bluuebunny/crossref_metadata_2025 huggingface dataset:
STEPWISE Project: Sorption-Enhanced Water-Gas Shift Technology to Reduce Carbon Footprint in the Iron and Steel Industry
Authors: (Eric) van Dijk H. A. J. , Cobden Paul D. , Lukashuk Liliana , de Water Leon van , Lundqvist Magnus , Manzolini Giampaolo , Cormos Calin-Cristian , van Dijk Camiel , Mancuso Luca , Johns Jeremy , Bellqvist David
Published: May 2018

Industrial processes contribute significantly to global carbon dioxide emissions, with iron and steel manufacturing alone responsible for 6% of the total figure. The STEPWISE project, funded through the European Horizon 2020 (H2020) Low Carbon Energy (LCE) programme under grant agreement number 640769, is looking at reducing CO2 emissions in the iron and steel making industries. At the heart of this project is the ECN technology called sorption-enhanced water-gas shift (SEWGS), which is a solid sorption technology for CO2 capture from fuel gases such as blast furnace gas (BFG). This technology combines water-gas shift (WGS) in the WGS section with CO2/H2 separation steps in the SEWGS section. Scaling up of the SEWGS technology for CO2 capture from BFG and demonstrating it in an industrially relevant environment are the key objectives of the STEPWISE project, which are achieved by international collaboration between the project partners towards design, construction and operation of a pilot plant at Swerea Mefos, Luleå, Sweden, next to the SSAB steel manufacturing site.
Marmara Denizi havzasının hidroklimatolojik dinamiklerinin belirlenmesi
Authors: Akbaş Abdullah , Özdemir Hasan
Published: May 2018

Bu çalışmada, Marmara Denizi havzasındaki yağış, akış, buharlaşma, akış katsayısı ve su dengesi arasındaki ilişkiler incelenmiş ve dağılışları ele alınmıştır. MGM’den 34 yağış ile 14 buharlaşma istasyonu ve DSİ’den 77 Akarsu Gözlem İstasyonunun (AGİ) kullanılmıştır. Öncelikle her bir AGİ’nin  su toplama havzası çıkarılmıştır. Burada verinin homojenliğinin bozulmaması ve insan etkisini ortadan kaldırmak için baraj altında bulunan istasyonlar analizlere dahil edilmemiştir. Daha sonra yağış ve buharlaşma istasyonları Thiessen poligon yöntemi kullanılarak noktasal veriden alansal veriye dönüştürülmüştür. Buna göre 1982-2006 yılları arasını kapsayan zaman dilimi içerisinde her bir AGİ havzası için alansal olarak dağıtılmış yağış, akış ve buharlaşma değerleri elde edilmiş ve bunlardan akış katsayısı ve su dengesi hesaplamaları yapılmış ve haritaları üretilmiştir. Swath profilleri kullanılarak elde edilen veri seti ile topografya arasındaki ilişkilere bakılmış ve buharlaşma ile istatisksel olarak anlamlı ilişkiler görülmüştür. Marmara Denizi havzasındaki tüm istasyonlar incelendiğinde yağış ve akış arasında istatiksel olarak anlamlı ve doğrusal ilişkiler elde edilmiştir. Bununla birlikte korelasyon matrisi ve saçılım diyagramı incelendiğinde akış, buharlaşma ve akış katsayısı ile su dengesi arasında istatistiksel açıdan anlamlı negatif doğrusal ilişkiler göze çarpmaktadır. Marmara Denizi havzasında su dengesi göreceli olarak Biga yarımadasında en fazla olmak üzere negatif değerler vermektedir. Bu bağlamda havzanın hidroklimatolojik dinamiklerinin oluşmasında en kuvvetli denetçinin buharlaşma olduğu görülmektedir.
All in one protocol (A.O.P) v1
Authors: Monsef Don
Published: May 2018

connect to localhost ip: 127.0.0.1 get deafult ip getway Get access to root get permmision create dump file run as administrator open=start adb server start=exit user
Self-care behaviors and practices of nursing students: Review of literature
Authors: Younas Ahtisham
Published: May 2018

Self-care is a vital component of nursing practice and is essential for the well-being of human beings, that is, both patients and nurses. However, nurses and nursing students tend to focus more on self-care of their patients and often pay little or no attention to personal self-care. This literature review explored self-care behaviors and practices of nursing students in general as well as across academic years of the study. In total, 11 studies were reviewed and critically appraised to identify current trends regarding nursing students’ self-care practices and behaviors in nursing literature. Nursing students realized the importance of maintaining their diet, sleep, and activity level to improve physical and physiological health. However, they tend to neglect self-care practices which could improve their emotional and psychological health because of academic stress, workload, and inadequate knowledge about the strategies to improve self-care in this domain. There is limited evidence for drawing any conclusions regarding students’ use of complementary therapies for self-care, the difference between self-care practices of nursing and non-nursing students, the usefulness of different interventions for improving students’ self-care practices, and the differences between self-care practices and behaviors of students across academic years.
Otolog kök hücre infüzyonu sırasında yaşanan bulantı kusmanın yönetiminde farmakolojik olmayan uygulamalar
Authors: Sözeri Öztürk Elif , Kutlutürkan Sevinç
Published: May 2018

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Profilaktif Negatif Basınçlı Yara Tedavisinin Cerrahi Alan Enfeksiyonlarının Önlenmesindeki Etkisi
Authors: YÜCELER KAÇMAZ Hatice , CEYHAN Özlem
Published: May 2018

