bluuebunny/crossref_metadata_2025 huggingface dataset:
Mapping tectonic stress at subduction zones with earthquake focal mechanisms: application to Cascadia, Japan, Nankai, Mexico, and northern Chile
Authors: Plourde A P , Cassidy J F
Published: November 2022

Earthquake focal mechanisms have contributed substantially to our understanding of modern tectonic stress regimes, perhaps more than any other data source. Studies generally group focal mechanisms by epicentral location to examine variations in stress across a
region. However, stress variations with depth have rarely been considered, either due to data limitations or because they were believed to be negligible. This study presents 3D grids of tectonic stress tensors using existing focal mechanism catalogs from several subduction zones, including Cascadia,
Japan, Nankai, Mexico, and northern Chile. We bin data into 50 x 50 x 10 km cells (north, east, vertical), with 50% overlap in all three directions. This resulted in 181380 stress inversions, with 90% of these in Japan (including Nankai). To the best of our knowledge, this is the first
examination of stress changes with depth in several of these regions. The resulting maps and cross-sections of stress can help distinguish locked and creeping segments of the plate interface. Similarly, by dividing the focal mechanism catalog in northern Japan into those before and those
>6 months after the 2011 Mw 9.1 Tohoku-Oki earthquake, we are able to produce detailed 3D maps of stress rotation, which is close to 90° near the areas of highest slip. These results could inform geodynamic rupture models of future megathrust earthquakes in order to more accurately
estimate slip, shaking, and seismic hazard. Southern Cascadia and Nankai appear to have sharp stress discontinuities at ~20 km depth, and northern Cascadia may have a similar discontinuity at ~30 km depth. These stress boundaries may relate to rheological discontinuities in the forearc,
and may help us unravel how forearc composition influences subduction zone behaviour and seismic hazard.
Christology and apology in Ephrem the Syrian
Authors: Botha P. J.
Published: November 2022

Christology is an attempt to relate the two natures of Christ; apology on the other hand, has the dual aim of justification and attack; both these entail polar structures. It is argued in this paper that these two binary systems of opposition interfered with each other to a certain extent. This occurred because of the practice of the early church to establish institutional stability and consent via a process of polarisation. The effect of apologetic antitheses on Ephrem’s description of the natures of Christ is investigated. Examples from Ephrem’s work relating to the polarity between the church and Judaism, between the nature of God and Arianism, and between the nature of God and humanity are discussed.
Development of models for predicting the objective response of immune checkpoint inhibitor therapy in patients with nonsmall-cell lung cancer
Authors: Yang Qiao , Cui Lin , Gao Yu , Yang Xiu , Sun Jianguo
Published: November 2022

Background:

Immune checkpoint inhibitors (ICIs) have significantly improved the therapeutic efficacy and extended the survival of patients with advanced nonsmall-cell lung cancer (NSCLC); however, the benefits were confined to certain populations. How to optimally select eligible patients for ICI therapy needs to be solved.

Materials and Methods:

A total of 100 NSCLC patients treated with ICIs from two independent studies were included and then were randomly assigned to the train dataset and the validation dataset. A logistic regression model and a decision tree model were developed to predict the objective response outcome. The area under the receiver operating characteristic curves (AUC) of the two models was evaluated. The confusion matrix for decision tree model was also calculated.

Results:

The comparison of baseline clinical features between the train and validation datasets showed no significant difference. The multivariable logistic regression identified three variables associated with objective response, i.e, age, tumor mutational burden (TMB), and programmed cell death ligand 1. Moreover, a logistic regression model was developed based on these variables. A decision tree, including age and TMB, was also developed. The AUCs of the two models were both 0.85 in the train dataset. And, that was better than each single variable. The AUC of the decision tree in the validation dataset was inferior to that of the logistic regression model. The performance showed that the decision tree could not effectively identify responders.

Conclusion:

The performance of the decision tree developed in this study was dismal. Its predictive ability was inferior to the logistic regression model.
Subclavian Artery Thrombosis Post Modified Radical Mastectomy Surgery - A Rare Case Report
Authors: Alim Sheikh Saif , Ammar Ahmad , Yadav Mayank , Rabbani Syed Shamayal , Chawla Surbhi , Shama Abu , Haseen Mohd Azam
Published: November 2022

Subclavian artery thrombosis is a relatively rare and unheard complication postmodified radical mastectomy (MRM) surgery and it is still not reported in the literature. We report a case of a 55-year-old female who underwent MRM for Stage II left ductal carcinoma of breast with level 2 lymph node involvement in a private hospital. She developed ischemic pain in the left upper limb on postoperative day 3. She came to JNMCH and was referred to us and initial imaging with computed tomography angiography revealed occlusion from the origin of the subclavian to axillary artery. We discuss the management of the aforementioned condition in our setup and would also discuss the steps needed to avoid the same in the future.
Ruptured Mycotic Abdominal Aortic Aneurysm with Perforated Colonic Malignancy – “Quadruple Jeopardy”
Authors: Pandey Ashutosh Kumar , Sun Neelamjingbha , Manchikanti Sriram , Pitchai Shivanesan
Published: November 2022

We describe an unusual presentation where a patient referred for ruptured abdominal aortic aneurysm was detected to have a concurrent colonic growth with perforation and localized spillage. Aneurysm repair was done with neoaortoiliac system reconstruction and Hartmann's procedure was done. This case report describes the management of a rare intraoperative challenge.
Cost-Effective Treatment for Deep-Vein Thrombosis in Rural Tertiary Care Hospital
Authors: Arasappa Arunkumar , Kumar Nirmal , Anto M , Manoharan GV , Selvanathan Duraipandian
Published: November 2022

Objective:

The aim was to compare the cost of treating deep-vein thrombosis (DVT) using unfractionated heparin (UFH) and low-molecular-weight heparin (LMWH) among patients in rural tertiary care hospitals.

