bluuebunny/crossref_metadata_2025 huggingface dataset:
Efetividade de um algoritmo para identificar precocemente a deterioração clínica em unidades de internação adulto
Authors: Pedroso Alves Jhessica , Fernandez Lourenço Haddad Maria do Carmo , Da Silva Melo Malaquias Tatiana , Rossaneis Mariana Angela , Trindade Radovanovic Cremilde Aparecida , Negrão Guassú Nogueira Danielly
Published: July 2023

Objetivo: Avaliar a efetividade de um algoritmo para identificar precocemente a deterioração clínica em unidades de internação adulto. Método: Estudo de coorte retrospectivo, realizado em um hospital filantrópico localizado no norte paranaense. Procedeu-se à análise de tendência de indicadores referentes à produtividade, produção e qualidade. Adotou-se um erro alfa de 5%.  Resultados: Os indicadores de produção mostraram tendência decrescente na taxa de ocupação, tanto dos leitos destinados a tratamentos eletivos, quanto daqueles reservados para urgência, e tendência crescente no número absoluto de internações e número de pacientes dia. Nos indicadores de produtividade, observou-se tendência estacionária no índice de renovação de leitos. Em relação à qualidade, verificou-se a predominância da tendência crescente em todas as taxas (infecção, sepse e mortalidade). Conclusão: Os resultados demonstraram que o algoritmo foi efetivo, visto que houve melhora nos indicadores de produção, que mostraram tendência decrescente na taxa de ocupação, tanto nos leitos eletivos, quanto nos de urgência; e dos indicadores de produtividade, onde observou-se tendência estacionária no índice de renovação de leitos.
Redes de apoio no continuum processo de reabilitação no quotidiano de pessoas com lesão medular
Authors: Cristina da Silva Lima Thamyres , Dutra Tholl Adriana , Gonçalves Nitschke Rosane , Maria da Fonseca Viegas Selma , Alves da Cruz Danielle , Carolina Silva Tamires
Published: July 2023

Objetivo: compreender a rede de apoio no continuum processo de reabilitação no quotidiano de pessoas com lesão medular. Metodologia: estudo descritivo, de natureza qualitativa, fundamentado na Sociologia Compreensiva e do Quotidiano, com 23 pessoas com lesão medular, acompanhadas em Serviço de Enfermagem e de Reabilitação do sul do Brasil. Para a coleta de dados, utilizou-se do prontuário, genograma, ecomapa e entrevista individual. Para a análise da entrevista, utilizou-se a Análise de Conteúdo. Resultados: ao ingressar no Programa de Reabilitação, as redes de apoio se configuravam como uma vinculação fraca quando a inacessibilidade era uma barreira, especificamente, o trabalho/escola; hobby/lazer. As vinculações fortes consideram as redes cuidador principal, centro de saúde, amigos, orientação religiosa e família. Considerações finais: as redes de apoio que circundam cada indivíduo com lesão medular e a família e como elas se relacionam, auxiliam o enfrentamento do novo ritmo de vida, colaborando para o alcance das metas de reabilitação e ressocialização.
Vacinação contra a influenza em coorte de idosos de município do sul do Brasil
Authors: Rohde Krolow Michele , Pereira Machado Karla , Timm Oliveira Adriéli , Pereira Xavier Nicole , Santiago Dilélio Alitéia , Uhlmann Soares Mariangela , Thumé Elaine
Published: July 2023

Objetivo: este estudo objetivou verificar a prevalência de vacinação da influenza e investigar os motivos da não vacinação na população idosa. Método: estudo de coorte “Saúde do Idoso Gaúcho de Bagé, RS, realizada em Bagé em 2008 e 2016/2017. A variável dependente foi obtida através da pergunta: “Neste ano o(a) Sr.(a) fez a vacina contra a gripe? Sim/não”. Em caso de resposta negativa o idoso era questionado sobre a razão de não ter se vacinado. Realizou-se análise descritiva, prevalência de vacinação e cálculo de Razão de prevalência no programa Stata 14.0. Resultados: a prevalência de vacinação contra Influenza no ano de 2008 foi de 58,8% e em 2016/2017 de 80,8%. O motivo mais frequente referido pelos idosos para a não realização da vacina em 2008 foram: “não quis” (29%) e em 2016/2017 “ter medo” (26,7%). Conclusão: apesar da prevalência de vacinação ter aumentado, evidencia-se que os idosos continuam com dúvidas e receios acerca da vacina, sendo necessário repensar novas estratégias em conjunto com as Equipes de Saúde da Família.
The Endogenous Retinoic Acid Receptor Pathway Is Exploited by Mycobacterium tuberculosis during Infection, Both In Vitro and In Vivo
Authors: Tenório de Menezes Yonne Karoline , Eto Carolina , de Oliveira Joseana , Larson Erica C , Mendes Daniel A G B , Dias Greicy Brisa Malaquias , Delgobo Murilo , Gubernat Abigail K , Gleim Janelle L , Munari Eduarda Laís , Starick Marick , Ferreira Fabienne , Mansur Daniel Santos , Costa Diego L , Scanga Charles A , Báfica André
Published: July 2023

