bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessment of airway parameters in obstetric patients and comparing them at different phases in the perinatal period: A prospective observational study
Authors: Kaur Kiranpreet , Vaishali  , Dahiya Pushpa , Kaur Svareen , Bhardwaj Mamta , Singhal Suresh K.
Published: November 2023

Background and Aims:

Airway changes occur in different stages of pregnancy. We aimed to evaluate the changes in the upper airway in obstetric patients during pregnancy, labour and after delivery using multiple airway indices and identify the predictive factors of these changes.

Methods:

This observational study was conducted on 90 parturients aged >20 years, having monofoetal pregnancy. The patient’s weight was noted, airway assessment including Mallampati grading (MPG), and thyromental distance (TMD), sternomental distance (SMD), neck circumference (NC) and Wilson’s risk score were measured in the second trimester of pregnancy (T0), between 32 and 34 weeks of gestation (T1), at the time of admission for safe confinement, between 38 and 40 weeks of gestation (T2), 2 h after delivery of baby (T3) and, 24 h after delivery (T4). Unpaired t-test and analysis of variance test were applied.

Results:

Changes in mean (standard deviation [SD]) weight, recorded from T0 to T2, were from 56.96 (10.77) to 65.322 (11.49) kg (P = 0.001). A rise of one or two grades in MPG was detected as the pregnancy progressed, and a decrease of one grade was noted after delivery. A significant decrease in mean (SD) TMD was noted from 6.88 (0.65) to 6.36 (0.62) cm from T0 to T2 (P = 0.001). SMD also decreased in a similar manner as TMD. NC increased from T0 to T3 and then decreased at T4 (P = 0.004).

Conclusion:

Following the second trimester of pregnancy, MPG increased by either one or two grades, with a decrease in TMD and SMD and an increase in NC.
Comparison of cycloplegia with atropine 1% versus cyclopentolate 1%
Authors: Singh Ram P , Amitava Abadan K , Sharma Nikita , Gupta Yogesh , Raza Syed A , Bose Aparna , Meena Ganga S
Published: November 2023

Purpose:

Cycloplegic refraction is mandatory for children to know the eye's refractive status. In this study, we compared cycloplegia induced by cyclopentolate 1% to that induced by atropine 1% by means of retinoscopy.

Methods:

In this parallel-designed interventional study, we included 67 children aged between 4 and 17 years. After the initial retinoscopy under cyclopentolate 1% (used twice in each eye), we repeated it a week later under atropine ointment 1% (used twice a day for 3 days); both were done by the same trained optometrist masked to the drug. Each eye's refraction was converted to spherical equivalents (SEs), and the values averaged between the two eyes of each child under each drug. We compared SE with paired t-test (JASP 16.4). In addition, we performed correlational analysis, and looked for agreement using the Bland–Altman plot. Significance was set at P < 0.05. Wherever possible, 95% confidence intervals (CIs) are quoted.

Results:

The mean SE with atropine was +1.93 ± 2.0 D, compared to +1.75 ± 1.95 D under cyclopentolate. On average, atropine induced greater cycloplegia by a mere 0.18 D (95% CI: 0.07 to 0.29 D, P value 0.002). The two cycloplegic refractions correlated significantly (Pearson's r: 0.975, P < 0.001). The Bland–Altman plot revealed the limits of agreement as 1.06 and −0.71 D.

Conclusion:

Our study suggests that cyclopentolate works for the most part as well as atropine to attain cycloplegia. Atropine may be considered for children less than 15 years of age with greater than 5.0 D of hyperopia. Cycloplentolate, with its advantages of quick action and short duration, should form the first go-to topical cycloplegic in busy outpatient clinics.
Mobile battery blast injuries: An emerging ocular health hazard in children
Authors: Shah Chintan , Goyal Anand , Sen Pradhnya , Peeush Parimal , Sen Alok , More Amruta , Jain Elesh
Published: November 2023

Purpose:

To assess clinical features, visual outcomes, and setting of mobile battery blast-induced eye injuries in children.

Methods:

Retrospective case sheets of children with mobile battery blast injuries were reviewed at a tertiary eye care center from January 2015 to March 2022. We noted the mode of injury, battery status, and clinical presentation and analyzed the treatment outcomes.

Results:

The study included 14 eyes of 11 patients. Three patients (27%) had bilateral ocular injuries. The most common reasons for the blast were wiring a bulb to the battery or charging the battery with a universal mobile charger, seen in four cases each. Three eyes had closed-globe injuries (CGIs), whereas 11 had open-globe injuries (OGIs). Of the 11 eyes with OGI, four also had a retained intraocular foreign body (IOFB). Only four (36%) eyes having OGI could achieve vision better than 6/60. All three eyes with CGIs developed secondary glaucoma, and two underwent trabeculectomy. However, the visual prognosis was better (>6/36) in eyes with CGI. Overall, mean visual acuity at the final follow-up was improved to 1.41 ± 1.14 logMAR from 2.32 ± 0.76 logMAR at presentation. This was also found to be statistically significant with a P value of 0.02.