Materials and Methods:

A retrospective study was conducted at a Rural Tertiary Care Hospital from April 2017 to April 2019. Fifty-four patients who had symptoms of swelling of the unilateral or bilateral lower limb with or without pain were subjected to Padua prediction score and Doppler study of both lower limbs. Confirmed cases of DVT were treated with UFH or LMWH. The cost of these two treatments was compared.

Results:

The mean cost of heparin was 2493.33 ± 1406.27 Indian rupee (INR) in the study population. The mean cost of LMWH was 13,520 ± 9806.35 (INR) in the study population. There was a statistically significant difference between UFH and LMWH with regard to the cost of drugs (INR) for treatment (P < 0.001), which indicated that UFH was a cost-effective treatment compared to LMWH.

Conclusions:

The study's findings prove that UFH is a cost-effective treatment compared to LMWH in Rural Tertiary Care Hospitals for DVT. Based on the patient's affordability, the treatment decision can be made.
Perioperative Outcomes of Open Surgical Repair for Juxtarenal and Infrarenal Aortoiliac Occlusive Disease in Patients with Poor Cardiac Status
Authors: Balaji S K , Robinson C Saravanan , Yalamuru Sudharsan Reddy , Kumar Sabarish G , Maruthupandian Adharsh Kumar , Ahmed Syed Mohammed Ali , Bharat Arun M V , Ray Ruru
Published: November 2022

Purpose:

The most common cause of mortality in patients undergoing open surgical repair for aortoiliac disease is from cardiac complications. As there is a paucity of literature about the surgical outcomes in patients with compromised cardiac status, this study was undertaken to study the perioperative outcomes of open surgical repair for aortoiliac occlusive disease in patients with poor cardiac status.

Methodology:

A retrospective study was carried out from January 2017 to December 2020. Patients with aortoiliac occlusive disease based on computed tomography angiographic findings with poor cardiac reserve (ejection fraction ≤40% on echocardiography) were included in the study. The primary endpoints were perioperative complications which included intraoperative hemodynamic complications and early postoperative complications.

Results:

During 2017–2020, a total of 44 patients with aortoiliac occlusive disease (AIOD) with erectile function ≤40% underwent open surgical repair. Of these, 25 (57%) patients had infrarenal aortoiliac involvement and 19 (43%) had juxtarenal aortoiliac involvement. In our study of open surgical repair for juxtarenal and infrarenal aortoiliac occlusive disease in patients with poor cardiac status, intraoperative hemodynamic complications were noted in 26 (59%) patients, early postoperative complications were noted in 11 (25%), and mortality rate was 4.5%.

Conclusion:

Even though AIOD patients with poor cardiac status are at high operative risk than patients with normal cardiac status, open surgical repair with in-line bypass can be considered as a suitable option in these patients, especially where facilities for appropriate intraoperative monitoring and management are available.
Lower Limb Dialysis Grafts
Authors: Patkar Amrita , Singh Sumanshi , Kalwadia Neha , Gadhavi Rishabh , Sekhar R
Published: November 2022

The exponential rise in diabetes in India has led to a steady rise in end-stage renal disease patients requiring renal replacement therapy (RRT). Affordability and access to centers providing RRT and maintenance of functioning upper extremity vascular access for prolonged periods remain a challenge. Frequently facing no upper extremity access situations, we decided to reassess the feasibility of lower extremity vascular access. A retrospective study was carried out evaluating data from January 2009 to March 2022 including patients with a graft tunneled in the thigh (lower superficial femoral artery end to side to terminal great saphenous vein end to end). Totally 26 cases were studied with respect to age, sex, body mass index, comorbidities, difficulty in cannulation, complications, graft dysfunction, and patency rates. Follow-up was a dynamic ongoing process without a fixed endpoint. Graft dysfunction was seen in seven of 26 patients (26.92%), with a primary patency rate of 88.46% (23/26) at 1 year. Twelve subjects died during the study period, however, all had a functioning lower limb arteriovenous graft (AVG). Lack of surgical training, fear of complications, and absence of team approach in decision-making are some reasons why lower extremity permanent dialysis access is infrequently used. However, in view of increased survival on dialysis, advancing age of the dialysis population, associated comorbidities, and multiple access failures, lower limb AVGs may be considered a feasible access modality with acceptable patency rates and minimal complications.
COVID-19 and Clotting
Authors: Agarwal Rahul , Atreyapurapu Viswanath , Sharma Pritee , Yerramsetty Vamsi Krishna , Saripalli Chainulu , Reddy K Santhosh , Atturu Gnaneswar , Gupta Prem Chand
Published: November 2022

Introduction:

A surge in the number of patients with acute limb ischemia (ALI) was seen during the first and second waves of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. This has been ascribed to the hypercoagulable state seen in COVID infections. The aim of this study is to report our experience and outcomes of ALI associated with SARS-CoV-2 infection.