Retinoic acid (RA) is a fundamental vitamin A metabolite involved in regulating immune responses through the nuclear RA receptor (RAR) and retinoid X receptor. While performing experiments using THP-1 cells as a model for Mycobacterium tuberculosis infection, we observed that serum-supplemented cultures displayed high levels of baseline RAR activation in the presence of live, but not heat-killed, bacteria, suggesting that M. tuberculosis robustly induces the endogenous RAR pathway. Using in vitro and in vivo models, we have further explored the role of endogenous RAR activity in M. tuberculosis infection through pharmacological inhibition of RARs. We found that M. tuberculosis induces classical RA response element genes such as CD38 and DHRS3 in both THP-1 cells and human primary CD14+ monocytes via a RAR-dependent pathway. M. tuberculosis–stimulated RAR activation was observed with conditioned media and required nonproteinaceous factor(s) present in FBS. Importantly, RAR blockade by (4-[(E)-2-[5,5-dimethyl-8-(2-phenylethynyl)-6H-naphthalen-2-yl]ethenyl]benzoic acid), a specific pan-RAR inverse agonist, in a low-dose murine model of tuberculosis significantly reduced SIGLEC-F+CD64+CD11c+high alveolar macrophages in the lungs, which correlated with 2× reduction in tissue mycobacterial burden. These results suggest that the endogenous RAR activation axis contributes to M. tuberculosis infection both in vitro and in vivo and reveal an opportunity for further investigation of new antituberculosis therapies.
Polymorphisms in Maternal Selected Folate Metabolism-Related Genes in Neural Tube Defect-Affected Pregnancy
Authors: Dewelle Winner K. , Melka Daniel S. , Aklilu Abenezer T. , Gebremariam Mahlet Y. , Alemayehu Markos A. , Alemayehu Dawit H. , Woldemichael Tamrayehu S. , Gebre Solomon G.
Published: July 2023

Background:

Neural tube defects (NTDs) are abnormalities of the brain and spinal cord, which occur as a result of failure in neural tube closure during embryogenesis. Causes of NTDs are complex and multiple, with hereditary, lifestyle, and environmental factors appearing to play a role. In spite of their impact on public health, the role genetics play on NTDs in Ethiopia is lacking. In this study, the role of polymorphisms in MTHFR 677C > T (rs1801133), MTHFR 1298A > C (rs1801131), MTRR 66A > G (rs1801394), RFC1 80A > G (rs1051266), and TCN2 776C > G (rs1801198) on the risk of having NTD-affected pregnancy was investigated.

Materials and Methods:

One hundred women with NTD-affected pregnancy and 100 women with normal pregnancy were included in the study. DNA was extracted from saliva and genotyping for five polymorphisms in four genes was analyzed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). The departure of the genotype's distribution from Hardy–Weinberg equilibrium (HWE) was evaluated using the x2 goodness-of-fit test. Frequencies of genotypes and alleles in case and control mothers were determined and differences between relative frequencies were evaluated by the x2 or the Fisher's exact test.

Results:

The statistically significant difference was absent in the genotype and allele frequencies for all the analyzed polymorphisms between cases and controls (P > 0.05).

Conclusion:

MTHFR 677C > T, MTHFR 1298A > C, MTRR 66A > G, RFC1 80A > G, and TCN2 776C > G polymorphisms lack association with the risk of having a pregnancy affected by NTD. The role of other genes or environmental factors in NTD etiology needs to be investigated.
Remdesivir Prescription in Pregnant Women Infected with COVID-19: A Report of Compassionate Use
Authors: Zafarbakhsh Azam , Vaezi Atefeh , Haghjooy Javanmard Shaghayegh , Sabet Fahimeh , Dehghan Maryam
Published: July 2023

Background:

Coronavirus disease 2019 (COVID-19) is an infectious disease that the physiological changes in pregnancy can make pregnant patients more susceptible to more severe forms of this infection. Hence, the treatment of COVID-19 in pregnant women can be challenging. This study was designed to evaluate the safety and efficacy of Remdesivir in pregnant women with COVID-19.