Sağlık hizmeti ile ilişkili enfeksiyon türlerinden biri olan cerrahi alan enfeksiyonları her yıl milyonlarca hastayı etkilemektedir. Cerrahi alan enfeksiyonlarının önlenmesi ve uygun tedavinin sağlanmasında çok disiplinli bir ekip çalışmasının şarttır. Her gün yeni araştırmalar ve kanıtların geliştirildiği düşünülürse cerrahi alan enfeksiyonları önleme stratejileri konusunda sağlık profesyonellerinin güncel yaklaşımları takip etmeleri önemlidir.  Bu makale cerrahi alan enfeksiyonlarının önlenmesinde profilaktif negatif basınçlı yara tedavisi kullanımı hakkında farkındalık yaratmayı amaçlanmıştır.
Yeni Kardiyovasküler İlaçların Gebe Hastalarda Kullanımı: Teratojenik Riskler
Authors: ALTINTAŞ AYKAN Duygun
Published: May 2018

Yeni oral antikoagülan ilaçlar dabigatran, rivaroksaban, apiksaban, edoksaban; antitrombositer ajanlar prasugrel, tikagrelor; antilipidemik ajanlar alirocumab ve evolocumab kardiyovasküler tedavilere alternatif yeni ajanlar olarak geliştirilmiş olup günümüzde sıklıkla reçetelendirilmektedir. Bu ajanlara maruz kalacak olan gebe hastaların veya gebeliğinin farkında olmadan ilacı kullanan kadınların sayısının yakın gelecekte hızla artması muhtemeldir. Bu çalışmada, farmakokinetik parametrelerin ışığı altında bu ilaçların gebelikte maruziyeti ile ilgili literatürdeki hayvan çalışmaları ve insan gebelik raporları incelenmiş ve bu ilaçların gebelikte kullanımı sonucunda oluşabilecek potansiyel teratojenik etkiler derlenmiştir.
MUHASEBE MESLEK MENSUPLARININ DUYGUSAL TÜKENME VE MESLEKTEN AYRILMA NİYETLERİ ARASINDAKİ İLİŞKİDE MESLEK MEMNUNİYETİNİN ARA DEĞİŞKEN ETKİSİ
Authors: Özer Gökhan , Günlük Mehmet , Yüksel Setenay
Published: May 2018

Bu
çalışmada muhasebe meslek mensuplarının duygusal tükenme, meslek memnuniyeti ve
meslekten ayrılma niyetleri arasındaki sebep sonuç ilişkilerini ortaya koymak
amaçlanmaktadır. Ayrıca meslek memnuniyetinin, duygusal tükenme ve meslekten
ayrılma niyeti arasında bir ara değişken olup olmadığı da araştırılacaktır.
Geliştirilen modelin değişkenlerine dayalı olarak oluşturulmuş anket, bağımlı
ve bağımsız olarak çalışan 110 muhasebe meslek mensubuna uygulanmıştır. Elde
edilen verinin analizi ile duygusal tükenmenin meslek memnuniyetini olumsuz,
meslekten ayrılma niyetini olumlu; meslek memnuniyetinin ise, meslekten ayrılma
niyetini olumsuz etkilediği sonucuna ulaşılmıştır. Ayrıca araştırmanın ara
değişken analizine yönelik bulguları, duygusal tükenme ve meslekten ayrılma
niyeti ilişkisinde meslek memnuniyetinin kısmi ara değişken olduğunu
göstermektedir.
Rationality verses irrationality in fixed dose combinations: at a tertiary teaching hospital of rural Chhattisgarh, India
Authors: Tabish Ahmed , Khan Tanveer A. , N. B. Chandel , Anand Rao , Chandresh Mishra
Published: May 2018

Background: Rational drug prescribing can be defined as appropriate drugs prescribed in the right dose, at correct time intervals and for a sufficient duration. Irrational drug use is a common problem in many countries of the world.Methods: A prospective observational study was conducted, total 300 patients attending various outpatient departments of tertiary health care rural hospital in Rajnandgaon district were interviewed and their prescriptions were analysed.Results: Total 350 drugs were prescribed 60 (17.14%) were prescribed by generic name and the rest 290 (82.86%) were prescribed by brand name. Only 18 (5.14%) drugs were not prescribed from hospital formulary. 264 (75.43%) drugs were dispensed from hospital pharmacy. On the basis of rationality score 53% prescriptions were rational, 30% semi rational and 17% irrational.Conclusions: In a rural hospital, where hospital formulary is based on WHO Essential medicine list, hundred percent utilization of hospital pharmacy service doctors and patients would ensure rational prescribing benefits of the patients coming from rural and uneducated background.
Cost-effectiveness of newer anti-emetics in the prevention of chemotherapy induced nausea and vomiting: a pharmaco-economic study analysis
Authors: J. K. Akshay , P. L. Basavanna
Published: May 2018