Materials and Methods:

It was a single-center observational retrospective study from a prospectively maintained database of patients with SARS-CoV-2 infection presenting with ALI between July 2020 and December 2020 with 1-year follow-up.

Results:

Thirty-nine acutely ischemic limbs were treated in 32 patients including three upper limbs. The mean age of patients was 55.75 (range: 27–80). There were 23 (71.87%) males and 9 (28.12%) females. Majority of the limbs were in Class IIB of ALI, whereas 20.51% had irreversible ischemia. Of the 39 affected limbs in 32 patients, 22 limbs were revascularized, 9 had primary amputation, and 8 were managed conservatively with anticoagulation. The overall limb salvage was 26 out of 39 limbs (66.7%), whereas it was 81.8% for the limbs that had an intervention. The overall mortality was 9.4%. There was no further limb loss or mortality during 1-year follow-up. Interestingly, 15 patients did not have any symptoms suggestive of SARS-CoV-2 infection other than ALI. The severity of COVID infection did not correlate with the severity of ALI.

Conclusion:

COVID-19 infection can be associated with arterial thrombosis and ALI, which, if treated early with appropriate intervention, can result in a satisfactory limb salvage rate. Prophylactic anticoagulation in COVID-19-infected patients may not prevent arterial thrombosis, and the clinical severity of the COVID-19 infection is not a predictor of arterial thrombosis.
Kite String Injury
Authors: Singh Devender , Aryala Shalini
Published: November 2022

Vascular injuries due to kite string are uncommon but are associated with significant morbidities and mortality. We report a case of 45 years female sustaining kite string injury to her ankle resulting in neurovascular injuries and total transection of the tendoachilles. The aim of the article is to highlight this rare injury, its mechanism and the importance of awareness which can prevent this to a large extent.
Systemic Inflammatory Response and Delayed Thrombocytopenia Following Endovascular Aneurysm Repair for Abdominal Aortic Aneurysm
Authors: Sivagnanam Karthikeyan
Published: November 2022

Postimplantation syndrome following endovascular aneurysm repair (EVAR) is a known entity which presents within the 1st week of EVAR. The symptoms include fever, leukocytosis, and elevated C-reactive protein. Although the pathogenesis is unknown, it resolves within a 5 days. This case report involves elaborating on delayed onset inflammatory response in the 3rd week following EVAR when the patient developed thrombocytopenia which went as low as 55,000/μL. It resolved gradually with supportive measures and systemic steroids.
Locating frontline workers’ position up against COVID-19
Authors: Gupta Harish
Published: November 2022

ABSTRACT

History of mankind has been brutal and marred by wars, attacks, invasions, occupying others territory and killing other human beings with their animals in the process. But now with arrival of Industrial Revolutions in last century or so, we gradually realized that for having and maintaining economic prosperity; we need others’ cooperation and since then full- scale wars almost disappeared. But when we fight now and support others in the process, we realise that brute force is only occasionally used entity and most of the times technological methods are deployed to injure others. It is this rationale which makes way for people of either gender having capability to use highly advanced weaponry to enter the arena to decide fate of their side. Therefore, now war is not exclusively masculine entity and that analogy may not be appropriate in modern era. When we use masculine notion to explain our war against COVID-19, there are many shortcomings.
Insulinoma: Presenting as hypoglycemia in a non-diabetic patient: A rare case report
Authors: Kumar Ranjan , Chatterjee Abhik , Kishore Kandula , Chattoraj Ashok K. , Sunder Ashok , Jakka Sridevi
Published: November 2022

ABSTRACT

PNETs (pancreatic neuroendocrine tumors) are a rare sub-type of pancreatic tumors, with the majority of them being insulinomas. The vast majority of insulinomas (90%) are benign and solitary, with only 10% being malignant. It has a wide range of clinical manifestations and requires a high level of suspicion to diagnose. Surgical excision has long been the gold standard for treating localized PNET and is still the therapy of choice. Recurrent hypoglycemia is usual in diabetic patients, but this is a rare finding in non-diabetic individuals. Here, we are presenting a rare case of insulinoma who was non-diabetic and presented with recurrent hypoglycemic episodes. A 61-year-old non-diabetic male presented with multiple episodes of hypoglycemia in the past. On thorough workup, there was an increased fasting insulin level with the fasting blood glucose level ranging from 60 to 90 mg/dl. His C-peptide and proinsulin were markedly elevated. His abdominal ultrasound failed to pick up any abnormality. His DOTANOC scan revealed a 2 × 2 cm sized lesion in the distal pancreas suggestive of neuroendocrine pathology. He subsequently underwent spleen preserving distal pancreatectomy, following which his blood sugar levels remained normal, and continued to be free of symptoms on follow-up. Our instance emphasizes the need for evaluating insulinoma as a cause of recurrent hypoglycemia in people who are not diabetic. A high index of suspicion in hypoglycemic individuals who do not respond to standard treatment or whose symptom pattern changes will lower the likelihood of insulinoma diagnosis being delayed.
Serum levels of Activin A: Marker of insulin resistance and cardiovascular risk in prediabetics
Authors: Chauhan Ajay , Gupta Asmita , Goyal Parul , Kumar Tarun
Published: November 2022

ABSTRACT

Background:

A substantial proportion of health burden in diabetic individuals can be attributed to cardiovascular complications. The increasing risk of cardiovascular complications along the spectrum of dysglycemia warrants the need to devise novel markers for early assessment and management. Activin A is a multifunctional cytokine with an important role in glucose homeostasis and vascular diseases. It can thus serve as a guide for early identification of cardiovascular disease (CVD) risk in prediabetes.