Materials and Methods:

This study was conducted on 150 pregnant women with moderate to severe COVID-19 infection. Remdesivir was prescribed and continued for 5 or 10 days according to the patient's condition. Maternal and pregnancy outcomes and also recovery rates were evaluated. Moreover, additional variables were examined: age, gestational age, symptoms, O2 saturation and laboratory tests at admission, the interval between symptom initiation and admission to hospital and Remdesivir prescription, hospitalization days, and ICU admission.

Results:

The mean age was 32.37 years. Cough and dyspnea were the most prevalent symptoms (74% and 68.7%, respectively). At the time of admission, 79 (52.7%) women needed low-flow oxygen support, 67 (44.7%) needed high-flow oxygen support, and 4 (2.7%) were intubated. Fifty-four (36%) patients required ICU care. In patients who died (12 women), Remdesivir was prescribed later than those discharged (P value, 0.04). Patients with favorable pregnancy outcomes received Remdesivir earlier than those with unfavorable pregnancy outcomes (P value: 0.008). The recovery rate was 70% (89.9% in the low-flow oxygen, 50.7% in the NIPPV/high flow oxygen, and 0% in the intubated women).

Conclusion:

The results suggest that the early prescription of Remdesivir in pregnant women with moderate COVID-19 can improve the outcomes.
Comparison of High Uterosacral and Sacrospinous Ligament Suspension Surgeries for the Treatment of Pelvic Organ Prolapse in Women
Authors: Hajhashemi Maryam , Zafarbakhsh Aazam , Movahedi Minoo , Rafieezadeh Aryan , Sattari Rizi Behnaz
Published: July 2023

Background:

Pelvic floor disorders include urinary incontinence, fecal incontinence, and pelvic floor prolapse, which are common complaints in women. Patients that suffer from uterine prolapse could benefit from surgical procedures that stabilize pelvic ligaments. Here, we aimed to compare the high uterosacral and sacrospinous ligament suspension surgeries.

Materials and Methods:

This clinical trial was performed in 2019–2021 on 64 women with uterine prolapse. Demographic data of the patients, including age, body mass index (BMI), past medical diseases, history of delivery, type of delivery, and duration of hospitalization, were collected. We assessed their urinary symptoms, prolapse degree, and sexual symptoms using the Female Sexual Function Index (FSFI) and Pelvic Floor Disability Index (PFDI-20) questionnaires before surgical interventions. Patients were divided into two groups undergoing high uterosacral and sacrospinous ligament suspension. They were followed up 6 and 12 months after surgeries.

Results:

Patients treated with sacrospinous ligament suspension had higher frequencies of surgical complications (P = 0.039), and the most common complication was low back pain (15.6%). The uterine prolapse andC point degree improved significantly in all cases after 6 and 12 months (P < 0.001). The Pelvic Organ Prolapse Quantifications System (POP-Q) scores improved significantly in both groups 6 and 12 months after surgery (P < 0.001), and patients who underwent sacrospinous ligament suspension had significantly lower pain intensity compared to the other group (P = 0.003). FSFI scores improved significantly in patients treated in both groups (P < 0.001).

Conclusion:

Both high uterosacral and sacrospinous ligament suspension techniques significantly improved pain, uterine prolapse, and C point degree.
Association between the Treatment of Rosacea and Eradication of Helicobacter Pylori Infection
Authors: Aghaei Maryam , Aghaei Shahrzad , Behshadnia Fatemeh , Ghomashlooyan Mohsen , Khaghani Armin , Baradaran Elahe H. , Naeini Farahnaz F. , Iraji Fariba , Shahmoradi Zabihollah , Hosseini Sayed M. , Hejazi Seyed H.
Published: July 2023

Background:

Rosacea is a multifactorial skin inflammatory disorder with an unknown cure. Genetics and environmental factors such as microorganisms are involved in the rosacea etiology, for example, Helicobacter pylori have been suggested in rosacea progression. The present study investigated the relationship between H. pylori eradication and rosacea patient's improvement.

