course. The students opined that teachers who were friendly and approachable enhanced their learning. The attitude of teachers, the methodology of teaching, and the cooperation of peers all played a significant role in enhancing the learning. This course was helpful and increased their orientation to the curriculum and eased out the apprehension to cope up with the challenges.

Conclusion:

This foundation course enhanced their orientation to the curriculum and campus, boosted confidence to cope up with the challenging syllabus, helped them develop time and stress management skills, and sensitized them to achieve the highest standards of morale required to ensure ethical practice. Students' feedback revealed that how the faculty taught and interacted with the students had more impact than the content.
A Study of Fetal Umbilical Artery and Middle Cerebral Artery Doppler Velocimetry Before and after Treatment of Severe Maternal Iron Deficiency Anaemia
Authors: Rafiq Suhail , Posh Sheema , Wani Saima , Tang Shahnaz
Published: October 2022

Background:

Despite maternal iron deficiency anemia being a worldwide medical complication, very few studies have been performed to evaluate the efficacy of iron supplementations for treating and preventing adverse pregnancy sequelae. This study attempts to show the impact of maternal iron deficiency anemia on the mother and the fetus and whether treatment can reverse the physiological and pathological effects of anemia on the mother as well as the fetus.

Objective:

To evaluate the effect of vascular adaptation and extent of compensatory changes in the fetus with the change in maternal hemoglobin (Hb) levels and to study maternal and perinatal outcomes after treatment of maternal iron deficiency anemia.

Methodology:

The present study was an observational prospective study conducted on 50 pregnant women in GMC, Srinagar from January 2016 to June 2017. The study population was divided into two groups-Group A-Patients with moderate anemia – Hb 7–9 g/dl and Group B-Patients with severe anemia – Hb <7 g/dl. Group A received parenteral iron preparation and Group B received blood transfusion or packed red blood cells until Hb exceeded 7 g/dL, then parenteral iron was used. Maternal Hb and color Doppler were performed before and after treatment of anemia.

Results:

There was a decrease in the umbilical artery resistivity index (RI) after treatment of maternal anemia in both the groups and the decrease was more in those who received blood transfusion. There was an improvement in middle cerebral artery RI in both the groups after treatment and the increase was statistically significant. The C/U ratio was normalized to >1.1 in both the study groups after treatment of anemia.

Conclusion:

Our data support the fact that maternal Hb content of <7 g/dl is strongly associated with marked fetal hemodynamic adaptation and must be treated with acute red cell transfusion. Moderate anemia (>7 g/dl) is not sufficient to trigger fetal blood flow redistribution and can be treated with parenteral iron. Close monitoring of the fetal umbilical and cerebral circulation by Doppler examination in anemic pregnancies allows the measurement of the amplitude of fetal vascular response, early assessment of fetal damage and helps in improving fetal outcome as well.
To Compare Creatinine Estimation by Jaffe and Enzymatic Method
Authors: Augustin Sahaya Merina , Deshpande Ravi Prakash , Shanthaveeranna Girish Konasagara
Published: October 2022

Introduction:

Creatinine in urine and serum are used in the assessment of renal function. It is commonly estimated by Jaffe's and enzymatic method. In many institutions, serum creatinine is estimated by (POCT) Point of care testing device (Enzymatic method) and follow-up of the patients with creatinine results by other methods, analyzed in the Biochemistry laboratory. If the results of POCT do not correlate with the Jaffe method, it leads to differences in serum creatinine values and wrong treatment decisions during the follow-up of the patients. Hence, this study was done to know the difference between the two methods in a tertiary care hospital.

Aim and Objective:

To estimate creatinine by Jaffe's and enzymatic method and to compare the serum creatinine values between the two methods.

Materials and Methods:

It is an observational cross-sectional study, for a period of 17 months from November 2018 to March 2020. Seventy-five samples were analyzed for serum creatinine by Jaffe's method in the Biochemistry laboratory and by enzymatic method in the emergency department in POCT device.

Results:

Mean differences between Jaffe's and enzymatic method were −0.063 mg/dL, 0.070 mg/dL, 0.198 mg/dL, and 0.0685 in Group I, II, III, and all the groups together. The overall intraclass correlation coefficient including all the three groups (0.995) indicates a very good correlation between the two methods.

