bluuebunny/crossref_metadata_2025 huggingface dataset:
Investigation of Mechanical Properties in Ductile Iron with Alloyed and Unalloyed at Time and Temperature on Austempering
Authors: Rao Tangi Lakshman , Lakshminarayana V. , Shankar Rao Y.B.
Published: October 2023

Due to the combination of its numerous excellent mechanical qualities, the flexible iron has been used more and more since its invention in 1948. To develop significantly improved characteristics, the unnecessary investigation is being done. The most recent development in the field of flexible iron, or SG iron, is Austempererd malleable iron. At four different temperatures, two different types of spheroidal graphite (SG) cast iron samples with varying copper weight levels were austempered. The temperatures used for austempering were 200°C, 300°C, 350°C, and 400°C. As a component of the austempering time and temperature, the effect of the austempering process (i.e. time and temperature) on the mechanical characteristics of spheroidal graphite iron was investigated. The progress of spheroidal graphite iron's properties was significantly influenced by the pace of cooling and the extinguishing process. The organisation of different stages during isothermal change under varied austempering settings has also been the focus of XRD analysis. By using SEM, graphite morphology has been focused on. For this investigation, samples were obtained from the castings' focal point for XRD analysis. It was discovered that virtually always, it is possible to discriminate between the ferrite (110) and austenite (111) lines. The ferrite (110) line is growing with expanding austempering time and declining with increasing austempering temperature, whereas the highest power of the austenite (111) line is expanding with expanding temperature. Thus, very precise control of the interaction components (austempering duration and temperature) is required for austempering. The results showed that, when compared to other grades (N1) through the various austempering processes used in this evaluation, ADI containing the alloying component copper (grade N2) achieved crucial mechanical qualities.
Analysis of garbage collection network of Colombo district using centrality measures
Authors: Dewanthi K. A. T. , Perera K. K. K. R.
Published: October 2023

Waste management is a common problem faced by all developing countries. Colombo city faces the biggest garbage problem than other cities in Sri Lanka. Even through many studies were carried out for waste management problem using different approaches, there were very few research findings were available using graph theoretical approach. In this research, applications of graph theory in garbage collection procedure are depicted. The study mainly focuses on analyzing the garbage collection procedure of Colombo municipal council area in western province through constructing garbage collection network and using centrality measures. Centrality measures are used to compute the importance of any node in a network. Colombo municipal area divides into 6 main administrative districts, and each of these is divided into municipal wards with several junctions and streets. Garbage collection network was initially constructed by assigning a node by a location in google map, and an edge by a street or a path between two locations. Constructed network is an undirected unweighted graph and betweenness, closeness, degree, and eigenvector centrality measures are used to find central locations of the network. By identifying central locations, some machines or recycling trucks can be placed in that central places to deposit the waste. Next, a weighted graph was constructed by taking the weights of an edge as a fraction of weight of collected garbage between two locations. Collected garbage weights and betweenness and degree centrality values for weighted graph are used to identify the shortest paths between central nodes in each municipal ward. Garbage collection trucks can be followed this shortest path in order to reduce their fuel cost and collection time.
Descriptive analysis of patients positive for anti-phospholipid antibodies included in two Italian registries
Authors: Pengo Vittorio , Sarti Luca , Antonucci Emilia , Di Agostino Stefania , Bison Elisa , Denas Gentian , Poli Daniela , Meroni Pier Luigi , Gerli Roberto , Radice Antonella , Palareti Gualtiero , FIRMA group and START collaborators On behalf of
Published: October 2023

The definite diagnosis of antiphospholipid syndrome (APS) depends on the laboratory performance and clinicians’ interpre- tation. Results from two Italian inception cohort studies of anti- phospholipid antibodies (aPL)-positive subjects, the Italian Survey on ANtiphoSpholipid antibody Positive Individuals Reg- istry (INSPIRE) and the Survey on AnTicoagulated Patients- Reg- isTry (START) have been compared. Data from INSPIRE were collected by rheumatologists of the FIRMA group while those of START by physicians working in Italian thrombosis centers. Ev- idence on several, still unraveled, clinical and methodological as- pects of ‘real life’ aPL testing and APS diagnosis was collected. In this paper, we report the characteristics of 123 cases enrolled in INSPIRE and 229 in START registries, with particular refer- ence to the reasons why these tests were requested, the obtained aPL profile, and consequent treatment. Laboratory testing for aPL in the absence of clinical criteria defining APS was more frequent in INSPIRE (p<0.0001). The rate of patients in classification cat- egory I (more than one aPL test positive) was significantly higher in START (p<0.0001) as well as the use of warfarin. A wide va- riety of treatments has been observed in patients in classification category II (single aPL positivity). These data indicate that there is a need to harmonize many aspects among the various specialists dealing with APS.
Shared psychotic disorder: a case report in Switzerland
Authors: Mastromo Daniele , De Pietra Aldo
Published: October 2023

Folie à deux is a rare psychiatric syndrome in which one individual transmits a psychotic symptom to another. In this report, we present a case of folie à deux. The case suggests a possible correlation with neglect, which may have played a role in the development of the symptoms. A 21-year-old Swiss boy and his mother were found to share the same delusional beliefs, forming a case of folie à deux (shared psychotic disorder). The boy had suffered neglect from his parents and was being cared for by his mother, who had no history of mental disorder. The close relationship between the boy and his mother, the family history of first-degree psychosis, and the boy’s experience of neglect may have increased his vulnerability to early-onset psychosis and folie à deux.
Management interventions for amputation stump neuromas: evidence based review and cost-benefit analysis
Authors: Azzopardi Ernest A. , Stewart Philippa , Boyce Dean Edward , Murison Maxwell , Sadideen Hazim , Tretti Clementoni Matteo
Published: October 2023