Materials and Methods:

H. pylori infection was investigated in 60 rosacea patients and 65 sex- and age-matched healthy control through enzyme-linked immunosorbent assay (ELISA) and HpSag tests. After infection confirmation, randomly half of the rosacea patients were treated for H. pylori eradication (test), and others received standard treatment (control). HpSag and ELISA tests were repeated after infection eradication and disease flow was surveyed for 60 days. The groups were compared using the ANOVA (Analysis Of Variance) test at the significant level of P < 0.05.

Results:

At the baseline, the mean of immunoglobulin G (IgG) (59.27 ± 41.4 RU/mL) and immunoglobulin M (IgM) (11.55 ± 6.1 RU/mL) in rosacea patients was higher than the level of IgG (41.38 ± 54.33 RU/mL) and IgM (8.11 ± 8.91 RU/mL) in healthy control (P < 0.04) and (P < 0.01), respectively. Also, the values for H. pylori infection were positive in all patients and 10 healthy controls. The mean titer of IgM and IgG in the test and control patients groups were different at baseline and after treatment. Furthermore, in the test patients group, the mean of IgG was reduced in active rosacea after treatment, and 63.9% of active patients showed rosacea remission after H. pylori eradication.

Conclusion:

Data suggest the exacerbating role of H. pylori in rosacea, and its eradication along with other therapeutic methods causes rosacea improvement.
The Topical Formulation of Whey Protein for the Prevention of Pressure Ulcers in Critically Ill Patients: A Novel Intervention in a Randomized-Controlled Clinical Trial
Authors: Samimi Soroush , Abbasi Saeed , Taheri Azadeh , Farsaei Shadi
Published: July 2023

Background:

High prevalence of pressure ulcers (PUs) and their complications are important dilemmas in the intensive care unit (ICU). Therefore this study was designed to evaluate the effectiveness of topical whey protein formulation in preventing PUs in patients admitted to the ICU.

Materials and Methods:

In this randomized placebo-controlled clinical trial under registration number [IRCTdeted for blinded article], 80 eligible ICU patients were randomly allocated to receive topical ointment of whey protein or placebo on the sacrum with a diameter of 15 cm twice daily for seven days, in addition to the routine care. The mean risk score for developing PUs was calculated at baseline using the Braden tool, and the PUSH score was used to assess PUs on days 4, 7, and 14. Patients' related demographic and clinical variables were also collected using a medical record for more evaluation.

Results:

Our results showed that demographic characteristics and the Braden scores' baseline mean were not significantly different between groups (P > 0.05). The repeated measures ANOVA test revealed that the mean scores of PUs at various times were markedly lower in the whey protein than in the placebo group (P < 0.001).

Conclusion:

This intervention can be routinely added as effective, safe, inexpensive, and accessible care to reduce the incidence of PUs for patients at risk of developing this injury.
Assessment of Hip Range of Motion Limitations in Cases with Low Back Pain Based on the Classified Movement System Impairment
Authors: Khayam Nekoie Farzaneh , Kouhzad Mohammadi Hosein , Afshari-Safavi Alireza , Mahdidust Jalali Hossein , Taheri Navid
Published: July 2023

Background:

The hip joint's limitation causes lumbopelvic compensatory motions, accumulating tissue stress on the lumbar spines. It is essential and valuable to evaluate hip rotation range of motion (ROM) in different low back pain (LBP) classifications to understand them and plan the best exercise program. This study aimed to compare hip rotation ROM between subjects with and without LBP classified in movement system impairment (MSI).

Materials and Methods:

In this cross-sectional study, 100 subjects with LBP were classified into different MSI subgroups (mean age of 41.66 ± 7.82 years), and 100 healthy subjects (mean age of 38.96 ± 8.84 years) participated. Passive and active hip medial and lateral rotations ROM in prone and supine positions for dominant and non-dominant lower limbs were measured.

Results:

Generally, in the LBP group, minimal lateral rotation as compared to controls in movement tests measuring hip rotation ROM actively and passively, in prone and sitting positions, and for dominant and non-dominant limbs (P < 0.05). There were no significant differences among the LBP subgroups (P > 0.05).