Background: Chemotherapy induced Nausea and Vomiting (CINV) is one the most common adverse effects associated with chemotherapeutic management of carcinoma breast. Preventing CINV becomes a vital part in treatment of these cancer patients for better compliance. The conventional regimen of newer 5-HT3 receptor antagonist and dexamethasone along with newer agents - Aprepitant, a NK-1 receptor antagonist and a recently approved atypical antipsychotic, Olanzapine have shown better control of CINV. These newer agents are effective but also very expensive.Methods: The study included carcinoma breast patients scheduled for chemotherapy (n = 55 in each group) who either received aprepitant or olanzapine or a combination of both as the anti-emetic regimen. Considering Cost-Effectiveness Analysis (CEA), the cost included was the cost of anti-emetic agents (sponsor’s perspective) and outcome measured as control of nausea and vomiting - as Complete Protection (CP), Complete Response to Best (CRB) and Incomplete Response (IR) for acute (0-24 hours) and delayed (24-120 hours) phases. The cost effectiveness(CE) ratio for emesis and CINV free days were calculated.Results: CP was seen better during the acute period than the delayed period. With Aprepitant, delayed CRB and IR was seen with 13 (23.6%) and 10 (18.2%) subjects. 16 (29.1%) showed IR with Olanzapine during the delayed period.The average number of Emesis and CINV free days were 4.65, 4.51, 4.89 and 3.38, 3.96, 4.15 for the three groups respectively. The cost required to achieve 1 emesis and 1 CINV free day per subject in the 3 groups was INR 351.19, INR 27.20, INR 339.54 and INR 483.36, INR 30.94, INR 400.60 respectively.Conclusions: The newer anti-emetic even though being expensive at cost, pharmacoeconomically provide better outcomes and seem to have better control rates than the conventional regimen.
A cost-effective analysis of various disease modifying anti-rheumatic drugs for patients with Rheumatoid Arthritis
Authors: Krishnan Soniya , C. S. Balan , Mohamedali Seema P.
Published: May 2018

Background: Rheumatoid Arthritis (RA) is a chronic disabling disorder that lowers quality of life in the affected patients. Early treatment with disease-modifying anti-rheumatic drugs (DMARDs, provides better control of disease and minimize joint destruction. Long term therapy imparts considerable economic burden to the patients. Cost effective analysis was performed among the patients treated with methotrexate (MTX) alone, hydroxychloroquine (HCQ) alone, and both (MTX+HCQ).Methods: A prospective, observational study for six months to analyze the cost-effectiveness in RA patients with DMARDs-MTX, HCQ and MTX+HCQ. A total of 91 patients were included for analysis; 43 patients in MTX and HCQ group; 37 patients in MTX group and 11 patients in HCQ group. To assess the functional disability,” Stanford Health Assessment Questionnaire - Disability Index” (HAQ-DI) was administered. The patients were followed up for four months. The HAQ-DI at the baseline was compared with that of final follow up. The change in HAQ-DI and the total costs were used to find out the average cost- effective ratio (ACER).Results: The least ACER was obtained for Hydroxychloroquine and highest was for Methotrexate. But there was no statistically significant difference in ACER between various treatment groups. There was no significant difference in the disease activity improvement between the three groups.Conclusions: MTX, HCQ and MTX+HCQ showed improvement in disease activity without any significant difference. MTX is superior considering direct cost but there is no difference in the total cost between three groups.
A randomized open label comparative study to determine the various side effects and patient satisfaction of low dose continuous versus low dose intermittent oral isotretinoin therapy in moderate to severe acne vulgaris
Authors: Shetti Santhosh A. , H. N. Nagesh , Hanumanthaiah Nagabushan
Published: May 2018

Background: Acne Vulgaris is chronic inflammatory disease of pilosebaceous units. Oral isotretinoin is recommended for moderate to severe acne vulgaris who are not responding satisfactorily to conventional therapies. Recent reports indicate that acne patients have been benefiting from the low dose treatment protocols. However, long term daily use of this drug results in frequent side effects such mucocutaneous and systemic side effects. Our aim was to assess and compare the various side effects and patient satisfaction of oral isotretinoin in low dose continuous and intermittent treatment of moderate to severe acne vulgaris.Methods: This was a prospective randomized open labeled comparative study carried out at outpatient department in the Department of Dermatology in Mandya Institute of Medical sciences, Mandya. Patients with moderate to severe acne were assigned equally (50 subjects each) to one of the two treatment regimens by using block randomization technique, Group A was given low dose continuous regimen-20 mg oral isotretinoin once daily for 4 months and Group B was given low dose intermittent regimen-20 mg oral isotretinoin once daily for 1 week out of every 4 weeks. The patients were followed up every 4th week during the treatment period. The patients were examined and side effects were noted in each visit. A six month follow-up evaluation was done to analyze patient satisfaction.Results: Muco-cutaneous dryness was most common adverse effect noted in both the groups A and B. Itching (42%), Alopecia (44%), Myalgia (36%) were seen most commonly in group A and Acne flaring (47%) was most common with group B. With regard to patient satisfaction, in group A 42% were satisfied and 20% were very satisfied, in group B 36% were satisfied and 14% were very satisfied.Conclusions: Study suggests that, Muco-cutaneous dryness was most common side effect in both treatment regimens. Side effects were more frequent with low dose continuous than low dose intermittent isotretinoin regimen. Patient satisfaction was better in continuous regimen.
Study of knowledge, attitude and practice of self medication among health care workers at MC Gann Teaching District hospital of Shivamogga, India
Authors: Hanumaiah Vedavathi , Manjunath Harini
Published: May 2018

Background: Healthcare workers gain adequate knowledge related to medications used in treating illness from their work experiences which influences self medication practices.Methods: The present study was conducted in N=150 healthcare workers, divided into 2 groups with group I (nursing staff) and group II (paramedical staff) with 75 participants in each group. Data related to self medication was obtained from a pretested validated semi structured questionnaire either in Kannada or English. The responses were compared between each group with chi square test. P value ≤0.05 was considered significant. All statistical analysis was conducted with SPSS 16.Results: The mean age (mean±SD) of the participants in group I and group II is 31.79±8.309 and 34.15 (±8.168) respectively with p =0.081. The prevalence of self medication was 100% in both the groups. Both the groups knowledge related to the definition of self medication was similar (group I 63 (84.0%) and group II 62 (82.7%) p = 0.900). Group I believes that self medication is entirely safe compared to group II which was statistically significant (group I 66 (88.7%) and group II 46 (61.3%) p=0.029). Most common drugs used for self medication was NSAIDS (non steroidal anti-inflammatory drugs) in both the groups being 75 (100%). Antibiotics was used by 26 (2.66%) in group I and 14 (18.66%) in group II.Conclusions: Self medication practice is highly prevalent in the healthcare workers, who also influence the other populations to practice self medication. Practicing responsible self medication is more appreciable.
Comparative efficacy of melatonin in attenuation of endotoxin/LPS induced hepatotoxicity in BALB/c mice
Authors: Khan Ammara , Afzal Ayesha , Rauf Abdul , Waheed Akbar
Published: May 2018