Amputation is a common military and civilian surgery with high morbidity. Patients without prostheses due to neuroma pain lose productivity and lifelong contributions, which is often underestimated. The surgical and non-surgical treatment of painful stump neuromas is controversial. An evidence-based assessment and cost-benefit analysis of painful stump neuroma management modalities emphasizes institutional awareness and disruptive technologies. An Oxford Centre for Evidence Based Methodology critical appraisal and structured literature review were used in the research. We found 154 records using a reproducible literature search strategy that included electronic databases and references. A full review of 27 manuscripts after exclusion criteria yielded data for analysis. Surgical, injectable, and electromagnetic spectrum methods were used. Surgical interventions had longer follow-up times than injection and radiofrequency treatments, which affected outcomes. CEBM level 4 evidence dominated primary literature, indicating low quality. No therapy was superior, but the risks varied. Injection therapies like sclerosing alcohol had limited success and side effects. Despite limited evidence, electromagnetic spectrum modalities showed potential. Including direct and indirect costs, amputation stump refitting costs millions annually. Compared to outpatient non-surgical interventions, laser therapy could save a lot of money. According to the study, surgical interventions are common but expensive and have limited functional success. Low-risk non-surgical methods like co-ablation, pulsed radiofrequency, and transcutaneous laser therapy have mixed results. The short follow-up of all non-surgical studies seems to limit them. Follow-up duration is crucial to outcome assessment. Long-term, low-risk laser-induced thermotherapy is promising for future research. This study emphasizes the need for more research and the economic benefits of disruptive technologies in treating painful stump neuromas.
The impact of COVID-19 prevention measures on surgical wound infection rates post-cardiac surgery
Authors: Bashir Aladdin , Holmes Matthew , Suresh Nebumathew , Panahi Pedram , Atta Sameh , Perkins Hannah T. , Lloyd Clinton , Asopa Sanjay
Published: October 2023

The COVID-19 pandemic had a huge impact on medical services. Several measures have been implemented to reduce the risk of viral transmission. In this paper, we assessed the impact of these measures on surgical wound infection rates in patients post-cardiac surgery. Hypothesis testing was used to compare post-cardiac operation infection rates between the year prior to the COVID-19 pandemic being declared and the first 13 months of the pandemic. The infection rates in 969 patients with operations between 01/03/2019 and 29/02/2020 were compared to those of 925 patients with cardiac surgery between 01/03/2020 and 31/03/2021. Infection rates for various operative urgencies and infection types were analysed. To compare infection rates, a two-tailed pooled z-test using the difference in infection proportions was performed. A 5% significance level was used and only categories with at least 10 patients in both the pre-covid and covid populations were tested. For leg infections, only operations involving coronary artery bypass grafting were included. To ensure that any differences in outcomes were not due to differences in patient demographics resulting in unequal operative risks, Euroscore II values, a measure of cardiac operative risk, were compared between the pre-covid and post-covid cohorts. The Mann-Whitney U-test was used to determine whether the distributions of Euroscore II values were likely to be drawn from the same population. A significance level of 5% was used. A total of 1901 patients (932 during the COVID-19 pandemic) were included in this study. Significant reduction in post-operative infections for all patients undergoing cardiac surgery from 4.3% of patients before COVID to 1.5% during the pandemic. During the pandemic, fewer elective and more urgent operations were performed. This study suggests a significant role of iatrogenic causes in wound infections prior to the pandemic. The implementation of COVID-19 prevention measures in healthcare providers can reduce surgical infection rates. As COVID-19-related restrictions have been eased, we suggest maintaining them in healthcare providers to reduce the incidence of surgical wound infections.
Comparison of immediate withdrawal and stepwise reduction in duration of non-invasive ventilation in chronic obstructive pulmonary disease patients presenting with acute hypercapnic respiratory failure
Authors: Purohit Swetabh , Madan Manu , Kumar Rohit , Kaushik Rajnish , Ish Pranav , AJ Mahendran , Chakrabarti Shibdas , Gupta Neeraj Kumar , Gupta Nitesh
Published: October 2023

There is no universally acceptable protocol for the withdrawal of non-invasive ventilation (NIV) in chronic obstructive pulmonary disease (COPD) patients presenting with acute hypercapnic respiratory failure (AHcRF). This study was carried out to evaluate immediate against stepwise reduction in NIV. Sixty COPD patients with AHcRF who were managed with NIV were randomized into two groups - immediate NIV withdrawal (Group A), and stepwise reduction of NIV duration (Group B). The rate of successful NIV withdrawal, time to recurrence of hypercapnic respiratory failure, total duration of NIV use, and hospital length of stay (LOS), were compared among the 2 groups. NIV was successfully withdrawn in 51/60 (85%) patients. NIV was successfully withdrawn in 24/30 (80%) patients in Group A and 27/30 (90%) patients in Group B (p=0.472). The total duration of NIV use was significantly lower in Group A (38.97±17 hours) as compared to Group B (64.3±7.74 hours) (p<0.0001). The hospital LOS was significantly lower in group A (5.8±1.6 days) as compared to Group B (7.7±0.61 days) (p<0.0001). To conclude, immediate withdrawal of the NIV after recovery of respiratory failure among patients with exacerbation of COPD is feasible and does not increase the risk of weaning failure.
Desire to learn qualitative methods among researchers in healthcare fields
Authors: Bareiss Warren
Published: October 2023