Conclusion:

Battery blast-induced ocular injuries, although rare, often lead to poor outcomes. Apart from charging, playing with discarded or damaged batteries was a common reason for battery blasts in our series.
Eyelid cleaning: Methods, tools, and clinical applications
Authors: Zhang Ling , Wang Jingru , Gao Yingying
Published: November 2023

Nowadays, people give more importance and pay closer attention to the condition of their eyelids and lid margins. This increased recognition of eyelid hygiene is due to the growing awareness that improper eyelid cleaning might lead to various ocular surface diseases such as blepharitis and meibomian gland dysfunction. These ocular surface diseases can greatly affect people's quality of life. This article reviews the latest procedures for proper eyelid cleaning, including indications, methods, tools, detergents, and clinical applications, to maintain a healthy ocular surface and assist in the treatment of dry eye and blepharitis.
Pterygium surgery using inferior rotational conjunctival autograft versus conventional conjunctival autograft with sutures – A comparative study
Authors: Gudimetla Jayamadhury , Potti Sudhakar , Shivaprasad Shyam , Bhide Milind , Prabhakar Venkat
Published: November 2023

Purpose:

To compare the outcomes of pterygium surgery by using an inferior rotational autograft and a conventional superior conjunctival autograft.

Methods:

This was a prospective interventional comparative study of 85 eyes of patients who were divided into two groups of 45 and 40. Standard techniques of both procedures were performed by a single surgeon. Astigmatism, recurrence rates, time taken, and other complications were compared.

Results:

All the subjects were in the age group 53 ± 7.56 (40–74) years. Demographic data and type of pterygium were comparable in the two groups. In the rotational group, the preoperative astigmatism was − 2.14 ± 1.36 D, which decreased in 1 week to 1.42 ± 1.11 D, in 1 month to − 1.13 ± 0.99 D, in 3 months to 0.91 ± 0.72 D, and in 6 months to 0.81 ± 0.85 D (P < 0.05 each). Preoperative astigmatism in the conventional group was − 2.63 ± 1.47 D, which decreased to − 1.43 ± 1.04 D in 1 week, −1.18 ± 0.85 D in 1 month, −1.07 ± 0.81 D in 3 months, and − 1.01 ± 0.78 D in 6 months (P < 0.05 each). There was no significant difference between the groups in terms of astigmatism at any follow-up visit (P < 0.05). Complications like dellen, graft edema, and superficial vascularization were seen in both groups. The rotational group had one recurrence (2.86%). No recurrence was noted in the conventional group. None of the complication rates was significantly different between the two groups (P < 0.05).

Conclusion:

Inferior rotational conjunctival autografting is a good technique for management of pterygium. It has a profile similar to that of conventional conjunctival autograft.
Customized corneal allogenic intrastromal ring segments (CAIRS) for keratoconus with decentered asymmetric cone
Authors: Jacob Soosan , Agarwal Amar , Awwad Shady T , Mazzotta Cosimo , Parashar Parnika , Jambulingam Sambath
Published: November 2023

Corneal allogenic intrastromal ring segments (CAIRS) refer to the intracorneal placement of fresh, unprocessed, processed, preserved, or packaged allogenic rings/segments of any type/length. We described uniform-thickness CAIRS previously. We now describe a new technique of customized CAIRS to personalize the flattening effect as per individual topography. A prospective interventional case series of patients with pericentral/ paracentral decentered cones and gradation of keratometry with one side steeper than the other was conducted. Individually customized tapered CAIRS with variable volume, arc length, taper length, and gradient of taper were implanted. In total, 32 eyes of 29 patients with at least 1-year follow-up were included. Special double-bladed trephines and a CAIRS customizer template allowed the creation of individually customized CAIRS. Mean uncorrected distance visual acuity (UDVA) and spectacle-corrected distance visual acuity improved from 0.22 to 0.47 (P = 0.000) and from 0.76 to 0.89 (P = 0.001), respectively. Significant improvement was seen in K1, K2, Km, Kmax, topographic astigmatism, Q-value, sphere, cylinder, spherical equivalent, Root Mean Square (RMS), Higher Order Aberrations (HOA), and vertical coma (P < 0.01, 0.05). There was no significant change in the width or height of CAIRS between 1 month and last visit on anterior-segment optical coherence tomography. Five eyes continued to remain at the same UDVA, 27 eyes had at least 2 lines, and 13 eyes had at least 3 or more lines improvement in UDVA. The maximum improvement in UDVA was 7 lines. A significant difference in flattening was obtained at different zones across the tapered CAIRS. Thus, differential flattening was achieved across the cone based on the customization plan. Personalized customization was possible for each cornea, unlike limited models of progressive-thickness synthetic segments. Allogenic nature, greater customizability, efficacy, and absent need for large inventories are advantages compared to synthetic segments.
Transmittance characteristics of transparent hydrophobic acrylic foldable intraocular lenses that were in vivo for a prolonged period of time: A UV visible spectrophotometric study
Authors: Bhattacharjee Harsha , Das Dipankar , Bhattacharjee Kasturi , Buragohain Suklengmung , Javeri Henal
Published: November 2023

Purpose:

To record experimental data on the spectral transmittance characteristics of transparent hydrophobic acrylic foldable IOLs, which were in vivo for a prolonged period of time and explanted under clinical indications and also to compare the data with that of corresponding control and crystalline lens along with review of the relevant literature.

Method:

Material and make of each of the explanted intraocular lenses (IOLs) as well as pre-explantation clinical status of the eyes were confirmed from the medical record. The transmittance of wavelength from 185 to 900 nm of each of the selected IOLs was measured using Shimadzu UV 2600 UV visible (UV-Vis) spectrophotometer in double-beam configuration and probe version 2.16 software. The data obtained were statistically analyzed.