Background: Sepsis is characterized by overwhelming surge of cytokines and oxidative stress to one of many factors, gram negative bacteria commonly implicated. Despite major expansion and elaboration of sepsis pathophysiology and therapeutic approach; death rate remains very high in septic patients due to multiple organ damage including hepatotoxicity. The present study was aimed to ascertain the adequacy of melatonin (10mg/kg i.p), and its comparability with dexamethasone (3mg/kg i.p), delivered separately and collectively in endotoxin induced hepatotoxicity.Methods: The number of animals in each group was six. Endotoxin/LPS induced hepatotoxicity was reproduced in mice by giving LPS of serotype E. coli intraperitoneally. Preventive role was questioned by giving the experimental agent half an hour prior to LPS injection whereas therapeutic potential of the experimental agent was searched out via post LPS delivering. The extent of liver damage was adjudged via serum alanine aminotransferases (ALT) and aspartate aminotransferase (AST) estimation along with histopathological examination of liver tissue.Results: Melatonin was prosperous in aversion (Group 3) and curation (Group 4) of LPS invoked hepatotoxicity as evident by lessening of augmented ALT (≤0.01) and AST (≤0.01) along with restoration of pathological changes on liver sections (p≤0.05). Dexamethasone given before (Group5) and after LPS (Group 6) significantly (p≤0.05) attenuated LPS generated liver injury. Combination therapy with dexamethasone in conjunction with melatonin (Group 7) after LPS administration tapered LPS evoked hepatic dysfunction statistically considerably, however the result was comparable to single agent therapy.Conclusions: Melatonin set up promising results in endotoxin induced hepatotoxicity and can be used therapeutic adjuncts to conventional treatment strategies in sepsis induced liver failure. Combination therapies however generated no synergistic results.
Phenytoin induced Stevens Johnson syndrome: a case report
Authors: Pendurthi Bharadwaja
Published: May 2018

Stevens-Johnson syndrome (SJS) is a rare consequence of hypersensitivity reaction precipitated by certain drugs and viral infections. It is an idiosyncratic drug reaction usually associated with drugs like anti-epileptics, non-steroidal anti-inflammatory compounds and antibiotics. The overall incidence of this entity is very low and is life-threatening if undiagnosed and untreated. The syndrome is characterized by purpuric macules and bullous eruptions involving the mucous membrane which may be followed by systemic manifestations. The mechanism of SJS due to drugs is not fully defined. Delayed Hypersensitivity reaction mediated by T lymphocytes in response to a drug is thought to be responsible. Here authors present a case of SJS induced by phenytoin in an adult male. The case warrants the need of adopting a meticulous approach while prescribing phenytoin. The case is being reported to accentuate the importance of adverse drug reactions and to emphasize the importance of reporting such reactions ensuring efficient pharmacovigilance.
Design and rationale of the effect of early nutritional therapy on frailty, functional outcomes and recovery of malnourished medical inpatients trial (EFFORT): a pragmatic, multicenter, randomized-controlled trial
Authors: Schuetz Philipp , Fehr Rebecca , Baechli Valerie , Geiser Martina , Gomes Filomena , Kutz Alexander , Tribolet Pascal , Bregenzer Thomas , Hoess Claus , Pavlicek Vojtech , Schmid Sarah , Bilz Stefan , Sigrist Sarah , Brändle Michael , Benz Carmen , Henzen Christoph , Mattmann Silvia , Thomann Robert , Brand Claudia , Rutishauser Jonas , Aujesky Drahomir , Rodondi Nicolas , Donze Jacques , Stanga Zeno , Mueller Beat
Published: May 2018

Background: Malnutrition is highly prevalent and strongly associated with clincial outcomes of medical inpatients. Still, the benefit of nutritional treatment to prevent adverse outcomes in medical inpatients at risk for malnutrition remains unproven. We describe the trial methods of the largest yet nutritional trial in medical inpatients including the rationale for key design decisions regarding the nutritional strategy, eligibility criteria, choice of control arm, and endpoints.

Methods: The Effect of early nutritional therapy on Frailty, Functional Outcomes and Recovery of malnourished medical inpatients Trial (EFFORT) is an investigator-initiated, non-commercial, open-label RCT to compare the effects of an intensified nutritional therapy (intervention group) with a control group on medical outcomes. We include adult medical inpatients at risk of malnutrition based on a Nutritional Risk Screening 2002 (NRS) score of ≥3 points with an expected length of stay of ≥5 days. An individualized systematic nutritional assessment by study dieticians is done to define nutritional targets and to establish an implementation plan. Patients in the intervention group receive individualized early nutritional therapy based on a previously published consensus algorithm, while control group patients receive standard hospital nutrition. The study is powered to compare clinical outcomes (composite adverse outcome and mortality) in the 2 study arms as well as to address several mechanistical questions.

Conclusion: EFFORT aims to close important gaps in the literature regarding the controversy about benefit and possible harm of nutritional therapy in medical inpatients at risk for malnutrition.