Objective:

The aim of the study was to measure serum levels of activin A in prediabetics, compare them with normoglycemic controls and find the correlation of activin A with markers of insulin resistance such as the homeostatic model assessment of insulin resistance (HOMA-IR).

Methods:

Sixty prediabetic patients and similar age-, sex-, blood pressure–, and BMI-matched controls were recruited in the study. In both groups, serum levels of fasting blood glucose and post prandial glucose, glycated hemoglobin (HbA1c) and fasting insulin were measured. HOMA-IR values were calculated. Serum activin A levels were measured in both groups using ELISA. The obtained values were compared between the two groups.

Results:

The median (IQR) of s. fasting insulin (mIU/L) in the case group was 15.3 (12.2–18.62) which was significantly higher than that in the control group, which was 6 (4.2–7.3). The median (IQR) of s. activin A (ng/mL) in the case group was 263.55 (227.18–279.56) which was significantly higher than that in the control group, which was 159.9 (150.73–178.75) (P < 0.001). There was a very strong positive correlation of s. activin A (ng/mL) with s. fasting insulin (mIU/L) and HOMA-IR (rho = 0.67 and 0.75, respectively, P < 0.001).

Conclusion:

Activin A, if combined with other atherosclerotic markers, might improve the assessment of insulin resistance and cardiovascular risk in prediabetics and lead to focus on lifestyle modifications and preventive medical therapy, thereby contributing to the prevention of CVD-related mortality and morbidity in these patients.
Electrocardiographic abnormalities in patients with COVID-19 pneumonia and raised interleukin-6
Authors: Kaeley Nidhi , Mahala Prakash , Walia Rohit , Arora Poonam , Dhingra Vandana
Published: November 2022

ABSTRACT

Background:

Cardiac injury is associated with high mortality in patients with COVID-19 infection. Electrocardiographic changes can give clues to the underlying cardiovascular abnormalities. Raised inflammatory markers like raised interleukin-6 (IL-6) are associated with arrhythmia, heart failure, and coronary artery disease. However, past studies have not highlighted the electrocardiographic abnormalities in patients with COVID-19 infection with raised IL- 6 levels. This study compared the electrocardiogram (ECG) changes in COVID-19 patients with high and normal IL-6 levels.

Methods:

A retrospective analysis of ECG of 306 patients with COVID-19 infection was done, out of which 250 patients had normal IL- 6 levels, whereas 56 patients had raised IL-6 levels. IL-6 levels were measured in all the patients. Detailed clinicodemographic profile of all the serial COVID-19 patients admitted with moderate to severe COVID-19 pneumonia was noted from the hospital record section. Electrocardiographic findings and biochemical parameters of all the patients were noted.

Results:

Out of 56 patients with raised IL-6 levels, 41 (73.2%) patients had ECG abnormalities compared to 177 (70.8%) patients with normal IL-6 levels. This difference was not statistically significant. However, ECG abnormality such as sinus tachycardia was significantly more common in patients with raised IL-6 levels than those with normal levels. Among patients with raised IL-6 levels who were discharged, 5 (16.6%) had sinus tachycardia, 2 (6.6%) had ST/T wave changes as compared to 15 (57.6%), and 10 (38.4%) who had tachycardia and ST/T wave change respectably succumbed to death. This difference was statistically significant.

Conclusions:

Sinus tachycardia followed by atrial fibrillation and right bundle branch block are common ECG changes in patients with COVID-19 infection with raised IL-6. The possible association of cardiac injury in patients with COVID-19 infection with coexisting raised IL-6 levels should be explored further.
Acceptance of artificial intelligence (AI)-based screening for breast health in urban slums of central Karnataka, India – SWOC analysis
Authors: Davalagi Shubha B. , Palicheralu Balu S. , Murthy Sanjana S Narasimha , Hurlihal Shalini
Published: November 2022

ABSTRACT

Background:

Artificial intelligence-based imaging is a low-cost, radiation-free solution for the breast imaging process that uses infrared radiation emitted by the body. This is a novel procedure that, when feasible, could be a better solution, particularly in underprivileged communities having low access to breast health care.

Aims:

To assess the acceptance and explore challenges for an artificial intelligence-based screening solution for breast health among the urban slum population.

Settings and Design:

A mixed-method study was conducted in urban slums of central Karnataka, India.

Material and Methods:

The study was carried out for a period of two years in 2019–21 among women in the reproductive age group in urban slums of central Karnataka to understand the acceptance of an artificial intelligence-based imaging solution for screening breast health. In-depth interviews were conducted to identify the strength, weaknesses, opportunities, and challenges (SWOC) screening for breast health.