July 2023 saw the high point to date of my 25+ years in academe. I had the pleasure of presenting a workshop—“ Strategies for Writing Effective Qualitative Research in Healthcare”—at the 18th annual conference of the International Society for the Study of Self-Injury (NSSI). Hosted by the Medical University of Vienna, the conference featured dozens of presentations, of which a sizeable minority were qualitative in nature. Qualitative research at the conference addressed such topics as stigma pertaining to NSSI, young adults’ experiences with NSSI in India, healthcare staff views of NSSI behaviors, and reasoning/beliefs among patients who self-injure [...]
Prevalence and Pattern of Olanzapine Emergent Obsessive–Compulsive Symptoms: A Cross-sectional Study
Authors: Mishra Dheerendra Kumar , Singh Umesh Pratap , Kishore Aman , Niranjan Vijay
Published: October 2023

Objective:

Olanzapine is an atypical antipsychotic medication and known for metabolic side effects but olanzapine-induced obsessive–compulsive symptoms are another important behavioral side effects which are less studied and only a few case reports reported these side effects. This study aims to estimate the prevalence and pattern of olanzapine-induced obsessive–compulsive symptoms in schizophrenia and bipolar affective disorders (BPADs).

Methods:

Subjects were recruited from psychiatry outpatient department. Subjects with schizophrenia ( n = 41) and BPAD ( n = 18) taking olanzapine at least more than 6 months were evaluated for clinical profile and the presence of obsession and compulsion symptoms by means of Yale-Brown Obsessive–Compulsive Symptom (YBOCS) checklist scale and data were collected on the structured format.

Results:

Eighteen (30.5%) of the 59 patients met YBOCS checklist scale for both obsessive–compulsive symptoms among subjects with schizophrenia and BPAD subjects. The mean duration of olanzapine intake was 2 years and the mean dose of olanzapine was 12.5 ± 5.21 mg in obsessive–compulsive symptoms (OCSs) present subjects and the mean dose was 13.78 ± 5.21 mg in subjects not having OCSs. Contamination was the most common obsession and checking was the most common compulsion.

Conclusions:

These findings suggest that obsessive–compulsive symptoms occur in a substantial percentage of patients taking olanzapine in schizophrenia and BPAD and most of the subjects had more than one OCS.
Clinical Profile of Patients with Hypertensive Crisis Presenting to an Emergency Department of a Tertiary Care Hospital in Western India
Authors: Goswami Brijesh , Nanda Vivek
Published: October 2023

Objectives:

A hospital-based retrospective study was undertaken among the adult patients presenting to document the incidence of hypertensive urgency (HTN-U) and emergency while the secondary objectives included clinical presentations, disposition from emergency room, and inhospital mortality.

Materials and Methods:

All patients were evaluated by vital signs, clinical examination as well as relevant laboratory tests and radiological tests. Patients with target organ damage were grouped under the hypertensive emergency (HTN-E) group ( n = 104) and patients without target organ damage were included under the HTN-U group ( n = 52). The data were analyzed using GraphPad Prism (vs. 9.4.1) and MedCalc (vs. 20.118).

Results:

The incidence of HTN-E and HTN-U was 68.4% and 31.6%, respectively. The most common symptom observed in patients with HTN-E was breathlessness (53.8%), followed by chest pain (34.6%) and headache (27.9%). While, in HTN-U patients, most patients reported chest pain (43.8%), headache (39.6%), and epistaxis (22.9%). Majority of the patients in both the groups presented with signs of tachycardia, tachypnea, and hypoxia. The mortality in HTN-E and HTN-U patients was 15.4% and 2.1%, respectively. Among 104 patients with HTN-E, 53.8% each of the patients had acute heart failure and acute pulmonary edema. While, in HTN-U patients, acute pulmonary edema and acute coronary syndrome were observed in 2.1% each of the study subjects.

Conclusion:

Patients at high risk or end-organ damage should be immediately referred to the emergency department from the outpatient settings, as a rapid reduction in blood pressure is essential over minutes to hours, to prevent further organ damage.
Comparative Study of Postoperative Macular Thickness Following Uncomplicated Cataract Surgery – Diabetic versus Nondiabetic Patients in a Tertiary Care Center at Chengalpattu District
Authors: Kumar M. Mohan Ram , Rinita Deborah , Arthi P. S. , Roopa Priya
Published: October 2023

Background:

Cataracts are the most common cause of blindness in the world. This study aims to determine whether cataract surgery has an effect on the progression of macular thickness in nondiabetic and diabetic patients, specifically in the absence of pre-existing diabetic retinopathy (DR) changes.