Results:

The mean transmittance of 12 clinically explanted IOLs at spectral range 300–700 nm was 49.5% ± SD 6.9%. This value was 10% and 38% less than the corresponding clear (59% ± SD 0.4%) and yellow (87.5% ± SD 0.4%) control, respectively. The mean transmittance of the analytes in the UV range was 43.3 ± SD 6.9%, and it was almost similar to the control. The data showed wide variations without good correlation, and it matches with the human crystalline lens at the age range of 50–60 years. All eyes were otherwise healthy, and none had age-related macular degeneration.

Conclusion:

In comparison with fresh IOL with a yellow filter, light transmittance at the spectral range 300–700 nm was found decreased in all the IOLs, which were in vivo for an average period of 12.25 ± 4.4 years. All IOLs transmitted variable amounts of UV radiation. More data are required for further analysis on the subject.
Post-COVID-19 endogenous endophthalmitis case series and review of literature
Authors: Samanta Ramanuj , Jayaraj Sreeram , Mittal Sanjeev K , Kumari Jyoti , Naharwal Aarshi , Agrawal Ajai
Published: November 2023

Purpose:

To describe a series of post-coronavirus disease 2019 (COVID-19) endogenous endophthalmitis (EE) patients from a multispecialty tertiary hospital in North India.

Methods:

A retrospective chart review including all consecutive cases with EE following confirmed COVID-19 disease from July 2020 to June 2021.

Results:

Seven eyes of four patients (three female and one male) were included. Two patients had confirmed bilateral fungal (Aspergillus sp.) EE and two patients had presumed fungal EE (one bilateral and one unilateral). Three of these four patients received systemic steroids as part of COVID-19 treatment previously. Five eyes were managed with initial intravitreal injection (IVI), followed by pars plana vitrectomy (PPV), and two eyes were managed with only IVI. All patients received systemic antifungal agents. Intraocular inflammation resolved in all eyes with treatment. One patient of EE also developed voriconazole-induced transient visual hallucination, which resolved on discontinuing the medication.

Conclusion:

This case series represents a series of EE cases following COVID-19 disease or its sequelae or as a result of prior treatment for COVID-19. Ophthalmologists and physicians must be vigilant about these complications and initiate prompt management at the earliest.
A modified 23-G trocar and cannula system with lateral micropores for drainage of vitreous humor
Authors: Zhang Wen-Wen , Chen Fei-Fei , Liu Ya-Jun , Jiang Feng , Xie Zheng-Gao
Published: November 2023

When primary angle-closure glaucoma occurs during an acute attack, routine phacoemulsification is challenging because of the high intra-ocular pressure (IOP) and shallow anterior chamber (AC). To reduce IOP and deepen the AC before phacoemulsification, a portion of the vitreous body is often removed. In this report, we introduce an extended trocar/cannula system with lateral micropores to drain the liquid vitreous before routine phacoemulsification to solve this problem. A modified trocar was used to drain the liquefied vitreous before routine phacoemulsification. We demonstrated that this novel trocar/cannula system is safe and effective for draining liquefied vitreous before routine phacoemulsification. It also facilitates the transition to smooth phacoemulsification.
Efficacy of preserved Tafluprost 0.0015% in lowering intraocular pressure
Authors: Paul Chandrima
Published: November 2023

Objective:

To investigate the intraocular pressure (IOP) lowering effect of topical preserved tafluprost 0.0015% in a tertiary hospital setting in India.

Methods:

This is a retrospective chart review of patients with primary open-angle glaucoma (POAG) or ocular hypertension (OHT) attending regular outpatient visits in December 2019 and January 2021, and treated with topical preserved tafluprost 0.0015%. Based on their medication history, patients were divided into two groups, the “treatment naïve” group and the “switched” group, which included patients switched to tafluprost monotherapy after treatment with at least one prior drug.

Results:

The mean IOP of the study population reduced significantly from baseline level by 20.6% and 25.5% at 1 month and 3 months after preserved tafluprost 0.0015% treatment (P < 0.001 for both). The mean IOP in patients with only OHT reduced significantly from baseline level by 21% and 26% at 1 month and 3 months after preserved tafluprost 0.0015% treatment (P < 0.001 for both). The mean IOP in patients with POAG reduced significantly from baseline level by 19% and 24% at 1 month and 3 months after preserved tafluprost 0.0015% treatment (P < 0.001 for both). The baseline IOP ± SD in POAG treatment naïve patients was 25.3 ± 0.3 mmHg, which reduced significantly by 24% and 28% at 1 month and 3 months after preserved tafluprost 0.0015% treatment (P < 0.001 for both). The baseline IOP ± SD in POAG switched patients was 24.3 ± 0.1 mmHg, which reduced significantly by 18% and 22% at 1 month and 3 months after preserved tafluprost 0.0015% treatment (P < 0.001 for both). In the POAG switch group, the percent reduction in IOP at 3 months after preserved tafluprost 0.0015% treatment was 23% with timolol as first line, 22% with bimatoprost as first line, 20% with latanoprost as first line, and 19% with travoprost as first line (P < 0.001 for all).

