bluuebunny/crossref_metadata_2025 huggingface dataset:
Let’s Talk About Epilepsy
Authors: Bennet Divya
Published: June 2024

Epilepsy, a brain disorder marked by recurrent, unprovoked seizures, affects over 50 million people globally according to the WHO. Modern medicine has evolved to offer various antiepileptic medications and precision-targeted medicine, highlighting the critical role of continued research and financial investment in developing innovative treatments. Brazilian Ronaldo Nazario, who is one of the greatest football players, had seizures throughout his career. The most critical seizure that he had was during the final of the FIFA World Cup in 1998, which affected his performance and led to his team’s defeat. Legends with epilepsy did not let epilepsy define them; they struggled and believed that they could. After all, NO PAIN, NO GAIN. While legal advancements, such as amendments to the Hindu Marriage Act in India, which permits those with epilepsy to marry, have been made, challenges persist. Today, there are restrictions on obtaining a driving license, illustrating the ongoing battle against societal barriers. Purple Day, observed annually on March 26, symbolizes a global effort to raise epilepsy awareness. The choice of purple is related to the lavender flower, which is associated with solitude – a reflection of the isolation that people with epilepsy may feel. Stigma leads to depression, and a decline in self-esteem, underlining the importance of comprehensive support systems. Epilepsy may bring challenges, but it also brings strength and resilience. As health-care workers, we are bound to help in spreading awareness, alleviate the stigma, and provide holistic care to those with epilepsy. The love and support that we render will help them take more steps forward and come out with flying colors in this battle against epilepsy. Let us help them “Seize the day.”

“Courage is not having the strength to go on, it is going on when you don’t have the strength.”

–Theodore Roosevelt
A Mental Health Crisis: The Ripple Effects of COVID-19
Authors: Chandrakar Mayank
Published: June 2024

There is little doubt that the COVID-19 pandemic has had an impact on people’s mental health all around the world. The impact has been felt by various groups, including health-care workers, patients, children, and marginalized communities. Coping strategies have been identified to mitigate the psychological effects of the crisis and promote resilience. These strategies include psychological first aid, telemental health, self-help resources, peer support, community mobilization, social protection, and mental health advocacy. There is still much work to be done in the field of global mental health about COVID-19. In addition to collaborative and interdisciplinary methods, attention to mental health fairness and human rights, and more integration of mental health into the COVID-19 response and rehabilitation, more robust and representative studies are required. Collaboration among policymakers, program implementers, donors, and researchers is crucial in addressing mental health issues and improving coping techniques during and after the COVID-19 epidemic. Priorities include tackling stigma and prejudice, expanding access to mental health services, and making that mental health is included into larger health and social policy. During and after the COVID-19 pandemic, it is imperative that we keep making mental health a top priority and investing in it. We can encourage well-being and resilience in people and communities all throughout the world.
Diabetes Mellitus Induced by Nivolumab plus Regorafenib in a Patient with Esophageal Cancer
Authors: Lin Mei-Chen , Bai Li-Yuan , Yeh Shih-Peng , Chiu Chang-Fang , Lien Ming-Yu
Published: June 2024

Nivolumab is now preferred as first-line and second-line treatment for advanced esophageal cancer, while regorafenib improves survival in refractory gastroesophageal cancer. The combined use of nivolumab and regorafenib has shown promising results. Nivolumab-induced thyroid dysfunction is a common immune-related adverse event (irAE), while type 1 diabetes mellitus induced by immune checkpoint inhibitors is rare and usually permanent. It is unclear whether the combination of regorafenib and nivolumab increases the risk of irAEs. We report a patient with recurrent esophageal squamous cell carcinoma who was treated with nivolumab plus regorafenib and developed thyroiditis and diabetic ketoacidosis. The rechallenge was successful, and the patient achieved a good treatment response.
Meeting Notes of the Taiwan Neuroendocrine Tumor Society & Taiwan Society of Nuclear Medicine Joint Conference - Peptide Receptor Radionuclide Therapy Targeting for Gastroenteropancreatic Neuroendocrine Tumors: Basic Principles and State-of-the-art Clinical Practice
Authors: Cheng Mei-Fang , Yen Chih-Chieh , Du Jeng-Shiun , Chiu Yu-Li , Chen Ming-Huang , Tsai Hui-Jen , Wu I-Chen , Shen Hueng-Yuan , Yen Ruoh-Fang , Chen Li-Tzong ,   On Behalf of Taiwan Neuroendocrine Tumor Society and Taiwan Society of Nuclear Medicine
Published: June 2024

Objective:

The current study aimed to investigate the basic principles and clinical applications, including the selection of proper candidates, follow-up strategies, and radiation protection issues relating to peptide receptor radionuclide therapy (PRRT).

Data Sources and Study Selection:

We searched various scientific databases using specific keywords.

Results:

Due to the overexpression of somatostatin receptors in neuroendocrine tumors (NETs), PRRT is currently considered an important therapeutic modality for the management of NETs.