Methods:

It is a prospective cohort study carried out between January 2022 and September 2022 at Shri Sathya Sai Medical College, which is a Tertiary Health-care Center situated at Chengalpattu district in Tamil Nadu, after obtaining ethical clearance from the Institutional Review Board. A total of 72 patients posted for cataract surgery were divided into two groups each group of 36 patients, Group 1 well-controlled diabetics without DR planned for cataract surgery and Group 2 nondiabetics. The patients underwent cataract surgery by small incision cataract surgery/phacoemulsification method based on the staging of cataract and also the surgeon’s choice and cataract surgery was done by the same surgeon and the patients were implanted with rigid/foldable intraocular lens.

Results:

Out of 72 patients analyzed in both the groups, 37 were male patients and 35 were female patients in the age group commonly 50–65 years. The mean age group in the diabetes group was 57.19 ± 9.18 and the normal group was 61.67 ± 7.73. The mean foveal thickness of the DR group was higher than that of the control group, but the difference was not statistically significant. At the end of the 3rd month, the mean foveal thickness returned to near-normal range.

Conclusion:

The thickness of the fovea is increased after cataract surgery in the 1st week postoperatively in both diabetic and nondiabetic groups and returns to near-normal preoperative value in both the groups at the end of 3 months postoperative period.
Ankle-brachial Index as Predictor of Coronary Artery Disease in Diabetic Patients
Authors: Niranjan Ajeet Singh , Gangwar Pooja , Mishra Dheerendra Kumar , Singh Umesh Pratap
Published: October 2023

Introduction:

In India, the incidence of coronary artery disease (CAD) has doubled, and the association between diabetes mellitus, peripheral arterial disease, and CAD remains unclear. This study aimed to explore the relationship between ankle-brachial index (ABI) and CAD in diabetic patients, using the ABI as a diagnostic tool for peripheral arterial disease.

Materials and Methods:

A cross-sectional study at a tertiary care center analyzed 100 diabetes cases for CAD using angina history, past treatment, electrocardiography, and two-dimensional echocardiography. Blood pressure was measured in all limbs, and ABI was calculated by dividing ankle pressure by brachial pressure, selecting the lower ratio.

Results:

Out of 100 patients, 28 had ABI <0.9 and 72 had ABI ≥0.9. The majority of both groups were male. The highest percentage in both groups was aged 51–60. The ABI +VE group had higher proportions of hypertension, smokers, and dyslipidemia. The majority in the ABI −VE group were nonsmokers and without dyslipidemia. Both groups had a majority with body mass index ≥25 kg/m2. Mean diabetes duration was higher in the ABI +VE group, while mean glycated hemoglobin levels were higher in the ABI −VE group.

Conclusion:

In our study, the prevalence of ABI +VE patients was 28% and prevalence of CAD in this group was 42.85%, which is statistically significant. Hypertension, smoking, dyslipidemia, diabetes duration, and glycemic control were significantly associated with low ABI index (ABI <0.9).
Depression in Type 2 Diabetes Mellitus and its Relation with Complications of Diabetes Mellitus: A Cross-sectional Study in Central India
Authors: Pandit Surabhi , Mishra Nimisha , Mishra Dheerendra Kumar , Singh Umesh Pratap , Rure Daisy , Pathak Umesh , Rawat Manju , Singhal Akanksha , Maravi Prashant
Published: October 2023

Background:

The prevalence of Type 2 diabetes mellitus (T2DM) and depression has witnessed a steep rise. The relationship between these two conditions has been mostly studied in Western countries. The existing literature indicates that depression is more common in T2DM. However, data regarding its association with clinical profile of diabetes is conflicting. Despite the extensive occurrence of T2DM and depression in India, research on their association is limited.

Aims and Objectives:

To study the prevalence of depression and its association with complications of T2DM among inpatients of T2DM in a tertiary care center in Central India.

Materials and Methods:

Inpatients department of Medicine was taken as study site and 120 inpatients of T2DM aged 18 to 65 years were recruited after applying strict inclusion and exclusion criteria. They were assessed for depression using structured interview and ICD-10 criteria. The severity was assessed by HAMD-17 (Hamilton Rating Scale for Depression). The complications of diabetes were assessed.

Results:

The prevalence of depression in T2DM patients was 24.2% (29 cases) among which mild depression was present in 62.1% cases. There was a significant positive association (p<0.05) between depression and socio-demographic variables of age, female gender, rural habitat and lower socio-economic status. There was a significant positive association between depression and duration of diabetes, BMI, serum triglyceride, serum creatinine and a significant negative association with serum HDL. Depression had a significant positive association with nephropathy and Coronary Artery Disease (CAD).

Conclusion:

The prevalence of depression is higher in T2DM as compared to normal population and is significantly associated with nephropathy and coronary artery disease. The findings highlight the need for timely screening of depression and integrated management approach.
One Hundred Most-cited Papers on Bacterial Meningitis: A Bibliometric Study
Authors: Hakkaraki Vinayak Parashuram
Published: October 2023

Background:

In previous decades, large-scale research has been carried out on bacterial meningitis. In every field, citation analysis is the most significant contribution. The study’s objective was to identify and analyze the 100 articles on bacterial meningitis that received the most citations between 2000 and 2023, highlighting the most significant developments in the field.

Objective:

The objective of this study was to find out what makes a highly influential article by identifying and analyzing the characteristics of the 100 articles in the field of bacterial meningitis that receive the most citations. The goal of this study was to find and examine the 100 articles on bacterial meningitis that received the most citations.