Conclusions:

We show significant IOP reduction with preserved tafluprost 0.0015% in a real-world setting. As first-line monotherapy in patients with OHT and in POAG–naïve patients, preserved tafluprost 0.0015% significantly reduced IOP at 3 months. Even as second-line therapy in nonresponders (POAG-Switched) to various drugs (same class [PGAs] versus different class), treatment with preserved tafluprost 0.0015% resulted in significant IOP reduction at 3 months.
Ocular manifestations in HIV patients attending a tertiary care hospital in Eastern India and correlation of posterior segment lesions with CD4+ counts
Authors: Swain Jyotirmayee , Sharma Pramod Kumar , Mohanty Loknath , Panigrahi Pradeep Kumar
Published: November 2023

Purpose:

We aimed to study the ocular manifestations in human immunodeficiency virus (HIV)-infected patients and the correlation of posterior segment lesions with CD4+ counts.

Methods:

This hospital-based, cross-sectional study enrolled HIV-positive patients attending the ophthalmology department of a tertiary care hospital in Eastern India. Complete demographic information was obtained for each patient. Comprehensive ophthalmic evaluation was done in each case.

Results:

A total of 184 HIV-positive patients were enrolled in the study. Ocular manifestations were detected in 62 cases. The prevalence of ocular manifestations in the present study was 33.69%. Mean age of patients included in the study was 34.8 ± 10.77 years. Prevalence of ocular manifestations was highest in the age group of 30–39 years (41.93%). Highest prevalence of ocular manifestations was noted in patients with low level of education and poor socioeconomic status. Sexual transmission was the major route of HIV transmission (in 92% of cases). Posterior segment lesions were seen in 69.35% of cases. HIV retinopathy was the most common posterior segment manifestation noted in 25 eyes. Significant positive correlation was noted between severities of posterior segment findings and CD4+ counts, which we found to increase with decrease in CD4+ counts (P < 0.001).

Conclusion:

Detailed ophthalmic evaluation including fundus examination is must in all cases of HIV/acquired immunodeficiency syndrome (AIDS) patients as it may help in early diagnosis, treatment, and prevention of sight-threatening complications due to opportunistic infections.
Prevalence and pattern of refractive errors among school-going children in district Baramulla, Kashmir: A cross sectional study
Authors: Hassan Sabreena , Nabi Sahila , Zahoor Nazia , Khan Shabana , Makayee Abdul A , Wahab Abdul
Published: November 2023

Purpose:

Uncorrected refractive error is one of the most important causes of visual impairment worldwide. Addressing childhood vision impairment (VI) is one of the main goals of the World Health Organization (WHO) to combat blindness strategies.

Objective:

To ascertain the prevalence and pattern of refractive errors among children aged 10 to 16 years in Baramulla district, Kashmir.

Methods:

A cross-sectional study was carried out among 680 school children during an eye camp under the school health program of the national program for control of blindness. The screening was conducted in four schools in Baramulla district, Kashmir. The schools were selected using the non-probability convenient sampling technique.

Results:

A total of 680 school children from classes sixth to tenth aged 10–16 years participated in the study. Out of 680 students, 545 (80%) had normal vision, 97 (14%) had impaired visual acuity ranging between 6/9 and 6/24, and 38 (6%) had severe VI ranging from 6/36 to 6/60. Among the various types of refractive errors, myopia was the most prevalent affecting 54 children. Age distribution of refractive errors showed myopia to be more prevalent in the age group 13–14 years (16, 14 cases), hypermetropia was more prevalent in the age group 14–15 years (10, 8 cases), and astigmatism 5 cases in the age group 14–15 years.

Conclusion:

The study provides useful and baseline data about the refractive error amongst the school children of the Baramulla district. A larger study needs to be conducted in all schools of the state to get a clear picture of RE and other eye-related problems to detect vision problems earlier.
The Pattern of Midface Fractures in Jordan: A Retrospective Review of Medical Records
Authors: Bataineh Anwar B. , Khader Yousef
Published: November 2023

Introduction:

Midface fracture incidence and trauma patterns vary across countries, due to socioeconomic, environmental, and cultural factors. The aim of this retrospective study was to assess the etiology, pattern, and treatment of midface fractures in North of Jordan during 2018–2021.

Methods:

This single-center retrospective study was based on the review of the medical records of patients who had suffered midface fractures and were treated at the Department of Oral and Maxillofacial Surgery at the King Abdullah University Hospital. The dataset for this investigation spanned the 4-year period from January 2018 to December 2021.

Results:

During the 4-year period, 267 patients presented with 376 different maxillofacial fractures. Of those, 140 patients had 250 midface fractures, with a mean of 1.79 per patient. Their age ranged from 2 to 68 years (mean [standard deviation] = 25.8 [12.0] years). The most frequent injury cause was road traffic accidents (RTA) (n = 72, 51.3%), followed by falls (n = 27, 19.3%). Among midface fractures, the most frequent were orbit fractures (42.4%), followed by zygomatic fractures (31.6%) and maxillary fractures (26%). The majority of fractures (77.9%) were treated through open reduction and internal fixation (ORIF), while the remaining (15.7%) required closed reduction and conservative treatment was sufficient in 6.43% of fractures.