Statistical Analysis Used:

Quantitative data were analysed using Statistical Package for the Social Sciences (SPSS) v16.0, and for qualitative data, manual descriptive content analysis was carried out, and the sub-themes were generated.

Results:

A total of 768 women accessed the thermalytix ® breast imaging services, the majority of them in the age group 31–40 years (35%), belonging to the Muslim religion (68.5%) with a mean monthly family income of Rs. 11,950.67/-. SWOC analysis identified reduced cost for the screening services and involvement of female self-help groups (SHGs) as strengths. Weaknesses included poor breast health awareness among women and the stigma associated with breast cancer.

Conclusions:

Artificial intelligence-based screening is a feasible solution for breast health in low-income, low health access areas like urban slums. Engagement of the local community and active involvement of the health system is of paramount importance for the sustainability of any novel strategy.
COVID-19 suspicion and diagnosis in pregnancy: A big conundrum!
Authors: Singh Parul , Bhuriya Vandana , Nanda Smiti , Chauhan Meenakshi Barsaul , Dahiya Pushpa , Singhal Savita
Published: November 2022

ABSTRACT

Introduction:

This article aims to discuss all the challenges faced in the diagnosis of coronavirus disease 2019 (COVID-19) in pregnancy, isolation of suspected and positive patients, their management, and the strategies to prevent the transmission of infection among the healthy population and medical fraternity. The diagnosis of COVID in pregnancy is influenced by many factors, including normal physiological changes in pregnancy, comorbid conditions associated with pregnancy, and the presence of asymptomatic infection in patients. Suspicion of COVID-19 in pregnant females is of utmost importance at a primary health center for risk mitigation of exposure to medical personnel.

Material and Methods:

A retrospective study was carried out in the labour room in a tertiary care center in India. Two groups were made, suspected COVID and confirmed COVID in pregnant patients. The case records were analysed.

Results:

Out of a total of 5164 admissions, 95 patients were admitted as suspected (1.8%), but only two patients were COVID-positive amongst them. 84% of COVID-positive patients were asymptomatic. Fever was the most common symptom in both groups (P-value: 0.15). Preeclampsia and anaemia were the most common comorbidities in both groups, not statistically significant. There were 32% of intensive acre unit (ICU) admissions in suspected COVID patients, and 77% of them were having respiratory distress.

Conclusion:

COVID-19 presents as an asymptomatic infection in most pregnant patients. Physiological changes to the cardiorespiratory and immune systems along with associated comorbidities in pregnancy, increase a woman’s susceptibility and delay diagnosis. Consideration of patients as suspected COVID at triage stations on the basis of only contact or travel history poses a great burden on the health care system. Although triage is an essential tool to identify symptomatic COVID patients, universal testing strategies should continue simultaneously. Streamlining medical care professionals into self-sufficient teams ensures adequate clinical coverage amongst the suspected COVID, confirmed COVID, and routine labour room admissions.
A study on the knowledge and practices of menstrual hygiene among the adolescent girls of Nagaon, Barpeta District, Assam
Authors: Boruah Beeva , Hakmaosa Annamika , Hajong Sudipta
Published: November 2022

ABSTRACT

Background:

The onset of menstruation is an important event in a woman’s lifecycle. It is associated with taboos and sociocultural restrictions. Faulty hygienic practices increase the risk of reproductive tract infections (RTI), leading to further complications if left untreated. With this background, the study was planned to assess adolescent school girls’ knowledge of menstruation and menstrual hygiene as well as their practices of menstrual hygiene.

Materials and Methods:

A community-based cross-sectional study was conducted in Nagaon, Barpeta district, Assam, among 170 adolescents aged between 10 and 19 years, using a convenient sampling technique. A predesigned, pretested, semi-structured questionnaire was used to collect the information from the study participants. Data analysis was done using SPSS version 17 and the results were expressed in percentages.

Results:

The study reveals that 91.76% of the adolescents knew that menstruation was normal. About 27.65% of the study participants did not know the cause of menstruation, and 54.12% did not know about the source of menstrual bleeding. Only 33.53% knew that uterus is the source of bleeding. About 61.76% of the study participants knew about the duration of a normal menstrual period. Regarding practices, 74.12% of the adolescents use sanitary pads during menstruation, 18.82% use cloth, and 7.06% use both cloth and sanitary pads. In about 63.53%, the method of disposal of used absorbent was throwing with domestic waste.

Conclusion:

The current study has revealed that menstruation and menstrual hygiene knowledge is poor among adolescent girls and practices regarding menstrual hygiene are not optimal.
Comparative study between “case-based learning” and “flipped Classroom” for teaching clinical and applied aspects of physiology in “competency-based UG curriculum”
Authors: Kumar Tarun , Sakshi Pooja , Kumar Chandan
Published: November 2022

ABSTRACT

Background:

The new curriculum is competency-based and revised. The student must be imparted and should have learned these competencies. New teaching–learning methods such as “Case-based learning (CBL)” and “Flipped classroom (FCR)” can help medical students to be competent Indian medical graduates.

Aims and Objectives:

This study was aimed to evaluate the effectiveness of “CBL” over “FCR” for teaching clinical and applied aspects of physiology.