Conclusion:

Our study showed a good agreement and good correlation between the two methods, which is similar to other studies analyzed on same instrument.
Endemic Viral Disease - Expert Group Opinion for Solid Organ Transplant Recipients in South Asia – Dengue, Chikungunya, Zika, Rabies, Japanese Encephalitis, and Nipah Virus
Authors: Ramsubramanian Venktasubramanian , Guruprasad Suba , Prabha P. Krishna , Sridharan Sowmya , Kohli Harbir Singh , Wazil A W M , Bansal Shyam Bihari
Published: October 2022

South Asia is endemic to many virus infections such as arboviruses such as dengue virus, chikungunya virus, Zika virus, Japanese encephalitis (JE) virus, and rabies virus. Arbovirus infections present as fever, rash, arthralgia, myalgia, etc., Although transmission of these viruses has rarely been reported in organ transplants, in the endemic season, there is a possibility as the donor might be in an incubation period. Donor deferral for at least 30 days is advised in any donor with confirmed or suspected cases of arboviral infection. Rabies and JE can cause encephalitis and remain undiagnosed many times, so donors with unknown etiology of encephalitis should be excluded from donation. Nipah virus is an emerging virus, which is reported mainly from Bangladesh, Siliguri, and Kerala in India, however, no case of donor-derived infection has been reported yet.
A study on child sexual abuse reported by urban indian college students
Authors: Chacko Arman Z. , Paul Jackwin S. G. , Vishwanath Ranjith , Sreevathsan S. , Bennet Divya , Livingstone Pranuth D. , John Jacob
Published: October 2022

Background and Objectives:

The prevalence of child sexual abuse (CSA) in India is 18–50% depending on the population studied. To devise strategies for prevention of CSA at the primary care level, we studied the prevalence of CSA amongst college students aged 17–25 years.

Methods:

A group of medical students and their friends were sent, an anonymous questionnaire validated by experts via WhatsApp. The questionnaire assessed demography, occurrence of prior CSA and details of the sexual abuse.

Results:

About 574 students participated in the study. The majority of respondents were female (380, 66.2%). About 467 (81.2%) of participants were from South India. Of the 380 women and 194 men who consented to participate in the study, 218 (57.3%) and 65 (33.5%), respectively, said that they had been sexually abused in the past (p < 0.00001). The event commonly occurred at 12–14 years (22.6%), but about 53% of victims were <12 years of age. The perpetrator was usually male (93.2%), less than 30 years of age (54%) and a stranger (42.7%). The most common form of CSA from 348 instances in 283 respondents was some form of “bad touch or caresses” (56.6%). About 25.8% of those abused did not speak to anyone about the event. Only 249 respondents (43%) were counselled regarding CSA by their parents.

Conclusions:

The prevalence of CSA amongst South Indian college students is 49.3%. The victims were mainly girls <12 years of age and the perpetrators were mainly male (93.2%). Primary Care Physicians can play a greater role in the early detection and prevention of CSA.
Oral capillary hemangioma in a ten year old female child with hepatitis B treated with monopolar electrocautery
Authors: Kumar Vinod , Nanda Anisha , Kalele Ketki , Amrutha Rudraraju , Kuniyil Shakir Mekkalayil , Babu Aleena
Published: October 2022

Capillary hemangioma is a benign, vascular tumor characterized by proliferation of blood vessels that are primarily reported to be a developmental hamartomatous lesion of infancy and childhood. Till date, many cases of capillary hemangiomas have been reported in the literature, but juvenile hemangiomas with other systemic manifestations such as hepatitis B have not been studied well so far. The present paper reports a rare case of capillary hemangioma in a ten-year-old female with hepatitis B, which was treated under general anesthesia using electrocautery and followed up for one year and no recurrence was found.
Assessment of cardiovascular risk using WHO CVD risk prediction chart with respect to hypertension status among Indian population: A secondary analysis of National Family Health Survey (2015–16)
Authors: Jaiswal Abhishek , Selva Das P. Ananda , Singh Garima , Sathiyamoorthy Ramadass , Deori Trideep Jyoti , Dwarakanathan Vignesh , Malhotra Sumit , Verma Madhur , Goel Sonu
Published: October 2022

Background:

Hypertension, is a crucial risk factor for the development of cardiovascular disease (CVD). Studies assessing the risk of developing CVD among high-risk groups like hypertensives is limited.

Aim:

The purpose of this study was to find the distribution of CVD risk with respect to hypertension status among Indian adults.

Material and Methods:

This was a secondary data analysis of NFHS-4 survey data. The distribution of CVD risk among hypertensive participants using 2019 WHO CVD risk prediction charts was compared with normotensive participants among women aged 40–49 years and men in the age group of 40–54 years.