Conclusion:

PRRT incorporates the systemic administration of a tumor-targeting radiolabeled peptide to patients with tumors, allowing for more precise delivery of radiation doses to tumor sites while sparing normal tissues.
Clinico-Epidemiologic Profile and Response to Levocetirizine in Chronic Spontaneous Urticaria: A Retrospective Cohort Study from a Tertiary Care Center in North India
Authors: Ashraf Raihan , Bishnoi Anuradha , Mehta Hitaishi , Parsad Davinder , Kumaran Muthu Sendhil
Published: June 2024

Background:

Comprehensive long-term follow-up data regarding chronic spontaneous urticaria (CSU) among general populations, especially from the Indian subcontinent is scanty.

Aim and Objectives:

The aim of the study were to analyze the clinico-epidemiological profile, comorbidities of CSU patients, and factors affecting patient response to various doses of levocetirizine.

Materials and Methods:

In this retrospective cohort study, complete history regarding demographic profile, clinical examination, investigations, treatment given, and follow-up details of all CSU patients attending urticaria clinic between 2010 and 2019 were analyzed. These were considered variables to determine the factors playing a role in response to various doses of levocetirizine.

Results:

Totally, 1104 files of CSU were analyzed. The male-to-female ratio was 1:1.5 with a mean age of 33.03 ± 14.33 years. Thyroid dysfunction and atopy were seen in 142 (12.8%) and 184 (16.7%) patients, respectively. Vitamin D deficiency and high serum immunoglobulin E (IgE) levels were seen in 461 (41.7%) and 340 (30.7%) patients, respectively. Immunosuppressives were required at some point in 196 (17.7%) patients. Patients with higher levels of serum IgE and D-dimer (P < 0.05) were found to require frequent updosing of levocetirizine, while age, sex, duration of illness, presence of angioedema, co-morbidities, identifiable precipitating factors, presence of diurnal variation, family history, and vitamin D deficiency were found to not have an effect on levocetirizine dosing.

Conclusion:

Ours is a large single-center study exemplifying the biomarkers including baseline serum IgE and D-dimer levels, which could identify a CSU patient who could warrant a higher dose of antihistamine/antihistamine refractory urticaria.
Perception on self-directed learning among medical students: A qualitative analysis
Authors: Anil Deepak , Kumar D. Sunil , Divya K. L.
Published: June 2024

Introduction:

Self-directed learning (SDL) is defined as learning on one’s initiative, with the learner having primary responsibility for planning, implementing, and evaluating the effort. The present study aims to evaluate the effects of SDL on medical students and to find out how well they understood it and how to make it better.

Materials and Methods:

A longitudinal study was conducted among 131 1st-year medical students for a period of 12 months. A poster competition was conducted, and students were approached by the research team through an in-depth interview to know their experience regarding SDL 10 days following the assignment. Students were asked how the exercise changed their perception of their SDL skills and what improvements they could make. Descriptive statistics were used to analyze sociodemographic data. Thematic analysis was applied to the comments.

Results:

SDL improved the participants’ comprehension of the subject matter, which made learning easier and more engaging. In addition, discussions in groups assisted students in developing their critical thinking and creative abilities. In addition, it enhanced their capacity for cooperative learning and teamwork. Students said that SDL might assist them in examining many facets of their education and modifying it for situations that arise in the real world. The students expressed a desire to participate in more group and individual activities that would increase their engagement, strengthen and improve their learning, and help them develop their abilities.

Conclusion:

This study shows that SDL methods are likely to be positively appraised by the students, where they improve the cognitive, psychomotor, and affective skills of the students. The students commented that adding more creative SDL activities can further make it interesting helping them learn on their own to gain valuable experience and social skills.

The following core competencies are addressed in this article: Medical knowledge, Practice-based learning and improvement, and Interpersonal and communication skills.
A narrative literature review on new technologies for teaching anatomy
Authors: Bankar Maithili N. , Bankar Nandkishor J. , Gajbe Ujwal , Singh Brijraj , Mishra Vaishnavi H. , Bahadure Sweta , Bandre Gulshan R. , Bankar Swati N. , Shelke Yogendra P.
Published: June 2024

The study examines the integration of emerging technologies into anatomy education and focuses on the impact on learning results and student involvement. It uses a comprehensive literature search to identify technologies such as virtual reality, three-dimensional printing of anatomical models, augmented reality, artificial intelligence, virtual dissection, online resources, interactive software, haptic technology, anatomy software, simulation technology, gamification, mobile applications, and social media. The findings reveal that these technologies offer advantages such as enhanced interactive learning experiences, realistic simulations, and adaptability to various learning styles. However, challenges such as cost, ethical concerns, and specialized training accompany their implementation. The study concludes that the integration of advanced technologies in anatomy education has the potential to revolutionize the learning experience, fostering increased accessibility and engagement.

The following core competencies are addressed in this article: Medical knowledge, Systems-based practice.
Impact of using active learning principles on perception of medical students toward e-learning environment
Authors: Irfan Ali Syed , Begum Jarina , Lakshmi Lalitha D. , Manasee Panda
Published: June 2024

Introduction:

The COVID-19 pandemic has necessitated a transition from face-to-face to e-learning, which caught many medical educators unaware. However, it is imperative to develop skills as an e-educator through the application of active learning (AL) principles based on Bloom’s taxonomy. This study highlights the effect of using AL principles on the perception of students toward an e-learning environment using Dundee ready education environment measure (DREEM) questionnaire. The aims of this study were as follows: (1) to introduce the AL principles during online teaching learning sessions. (2) To assess the feedback on the module among the students. (3) To evaluate the change of perception of students toward the e-learning environment through the DREEM questionnaire.