Methodology:

We identified the top 100 most-cited papers in the field of bacterial meningitis from 55 journals using the Dimensions AI database. The results of each author’s analysis of 100 articles were then compared. We gathered fundamental data such as the journal’s title, country of publication, and study type. Descriptive counts or percentages were used to compare the various categories.

Results:

Between the year 2000 and the year 2023, articles were published. The total number of citations ranged from 115 to 1176, with 42 papers receiving more than 200 citations. In 2008, 14 articles were published, followed by 10 in 2000 and 2007. One thousand one hundred and seventy-six times were given to the most-cited paper, whereas 115 times were given to the least-cited article. “Clinical Features and Prognostic Factors in Adults with Bacterial Meningitis,” by Diederik van de Beek, et al. (2004) was the article that received the most citations. 1176 people have cited this article. van de Beek Diederik of the Academic Medical Center in The Netherlands is the author who has written the most articles, was mentioned in 14 of the top 100 articles. Papers were primarily published in Pediatrics ( n = 9) publication with 1861 citations. The Netherlands came in second with 18 publications, followed by the United States ( n = 46).

Conclusion:

Our study uses bibliometrics and visualization analysis of the most important articles in this field to show the current state of research in the area of bacterial meningitis, provide a history of research trends, and offer a perspective for future bacterial predicts the growth of meningitis.
Validity of Reflux Symptom Index in the Diagnosis of Laryngopharyngeal Reflux Disease
Authors: Kiren T , Arun T , Jacob Anu
Published: October 2023

Introduction:

Laryngopharyngeal reflux (LPR) is a disease, in which the diagnosis and treatment are controversial. The main objectives of this study were to assess the validity of the reflux symptom index (RSI) in patients exhibiting symptoms of LPR disease (LPRD) or gastroesophageal reflux disease (GERD).

Materials and Methods:

This study was a hospital-based, cross-sectional study. The study included all patients above the age of 12 years who presented to the ENT outpatient department with symptoms of LPRD or GERD. Patients who refused to give consent for the study, those who had undergone medical treatment past 6 weeks or surgical treatment for similar complaints, patients with malignancy of the hypopharynx and esophagus, patients with neurological causes of dysphonia and dysphagia, patients with a history of throat trauma or prior intubation, patients with allergies or chronic upper respiratory tract infections, and pregnant patients were excluded from the study. The variables examined in this study included age, sex, RSI, and reflux finding score.

Results:

The majority of patients (49.3%) with LPRD were in the age group of 31–50 years. Among the patients diagnosed with LPRD were females, only 15 patients (21.7%) diagnosed with LPRD had diabetes mellitus, only 7 patients (10.1%) had bronchial asthma, 4 patients (5.8%) diagnosed with LPRD had a history of thyroid disease, 8.7% had a history of smoking/tobacco usage addiction, and 18.8% of the patients experienced recurrent throat infection. The sensitivity was found to be 97.1%, specificity 66.7%, positive predictive value 84.8%, and negative predictive value 92.3%. The diagnostic accuracy of RSI was calculated to be 86.7%. It was found that only 46 of the 69 LPRD-positive patients (66.7%) showed symptoms suggestive of GERD.

Conclusion:

LPRD is predominantly a lifestyle-related disease. The fast-food lifestyle and the irregular and unhealthy spicy high acid dietary habits have led to a rapid increase in the prevalence of gastroesophageal reflux, and hence, the LPR in the general population, especially India.
Does Hepatitis B Virus DNA Forecast Chronic Hepatitis in Hepatitis B Surface Antigen-positive Patients?
Authors: Pandi Kaviya Chella , Kumarasamy Poongodi Santhana
Published: October 2023

Introduction:

Chronic hepatitis B (CHB) infection is accountable for nearly 240 million cases worldwide. Hepatitis B virus (HBV) has a propensity to show a divergent phase, and isolated measure of high HBV DNA level may not reflect the stage of the disease. In this background, this study was done to detect hepatitis B e antigen (HBeAg) and HBV DNA levels among hepatitis B surface antigen (HBsAg)-positive CHB cases and to determine the stage of disease with viral markers and biochemical parameters such as alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels.

Materials and Methods:

Blood samples were collected from 50 participants with CHB (HBsAg positive for more than 6 months) tested for HBe Ag by enzyme-linked immunosorbent assay, HBV DNA, ALT, and AST levels.

Results:

Among the 50 cases, 31 (62%) were HBeAg negative. Among these 31 HBeAg-negative groups, 16 (52%) had HBV DNA levels >2000 IU/mL. In these 16 patients, six had ALT >40IU/mL.

Conclusion:

HBsAg, HBeAg, ALT levels, and HBV DNA are important markers to determine the clinical stage of the disease. Since it is a chronic disease, patients need long-term follow-up. Further, emergence of viral mutants among vaccinated and those on lamivudine aggravates the existing problem.
Obstacles in Dengue Diagnosis and Severity Prediction
Authors: Chidambaram Latha Bharathi , Kumarasamy Poongodi Santhana
Published: October 2023

Background:

Dengue emerges as a perennial public health menace. Identification of patients at risk of developing dengue hemorrhagic fever (DHF)/dengue shock syndrome is still a huge challenge.

Objective:

In this background, this study was done to predict the severity of dengue by measuring the interleukin (IL) 6 and IL8 by enzyme-linked immunosorbent assay (ELISA).