Trial Registration: ClinicalTrials.gov NCT02517476; registered July 30, 2015.
Metabolic syndrome in chronic obstructive pulmonary disease
Authors: Pasha M. D. Majeed , Salimath Shivalingaswamy , K. N. Mohan Rao , H. J. Gayathri Devi , Aneja Anshum , Padmaja Mantha Satya , Halappa Sujith
Published: May 2018

Background: COPD (Chronic obstructive pulmonary disease) is considered as a systemic disease due to associated systemic inflammation which can manifest as metabolic syndrome or its component illnesses. This study was undertaken to determine the proportion of metabolic syndrome in patients with COPD.Methods: 51 patients with COPD were compared with equal number of age and gender matched controls. GOLD (Global Initiative for Chronic Obstructive Lung Disease) criteria were used for diagnosing COPD. Metabolic Syndrome (MS) was diagnosed based on modified NCEP:ATP III criteria (National cholesterol education Program Adult Treatment Panel III). Subjects were evaluated for hypertension, WC, FBS, and serum triglycerides and serum HDL (High-density lipoprotein) to diagnose MS.Results: Metabolic syndrome was diagnosed in 16 (31.4%) patients with COPD and in 8 (15.7%) controls. The proportion of individual parameters of MS in cases and controls was as follows: DM in 19 (37.3%) cases and 13 (25.5%) controls, hypertension in 21(41.2%) cases and 9 (17.6%) controls, low serum HDL in 31 (60.7%) cases and 22 (43.1%) controls increased WC in 14 (27.5%) cases and 7 (13.7%) controls and elevated serum TG in 12 (23.5%) cases and an equal number of controls.Conclusions: Metabolic syndrome and its parameters are more prevalent in COPD patients. Early detection and treatment of MS in COPD patients can prevent development of complications due to the combined effects of both diseases.
A cross-sectional study on behavioural and psychological symptoms of dementia in elderly and its impact on quality of life in a tertiary care hospital
Authors: Bhagat Gaurav , Raj Rajnish , Sidhu Balwant Singh , Sidhu Amarjit Kaur
Published: May 2018

Background: Historically, the word dementia was derived from Latin word ‘dementatus’, which means ‘out of one’s mind’. There were 24.3 million people with dementia in the world and 4.6 million are being added every year. Present study was done to evaluate the behavioral and psychological symptoms of dementia in elderly patients and its impact on their quality of life.Methods: It was a hospital based descriptive, cross-sectional study. 100 cognitively impaired patients in the age group of 60 years and above were enrolled. The socio-demographic profile, severity of dementia on MMSE; behavioral disturbances on BPSD; psychiatric illness on NPI; agitation on CMAI and their impact on quality of life, and disability were assessed on WHOQOL-Bref and WHO DAS 2.0 scales, respectively.Results: Out of 110 patients that were screened, 100 participated in the study (response rate 91%). Majority of subjects (53%) were illiterate and belongs to rural background (57%). Mean dementia severity score was 17.01±4.439 SD which was of mild to moderate level. Overall mean age was 68.16±8.16 SD and negatively related (r= -0.652; F=27.044, p<0.001) but weakly associated to severity of dementia. There was a statistically significant increase in the NPI scores with increase in dementia severity (Item score F=91.754, p<0.001 and distress score F=81.647, p<0.001). There was significant increase in agitation/aggression (CMAI) with an increase in severity of dementia. BPSD on NPI item score was weakly related (r=0.757) and caused increase in disability but decrease in quality of life. Dementia severity as per MMSE score was negatively related to WHO DAS disability (r= -0.863), BPSD on NPI item (r= -0.797) and agitation/aggression on CMAI (r= -0.587). WHOQOL-Bref decreases with increase in severity of dementia and disability.Conclusions: Dementia severity was of mild to moderate level and it increased with age. Most common psychiatric symptom was agitation/aggression (76%) and least common was hallucinations (12%). BPSD causes significant decrease in quality of life and an increase in severity of disability.
Biofilm production and its correlation with antibiogram among clinical isolates of uropathogenic Escherichia coli
Authors: Yadav Monika , Khumanthem Sulochana D. , Kshetrimayum Mamta D. , Damrolien Shan
Published: May 2018

Background: Urinary tract infection (UTI) is one of the commonest health problem encountered in clinical practice. The biofilms play major role in decreasing the susceptibility to the antimicrobial agents. The present study aimed at isolation and identification of Escherichia coli from cases of urinary tract infection, and to find out production of biofilms by these isolates and to correlate it with antimicrobial resistance.Methods: This study was a cross sectional study. Urine specimen from patients suspected of UTIs were collected and processed by standard operative procedure, antibiotic susceptibility test was done by Kirby Bauer disc diffusion method. Biofilm production in isolates was done by Tissue culture plate (TCP) method, Christensen’s test tube (CTT) method, and Congo red agar (CRA) method.Results: Out of the total of 250 isolates 191 (76%) showed biofilm positive by TCP method, 180 (72%) showed biofilm positive by CTT method, 161 (64%) showed biofilm positive by CRA method. 90% of total extended spectrum beta lactamase (ESBL) producing Escherichia coli were biofilm producers. There is more resistance for each and every antibiotic among biofilm producers in comparision to biofilm non producers.Conclusions: The microbial biofilms may pose a public health problem, as the microorganisms in the biofilms are difficult to be treated with antimicrobial agents.
A study on clinical and laboratory features of pit viper envenomation from Central Kerala, India
Authors: P. T. Hijaz , C. R. Anil Kumar , John Bins M.
Published: May 2018