Results:

The proportion of hypertension was higher among women who consumed alcohol (31.5%) than those who did not (24.3%). The proportion of hypertensives increased with increasing BMI, with maximum proportion among obese women (37.3%). Among women, majority (95.7%) had low CVD risk (<5%) while 4.2% had 5% to <10% CVD risk, and only 0.1% had >10% risk. Among men, those with low CVD risk (<5%) was 65%, those with 5% to <10% CVD risk was 32.3%, 10% to <20% was 2.7%, and a meagre 0.03% had 20 to <30% risk.

Conclusion:

In the current study, prevalence of hypertension was seen to be increasing with age and was higher in urban residents than rural among both men and women. Both high blood pressure reading during the survey and self-reported hypertension was found to be higher among richest wealth index category. Although risk was higher among hypertensives, self-reported hypertensives who had their blood pressure controlled, had risk similar to normotensives indicating the importance of management of hypertension.
Establishing nomogram of blood pressure for late adolescents in India: Secondary analysis of NFHS-4 data
Authors: Jaiswal Abhishek , Dwarakanathan Vignesh , Selva Das P. Ananda , Singh Garima , Sathiyamoorthy Ramadass , Deori Trideep Jyoti , Malhotra Sumit , Jaswal Nidhi , Goel Sonu
Published: October 2022

Background:

Hypertension among adolescents is a public health problem, which is going to become more severe given the current obesity epidemic. There is a scarcity of information on the reference range value for blood pressure (BP) cut-off for adolescents.

Aim:

We aimed to establish BP distribution in adolescents aged 15–19 years by using the nationally representative National Family Health Survey-4 (NFHS-4) data.

Materials and Methods:

We analyzed the data of 15,936 boys and 1,04,132 girls aged 15–19 years in the NFHS-4 survey. We took the mean of systolic and diastolic BPs. Height for age z scores for each individual was calculated using the WHO Anthro plus. The sampling weight was taken as provided by the demographic and health surveys (DHS) website. Nomograms of systolic and diastolic BPs were made by calculating their 50th, 90th, and 95th percentiles for each age (in months), gender, and height percentile for age categories.

Results:

Both systolic and diastolic BPs increased with age and height centiles. The BP was higher in boys than girls. The average annual increase in systolic and diastolic BPs was 2.52 and 1.20 mmHg in boys and 0.50 and 0.46 mmHg in girls, respectively, when adjusted for height centiles.

Conclusion:

This study provides a BP nomogram that can be generalized to all the Indian population. Research is required for the diagnostic performance of this nomogram for the diagnosis of adolescent hypertension.
Utility of modified Mann assessment of swallowing ability (MMASA) in predicting aspiration risk and safe swallow in stroke patients
Authors: Panjikaran Nittu Devassy , Iyer Rajalakshmi , Sudevan Remya , Bhaskaran Renjitha
Published: October 2022

Introduction:

Aspiration pneumonia is one of the commonest causes of post-stroke mortality. We may be able to reduce this morbidity and mortality by assessing the risk of aspiration in stroke patients. Assessment of this risk can be done using a physician-administered screening protocol to assess dysphagia. A score of ≥95 is a good cut off to detect patients who can take oral feeds safely.

Objectives:

The primary objective was to predict aspiration risk using the Modified Mann Assessment Swallowing Ability (mMASA) scale. The secondary objective was to predict the safety of oral feeds using the same scale.

Materials and Methods:

An analytical cross-sectional study was conducted at a tertiary care rehabilitation centre in South India. A total of 100 stroke patients who underwent stroke rehabilitation in the study institution were divided into patients who were able to eat orally or not based on the mMASA scale. Demographic and stroke characteristics were recorded. The mMASA score was calculated and those with a score of ≥95 were given oral feeds. Those who scored <95 were given swallow therapy and re-evaluated in 2 weeks. Also, the mMASA score below which the patient was likely to develop aspiration pneumonia was detected using the receiver operating characteristic curve (ROC).

Results:

Out of the 100 patients, 37 patients had a score of ≥95 and were started on oral feeds and had no complications; the rest were started on 2 weeks of swallow therapy. On re-evaluation after swallow therapy, 12 more were started on oral feeds. The remaining 51 patients did not reach the cut-off score of ≥95 and were continued on nasogastric tube feeding. A total of 11 patients developed features of aspiration pneumonia; all of them belonged to the group of 51 patients who consistently had a mMASA score <95. The ROC curve determined that a score of <89 was a good cut off to predict patients who are at high risk of aspiration.

Conclusion:

The scale can be used to predict the likelihood of aspiration and readiness to start oral feeds in sub-acute stroke patients.
Tobacco use and uncontrolled hypertension among Indian men: Insights from the National Family Health Survey (NFHS-4), 2015-2016
Authors: Singh Harshvardhan , Sharma Shailja , Kathiresan Jeyashree , Bhatt Garima , Goel Sonu
Published: October 2022

Background:

Tobacco use is a modifiable risk factor for developing cardiovascular diseases, of which hypertension is a major killer. Uncontrolled hypertension (UHT) is a major public health concern that exerts a financial and service burden on the health system.