Materials and Methods:

A total of 88 samples were collected from patients with clinical signs suggestive of dengue were tested for NS1 and immunoglobulin (Ig) M (NIV Pune), and proinflammatory markers IL-6 and IL-8 (Diaclone SAS Pvt Ltd., France) by ELISA.

Results:

All the 88 patients were positive for dengue IgM. Dengue NS1 was positive in 36 patients. IL-6 and IL-8 were raised in 56 cases and 46 cases, respectively. Out of 32 severe dengue cases, 24 had raised IL-6 and IL-8.

Conclusion:

The dynamic nature of dengue requires close monitoring and frequent clinical and laboratory evaluations. Early prediction requires prompt testing of all the markers (IgM, IgG, and NS1) irrespective of the day of illness. Although cytokine estimation aids in assessing the severity, other cost-effective alternatives (hematocrit and platelet count) are copacetic.
A Study of Spontaneous Bacterial Peritonitis in Cirrhosis of Liver with Ascites at a Tertiary Care Hospital in North India: Prevalence, Clinical, and Microbiological Profile
Authors: Mohan Gurinder , Kumar Pardeep , Singh Parminder
Published: October 2023

Background and Objectives:

In patients with chronic liver disease and ascites, spontaneous bacterial peritonitis (SBP) is a common complication. This can progress gradually and subtly or go undiagnosed until signs start to show. Early diagnosis is essential for effective treatment and the prevention of subsequent episodes because the mortality rate following a single episode varies from 20% to 40%. The goal was to study the incidence, clinical profile, and microbiological characteristics of SBP and its variants in people with liver cirrhosis and ascites.

Materials and Methods:

This observational study was done on 104 cirrhotic patients with ascites admitted at a tertiary care hospital. Basic demographics, symptoms, and clinical signs of patients were recorded. Diagnostic paracentesis was done aseptically and immediately sent for ascitic fluid cytology, biochemistry, and culture. Bacterial examination and antibiotic sensitivity tests were carried out by standard microbiological techniques.

Results:

Out of a total of 104 cirrhotic patients, 28 (26.9%) were diagnosed with SBP. Alcohol was the most common etiological factor, followed by hepatitis C infection. Among the SBP patients, the most common presentation was culture-negative neutrocytic ascites (71.4%), followed by classical SBP (17.8%), then mono bacterial non neutrocytic bacterascites MNB (10.7%). Among the symptoms, the most common was abdominal distension, followed by icterus, pedal edema, and abdominal pain. Majority of the patients belonged to Child–Pugh’s Grade C. Of 28 cases of SBP, 8 were culture positive. Gram-negative isolates were predominant (75%) and Escherichia coli were the most common isolate.

Interpretation and Conclusion:

The prevalence of SBP in cirrhotic patients was 26.9%, and Gram-negative isolates were predominant. Ascitic fluid culture and susceptibility testing can lead to accurate diagnosis of SBP and can guide for treatment as resistance to antibiotics is common.
Two tales of platoon intelligence for autonomous mobility control: Enabling deep learning recipes
Authors: Park Soohyun , Lee Haemin , Park Chanyoung , Jung Soyi , Choi Minseok , Kim Joongheon
Published: October 2023

This paper surveys recent multiagent reinforcement learning and neural Myerson auction deep learning efforts to improve mobility control and resource management in autonomous ground and aerial vehicles. The multiagent reinforcement learning communication network (CommNet) was introduced to enable multiple agents to perform actions in a distributed manner to achieve shared goals by training all agents' states and actions in a single neural network. Additionally, the Myerson auction method guarantees trustworthiness among multiple agents to optimize rewards in highly dynamic systems. Our findings suggest that the integration of MARL CommNet and Myerson techniques is very much needed for improved efficiency and trustworthiness.
A closer look at wound cord
Authors: Bērziņš Valdis
Published: October 2023

Wound cord (whipped cord, cord stamp) decoration on pottery from the late 4th to early 3rd millennium BC in Latvia has been subject to detailed stereomicroscope study, incorporating reflectance transformation imaging, which proved an invaluable tool for documenting impressions. While this kind of ceramic ornamentation constitutes a European-scale phenomenon, considerable local variation in the methods of making pottery stamps emerges, most significantly in the kinds of support used for winding the cord, which indicates the importance of vertical transmission for this component of pottery technology. Further, the similarity of the cordage to that used for fishing nets implies a close link between pottery-making and fisheries.
Genotypic characterization of extended spectrum beta-lactamase in gram negative bacterial contaminants of some door handles in Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun state
Authors: Bola Famojuro Oluwatoyin , Omolola Adesanya Ifeoluwa , Olu Ajewole Jerome , Ibukun Famojuro Tayo
Published: October 2023

Background: Nosocomial infections due to cross-transmission by microorganisms from inanimate surfaces have become a recognized public health problem.

Objectives: This research was carried out to detect bacterial contaminants of door handles and their production of extended spectrum beta-lactamase (ESBL) in Olabisi Onabanjo University Teaching Hospital.

Methods: Seventy door handles from twenty-seven sections of Olabisi Onabanjo University Teaching Hospital were swabbed and inoculated on different culture media. The isolates were identified using standard microbiological procedures. Susceptibility of the isolates to eleven antibiotics was determined by Kirby- Bauer disc diffusion test. Phenotypic detection of ESBL was determined by modified double disc synergy test (MDDST) followed by PCR amplification of ESBL- encoding genes.