Conclusions:

Due to LBP, regardless of the MSI categories, remarkably restricted hip lateral rotation ROM.
Spotlight on the Expanding Role of miR-647 in Human Cancers
Authors: Jalili Mohammadmahdi , Tavakoli Setayesh , Kargar Kamran , Rafat Milad , Rad Fatemeh R.
Published: July 2023

MicroRNAs are a large group of small, non-coding ssRNAs (miRNAs) that have an epigenetically pivotal role in gene expression and other biological processes in cells and can be regarded as capable biomarkers for the early detection and management of cancer. The aim of the present review article is to summarize the evidence for recognizing the molecular mechanism, target genes, and clinical significance of miR-647 in different cancers. Multiple studies have demonstrated that aberrant expression of miR-647 could be found in a variety of malignancies, such as bladder cancer, cervical cancer, colorectal cancer, gastric cancer, glioma, hepatocellular carcinoma, non-small cell lung cancer, ovarian cancer, and prostate cancer have reported, notably, increase or decrease in expression of miR-647 so that it can function as a tumorigenic (oncomiR) or tumor suppressor gene. MiR-647 is effective in the proliferation, migration, and invasion of cancer cells by playing a function in cell cycle pathways. MiR-647 can be a valuable potential biomarker for assessing the extent of cancer, prognosis, and response to therapy and shows great therapeutic efficacy in different solid tumors. Moreover, serum concentrations of miR-647 are directly effective in decreasing overall survival and disease progression. So, an efficient therapeutic target can be the effect on miR-647 expression by antitumor drugs.
Sella Turcica Size in Women with Sheehan Syndrome—A Case–Control Study
Authors: Laway Bashir Ahmad , Sharma Atul , Choh Naseer Ahmad , Shaheen Feroze , Wani Arshad Iqbal
Published: July 2023

Introduction:

Sheehan syndrome is a common cause of hypopituitarism in developing countries. Among risk factors, in addition to post-partum haemorrhage, a smaller sellar volume is also believed to predispose to pituitary necrosis. Some earlier studies have reported smaller sellar volume in these patients but involved a small number of patients and lacked matched controls. The main of the present study was to study the sellar volume in a large cohort of patients with Sheehan syndrome and compare it with age- and parity-matched controls.

Methods:

Fifty women with Sheehan syndrome and an equal number of age- and parity-matched controls were studied. Baseline investigations, relevant hormonal assay, and MRI of pituitary were studied in all.

Results:

Sellar volume was significantly lower in patients with Sheehan syndrome (334.50 ± 129.08 mm3 in patients as against 456.64 ± 169.25 mm3 in controls, P = 0.000). Far more women with Sheehan syndrome than controls had decreased sellar volume (40% vs. 12%).

Conclusions:

Patients with Sheehan syndrome have a smaller sellar volume that may be a non-modifiable risk factor for the development of post-partum pituitary necrosis.
Type 2 Diabetes and Precursors in Community Dwelling Asian Indian Adult Youth
Authors: Jabbar P. K. , Nair Abilash , Chellamma Jayakumari , Jayakumar R. V. , Ramesh Jeena , Gomez Ramesh , Vishnu G. Giri , Voise Syamji , Soumya S. , Vijayakumar Karthik
Published: July 2023

Background:

Recent studies have shown a high prevalence of Type-2-diabetes (T2DM) (24%) and prediabetes (18.1%) in Kerala. There is no community based study from South Asia regarding the prevalence of type 2 diabetes and its precursors in the young adult population. This community based study was done to find the prevalence of type 2 diabetes and its precursors in South Indian adult youth (18–30 years age) of Thiruvananthapuram district.

Research Design and Methods:

Cross sectional design was used for this study. Multistage cluster sampling was used to enrol community dwelling youth of 18 to 30 years, residing in Thiruvananthapuram district. Six panchayath wards from rural and urban regions and 4 from coastal area were randomly selected as the primary sampling units. Trained staff nurses conducted the survey with the help of accredited-social-health-activists (ASHA). Socio-demographic data, anthropometry, clinical features of insulin resistance, and random capillary glucose (CG) and blood pressure were assessed and recorded. Oral Glucose tolerance test or HbA1c was done for participants with a CG ≥130 mg/dl for diagnosis of diabetes and prediabetes.

Results:

A total of 1031 participants were included from the rural (n = 394), coastal (n = 269) and urban (n = 368) areas. Prevalence of hyperglycaemia i.e., T2DM and pre-diabetes was 0.48% (n = 5) and 2.4% (n = 25) respectively. Family-history of T2DM was present in 35.1% subjects. Prevalence of overweight, obesity and abdominal-obesity was 28.2%, 16.1% and 28.4% respectively. Clinical-features of insulin resistance (CFIR) were present in 27.1% subjects (acanthosis [17.7%], skin tags [1.7%] and PCOS phenotype [10.7%]). Among various anthropometric measurements and their derivatives, CFIR correlated best (r = 0.24, P < 0.01) with the product of BMI and the sum of abdominal circumference and hip circumference (Trivandrum Medical College [TMC] -adiposity-index), which is a newly proposed parameter. Hyperglycaemia was more common in males, did not correlate with waist hip ratio, and correlated best again with TMC-adiposity-index ((r = 0.13, P < 0.01).