Aim:

The current analysis aimed to determine the association between tobacco use and UHT among Indian males.

Material and Methods:

Data from the 4th National Family Health Survey (NFHS) of 1,04,120 men aged 15–54 years were used. We estimated the adjusted prevalence ratio for having UHT among reported tobacco users and non-users.

Results:

The prevalence of UHT was the lowest (41.02%) among those who did not consume tobacco in any form. Among tobacco users, those smoking tobacco had the highest prevalence (53.53%) of UHT followed by those using both smoked and smokeless forms of tobacco (43.84%) and those using only smokeless forms of tobacco (42.26%). Factors significantly associated with UHT were alcohol consumption (aPR: 1.30; 95% CI: 1.19–1.43), belonging to the richer wealth quintile (richest quintile- aPR: 1.27; 95% CI: 1.05–1.38), being overweight (aPR: 3.14, 95% CI: 2.35–4.21), and being obese (aPR: 2.89, 95% CI: 2.12–.94). Higher educational status was significantly protective against UHT (aPR: 0.75; 95% CI: 0.63–0.88).

Conclusions:

Tobacco use is significantly associated with hypertension in Indian men. Addressing tobacco control and prevention of UHT remain the cornerstones for achieving the SDG target 3.4 by 2030, which aims to reduce premature mortality from NCDs by a third by 2030 relative to 2015 levels.
Prevalence and determinants of isolated systolic and isolated diastolic hypertension in India: Insights from the national family health survey (NFHS)- 4
Authors: Gupta Puneet , Sarkar Prattay G. , Verma Vivek , Kumar Amit , Arora Sameer , Kotwal Atul , Raj Sonika , Goel Sonu , Malhotra Sumit
Published: October 2022

Background:

Isolated Systolic Hypertension (ISH) and Isolated Diastolic Hypertension (IDH) are often the ignored forms of hypertension and are determinants of future cardiac and neurological events and contribute to mortality. However, the nationally representative estimates of both these forms of hypertension remain unknown from India.

Aim:

To estimate the ISH and IDH from a nationally representative survey of India.

Material and Methods:

The present study used data from 7,23,181 people (15–54 years), recorded during the fourth round (2015–2016) of the National Family Health Survey (NFHS), India. The prevalence of ISH and IDH was calculated for state comparison, while multilevel logistic regression analysis was done to assess the correlates of both types of hypertension.

Results:

The prevalence of ISH and IDH was found to be 1.2% (95% CI 1.0–1.4) and 5.7% (95% CI 5.2–6.2), respectively. The prevalence of both ISH and IDH increased with age, with a more significant increase in systolic pressure towards the higher age. Northeastern states of India (Assam, Meghalaya, and Arunachal Pradesh) had the highest prevalence of both forms of hypertension. On multilevel logistic regression, male gender, increasing age groups (highest odds ratio (OR) being in 45–49 year age group), alcohol, and diabetes positively predicted both ISH and IDH. Urban residence, literacy, and tobacco were positive predictors of IDH, whereas urban residence, smoking, and literacy negatively predicted ISH.

Conclusion:

ISH and IDH have a significant presence among the population of India. This data provides insights to formulate strategies at the primary and primordial prevention levels.
Therapeutic response to ramucirumab + folfiri in patients with metastatic gastric cancer
Authors: Rezvani Hamid , Haghighi Shirin , Ghobakhlou Mehdi , Ataei Elnaz
Published: October 2022

Background:

Gastric tumors are important gastrointestinal malignancies, and the prediction of therapeutic responses and related factors are important to improve the prognosis. Hence the aim of this study was to determine the therapeutic response to ramucirumab + folfiri in patients with metastatic gastric cancer.

Methods and Materials:

In this prospective cohort, 13 consecutive patients with metastatic gastric cancer attending Taleghani Hospital that underwent ramucirumab + folfiri therapy were enrolled, and the therapeutic response among them was determined.

Results:

The results in this study demonstrated that initial therapeutic response was 92.3% and the Progression-free Survival (PFS) was 16.2 months (84.6%) (CI95%:13.2-19.3). The nine-month PFS was 69.2%. Total survival was 16.7 months (CI95%:13.5-19.9).

Conclusion:

Ultimately, according to the obtained results, it may be concluded that the therapeutic response to ramucirumab + folfiri in a patient with metastatic gastric cancer is good, and the use of this regimen is recommended.