Results: Forty-four (62.9%) out of 70 door swabs were positive for bacterial growth. S. aureus was the most common isolate (22.9%). Multidrug resistance was observed in 15(79.0%) and 20(69%) of Gram positive and Gram-negative isolates, respectively. Coagulase negative staphylococci, E. coli, Acinetobacter and Shigella species were totally resistant to ceftazidime (100%). PCR amplification of ESBL-genes revealed the presence of blaTEM blaCTX -M and blaSHV in 4(14.3%), 2(7.2%) and 1(3.6%) isolate, respectively.

Conclusion: This study revealed that door handles of different sections in hospital environment were contaminated by multidrug resistant Gram-negative bacteria encoding ESBL genes.

Keywords: Bacterial contamination; drug resistance; extended spectrum beta-lactamase.
Irrational use of antibiotics without a clinical diagnosis: a short case report
Authors: Agarwal Rajat , Mubeen Mohd , Singh Harpreet
Published: October 2023

Antibiotics are often started irrationally and continued injudiciously worldwide without a clinical diagnosis. Antibiotic prescription practises are governed by multiple factors like lack of diagnostic facilities, secondary infections, poor sanitary conditions, easy availability, pharmaceutical companies' marketing strategies and patients seeking the fastest cure from healthcare providers. We report a case of a 40-year-old male who was treated intermittently with multiple antibiotics for 3 months without being clinically diagnosed. The patient continued having episodes of fever with brief periods of remission. The occurrence of recurrent episodes of transient ischemic attacks alarmed him, and he was brought to a tertiary hospital, where a diagnosis of culture-negative Infective Endocarditis (IE) was made. He underwent successful high-risk double valve replacement and was discharged from the hospital in satisfactory condition.

Key messages: Antibiotics should be started judiciously with a proper clinical indication and should be reviewed from time to time regarding selection, duration, and response. In the case of non-responders, a thorough clinical examination followed by relevant investigations should be done for a proper clinical diagnosis.

Keywords: Antibiotics; infective endocarditis; fever; infection.
Mir-21 and Mir-125b as theranostic biomarkers for epithelial ovarian cancer in Tunisian women
Authors: Habel A , Nassar F , Itani M , Bouaziz H , Hadj-Ahmed M , Msheik Z , Stayoussef M , Nasr R , Yacoubi-Loueslati B
Published: October 2023

Background: Ovarian cancer (OC) is the third most common cancer in women and the leading cause of death associated with gynecologic tumors. Because this disease is asymptomatic in the early stages, most patients are not diagnosed until the late stages. This highlights the need for the development of diagnostic biomarkers. MicroRNAs (miRNAs), small non-coding RNAs, are currently being explored as potential biomarkers for the early detection of various malignancies in humans. However, their expression and diagnostic value in OC have not been well studied.

Materials and Methods: the plasma levels of miR-21, miR-200a, miR-200b, miR-200c, miR-205 and miR-125b were determined in epithelial ovarian cancer (EOC) patients and healthy controls by Reverse Transcription Quantitative Realtime Polymerase Chain Reaction (RT-qPCR). The expression levels of the deregulated microRNAs were analysed according to clinical characteristics.

Results: It was found that miR-21 and miR-125b were upregulated in EOC compared with healthy controls. Moreover, decreased miR-125b was associated with resistance to platinum-based chemotherapy.

Conclusions: Our data suggest that miR-21 and miR-125b in plasma may serve as potential circulating biomarkers for the early detection of EOC. MiR-125b may also be useful for predicting chemosensitivity in EOC patients.

Keywords: Epithelial ovarian cancer; miRNAs; biomarkers; resistance to treatment; Tunisia.
Anticancer effects of herbal medicine Emelia-M, Mshikazi and Delosma H against human leukaemia cells
Authors: Nkechinyere Adeniyi Joy , Nlooto Manimbulu , Ngcobo Mlungisi , Moodley Roshila , Gomo Exnevia
Published: October 2023

Background: Leukaemia is one of the three major types of blood cancers that lead to the overproduction of abnormal white blood cells. Emelia M (EMB), Mshikazi and Delosma H are herbal medicines that are being used by traditional healers in KwaZulu-Natal, South Africa to treat leukaemia and other diseases.

Objectives: To gain insight into the safety (non-toxic effect), anti-cancer activity, mechanisms of action and phytochemical profiles of traditional herbal medicines (Emelia M (EMB), Mshikazi and Delosma H) in South Africa.

Methods: The viability of human peripheral blood mononuclear cells (PBMCs), monocytic (THP-1) and T-lymphocyte (Jurkat) cell lines exposed to varying concentrations of aqueous extracts of the three herbal medicines were assessed using adenosine triphosphate (ATP) assay.

Results: All three extracts showed a dose-dependent effect on the viability of PBMCs. Cell viability decreased with increasing concentrations of extracts when compared with the untreated cells at 24 and 48 hours. The inhibitory activities (IC50) of the extract were found in the order of Mshikazi > EMB, > Delosma H. All the extracts induced apoptosis with minimal necrosis. Many bioactive compounds that have been previously reported to have anticancer effects were identified in the extracts.

Conclusion: Mshikazi extract significantly inhibited the growth of THP-1 and Jurkat cells and induced cell death through apoptosis than the other two extracts.