Materials and Methods:

An educational interventional study was carried out among (76) undergraduate students of a medical institution in coastal Andhra Pradesh. Perception toward the e-learning environment was collected through the DREEM questionnaire online before and after the intervention (application of AL principles as per the Bloom’s taxonomy during online T/L sessions).

Statistical analysis:

The data thus collected were analyzed using IBM SPSS version 20 statistical software, descriptive and inferential statistics for quantitative data and thematic analysis for qualitative data.

Results:

The Global DREEM score was 122 which was 62 before the intervention. Similarly, 68% reported positive perception which was only 37% initially. Students’ social self-perception scored lowest initially, but scores were improved to 2nd highest after the intervention. For a few items such as teacher-centered, nonstimulating teaching, not being able to memorize, lack of motivating environment, feedback, feeling lonely, bored, and not having a good support system, the individual scores were negative, i.e., <2 which became positive, i.e., >3.5 after.

Conclusion:

There was a significant change perceived by the students toward the e-learning environment with increased DREEM scores. Thus, this study concludes use of AL principles in online platforms is effective in improving students’ perception of the e-learning environment.

The following core competencies are addressed in this article: Practice-based learning and improvement, Medical knowledge, Interpersonal and communication skills.
Total risk approach for noncommunicable diseases: A review of cardiovascular disease risk prediction tools for Indian setting
Authors: Das P. Ananda Selva , Nongkynrih Baridalyne , Kaur Ravneet , Salve Harshal Ramesh
Published: June 2024

Risk stratification approach considering total cardiovascular disease (CVD) risk and providing appropriate interventions is one of the WHO best-buys for tackling noncommunicable diseases (NCDs). Various risk prediction tools are available to assess total CVD risk and help identify high-risk individuals. Similarly, tools are available for the prediction of risk for specific NCDs such as diabetes and hypertension. Since these tools are context specific, we reviewed the CVD risk prediction tools and disease-specific risk scores relevant for Indian setting. A literature review was performed in PUBMED and Google Scholar using the keywords. A comparison of CVD risk prediction charts applicable for India has been carried out and includes WHO CVD risk charts, WHO/ISH risk charts, Globorisk, and INTERHEART modifiable risk charts. Among these, WHO CVD risk charts are highly recommended for use in India because of its robust methodology in development and have been externally validated. Disease-specific risk scores for Indian setting include Indian Diabetes Risk Score and Hypertension Risk Prediction Tool.
Socioclinical risk factors for cervical dysplasia and presence of human papillomavirus among women attending a tertiary care teaching hospital of Central Odisha
Authors: Ashe Swetaleena , Nanda Saumya , Rattan Roma , Behera Tapas Ranjan
Published: June 2024

Introduction:

Carcinoma cervix being the second-most common gynecological malignancy in India contributes nearly 14% of all cancers in females. Cervical dysplasia and presence of human papillomavirus (HPV) DNA are the two most important factors for developing cervical cancer. Hence, our study aims to be a flag bearer to raise the awareness for cervical screening with the main objective (i) to estimate the magnitude and distribution of cervical dysplasia among the women of 21–65 years and (ii) to find association between different socio-clinical risk factors and cervical dysplasia and HPV infection among the study subjects.

Methods:

It was a cross-sectional study carried out in a tertiary care hospital of Central Odisha, with a sample size of 176. Purposive sampling was done. Predesigned pretested questionnaire along with Pap smear and endocervical smear sample for HPV determination were used for data collection.

Results:

Nearly 62% of women suffered from cervical dysplasia. Women aged ≥35 years were found to have nearly thrice the risk of having cervical dysplasia. Nearly 20% of women tested positive for HPV DNA and these women were found to be 11 times more prone for developing cervical dysplasia compared to women tested negative for HPV DNA.

Conclusion:

Women with repeated genital infection with HPV and aged more than 35 years were more susceptible to cervical dysplasia. Those with early age at menarche, itching per vaginum, postcoital bleeding, and postmenopausal bleeding, etc., had a significant risk for developing cervical dysplasia. Hence, such symptomatic women should be made aware to undergo screening for cervical cancer at the earliest.
Steering the medical maze beyond memorization: Harnessing the potential of open-book tests in medical learning
Authors: Shrivastava Saurabh RamBihariLal , Shrivastava Prateek Saurabh
Published: June 2024

In the field of medical education, we have employed the closed-book test format as the standard approach for carrying out assessments for many decades. An open-book test in medical education is an assessment method wherein medical students are permitted to refer to learning resources during the examination. Thus, students do not rely primarily on their memory and understanding of the subject rather can access external resources to supplement their problem-solving and decision-making abilities. Even though multiple merits have been attributed to open-book tests, we must give attention to the time duration and the kind of references students can access during such tests. At this juncture, we must reiterate that we are not advocating that open-book tests should be introduced and they should replace the conventional closed-book tests. However, there is immense scope for open-book tests in medical education, and every medical institution must explore the scope and feasibility to introduce open-book tests within their settings.
Bed-up-head-elevated Position versus Supine Sniffing Position in Patients Undergoing Rapid Sequence Intubation Using Direct Laryngoscopy in the Emergency Department – A Randomized Controlled Trial
Authors: Reddy Admala Anudeep , Ayyan S. Manu , Anandhi D. , Ganessane Ezhilkugan , Amrithanand V. T.
Published: June 2024

Introduction:

The objective of this study is to compare bed-up-head-elevated (BUHE) position with supine sniffing position (SSP) in patients undergoing rapid sequence intubation (RSI) using direct laryngoscopy in the emergency department (ED).