Conclusions:

Midface fractures were more common among males, and primarily occurred in the orbital floor due to the high incidence of RTAs. Maxillary fractures were mostly of the LeFort I Type and ORIF was the most common treatment modality.
Using a Disposable Flexible Fiberoptic Scope as a Bougie for Difficult Intubation
Authors: Rabadi Daher K. , Almasarweh Sami A. , Abubaker Ahmad K. , Shawaqfeh Nedal , Alsalman Salem R. , Madain Zaid
Published: November 2023

In this case report, we describe two difficult intubations in which an endotracheal tube was threaded over a fiberoptic bronchoscope that was acting as a bougie. Our patients initially presented with limited neck extension, narrow mouth opening, and restricted view of the glottic region. A fiberoptic bronchoscope was guided through while the patient was oxygenated through a laryngeal mask. After the scope provided an unrestricted view of the vocal cords, the digital module was removed by cutting the fiberoptic thread, and an endotracheal tube was passed through. After proper confirmation of the endotracheal tube position, the intubation was deemed successful and thereby, we share our experience with the novel technique. This technique may potentially improve critical patient outcomes whether in trauma or an unexpectedly difficult intubation.
Orthostatic hypotension in the elderly: Prevalence and its management by simple isometric limb tensing exercises
Authors: Tephilla Epsibha , Elizabeth Tharion , Shalini Jeyapaul , Vinod Abraham
Published: November 2023

Objective:

Orthostatic hypotension (OH), an important cause of falls in the elderly, is grossly underdiagnosed. Our study aimed to determine the prevalence and associated factors of OH among the elderly attending a secondary care hospital. Furthermore, we assessed and compared the effectiveness of simple arm and leg tensing exercises, performed just prior to standing, to mitigate the orthostatic fall in blood pressure (BP) in elderly OH patients.

Materials and Methods:

A cross-sectional study screened elderly patients (≥65 years) for OH and recruited them into a randomized controlled trial (CTRI/2020/08/027182) of two parallel groups performing either arm tensing or leg tensing exercises just before standing up. We performed an interim analysis of the ongoing trial using paired t-test for within-group comparisons. Patients identified to have OH based on systolic or diastolic fall in BP were analyzed separately. Chi-square analysis compared the improvement in OH status between the two groups.

Results:

Nineteen out of 186 screened elderly patients were diagnosed with OH (10.21%, 95% CI: 7.99–12.43). Arm exercise significantly reduced the orthostatic-induced fall in systolic and diastolic BP, while leg exercise effectively reduced only the systolic fall in BP among patients with OH. The proportion of patients with OH after arm exercise (20%) was significantly lower than after leg exercise (77.8%) (P = 0.023, Fischer's exact test).

Conclusion:

We found a 10.21% prevalence of OH in our elderly population. Furthermore, we found that simple isometric arm tensing exercise ameliorates the fall in BP on standing up in OH patients.
Behavioural interventions for tobacco cessation in India: A systematic review and meta-analysis
Authors: Pahwa Vandita , Pimple Sharmila A. , Bhattacharjee Atanu , Kuberkar Deepali , Mishra Gauravi A. , Chaturvedi Pankaj
Published: November 2023

Tobacco consumption is an area of public health concern in India. One of the unmet needs of many low-resource countries is to provide cost-effective tobacco cessation interventions for reducing tobacco-related mortality. This article reviews studies on non-pharmacological interventions for tobacco cessation in India. A systematic review by PICO (population, intervention, comparison, outcome) of behavioural intervention-based tobacco cessation studies that met the inclusion criteria, with a minimum 1-month follow-up, reporting outcomes in terms of frequencies or percentages published between 2010 and 2020 was performed. Following the review stages, 16 studies comprising 9,613 participants were included in the review. A pooled estimate was derived using both fixed-effects and random-effects models. The intervention showed good overall efficacy for any tobacco user (relative risk [RR] = 1.73 [95% confidence interval [CI]: 1.58–1.90) (fixed-effect model)] and (RR = 2.02 [95% CI: 1.64–2.48] [random-effects model]). Behavioural intervention studies targeted towards only smokers (RR of 1.81 [95% CI: 1.55–2.11] and 1.96 [95% CI: 1.52–2.53]) and combined smoking and smokeless tobacco users (RR of 1.69 [95% CI: 1.50–1.90] and 2.12 [95% CI: 1.49–3.01]) were equally efficacious. The review provides the effectiveness of behavioural interventions in quitting tobacco among users of both smoking and smokeless forms of tobacco. The review findings are of particular significance to inform health policy decisions on the integration of cost-effective brief behavioural intervention into existing health care services in resource-constrained countries.
An epidemiological study of period poverty among females of reproductive age group in Lucknow (U.P.)
Authors: Singh Swati , Kunwar Rajesh , Sengar Mili , Gupta Abhishek
Published: November 2023

Background:

Females in developing countries face brunt of lack of access to affordable menstrual supplies and inequitable distribution of menstrual health education and are victims of period poverty. The objective of the present study was to estimate prevalence of period poverty and to determine association of period poverty with socio-demographic determinants, menstrual knowledge, menstrual hygiene management practices, and reproductive health.

Materials and Methods:

This was an analytical cross-sectional study, conducted at an urban primary health care centre. Reproductive age group (20–49 years) females attending the primary health care centre from December 2022 to May 2023 were selected for study. Data were collected on semi-structured, pre-tested questionnaires. The collected data were entered in M.S Excel and analysed in STATA version 17.0. Chi-square test was used for comparison of qualitative data, and for quantitative data, unpaired t-test was used.

Results:

The prevalence of period poverty in the present study was 92 (29.7%). The mean age of females with period poverty was 29.72 ± 7.13 years, and it was 26.45 ± 6.62 years with no period poverty (P 0.001). Period poverty was significantly associated with socio-demographic variables. Period poverty had significant association with menstrual knowledge, menstrual hygiene management practices, and reproductive health.