Keywords: Leukaemia; traditional herbal medicines; apoptosis; phytochemical compounds.
Study on short-term clinical observation of the effect of apically repositioned flap combined with free gingival graft to widen keratinized tissue in implant area
Authors: Jiang HuanHuan , Xiang Liu Lin , Dong Yan , Na Yu Mei , Yuan Yue , Tian Lei
Published: October 2023

Objective: To analyse the short-term clinical results of the effect of apically repositioned flap combined with free gingival graft to widen keratinized tissue in implant area, so as to provide a basis for its clinical application.

Methods: Fifteen patients with intraoral single or multiple missing teeth, who did not undergo implant restoration or who re-examined after implant restoration completed were included, along with KW less than 1-2 mm on the buccal side of the median line of the alveolar ridge crest in the implant area, or KW less than 1-2 mm on the buccal side of the abutments and dental crown margins. All underwent apically repositioned flap combined with free gingival graft, which were reviewed.

Results: Fifteen patients with missing keratinized gingivae underwent free gingival flap graft, survived with all grafted gingival flaps. Compared with before implantation, significant keratinized tissue widening and area gain were obtained at 1 and 3 months postoperatively.

Conclusion: The free gingival flap graft can significantly widen the buccal keratinized mucosa of the implant, and to some extent maintains the health status of the implant, which is worthy of clinical promotion and application.

Keywords: Apically repositioned flap; free gingival graft; implant; keratinized tissue.
Willingness of college students aged 10 to 24 years to get vaccinated against COVID-19 disease: a cross-sectional study in South-East Nigeria
Authors: T Chinawa Awoere , N Ossai Edmund , Ugwunna Nwachukwu Chinedu , A Uwaezuoke Ndubuisi , E Aronu Ann , M Chinawa Josephat
Published: October 2023

Background: Willingness to be vaccinated against COVID-19 is a topical issue that may change the course and distribution of the pandemic in the country.

Objectives: This study was aimed to determine the willingness to receive the COVID-19 vaccine among college adolescents and associated factors.

Methodology: This was a cross-sectional study carried out among one thousand college adolescents in six secondary schools in Enugu from April to August 2021. A pretested, self-administered questionnaire was used for data collection. Data entry and analysis were done using IBM Statistical Package for Social Sciences (SPSS) statistical software version 25. Descriptive statistics were used to describe college adolescents' characteristics. Categorical variables were reported as frequencies and percentages. Predictors of willingness to vaccinate were assessed using binary logistic regression.

Results: A minor proportion of the respondents, 13.2% (153) were willing to receive the COVID-19 vaccine. The respondents who were males were 1.6 times more willing to receive the COVID-19 vaccination when compared with those who were females. (AOR=1.6, 95%CI: 1.1- 2.3). The respondents who were aware they could be infected with COVID-19 were twice more likely to receive COVID-19 vaccination when compared with those who felt they could not be infected. (AOR=2.0, 95%CI: 1.1-3.1). The respondents who had good knowledge of COVID-19 vaccination were 2.2 times more likely to receive COVID-19 vaccination when compared with those who had poor knowledge. (AOR=2.2, 955CI: 1.5-3.3)

Conclusion: A small fraction of college adolescents were willing to receive the COVID-19 vaccine. Male gender, knowledge of vaccine and possibility of transmitting infection are predictors of willingness to receive the vaccination.

Keywords: Willingness; vaccination; college adolescents; COVID-19; knowledge; Enugu.
Clinical features of upper gastrointestinal endoscopy in 3146 patients: a 9-year retrospective cohort study in Zanzibar Archipelago, Tanzania
Authors: Qu Li-Shuai , Mohamed Gubi Mariam
Published: October 2023

Background/objectives: To investigate the demographic features, primary endoscopic findings, and the status of Helicobacter Pylori (H. pylori) infection of the enrolled subjects who underwent upper gastrointestinal endoscopy (UGIE) in the Zanzibar Archipelago, Tanzania.

Methods: Between December 2013 and October 2021, a total of 3146 eligible participants were finally recruited in present retrospective cohort. Demographic information and endoscopic findings of each participant was retrieved. H. pylori infection was confirmed by rapid-urease test of gastric antral and body biopsies at endoscopy.

Results: Among the recruited subjects, 1691 (53.76%) are females, remaining 1455 (46.24%) are males. The median age of this retrospective cohort was 40 years ranging from 8 to 97 years. The common identified endoscopic findings included gastro-duodenitis,normal endoscopic finding, peptic ulcer disease (PUD), esophagitis, esophagogastric varices, esophageal and gastric cancer, respectively. After adjustment for sex and age, a significant risk of gastric and/or duodenal ulcer (OR, 2.51; 95% CI, 1.82–3.48, P<0.001) and gastric cancer (OR, 3.49; 95% CI, 1.27–9.58, P=0.015) in H. pylori positive group was observed. Stratified analysis indicated a significant relationship between duodenal ulcer with younger age (adjusted OR, 0.98; 95% CI, 0.97–0.99, p = 0.002), and the presence of H. pylori (OR, 2.01; 95% CI, 1.12-3.91, p= 0.021).

Conclusions: The present study revealed that gastro-duodenitis, PUD, and normal finding are the most common endoscopic diagnoses in Zanzibar. The presence of H. pylori is significantly associated with duodenal ulcer and gastric cancer.

Keywords: Upper gastrointestinal endoscopy; Helicobacter Pylori; Zanzibar.