Methods:

This single-center randomized controlled superiority trial was carried out from September 2021 to December 2022 in an academic emergency medicine department. The patients undergoing RSI in ED were grouped into two arms, namely BUHE position and SSP. The primary outcome was the time taken for endotracheal intubation. The secondary outcomes were the first-pass success rates and postintubation complications.

Results:

A total of 136 patients were enrolled in the study. Time for intubation in the BUHE group was no different from SSP (32.09 s [interquartile range (IQR): 23.30–42.68] vs. 33.40 [IQR: 27.53–45.90], P = 0.17). There was a modest reduction in intubation time when performed by trained experts (22.5 s [IQR: 17.7–25.3] versus 30.3 s [IQR: 21.3–33.2], P = 0.04). The first-attempt success rate in the BUHE position was also similar to the SSP position ([91.18% vs. 90.91%] P = 0.958). Postintubation complications were lesser in BUHE compared to the SSP group ([7.4% vs. 19.7%] P = 0.04).

Conclusions:

In our study, BUHE position did not improve time to intubation and first-pass success rate in ED patients compared to SSP. A modest decrease in intubation time was noted while experts used the BUHE position. The postintubation complications were slightly lesser in the BUHE group.
Outcomes of Video-assisted Thoracic Surgery-guided Early Evacuation of Traumatic Hemothorax: A Randomized Pilot Study at Level I Trauma Center
Authors: Kumar Abhinav , Gora Dinesh , Bagaria Dinesh , Priyadarshini Pratyusha , Choudhary Narendra , Priyadarshi Amit , Gupta Sahil , Alam Junaid , Gupta Amit , Mishra Biplab , Kumar Subodh , Sagar Sushma
Published: June 2024

Introduction:

Traumatic hemothorax is accounted for about 20% of traumatic chest injuries. Although majority can be managed with the timely placement of intercostal tube (ICT) drainage, the remaining pose a challenge owing to high complication rates associated with retained hemothorax. Although various treatment modalities including intrapleural instillation of fibrinolytics, radioimage guided drainage, VATS guided evacuation and thoractomy do exist to address the retained hemothorax, but indications along with timing to employ a specific treatment option is still unclear and ambiguous.

Methods:

Patient with residual hemothorax (>200 mL) on ultrasonography after 48 h of indwelling ICT was randomized into either early video-assisted thoracic surgery (VATS) or conventional approach cohort. Early VATS cohort was subjected to video-assisted thoracoscopic evacuation of undrained blood along with normal saline irrigation and ICT placement. The conventional cohort underwent intrapleural thrombolytic instillation for 3 consecutive days. The outcome measures were the duration of indwelling ICT, removal rate of tube thoracostomy, length of hospital stay, duration of intensive care unit (ICU) monitoring, need for mechanical ventilation, incidence of pulmonary and pleural complications, and requirement of additional intervention to address undrained hemothorax and mortality rate.

Results:

The early VATS cohort had shorter length of hospital stay (7.50 ± 0.85 vs. 9.50 ± 3.03, P = 0.060), reduced duration of indwelling ICT (6.70 ± 1.25 vs. 8.30 ± 2.91, P = 0.127) with higher rate of tube thoracostomy removal (70% vs. 30%, P = 0.003) and lesser need of additional interventions (0% vs. 30%, P = 0.105). Thoracotomy (3 patients) and image-guided drainage (4 patients) were additional interventions to address retained hemothorax in the conventional cohort. However, similar length of ventilator assistance (0.7 ± 0.48 vs. 0.60 ± 1.08, P = 0.791) and prolonged ICU monitoring (1.30 ± 1.06 vs. 0.90 ± 1.45, P = 0.490) was observed in early VATS cohort. Both the cohorts had no mortality.

Conclusion:

VATS-guided early evacuation of traumatic hemothorax is associated with shorter length of hospital stay along with abbreviated indwelling ICT duration, reduced incidence of complications, lesser readmissions, and improved rate of tube thoracostomy removal. However, the duration of ventilator requirement, ICU stay, and mortality remain unchanged.
Using Children’s Artwork to Improve Adherence with Timely Antibiotic Administration in Open Fractures
Authors: Chu Kathy , Zehtabchi Shahriar , Roudnitsky Valery , Harry Fred , Baron Bonny J.
Published: June 2024

Introduction:

Antibiotics for open fractures (OFs) administered within 60 min of emergency department (ED) arrival reduce patients’ infection risk. We tested a novel method of displaying children’s drawings to prompt clinicians to improve adherence with early antibiotics for OFs.