Background: Snakebite envenomation is an important public health problem faced by the tropical countries with India, the worst affected in terms of mortality and morbidity. In spite of increasing reports of other snake species causing envenomation, the existing research and management strategies including antivenom are still focused on the “Big Four” species- Russel’s viper, saw scaled viper, common krait and spectacled cobra. Pit vipers as a group are being increasingly reported to cause human bites from different parts of the country. Hence, we decided to study the clinico-epidemiology of pit viper bites.Methods: 30 cases of proven pit viper bites who attended our Department during the study period of 18 months were analysed for the epidemiological factors, clinical features and abnormalities in laboratory parameters.Results: Hump nosed pit viper (Hypnale hypnale) was responsible for all the thirty cases. 57% of cases were females. Mean age of victims was 41.8 years. 17 patients had exclusively local envenomation. Ten cases had coagulopathy along with local envenomation. Three patients developed acute kidney injury of whom three underwent dialysis. No mortality was observed in the study. Low fibrinogen levels were observed in all cases with coagulopathy and some had low levels of factor V (70%) and factor VIII (40%).Conclusions: Hump nosed viper bites were observed to be common in this part of the country. Significant envenomation can occur. Further epidemiologic studies involving more centres will be helpful in quantifying the true incidence of bites. Since no specific antivenom is available, further researches in this direction are warranted.
Estimation of serum MDA (Malondialdehyde) in various morphological types and clinical stages of age related (senile cataract)
Authors: Angirekula Saseekala , Atti Lalitsiri , Atti Srihari
Published: May 2018

Background: The aim was to estimate the Serum Malondialdehyde (MDA) in the various morphological types and clinical stages of Age Related (Senile) Cataract, a common cause of curable blindness, especially in India.Methods: This was a study of estimation of serum Malondialdehyde (MDA) in 100 patients of Age Related (Senile) cataract with 80 cases of Senile Cortical type (40 cases of Posterior subcapsular and 40 cases of Mature) and 20 cases of Senile Nuclear type (10 cases of early Grades of I and II and 10 cases of Advanced Grades of III and IV) and in 20 cases of normal controls in the age group of 45 to 70 years.Results: Serum MDA (nmol/ml) values of the Mean with SD were 3.34±0.93 (Range 2.02-4.65) in normal controls, 4.38±1.01 (Range 2.4 - 6.7) in senile cataract,  4.39±1.02 ((Range 2.4-6.7) in Senile Cortical Cataract with 3.82±0.73 (Range 2.4-5.1) in its Posterior Subcapsular stage and 4.96 ± 0.88 (Range 3.3-6.7) in its mature stage and 4.3±0.99 (Range 2.4-6.2) in Senile Nuclear cataract with 3.68±0.66 (Range 2.4-4.7) in its early Grades of I and II and 4.86±0.94 (Range 3.8-6.2) in its Advanced Grades of III and IV.Conclusions: The present study showed a significant increased concentration of Serum MDA in Senile cataract especially in the advanced later clinical stages or grades of maturity than in the earlier clinical stages or grades of immaturity of senile cortical or nuclear compared to normal controls. And there was no statistically significant difference between the morphological types of Age related (Senile) cataract i.e. Cortical Cataract compared to Nuclear Cataract.
Prevalence and factors influencing sensorineural hearing loss among type II diabetes mellitus patients
Authors: Rajamani Shanmugasundaram , Senniappan Shivakumar , Radhakrishnan Shankar
Published: May 2018

Background: The typical hearing loss described among diabetes patients is progressive, bilateral, sensorineural deafness of gradual onset that predominantly affects the higher frequencies. Although there is mounting evidence for a relationship between diabetes and hearing impairment the awareness of auditory organ involvement in the course of diabetes is still not widespread among healthcare providers involved in diabetes care. Objective of present study was to assess the prevalence and the factors influencing sensorineural deafness among the patients with type II diabetes mellitus.Methods: A cross-sectional study was conducted at our hospital for a period of 6 months. All type II diabetes patients without any other major systemic illness (CVA, coronary artery disease, thyroid disorders) were included for the study. A total of 300 patients were included in our study and the informed consent was obtained from all the study participants. A detailed history related to hearing loss and diabetes status was elicited from all the patients. All basic blood investigations along with HbA1c was performed on all the patients. All the patients were subjected to pure tone audiometry and it was performed using a pure tone audiometer model AUL 12096 audiometer of Labat company in a sound proof room.Results: The total prevalence of sensori-neural deafness among the study subjects was found to be 51.3% with majority of them having mild to moderate degree of sensori-neural deafness. Increase in age, female gender, longer duration of diabetes and higher HbA1C levels are the factors which had influenced the state of sensorineural deafness among the study subjects.Conclusions: The use of audiological test at primary care level should be made mandate for screening all the diabetes patients for hearing loss such a way the quality of life can be improved for patients requiring therapeutic interventions for their hearing improvement.
Giant cystic pheochromocytoma masquerading as acute coronary syndrome and transient left ventricular dysfunction: a case report
Authors: P. B. Sryma , N. C. Mary Grace , A. K. Abdul Siyad , Ahamed Ijas
Published: May 2018