Materials and Methods:

Faculty and residents of the department of physiology and first-year MBBS students were introduced and oriented to the study and concept of CBL and FCR. Students were divided into two groups; one was taught clinical and applied aspects of cardiovascular physiology by CBL and another group by FCR. Pre- and post-test with a validated questionnaire were conducted for both groups. Feedback from the students was collected on 5-point Likert’s scale and the marks obtained by them were analyzed statistically by paired t-test.

Results:

Both CBL and FCR improved the post-test marks significantly when compared to pre-test marks (P < 0.0001). CBL and FCR methods showed no significant difference, but the mean post-test marks were higher in FCR. As per the students’ feedback, 62% of students strongly agreed that CBL is useful for clinical and applied aspects of physiology.

Conclusion:

CBL and FCR both are equally important and complementary to each other. CBL was found to be slightly more effective for later days of clinical practices, whereas FCR slightly more effective for better performance in university examinations.
Use of disposable needle hub for decompression of large dentigerous cyst: A case report
Authors: Inturi Naga M. R. , Natra Poornima S. , Tummalapalli Swathi
Published: November 2022

ABSTRACT

Developmental cysts are commonly seen in children, dentigerous cyst is one among them. Cysts associated with vital structures like erupting permanent teeth have to be treated more conservatively. Marsupialization or decompression is more routinely done procedures; the only hitch is maintaining the patency of the window. Various materials are being tried like customized acrylic stents, plastic tubings, disposable suction tips, etc. We want to present a case of decompression of maxillary dentigerous cyst with the use of readily available disposable syringe hub. Syringe hub is cut and trimmed to adapt to the edges of the window created for decompression and stabilized with sutures. It causes less tissue trauma and the larger outer rim provides retention for the stent. Disposable anesthetic syringe hubs can be additional material for decompression with better handling and usage.
Coverage of home-based newborn care and screening by ASHA community health workers: Findings from a household survey in Chhattisgarh state of India
Authors: Garg Samir , Dewangan Mukesh , Krishnendu C , Patel Kavita
Published: November 2022

ABSTRACT

Background and Objectives:

Community health workers known as Accredited Social Health Activists (ASHAs) provide home visits for home-based newborn care (HBNC) in India. The objectives of the study were to assess coverage of HBNC, to assess current practices of newborn care by the care providers and to assess status of screening of sick newborns by ASHAs in rural Chhattisgarh.

Methods:

The study was a quantitative cross-sectional study. Multi-stage random sampling was applied to draw a representative sample from rural Chhattisgarh. The survey collected primary data of 1928 newborns by interviewing the caregivers. Descriptive statistical analysis using cross tabulations was performed. Confidence intervals at 95% were computed for key indicators.

Results:

ASHAs were present during 84.3% of the deliveries. 74.1% newborns received the designated six home visits from ASHAs whereas 3.6% newborns did not receive any visits. Coverage of different important messages ranged from 74% to 90%. Around 95% of newborns were screened by ASHAs for signs of sickness. ASHAs identified 12.9% of newborns as sick. Of the identified sick newborns, 48.1% were referred by ASHAs to health facilities, whereas 34.7% were treated directly by ASHAs by using amoxicillin. Early initiation of breastfeeding was reported for 85.4% of newborns and skin-to-skin contact was practiced for 63.6%.

Conclusions:

ASHAs were able to achieve an adequate coverage of HBNC in rural Chhattisgarh. Uptake of desired newborn care practices by caregivers was found. Identification of sick newborn was also adequate. Further research is recommended to identify factors facilitating the coverage under HBNC.
A review on oral manifestations of COVID-19 disease
Authors: Kumar Harish , Nishat Roquaiya , Desai Anupama
Published: November 2022

ABSTRACT

COVID-19, a multi-system-affecting disease presents with an extensive clinical spectrum, ranging from no symptoms at all to fatal lung involvement. Several orofacial manifestations have also been reported, among which dysgeusia is one of the earliest reported symptoms. Several other manifestations of extensive variety have also been reported by various authors worldwide since the outbreak of the disease. This comprehensive review dispenses a synopsis of the orofacial manifestations of COVID-19 along with a working classification, the knowledge of which is of utmost importance to medical and dental professionals for early detection and prevention of transmission of the disease.
Effect of single-dose methotrexate injection to prevent neoplastic changes in high risk complete hydatidiform mole: A randomised control trial
Authors: Biswas Jhuma , Dasgupta Shyamal , Datta Mallika , Datta Mousumi , Saha Santa , Pradhan Parthapratim
Published: November 2022

ABSTRACT

Background:

Complete hydatidiform mole affects women in their reproductive age. About 15-20% develops persistent molar gestational trophoblastic neoplasia (GTN), which is linked with delayed (beyond 56 days) normalization of serum βHCG after surgical evacuation.

Objective:

The objective of the article is to shorten the duration of normalization time of βHCG with single-dose methotrexate injection in women with high risk complete hydatidiform mole (CHM) after suction evacuation.

Methods:

Total 76 women with CHM were randomized into intervention and control groups. In the intervention arm (n = 34) women received single dose 100 mg intramuscular methotrexate injection post evacuation and the control group (n = 42) had standard care. Surveillance was done in both groups at two weeks intervals for next six months and duration of normalization of βHCG level was recorded.

Results:

Total 94.7% women completed follow-up. Mean of normalization time was significantly lower in the intervention group compared to controls (9.7 weeks versus 14.7 week; P < 0.01). Time to event curve showed significantly earlier cumulative normalization time for the intervention group.