Methods:

Registry-based pre- (January 1, 2016–June 30, 2019) and post- (July 1, 2019–March 31, 2022) intervention at a level 1 trauma center. In July 2019, children’s artwork depicting OF was displayed in the ED alongside OF guidelines and E-mailed to faculty and residents. Primary outcome: proportion of OF patients who received antibiotics within 60 min of arrival. Time to antibiotics was calculated from ED arrival to time-stamped administration in the electronic health record. We compared time to antibiotics as continuous variables between the two groups. Proportions are presented with percentages and 95% confidence interval (CI); continuous variables as median and quartiles. Chi-square or Mann–Whitney U-tests were used for group comparisons.

Results:

Five hundred fifty-four total OF patients were identified (excluded: transferred = 1, ED death = 4, unclear time to antibiotics = 11); 281 pre-implementation and 257 post-implementation. The median age was 34 years (quartiles 24 and 46). Trauma mechanisms of injury included 300 blunt (56%) and 238 penetrating (44%). Gustilo OF classification by type were as follows: 71% I, 13% II, 15% III, 1% unclassified. There was a significant difference (P = 0.001) in both percentage of patients who received antibiotics within 60 min (58%, 95% CI, 52%–63% vs. 79%, 95% CI, 74%–84%) and time to antibiotics (median: 46 min vs. 25 min) between pre- and postphases, respectively.

Conclusions:

Children’s artwork in our ED improved adherence with OF guidelines and decreased time to antibiotics.
Navigating the swells: A case report of hereditary angioedema
Authors: Taori Kamlesh , Kirnake Vijendra , Junare Parmeshwar , Padwale Vishal
Published: June 2024

ABSTRACT

Hereditary angioedema (HAE) is a rare genetic disorder characterized by recurrent episodes of localized edema caused by a deficiency or dysfunction of C1 inhibitor (C1-INH). This case report presents the clinical features, diagnostic evaluation, and management of a 23-year-old man with HAE. We discuss the challenges of diagnosing and treating this condition, emphasizing the importance of early recognition and appropriate therapeutic interventions.
Food taboos practice and associated factors among pregnant women attending antenatal care at Doctor Bogalech Gebre memorial general hospital, Durame town, Southern Ethiopia, 2022
Authors: Akiso Denebo E. , Mosisa Merisa , Abame Desta E.
Published: June 2024

ABSTRACT

Background:

Food taboos are customs that prevent certain foods and beverages from being consumed within a society for religious and cultural reasons. Due to the restriction of essential foods and beverages, it has a significant negative health impact on pregnant women and offspring. However, there is a lack of data regarding Ethiopian food taboos practices in general and in this study area particularly.

Objective:

To assess the magnitude of food taboos practice and associated factors among pregnant women in Dr. Bogalech Gebre memorial general Hospital, Durame Town, Southern Ethiopia.

Materials and Methods:

An institution-based cross-sectional study was conducted among 422 pregnant women from August 1 to 30, 2022 by using systematic sampling techniques. Data were entered into epi-data version 3.1 and exported to SPSS version 26 for further analysis. Statistical significance was declared at a P-value < 0.05 with a 95% Confidence level.

Results:

From the total 422 pregnant mothers, 54.5% (95% CI 49.90–59.20) of them encounter food taboos practice at least for one food item. The age group of pregnant mothers was 25–34 years [AOR = 0.48, 95% CI (0.28–0.84)]; the number of family size was 4–6 were [AOR = 0.42, 95% CI (0.19–0.88)]. Previous antenatal care [AOR = 1.64, 95% CI (1.02–2.66)], change feeding habit [AOR = 1.52, 95% CI (1.02–2.33)], and nausea and vomiting during pregnancy [AOR = 1.83, 95% CI (1.16–2.91)] were significantly associated with food taboos practice.

Conclusion:

The magnitude of food taboos practice among pregnant women was public health problems. Age, family size, previous antenatal care follow-up, changing feeding habits, and nausea and vomiting during pregnancy were found to be factors affecting food taboos practice.
A rare case with double trouble: Peripartum cardiomyopathy and preeclampsia together with placental abruption resulting in both cardiac and kidney failure
Authors: Kumari Anupma , Prasad Indira , Sahay Nishant , Kumar Rajnish , Agrawal Mukta
Published: June 2024

ABSTRACT

Peripartum cardiomyopathy and hypertensive disorders of pregnancy are not very uncommon in routine practice, but when associated with abruptio placentae and significant hypotension, survival of both child and mother becomes challenging. We report a case of a 20-year-old primigravida who presented in the gynecology emergency unit of our hospital with an ejection fraction of < 20%, severe preeclampsia with abruptio placentae leading to fetal demise, and renal failure in the immediate postoperative period. Challenges faced during decision making regarding the mode of delivery and grave concerns during intraoperative and postoperative periods are discussed. In this case, prompt termination of pregnancy, various point-of-care sonographic measurements, and post-operative emergency dialysis played vital roles in the complete recovery of this patient with a failing heart and grossly jeopardized hemodynamics. Hence, multidisciplinary team-based management is crucial for managing such cases to prevent maternal mortality and morbidity.
Diagnostic accuracy of mean corpuscular volume in detecting coexisting iron deficiency in patients of sickle cell disorders: A hospital-based study
Authors: Joshi Madhura , Joshi Abhishek
Published: June 2024

ABSTRACT

Background:

Co-existing iron deficiency in patients of sickle cell disease (SCD) and trait may worsen anemia, and adversely affect neuro-cognitive development and growth. Determining a cut-off below which Mean corpuscular Volume (MCV) can predict iron deficiency in SCD patients can preclude use of more expensive test serum ferritin.