Conclusion:

Many females cannot afford menstrual health products to meet their monthly needs, and this may affect their education and socio-economic status. Improved access to affordable sanitary products is requisite of females.
Patients' satisfaction towards Wasfaty services in Al Ahsa province, Saudi Arabia – 2022
Authors: AlGhadeer Sarah Z. , AlAbdullah Meriam , Alibrahim Zainab , AlSalman Zahra , AlHaddad Hasan M.
Published: November 2023

Background:

The e-prescriptions service connects primary healthcare centers and hospitals to selected community pharmacies in various locations to allow easy access to the nearest pharmacy in the neighborhood, thus facilitating the process of drug dispensing. This study aims to assess patients' satisfaction towards Wasfaty services delivered by Ministry of Health healthcare centers.

Materials and Methods:

A cross-sectional study was conducted in Al Ahsa province in Saudi Arabia among adult patients who used Wasfaty services. An electronic Arabic questionnaire including demographic characteristics of patients and questions to assess their satisfaction level with the e-prescription “Wasfaty” service in terms of different aspects.

Results:

A total of 481 participants were included in the study. Females represented 53.4% of them, and 28.1% were aged 50 years or over. Overall, most of the patients (84.1%) were either satisfied or strongly satisfied with the service (4.28 ± 0.57). After controlling for confounding, patients with chronic diseases were more satisfied with the “wasfaty” service compared to those without chronic diseases. The history of chronic disease was responsible for approximately 2.4% variability of patient satisfaction (r-square = 0.024). Patients' geographic region, age, sex, and educational level were not significantly associated with their satisfaction with “wasfaty” service.

Conclusion:

The majority of patients, particularly those with chronic diseases, were satisfied with Wasfaty service. However, less satisfaction was observed regarding medication availability.
Coronavirus disease (COVID-19)-associated mucormycosis (CAM): The unholy triad of COVID-19, diabetes mellitus, and corticosteroid therapy
Authors: Juyal Deepak , Pal Shekhar , Negi Nidhi , Singh Minakshi , Kumar Manish , Singhal Shweta
Published: November 2023

The whole world has battled with multiple waves of coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 virus. However, the second wave of COVID-19 had caused a worldwide havoc in terms of disease transmissibility, severity, and mortality. India has been among the worst hit countries during the second wave, which substantially overburdened and overwhelmed the Indian health care system. While secondary infections and co-infections among COVID-19 patients were increasingly being reported, COVID-19-associated mucormycosis (CAM) emerged as a new challenge particularly from India and became a matter of immediate concern. The most common causes attributed to the rise of CAM were undiagnosed/uncontrolled diabetes mellitus, excessive use of corticosteroids, and prolonged hospital stay, all of which create a perfect environment for mucormycosis infection to set in.
Prevalence and factors associated with anaemia among pregnant women attending antenatal care in a district hospital and its feeder community healthcare centre of the Limpopo Province, South Africa
Authors: Ntuli Thembelihle S. , Mokoena Oratilwe P. , Maimela Eric , Sono Khanyisa
Published: November 2023

Background:

Pregnancy anaemia is a significant public health concern in South Africa (SA), particularly in rural areas, but little is known about its prevalence and risk factors in rural areas. The objective of the study was to determine the prevalence and identify risk factors of pregnancy anaemia in the public health facilities of Limpopo Province (LP), SA.

Methods:

A cross-sectional study was conducted among a consecutive sample of 211 pregnant women attending antenatal care at Seshego Hospital and its feeder health centre (May to June 2019). Anaemia was defined as haemoglobin (Hb) <11 g/dL and classified as mild (10–10.9 g/dL), moderate (7–9.9 g/dL) and severe anaemia (<7 g/dL). A multiple logistic regression analysis was used to identify predictors of anaemia.

Results:

The mean age of the women was 28.4 ± 5.7 years (range from 18 to 41 years). Over half (52%) had secondary education, 65% were unmarried, 72% were unemployed, 34% were nulliparous, 15% were human immunodeficiency virus (HIV) infected and 67% were in the third trimester. The anaemia prevalence was 18.0% and was significantly associated with parity, HIV status and body mass index (BMI) in a multivariate logistic regression analysis.

Conclusion:

This study found that less than one-third of pregnant women were affected by anaemia, associated with parity, HIV infected and BMI. It is essential to promote routine screening for anaemia, health education and prompt treatment of infections to reduce this burden. In addition, further studies on risk factors for anaemia during pregnancy in both urban and rural communities should be conducted to strengthen these findings.
Management of COVID-19 during the second wave at a tertiary care public hospital in Eastern India: An experience from the administrative control room
Authors: Mishra Siddharth , Mondal Ramkrishna , Pillai Jawahr S. K. , Sahoo Mukunda Chandra
Published: November 2023

Context:

Though many arrangements had been made during the first wave, multiple complaints were reported regarding the arrangements made for COVID patients. The control room was set up as a 24 × 7 administrative coordination center to attend to issues after the initial setup of COVID units.

Aim:

To identify the major problems reported to the control room during the second wave of COVID-19 and find the related cause for the same.

Methods and Materials:

Issues reported to the control room were recorded from April to June (2021). The control room residents were asked to allocate each problem into six categories. Next, the residents allotted a frequency score to each of the problems depending on how regularly it was reported. Secondary data from various reports were also considered.

Statistical Analysis Used:

Data were analyzed using MS Excel software.