Conclusion:

Single-dose 100 mg methotrexate injection is a low-cost, simple intervention to help one out of three women with CHM with high-risk features to achieve normalization of βHCG within 56 days. This might be helpful for people in resource-poor countries where adherence to prolonged surveillance is poor.
The clinical course and risk factors in COVID-19 patients with acute kidney injury
Authors: Shahidi Shahrzad , Vahdat Sahar , Atapour Abdolamir , Reisizadeh Shadi , Soltaninejad Forogh , Maghami-Mehr Asieh
Published: November 2022

ABSTRACT

Background:

Acute kidney injury (AKI) has the most prevalent complications in COVID-19 patients. A variety of factors is involved in the disease progression and its associated outcomes. The present study aimed at both examining the correlated clinical features of COVID-19 disease and AKI and evaluating its clinical outcomes.

Materials and Methods:

In the present retrospective study, 102 COVID-19 patients that encountered AKI were enrolled and categorized into three AKI stages. Basic and clinical characteristics, clinical signs and symptoms, laboratory and imaging findings, and treatment approaches were examined. Then, clinical outcomes as well as the factors associated with the mortality of patients were evaluated.

Results:

Diabetes was the only significant clinical characteristic among the patients (P = 0.004). An increasing trend was observed for neutrophil-to-lymphocyte ratio (P = 0.027) and potassium (K) (P = 0.006), and a decreasing trend was seen for hemoglobin (P < 0.001), albumin (P = 0.005), and calcium (P < 0.001) factors at higher stages of AKI. Secondary infection (P = 0.019) and hypoproteinemia (P = 0.018) were the most significant clinical outcomes. Chronic obstructive lung disease (OR = 1.362, P = 0.007), renal replacement therapy (OR = 2.067, P = 0.005), lung consolidation (OR = 0.722, P = 0.032), and bilateral pulmonary infiltration (OR = 4.793, P = 0.002) were the factors associated with mortality rate of COVID-19 patients with AKI.

Conclusion:

AKI, as an important complication of COVID-19, that can predict the higher mortality rate as well as the laboratory and clinical characteristics should receive more due consideration in order to employ proper preventive or supportive treatment approaches that are the pivotal key to reduce the mortality rate in target patients.
Investigation of nurses’ readiness levels in different wards of the hospital
Authors: Khosravi Shaqayeq , Dehkourdi Narges Jafari , Mousivand Farhad , Gapleh Najmeh
Published: November 2022

ABSTRACT

Introduction:

The level of nurses’ readiness and knowledge can significantly influence on the quality of treatment and patients’ health. Nurses should have a high level of knowledge and understanding of clinical care and its aspects. According to this issue, our study has been performed with the aim to compare the readiness of different wards of the hospital in evaluating important indicators of clinical care.

Methods:

This descriptive cross-sectional study was performed on 99 medical staff working in different wards of the hospital – during July 2020 to December 2021. Nurses in different wards of the hospital were compared in terms of care indicators. The tool used was a checklist for the effectiveness and evaluation of clinical care. The data were analyzed by SPSS statistical software.

Findings:

About 16.3% of the nurses were male, and 85.7% were female. Nurses in different wards were significantly different in terms of catheter and ligament care, blood transfusion and products, serum therapy and IV therapy, communication and training skills, pharmaceutical processes, and working with ventilators (p < 0.05). Emergency and general wards’ nurses showed better readiness for pharmaceutical processes and emergency, and neonatal intensive care unit (NICU) ward nurses showed the best readiness in relation to catheter care and absorption and excretion processes and blood transfusion and products (p < 0.05).

Conclusion:

Despite an appropriate readiness in many wards, care readiness was placed on a lower extent in some wards. There were also limitations, strengths, and weaknesses in some aspects, including medication, care and standards, and infection control, which, because of this issue, can help improve nurses’ performance in the future.
Facilitators and barriers influencing the post-crash emergency care of road traffic injuries in district Aligarh of Uttar Pradesh
Authors: Urfi  , Khalique Najam , Ahmad Anees
Published: November 2022

ABSTRACT

Context:

Road traffic injuries (RTIs) will become the fifth leading cause of death by 2030. It is often possible to mitigate the consequences of serious injury if victims have access to prompt, effective pre-hospital care within minutes following the crash.

Aims:

To find out the facilitators and barriers for providing post-crash emergency care in Road traffic injuries in district Aligarh.

Settings and Design:

The present study was undertaken on both the National highways (NH-91 and NH-93) and the bypass roads passing through district Aligarh of Uttar Pradesh.

Subjects and Methods:

All the individuals who met road traffic accidents (RTA) between the earmarked areas from 1st October 2018 to 30th November 2020 and reported for treatment to the selected hospitals were included in the study.

Statistical Analysis Used:

Data is presented in the form of frequency tables and percentages.