Objective of present study to present an atypical manifestation of pheochromocytoma and to illustrate the difficulty in managing an acute coronary syndrome and left ventricular dysfunction during a hypertensive crisis attributable to pheochromocytoma. We present the clinical history, physical findings, lab results and imaging studies of a 62year old man with acute coronary syndrome later found to have an adrenal mass. A 62-year-old man was suspected of having myocardial ischemia on the basis of symptoms of paroxysmal chest discomfort, diaphoresis, ST-segment elevation on an electrocardiogram, and elevated levels of cardiac enzymes. Coronary CT angiography was normal. Echocardiography revealed substantial ballooning of the apical, anterior, and inferior cardiac walls, consistent with catecholamine induced cardiomyopathy. He had a history of labile hypertension, headache, diaphoresis and palpitations of 4 years' duration. A right adrenal mass detected on Magnetic resonance imaging and increased plasma catecholamine levels were consistent with a pheochromocytoma. Treatment with prazosin and labetalol was initiated, and he underwent a right adrenalectomy, which confirmed thepheochromocytoma. Pheochromocytomas must be considered in the setting of acute coronary syndrome especially with presence of labile blood pressure. Inadvertent fibrinolysis can be avoided with proper clinical suspicion and timely coronary imaging.
Low birth weight and premature births and their associated maternal factors
Authors: Dayanithi Mithila
Published: May 2018

Background: LBW is a significant public health problem globally. In India every 3rd newborn is a LBW contributing to about 40% of the global burden. The objective of the study was to determine the prevalence of LBW and premature births and their associated maternal factors.Methods: A cross sectional study was done in antenatal women attending Rama Medical College Hospital& Research Centre, Hapur. Maternal factors and socioeconomic factors collected from 406 mothers were coded and analyzed using the SPSS 16. Chi square test was applied and p value less than 0.5 was considered as statistically significant.Results: Prevalence of LBW was 31.8% and prematurity was 25.6% in the study. LBW and premature babies were more associated with joint families, ≤Rs. 2999/- monthly income, maternal illiteracy and house wives. LBW and Premature babies decreased with increase in income, Hb >11.1 gms and ≥ 100 IFA tablets intake. The rates of LBW were the same whether mothers had no ANC or full ANC. This raises doubts about the content of the ANC.Conclusions: A good quality dedicated and sincere comprehensive ANC package including 4 ANCs, 100 IFA, 2TT/Booster, simple serial measurement of BP, weight, haemoglobin, fundal height and abdominal girth during each visit and screening for complications, counselling for birth and emergency preparedness, newborn care, breast feeding would help avert LBW and premature birth.
Study of substance use in teenage students in Miraj Town: a cross sectional descriptive study
Authors: Lokhande Ganesh S. , Rajderkar Shekhar S. , Jadhav Sachin B. , Ukey Ujwala U.
Published: May 2018

Background: Adolescence is recognized as the period for onset of behaviors and conditions that not only affect health limited to that time but also lead to adulthood disorders. Unhealthy behaviors such as smoking, drinking, and illicit drug use often begin during adolescence. Behavior patterns that influence health in adulthood have their origin in adolescence. The habit of substance use comes either from the peer groups or it may be generated within the family because the elders are resorting to one or the other form of substance use. Considering such factors, the present study had been undertaken with the objectives to study socio-economic class wise prevalence of substance use in study population; to study knowledge, attitude and practices of study population regarding substance use; to study various determinants that affect substance use.Methods: Cross sectional, descriptive study was being conducted in selected High schools and Junior Colleges in the Miraj Town. The method of data collection was the pre-designed, pre-tested proforma.Results: Various forms of tobacco, alcohol and pan masala were used by 58.9% of the family members/friends/peer groups of the study participants. Overall use [ever use + regular use] of tobacco products was observed in 9.0%, alcohol in 4.6% and pan masala in 33.3% of the study participants.Conclusions: Several factors can enhance the risk for initiating or continuing substance use including socioeconomic status, substance use by family members or friends and peer group influence.
Knowledge and perception of hypertension among hypertensive patients attending rural health and training centre, department of community medicine, SRMC & RI
Authors: Kongarasan Puveearasan , Shah Pankaj B.
Published: May 2018

Background: Hypertension is the most common treatable risk factor. Efforts have been made to raise the awareness of hypertension. Globally about one billion people have high blood pressure, of those two-thirds are in developing countries. In 2025, an estimated 1.56 billion adults will be living with hypertension. It is called as the “silent killer” because it often has no warning signs or symptoms. There is a lack of clear understanding of the current state of knowledge, attitudes, and perceptions about hypertension among patients and public. Objectives of the study were to assess the knowledge and perception of hypertension among hypertensive patients attending rural health and training centre (RHTC), Vayalanallur, Tamil Nadu.Methods: This is a hospital based, cross-sectional, observational study to assess the awareness of hypertension among hypertensive patients attending NCD clinic during the month of June 2016. After IEC approval, fifty participants who gave written consent were included and the study was conducted using a questionnaire covering knowledge and perception aspects of hypertension in one-to-one interviews.Results: The mean age of participants is 55.6±10.06 with illiterate of 18% and 37.1% unemployed. More than half of the participants were female 64%. Knowledge about the causes of hypertension were 94%, Perception that hypertension can be cured completely was 78% with periodic check-up was 74%, hypertension can be controlled with treatment was 90% and medication to be taken regularly was 100%.Conclusions: Knowledge and perception about hypertension is good and the thrush has to be given regarding the practice on control of blood pressure. Thus, health education programme might help the participants to prevent the complications of hypertension and for good adherence to treatment.
Creating awareness of rabies in pupil of Z.P. High School in Kallur (V), Kurnool (Dist), Andhra Pradesh
Authors: Srigouri Thalikota , Shridevi Kotina
Published: May 2018