Results:

Various administrative issues were identified to be due to issues in communication and coordination (23%), policy and procedures (22%), human resource and training (16%), administration and implementation (15%), infrastructure (14%), and HMIS and IT (10%).

Conclusion:

Most frequent problems reported to the control room were related to infrastructure, policy implementation, and manpower training. After the initial implementation of new processes, there was a requirement for regular follow-up and coordination. This model of setting up an administrative control room and evidence-based approach will serve as a template for public hospitals to ensure coordination of hospital operations.
The h-Index: Understanding its predictors, significance, and criticism
Authors: Mondal Himel , Deepak Kishore Kumar , Gupta Manisha , Kumar Raman
Published: November 2023

The h-index is an author-level scientometric index used to gauge the significance of a researcher's work. The index is determined by taking the number of publications and the number of times these publications have been cited by others. Although it is widely used in academia, many authors find its calculation confusing. There are websites such as Google Scholar, Scopus, Web of Science (WOS), and Vidwan that provide the h-index of an author. As this metrics is frequently used by recruiting agency and grant approving authority to see the output of researchers, the authors need to know in-depth about it. In this article, we describe both the manual calculation method of the h-index and the details of websites that provide an automated calculation. We discuss the advantages and disadvantages of the h-index and the factors that determine the h-index of an author. Overall, this article serves as a comprehensive guide for novice authors seeking to understand the h-index and its significance in academia.
Early neonatal hypoglycemia in exclusively breastfed babies in a developing country – India
Authors: Gill Simran K. , Peterson Rachel R. , Christ Joy H. , George Carolin E.
Published: November 2023

Background:

Neonatal hypoglycemia has been a cause for concern due to increasingly frequent reports of long-term sequelae, leading to undue concern and inadvertent administration of formula feeds. Though hypoglycemia is usually encountered only in neonates with classical risk factors, hypoglycemia is also rarely seen even in babies with no known risk factors. These babies may present only with sequelae in later childhood.

Methods:

This is a hospital-based observational, prospective study. We included 299 exclusively breastfed neonates who were shifted to mother's side with no congenital malformation or need for neonatal intensive care unit (NICU) admission. The neonates were studied in two groups: “ At Risk” and “No Risk.” The “At Risk” group included babies with known risk factors like low birth weight, late preterm (34–36 weeks), small for gestational age (birth weight <10th centile), infant of a diabetic mother, or large for gestational age (birth weight >90th centile). Hypoglycemia was the primary outcome measured independent of feeding time for both groups. For the “At Risk” group, monitoring was done at 0, 1, 2, 3, 4, 12, 24 plus 48 h. For the “Not At Risk” group, it was done at 12 and 24 h of life. The factors associated with both groups were studies as the secondary outcome.

Results and Conclusion:

Out of 299 exclusively breastfed neonates, 13% were hypoglycemic. 27.06% were hypoglycemic in the “At Risk” group. In the “At Risk” group, low birth weight and primiparity were significant risk factors. The incidence of hypoglycemia in the “No Risk” group was 1.80%. Breast problems and breastfeeding problems, low education status of mother, young age, and primiparity were significant risk factors in the “No Risk” group.
The determining factors of medical students in considering a specialty as a future career path: A cross-sectional multinational study in the Middle East
Authors: Alyazidi Anas S. , Gaddoury Mahmoud A. , Alotibi Fahad A. , Aljehani Khalid M. , Ahmed Renad A. , Alhudaifi Saeed A. , Aldharrab Abdulmohsen S. , Alkhallagi Abdulaziz S. , Al-Raddadi Rajaa
Published: November 2023

Background and Aims:

Throughout their years of study, undergraduate medical students are expected to gain broad comprehension of all medical specialties. After acquiring an undergraduate degree, the decision to choose a specialty is critical for every student's life as it determines the rest of their career path. This study aims to determine factors influencing medical students' choices between various specialties in different countries in the Middle East and North Africa.

Subjects and Methods:

A cross-sectional study was conducted in March 2022 targeting medical students from the Middle East and North African countries. A questionnaire was used to collect data from the students, which consisted of four sections. Ethical approval was obtained from the Unit of Biomedical Ethics Research Committee at King Abdulaziz University. Participation was voluntary and anonymous. For statistical analysis, IBM Statistical Package for the Social Sciences (SPSS) Statistics for Windows (Version 21.0; IBM Corp., Armonk, NY, USA) was used. Categorical variables were presented using numbers, associated frequencies, and percentages (%). Categorical variables were correlated using the Chi-square test. One-way analysis of variance (ANOVA) test was used to compare the means of three or more independent groups. Logistic regression, odds ratio (OR), and 95% confidence interval (CI) were used to identify the factors associated with specialty selection. P < 0.05 was considered statistically significant.

Results:

A total of 1109 students responded to the questionnaire. Participants' gender characteristics showed that there were 672 (60.6%) females and 437 (39.4%) males. Among them, 127 were in their second year, 180 in their third year, 362 in their fourth year, 85 in their fifth year, 37 in their sixth year, and 108 were interns. The median age of the participants was 22.0 years (mean = 22.09 ± 2.891). There were 473 (42.6%) students who were undecided about their future medical specialty. Income (759, 68.4%) and career prospects (723, 65.2%) were the most preferred factors in their decision to pursue a future medical specialization.