Results:

A total of 1126 patients were interviewed during the study period. Out of 1126, 937 (83.2%) were males, and 189 (16.8%) were females, with M:F ratio being 4.96:1. Six hundred sixty-two (58.8%) of the respondents identified the layperson or common man as the first person to respond at the time of the crash. 1110 (98.58%) respondents identified the layperson as the facilitator in providing post-crash emergency care, followed by police and roadside shopkeepers/dhabawalas. The role of the layperson in calling for help by utilizing the helpline numbers, suggesting a nearby health facility together with facilitating for transportation of the victim to the nearby health facility was appreciated by the majority of the respondents. An ambulance was the best available mode of transportation. Seven hundred thirty-three (65.10%) of the total respondents were aware of the toll-free number to be dialled in case of RTA. However, only 320 (43.70%) among them used this toll-free facility after meeting the crash.

Conclusion:

A layperson is the single most important facilitator for providing post-crash emergency care.
Comparing community-driven COVID-19 vaccine distribution methods: Faith-based organizations vs. outpatient clinics
Authors: McElfish Pearl A. , Rowland Brett , Hall Spencer , CarlLee Sheena , Reece Sharon , Macechko Michael D. , Shah Sumit K. , Rojo Martha O. , Riklon Sheldon , Richard-Davis Gloria , Marin Luis Paganelli , Laelan Melisa , Maddison Benetick K. , Alik Eldon , Selig James P.
Published: November 2022

ABSTRACT

Background:

Minority and low socioeconomic communities may face practical barriers to vaccination, including decreased access to health care and less trust in healthcare organizations; however, few studies have focused on these barriers as the cause of differential vaccine uptake. We worked with community partners to implement and evaluate two community-driven approaches to COVID-19 vaccination distribution—through faith-based organizations (FBOs) and outpatient clinics—with a focus on understanding the differences between the populations who accessed each distribution method.

Methodology:

Participants who came to the vaccination locations were approached and asked to complete a survey during their 15 min post-vaccination observation period. Differences between distribution locations were examined using Chi-square tests.

Results:

The survey rendered 1,476 valid responses, with a total of 927 participants recruited at clinical locations and 519 at FBOs during vaccination events. There were significant differences by race/ethnicity, with distribution methods at FBOs reaching a higher proportion of Hispanic/Latino and Marshallese participants. The proportion of uninsured participants who had lower health literacy and had lower educational attainment was higher with the FBO distribution method. FBO participants were more likely to report “completely” trusting the COVID-19 vaccine. There was no significant difference between FBO and clinic participants with regard to the level of vaccine hesitancy. There were no statistically significant differences with regard to access.

Conclusion:

A higher proportion of Hispanic/Latino and Marshallese participants utilized FBOs for vaccination, suggesting collaborations with FBOs can potentially increase vaccination uptake among minority communities and help mitigate vaccination disparities.
Mortality analysis of COVID-19 cases during the second wave and its comparison with the first wave: A hospital-based study
Authors: Goyal Pooja , Sikary Asit Kumar , Sachdeva Ruchi Arora , Parashar Lokesh , Tarique Aamir
Published: November 2022

ABSTRACT

Objectives:

This study was undertaken to determine the characteristics of COVID-19 deaths during the second wave and to compare these characteristics with the mortality during the first wave in a dedicated COVID hospital (DCH).

Study Design:

It was a hospital record–based descriptive study.

Methodology:

The study was conducted in a tertiary care COVID hospital, using a standard death audit proforma. The data were analyzed to know various demographic characteristics and factors related to mortality during the second wave from March to June 2021. The findings were compared with the mortality data during the first wave from April to July 2020 at the same hospital.

Results:

A total of 264 deaths occurred at the center during the study period with a mortality rate of 22.8%. Male cases were more in number, the age group was 21–70 years, the highest number of mortality was seen in the mid of the study period, duration of stay was five days on average and common causes of death were pneumonia alone or with acute respiratory distress syndrome with sepsis. In comparison to the first wave, the mortality rate was four times higher, the age group was younger and opportunistic infections viz. mucormycosis and aspergillosis were present during the second wave.

Conclusion:

The mortality rate was significantly higher and the younger age groups were involved during the second wave, with opportunistic fungal infections due to the use of immunomodulators.
Factors associated with diarrhea in children under 12 years of age referred to Ostad Motahari hospital of Jahrom in 2020
Authors: Mogharab Vahid , Rajput Shabnam
Published: November 2022

ABSTRACT

Background and Objective:

Despite the relatively high prevalence of diarrhea among children, clinical features and factors associated with the incidence of diarrhea in children have not been yet studied in Jahrom. Therefore, this study aimed to determine the factors associated with diarrhea in children under 12 years of age referred to Ostad Motahari Hospital of Jahrom, Iran, in 2020.

Materials and Methods:

The present study was a descriptive cross-sectional study, in which 385 children under 12 years of age with diarrhea complaints were selected using the census sampling method. The checklist used to collect data included patient-related factors, maternal factors, family factors, type of diarrhea, and stool test.

Results:

There was a significant relationship between the availability of proper hand-washing facilities, the use of water purifier, a history of antibiotic use, and the incidence season with a possible factor of diarrhea, type of diarrhea, the frequency of diarrhea per day, and pus cell outcome (P < 0.0001). However, no statistically significant relationship was observed between the availability of safe drinking water, travel history of patients, and consumption of raw or undercooked foods with a possible factor of diarrhea and OB/OP results (P < 0.05).

Conclusion:

Recognizing environmental risk factors to inform parents about preventing diarrhea in children can be an effective strategy to avoid imposing a heavy financial burden on the health system.