Aims:

This study was conducted to determine the diagnostic accuracy of low MCV in detecting iron deficiency compared to serum ferritin levels in patients with SCD.

Methods:

60 consecutive patients with SS or AS pattern on hemoglobin electrophoresis were enrolled. The index test (MCV) and the reference standard test (serum ferritin) were performed in a blind and independent manner. The measures of diagnostic accuracy were calculated and the precision of the point estimates were expressed by 95% confidence intervals. As MCV is a continuous variable, we also used multi-level likelihood ratios to compute diagnostic accuracy of MCV at several cut-points.

Results:

The sensitivity of low MCV in detecting iron deficiency was 40.0% (95% CI-20.0-63.6), the specificity was 78.4% (95% CI-61.3-89.6) using serum ferritin as a reference standard. The sensitivity and specificity of predicting coexisting iron deficiency at this point was 60.9% (CI-38.6-80.3%) and 75.7% (CI-58.8-88.2%) respectively.

Conclusions:

The low sensitivity (40%) of microcytosis in detecting iron deficiency indicates that many cases will be missed if MCV alone is used to detect co-existing iron deficiency anemia in SCD patients. No single test is good enough to detect co-existing iron deficiency and a combination of tests might be useful.
Journey of Guillain Barre syndrome from the pre-pandemic era to the pandemic era: A 4-year retrospective study
Authors: Maini Deepinder Kaur , Dixit Anubhuti , Sharma Bipan , Nanda Satyan , Rehani Varun , Anand Rajiv
Published: June 2024

ABSTRACT

Aims:

To study demographic and clinical profiles of Guillain Barre syndrome (GBS) in the pre-pandemic and coronavirus disease 2019 (COVID-19) pandemic era and to compare the GBS incidence, severity, and its outcome in the pre-pandemic and pandemic eras.

Methodology:

This is a 4-year retrospective study done in a tertiary care hospital in Delhi, India, between March 2018 and March 2022. Patients were divided into the pre-pandemic era and pandemic era (2 years before and 2 years after March 2020).

Results:

The number of patients (N) was 25 in the pandemic/vaccine era, while N = 49 in the pre-pandemic era. The mean duration of hospitalization was significantly higher (P = 0.03) during the pandemic era (10.68 ± 6.67 days) compared to the pre-pandemic era (7.59 ± 3.55 days). There was no statistical difference in age (P = 0.56), gender (P = 0.70), GBS variants (P = 0.40), clinical spectrum, antecedent infection (P = 0.91), Hughes Disability Score on admission and discharge (P = 0.93 and P = 0.52, respectively), respiratory involvement requiring a ventilator (P = 0.19), and mortality (P = 0.26) in both the eras.

Conclusion:

Our study showed no association of the incidence of GBS with the ongoing COVID-19 pandemic. The mean hospitalization days were significantly increased during COVID-19 in view of associated respiratory involvement. The commonly held hypothesis of the increase in GBS cases during the pandemic/vaccine era has not been observed in our study.
Changes in body mass index and three-year incidence of overweight/obesity among urban women aged 30–40 years in Vellore, Tamil Nadu, India: A non-concurrent cohort study
Authors: Thomas Beeson , Oommen Anu , Prasad Jasmine Helen , Ramachandran Sharanya , Minz Shantidani
Published: June 2024

ABSTRACT

Background:

Although studies often report the prevalence of obesity, community-based studies reporting the incidence of overweight or obesity in India are scarce. Such incidence data are crucial for improving projections about the future burden of obesity.

Methods:

A non-concurrent follow-up study was done in 2015 in urban Vellore, Tamil Nadu, among two groups of women aged 30-40 years, with body mass index (BMI) <25 kg/m2 (normal) and BMI ≥25 kg/m2 (overweight/obese) in 2012, to assess changes in BMI. The sampling frame consisted of 473 women: 209 women with BMI <25 kg/m2, and 264 women with BMI ≥25 kg/m2, who were part of a cross-sectional survey in 2012. A randomly selected list of 370 women (80% of the original cohort) was used to trace the women. Measurements at follow-up included weight, height, dietary and other risk factors.

Results:

Of 370 women, 170 (45.9%) were followed up at the end of three years, which included 82 with BMI <25 kg/m2 and 88 with BMI >25 kg/m2. The incidence of overweight (BMI ≥25 kg/m2) in three years, was 29.2% (24/82), among women with a normal BMI (<25 kg/m2) in 2012. Among the 88 women who were overweight/obese in 2012, there was no regression to normal BMI within the three years of follow-up. There was an association between the incidence of overweight and the intake of carbohydrates (adjusted odds ratios (AORs): 3, 95% confidence interval (CI): 1.04 to 8.63) and protein intake (AOR: 20.0, 95% CI:2.5 to 158.3).

Conclusions:

This study found an incidence of nearly one-third (29.2%) of developing high BMI (≥25.0 kg/m2) in 30-40-year-old urban women from Vellore, implying a rapid increase in overweight and obesity among young women.
A prospective study on risk assessment and prophylaxis of venous thromboembolism in general surgery patients
Authors: Bharti Nita , Luther Anil , Deodhar Michael , Mahajan Amit , Kumar Rajesh
Published: June 2024

ABSTRACT

Aims and Objective:

To evaluate the patients at risk of venous thromboembolism (VTE) based on Caprini VTE risk assessment scale and the effect of implementation of this scale on the use of thromboprophylaxis.