Background: Rabies is a deadly disease but mostly preventable. Poor public awareness towards rabies is considered as one of the bottle necks for the prevention and control of the disease. The objectives of the study were to create awareness of rabies in pupil of Z.P. High School in Kallur (V), Kurnool (Dt) and to formulate Recommendation to school and concerned authoritiesMethods: A longitudinal intervention study conducted in Z.P. High school from a period of November 1st 2011 to December 31st 2011 among 6th to 9th class school children. And sample size was 160 students. A predesigned, semi structured questionnaire consisting of 28 questions was given to assess their level of awareness regarding rabies.Results: Of the 160 school children interviewed, 98 (61%) of them were males and 62 (38%) female students. The major source of information regarding occurrence of rabies 54 (33.7%) is schools, awareness regarding rabies due to dog bite before pre educational intervention is only 65 (40.62%), only 25% were aware of T.T vaccination, 41% were aware of anti-rabies vaccination. 59.3% were aware of cleaning of wound. Only 36 to 38% were aware of dog vaccination.Conclusions: In conclusion, this study has shown that the level KAP about clinical signs of rabies, prevention methods after suspected animal bite, the first action taken after rabid dog bite is not so good in the school, An intervention was planned in three sessions, and students were educated on how to identify rabid dogs, preventive measures like cleaning of wound after bite, dog vaccination, human vaccination with anti-rabies vaccine and T.T vaccine.
Evaluation of health safety of direct biomedical waste handlers in a Government Medical College, Himachal Pradesh
Authors: Kashyap Rashmi , Mazta Salig Ram
Published: May 2018

Background: Hospital waste management is a crucial environmental issue of public health concern due to hazardous and infectious character of the waste. Since the hospital staff is at risk of being infected by the hospital waste, therefore occupational health and safety should be recommended as a component of biomedical management plans with qualified personnel. Health safety of the waste handlers is an issue of prime concern.Methods: A descriptive study was conducted in Government Medical College, Nahan, Sirmaur, Himachal Pradesh to evaluate the health safety of direct waste handlers. The information regarding the biomedical waste management awareness, practices and health safety was recorded from direct waste handlers. Semistructured questionnaire was used for interview.Results: A total of 26 biomedical waste handlers were interviewed from August 31, 2017 to September 13, 2017. Gender composition showed 18 (69.2%) females and 8 (30.8%) males. Awareness regarding the risk associated with biomedical waste handling like exposure to infections like HIV, HBV, injury with sharp objects and Chemical burns etc. was present in 19 (73.0%) workers. Most 10 (38.4%) demanded the provision of personal protective equipments, training and vaccination.Conclusions: Regular orientation and training programs should be organized for biomedical waste handlers and strict implementation of biomedical waste management guidelines should be in practice. Risk to the health of direct waste handlers in the form of exposure to infectious diseases needs to be considered by timely provision of vaccination.
A cross sectional study to assess the satisfaction level among people living with HIV/AIDS in a hilly state of northern India
Authors: . Sunita , Dhadwal D. S. , Gupta Anmol , Mahajan Anjali , Sachdeva Amit
Published: May 2018

Background: Patient satisfaction is the patient’s perception of care received compared with the care expected.Measurement of patient satisfaction helps in understanding patients’ experiences of health care, identifying problems and evaluation of health care. Increased patient satisfaction leads to increased patient retention and decreases medical malpractice claims. Dissatisfied patients may have worse outcomes as they may not follow treatment plans. The objective of the study was to determine the satisfaction level among people living with HIV/AIDS visiting ART Centre IGMC Shimla.Methods: A cross sectional study was conducted among >15 years from September 2016 to August 2017 in ART Centre IGMC Shimla and satisfaction level was assessed by using the PSQ18 instrument.Results: Total 160 participants were enrolled in study among which 71.9% were males while 92.5% were above 30 years of age. Most of the patients were asymptomatic (currently not ill) at the time of consultation and their mode of disease transmission was sexual. The mean scores of PSQ-18 domains i.e. general satisfaction, technical quality, interpersonal manner, communication, financial aspects, time spent with doctor, accessibility and convenience was calculated. Highest score in interpersonal manner, time spent with doctor (3.99±0.12) and lowest score in general satisfaction (3.77±0.54). There was no statistically significant difference between overall satisfaction in relation to different socio demographic and clinical variables found in our study.Conclusions: Our study reflects that patients were much satisfied with the way health care providers were treating them and spent time with them while they were dissatisfied with something about the health care they were receiving.
Assessment of role of burden in caregivers of substance abusers: a study done at Swami Vivekananda Drug De-addiction Centre, Govt. Medical College, Amritsar
Authors: Kaur Arshdeep , Mahajan Sanjeev , Deepti Shyam Sunder , Singh Tejbir
Published: May 2018

Background: Substance abuse is a multidimensional problem, which threatens the quality of life of not only substance abusers but also the family members who live with them. Most of the time a member of the family assumes the role of caregiver and he or she is most burdened from this process. Considering that the involvement of family members is recommended for the recovery process of chemical dependents, it is necessary to appropriately provide the training to caregivers and evaluate their needs for caregiving.Methods: This cross sectional study was conducted at Swami Vivekananda Drug De-addiction Centre attached to the Government Medical College, Amritsar from January 2016 to December 2016. A total of 349 caregivers of substance abusers were interviewed by using pretested and semi structured questionnaire.Results: 44.69% caregivers were wives. Mean age of the caregiver was 33.45 years. 25.21% were high pass. 67.6% were housewives. None was trained in caregiving professionally. 37.53% provided family care while emotional support to the patients was provided by only 10% women and 2% men, no gender specific association with emotional support was statistically significant. 54.15% developed stress while caregiving, 12.60% had social and financial problems.Conclusions: Findings confirmed that quality of life is compromised and stress is high among caregivers, highlighting the need for providing emotional support.