Conclusions:

In conclusion, medical and surgical specialties have been identified as the preferred future career path. It was discovered that student's decision-making is influenced by income, career prospects, and the sense of competency needed to choose a future medical specialty. Future research would be more revealing.
An interesting case of systemic lupus erythematosus with multiple myeloma
Authors: Basha Farhanulla K. M. , Reddy Vuluvala Thejeswar , Sharma Pragya , Vaishnav Bhumika
Published: November 2023

A rare association exists between systemic lupus erythematosus (SLE) and multiple myeloma (MM). SLE is associated with a variety of symptoms. A combination of MM and SLE is uncommon in the young population. An unusual case of SLE associated with MM is described here. We present the case of a 39-year-old woman who was a known case of SLE and presented with severe chest and abdominal pain. We summarize the clinical characteristics of MM in SLE. The possible mechanisms that could be at the root of this association are also discussed.
‘Oxidative stress’-A new target in the management of diabetes mellitus
Authors: Das Ashok K. , Kalra Sanjay , Punyani Hitesh , Deshmukh Swapnil , Taur Santosh
Published: November 2023

Diabetes mellitus (DM) is a chronic condition that poses a mammoth challenge for the healthcare system in developing as well as developed nations. Diabetes mellitus is associated with damage to the vasculature which leads to microvascular and macrovascular complications. Oxidative stress is a consequence of glucotoxicity and lipotoxicity, which are associated with diabetes. Glucotoxicity and lipotoxicity play a part in the pathogenesis of β-cell dysfunction. The hyperglycemic state in DM leads to oxidative stress which further hampers insulin secretion. In diabetes, the biological antioxidants also get depleted along with a reduction in glutathione (GSH), an increase in the oxidized glutathione (GSSG)/GSH ratio, and a depletion of non-enzymatic antioxidants. This results in the formation of a viscous circle of hyperglycemia leading to increased oxidative stress that further hampers insulin secretion which in turn results in hyperglycemia. Antioxidants are efficacious in reducing diabetic complications. The antioxidants produced biologically fall short, hence external supplements are required. In this review, the authors have discussed the relationship between oxidative stress in DM and the advantages of antioxidant supplements in controlling blood glucose levels and also in deaccelerating the complications related to DM.
Ankle brachial index and its correlation with cardiovascular risk factors in pre-diabetes: Two-year cross-sectional study
Authors: Phate Neha G. , Kumar Sunil , Acharya Sourya , Agrawal Sachin R. , Wanjari Anil , Wakode Monish , Gemnani Rinkle R.
Published: November 2023

Background:

A state of impaired glucose tolerance is called prediabetes. The diagnosis of prediabetes is controversial, yet it still puts a person at risk for developing diabetes. The ankle-brachial index (ABI) is useful for identifying persons at risk for peripheral artery disease and for diagnosing the condition in those who have symptoms in their lower extremities and subclinical atherosclerosis. This study highlights ABI and its correlation with cardiovascular risk factors like lipid profile and anthropometric measurement including neck circumference in prediabetes so that primary care physicians may be able to diagnose early before advancing to diabetes.

Materials and Methods:

This cross-sectional study of 2 years duration from December 2020 to September 2022 was conducted in the Department of Medicine, at a tertiary care teaching hospital situated in a rural area. Patients with pre-diabetes were enrolled and Ankle Brachial Index was calculated. The correlation of ABI with anthropometric measures and lipid profile was assessed.

Results:

On calculating ABI by manual method 21% which is 42 out of 200 had low ABI (<0.9). On the other hand, on calculating ABI by probe method low range of ABI was found to be 37% which is 74 patients out of 200. There was a significant correlation between ABI and body mass index and lipid profile. The diagnostic performance of ABI < 0.9 had 56.8% sensitivity and 100.0% specificity.

Conclusion:

ABI can be used as a noninvasive and cost-effective modality for assessing subclinical atherosclerosis in patients with prediabetes and thus prevent its morbid complications even assessed at the primary care physician level.
Unit costs for allopathic and AYUSH outpatient care in public facilities in Urban Delhi, India
Authors: Garg Charu C. , Goyanka Roopali
Published: November 2023

Introduction:

The National Health Policy, 2017, suggests pluralism in health care with the integrated delivery of AYUSH and allopathic care at public facilities. Information on unit cost of outpatient visits for both types of care at public facilities is useful to guide the policies on health-care delivery.

Methods:

The costs in 2019–20 were estimated for each type of care at allopathic urban primary health center (UPHC) and AYUSH facilities using top-down methodology and adding out-of-pocket expenditures (OOPE) incurred to reflect true costs. Data from national health survey, annual government budgets, and reports were used.

Results:

The average cost of an outpatient visit for allopathic care was ₹325 at a UPHC and ₹189 in a homeopathic dispensary and ₹692 in an Ayurvedic dispensary. While OOPE per visit at UPHC was ₹177, no OOPE was incurred at AYUSH facilities. The government expenditure per visit for allopathic care at UPHC at ₹148 was the lowest compared to any type of AYUSH care. The cost per facility for allopathic UPHC was higher than both Ayurvedic and homeopathic dispensaries. Unani dispensaries were least cost-effective, both in terms of cost per visit and cost per facility.

Conclusion:

Costs per visit at a facility are impacted by footfalls. For Ayurveda, despite lower facility costs as compared to UPHC, per visit costs were higher due to low utilization. Improving evidence-based utilization of AYUSH care is critical for the success of the government policy of mainstreaming AYUSH care at low cost.