Materials and Methods:

A prospective study was conducted, including patients who underwent major elective surgical procedures. Demographic details were noted, and VTE prophylaxis offered if needed. According to the VTE risk assessment scale, patients were categorised into very low-, low-, moderate-, and high-risk categories. The data were analysed statistically.

Results:

A total of 500 patients (women = 259; men = 241) were enrolled in this study. Of them, eight women and nine men developed VTE (P = 0.691). The maximum number of patients who developed VTE belonged to 61–70 years group (n = 7). According to VTE risk assessment, 61 patients were categorised as low-risk, 217 patients as moderate-risk, and 222 patients were categorised as high-risk. A significant (P < 0.0005) correlation was found between body mass index (BMI) and VTE development. In obese patients with BMI >25, 14 patients developed VTE. Out of total, 329 patients received prophylaxis for deep vein thrombosis. Of 284 patients who received pharmacologic prophylaxis, only three developed VTE (P = 0.002). Of 145 patients who received mechanical prophylaxis, 75 had high risk and none of them developed VTE. Four patients had mortality, and a significant (P = 0.022) correlation was found between mortality and VTE development.

Conclusion:

According to Caprini risk assessment scale, the prophylaxis for VTE was effective in patients undergoing major elective general surgery, resulting in significant lowering of morbidity and mortality.
Is anxiety a public health problem among older adults in India: Results from a systematic review and meta-analysis
Authors: Patel Mamta , Mantri Neha , Joshi Nitin , Jain Yogesh , Goel Akhil Dhanesh , Gupta Manoj , Srinivasan Srikanth , Yadav Vikas , Joshi Vibha , Singh Kuldeep , Bhardwaj Pankaj
Published: June 2024

ABSTRACT

For medical fraternity, health system and policymakers to undertake effective countermeasures, a comprehensive assessment of the prevalence of anxiety among older adults is required; hence, we conducted a systematic review and meta-analysis using data pooled from surveys across the country. The search strategy was developed using medical subject headings (MeSH) terms and free-text keywords. We searched PubMed and Scopus for articles to report the prevalence of anxiety among older adults. The appraisal tool for cross-sectional studies was used for quality assessment. Prevalence from different studies was pooled together using the inverse variance heterogeneity method. Sensitivity analyses were performed to assess the impact of included studies’ methodological quality on pooled results and to investigate potential causes of heterogeneity. Twenty-three studies were included in this systematic review. The overall pooled estimate of the prevalence of anxiety in older adults was 18.7% (95% CI: 2.4, 38.8). The studies had a high degree of heterogeneity. Publication bias was assessed using a Doi plot which showed an luis furuya-kanamori (LFK) index of 1.21 indicating minor asymmetry. Like other parts of the world, India has witnessed a rise in the number of elderly due to lower fertility rates, higher life expectancies and a shift in illness patterns from communicable to non-communicable. The number of elderly people suffering from diseases of mental health is expected to rise dramatically. This review consolidates the existing evidence to showcase anxiety as an upcoming public health problem requiring due focus from policymakers and health systems.
Determination of sample size for various study designs in medical research: A practical primer
Authors: Bhardwaj Reena , Agrawal Usha , Vashist Praveen , Manna Souvik
Published: June 2024

ABSTRACT

Formulating a research question and selecting an appropriate study design for answering that question are crucial initial steps in the research process. The population, intervention, control group, and outcomes measures (PICO time and setting [TS]) framework provides a practical guide in this regard, which stands for population, intervention, control, outcome, type of research question, and study design. The various study designs have their own merits and demerits, and implementing the methodology meticulously requires knowledge of all of these. Similarly, different methods of sample size calculation are warranted based on the most appropriate study design and outcome variables of interest. Sometimes, a post
hoc power analysis can be performed after the sample size calculation, to check whether the study was adequately powered or not. There are multiple validated free software tools for sample size calculation, including Open-Epi, R, StatCalc, etc. The practice by most researchers of reporting significant P values is to be replaced by reporting effect sizes, as the latter is a much better estimate of the strength of association. This review provides a comprehensive, ready reckoner for busy family physicians to quickly identify the appropriate study design for answering any applied research questions in their minds and estimating the sample size required for the same.
A cross-sectional study on clinical characteristics and severity of children with COVID-19 admitted to a teaching institute in North India
Authors: Nauriyal Deepty , Dubey Rishabh , Agrawal Pulak , Kumar Deepak , Punj Ajay , Nasser Kaynat
Published: June 2024

ABSTRACT

Background:

SARS-CoV-2 infection presentation in children is usually milder than in adults but can be severe and fatal as well. Data on the pediatric population regarding severity and clinical presentation are still limited, and there is a need to have a better understanding of clinical features, severity, and laboratory parameters.

Aims and Objective:

To document clinical and laboratory characteristics and outcomes of children with SARS-CoV-2 in a low-middle-income country and to evaluate clinicodemographic factors and biochemical markers associated with severity and mortality.

Materials and Methods:

A hospital-based cross-sectional study was conducted among 112 COVID-19-positive children at a designated Level-3 center in North India. Clinical characteristics, laboratory parameters, and severity of COVID-19 cases as well as factors associated with the severity of the disease, were analyzed by descriptive statistics and a Chi-square test.

Results:

The adolescent age group (age 12-18 years) was affected most (64.3%). Male patients accounted for 56.3% of total cases. Fever was the most common symptom (41.1%) followed by cough. Presenting complaints were highest from the respiratory system (32.1%) followed by the gastrointestinal (8.9%) and the neurological system (7.1%). Majority of patients had mild disease (87%) while 13% had the moderate-severe disease. Spo2 < 95% (P = 0.00001), neutrophilia (P < 0.000001), lymphopenia (P < 0.000001), elevated values of C-reactive protein (P < 0.00001), Interleukin-6 (P = 0.002), D- dimer (P = 0.00014) and respiratory symptoms as presenting complaints (P < 0.000001) were found to be significantly associated with severity of disease.

Conclusion:

The male and adolescent age group was affected most. Presenting complaints were highest from the respiratory system. Unusual presentation may have gastrointestinal or neurological presentation. Most children with COVID-19 had mild disease. Moderate to severe disease was not uncommon. Factors including neutrophilia, lymphopenia, elevated lab values of C-reactive protein, D-dimer, and interleukin-6 had a significant association with the severity of the disease. These biomarkers can help predict the severity of the disease.
Nicotine prevalence among youth of rural Jaipur, Rajasthan
Authors: Singh Sujan , Fatima Anum , Jain Ashish , Jain Anjali , Singh Sejjal
Published: June 2024

ABSTRACT

Background:

Children are more sensitive to tobacco advertisements than adults. The World Health Organization (WHO) reported that tobacco use has doubled in the past four decades particularly among the youth. Smoking among teenagers is an issue that affects countries worldwide.

Objective:

This study identified the prevalence of tobacco consumption among youth of rural Jaipur. We also studied, their age of initiation of tobacco and their correlation with the income and occupation of parents.

Method:

Community based cross-sectional type of study was conducted on youth of 15-24 years of age in 30 clusters in the Vatika, Jaipur. Cluster sampling technique was adopted. A semi-structured pretested and predesigned questionnaire was used for data collection. The inter-personal communication technique was used maintaining full confidentiality. All the results were transferred onto Microsoft excel sheet and evaluated statistically.

Results:

Out of 420 youths, 79.0% youths consumes nicotine in any form. More male subjects (90.9%) consume nicotine than females (62.8%) highly significantly. 33.1% youths started nicotine consumption <12 years. Youths from more income family(63.6%), illiterate father (76.2%), illiterate mother (74.4%), father having farming as occupation (67.2%), consumes more nicotine. more (88.6%) of youths consume nicotine with their friends. 58.1% parents oppose their children.

Conclusion:

The prevalence of nicotine intake was higher in boys than girls and majority of them consumes nicotine in any form gutka or beedi-cigarette. The reasons for such high dependence of nicotine according to the youth were lack of knowledge of the ill effects of nicotine intake and peer pressure. However, majority of the youth did not want to quit nicotine consumption.
Analysis of the usage and awareness of child safety seats for children aged 0-6 in Leshan City, Sichuan Province, China
Authors: Li Song , Wei Qiong , Rao Rui , Li Zhixin , Lu Zhili , Chen Sisi , Wang Li
Published: June 2024

ABSTRACT

Objective:

To investigate the current situation of child safety seat use and children’s cognition of safe riding in Leshan City, and to provide a basis for the promotion and application of child safety seats in Leshan City.

Methods:

From November 2021 to February 2022, a total of 500 car-owning families who visited or were hospitalized in the department of pediatrics of our hospital were surveyed by self-filling questionnaire method. Through the investigation of personal situation, family situation, travel habits, use of child safety seat, cognition of safe riding, etc., the influencing factors of possession and use of child safety seat and cognition were analyzed.

Results:

The ownership rate of car seats was 57.8%, the use rate was 47.6%, and the always use rate was 18.8% among all families with children surveyed. There were no statistically significant differences in the use rate and always use rate of child safety seats among different genders of children, parents’ education background, and car ownership price. The use rate and constant use rate of child safety seats in urban households were significantly higher than those in rural areas. When the main driver was the mother, the use rate of child safety seats was higher, and the difference was statistically significant. From the perspective of cognition, the use rate and constant use rate of the child safety seat of parents with correct cognition were 64.5% and 25.7% respectively, while the use rate and constant use rate of the child safety seat of parents with incorrect cognition were only 11.1% and 4.3%, which were significantly lower than those with correct cognition, and the difference was statistically significant. In terms of cognition, 10.4% of parents think it is safe for children to sit in the back seat with adults in their arms, and 9.0% of family members think it is safe for children to sit in the back seat with seat belts alone.

Conclusions:

At present, the ownership rate, utilization rate, and parents’ correct cognition of child safety seats in Leshan City are all at a low level, and there is a lack of regional legal guidance, so the safety situation of children in cars is worrying. To effectively improve the use of child safety seats, the promotion of child safety seats should be promoted from three aspects: improving parents’ cognition, forming good traffic habits, and legal guidance.