Conclusions:

The burden of insulin resistance in the young South Indian population, hitherto unknown in any community based study, has been studied for the first time. The prevalence of precursors of T2DM is high in this population. Early identification of ‘at risk’ individuals could provide a window of opportunity for preventing or delaying future diabetes and its long term complications. TMC adiposity index could become a valuable tool in the anthropometric assessment for predicting future T2DM.
Impact of Cardiac Autonomic Dysfunction on Cognitive Event-Related Potential in Type 2 Diabetes Mellitus Patients: A Cross-Sectional Study
Authors: Ramachandran Madumathy , Priyadarsini Nibedita , Kar Manisha , Behera Kishore Kumar
Published: July 2023

Introduction:

Type 2 diabetes mellitus (T2DM) is a chronic metabolic condition that is responsible for various long-term complications. Cognitive impairment is one of the most common complications, but the underlying mechanisms are still undetermined. The autonomic imbalance is a major cause for CVS morbidity in T2DM which could also potentially affect cognition. But there is sparse data available in the literature to prove the association between autonomic dysfunction and cognitive impairment.

Methodology:

We recruited 40 T2DM patients and 40 healthy controls. The assessment of cognitive functions was done by cognitive P300 event-related potential (ERP) and MoCA. Heart rate variability (HRV) was done to assess autonomic function.

Results:

The P300 ERP latency in Fz, Cz and Pz sites was significantly prolonged in T2DM patients (P < 0.001). We found moderate correlation is present between P300 latency and total power (r = -0.466, P < 0.01) and LFnu (r = -0.423, P < 0.01) in T2DM patients. The total power and HbA1C show independent association with P300 latency after adjustment for confounding factors like age and duration of diabetes (P < 0.05).

Conclusion:

As the incidence of Alzheimer’s disease is rising among T2DM patients increasing their dependency, making necessary lifestyle measures at earliest to improve autonomic balance may prevent or delay the onset of cognitive decline and alleviate its consequences and improve the quality of life in T2DM patients.
Germ Cell Tumors in 46, XY Gonadal Dysgenesis
Authors: Misgar Raiz A. , Islam Mir Sajad U. , Mir Mohmad H. , Bashir Mir I. , Wani Arshad I. , Masoodi Shariq R.
Published: July 2023

Introduction:

To present the clinical data, investigative profile, management, and follow-up of patients with 46, XY gonadal dysgenesis with germ cell tumors from the endocrine unit of a tertiary care university hospital.

Materials and Methods:

This retrospective study included 3 cases of 46, XY gonadal dysgenesis with germ cell tumors evaluated and managed at the Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, over a period of 13 years from (September 2008 to December 2021).

Results:

Over a period of 13 years, we diagnosed and managed 7 patients with 46, XY gonadal dysgenesis. This included 4 patients with pure gonadal dysgenesis (PGD; Swyer syndrome), 2 patients with mixed gonadal dysgenesis (MGD), and one patient with partial gonadal dysgenesis. Out of these 7 patients, three patients developed germ cell tumors, one patient with MGD, and two patients with pure PGD (Swyer syndrome). In all three patients, germ cell tumor was the first presentation of DSD. The patient with MGD presented with primary amenorrhea and virilization, while the two patients with PGD presented as phenotypic females with primary amenorrhea and pelvic mass. All three patients developed seminomatous cancers. Patient with MGD developed seminoma and the two patients with PGD (Swyer syndrome) developed dysgerminoma. The patients were managed with bilateral gonadectomy with removal of the tumor. In addition, the 2 patients with PGD (Swyer syndrome) received combined chemotherapy. On a follow up ranging from 1 to 10 years, all three patients are disease free.

Conclusions:

we conclude that germ cell tumors may be the first presentation of 46, XY gonadal dysgenesis. In all phenotypic females with primary amenorrhea and dysgerminoma, karyotype is a must to uncover the diagnosis of PGD. In addition virilization may be clue to the presence of germ cell tumor in a patient with 46, XY gonadal dysgenesis.
A Cross-Sectional Multicentre Study to Validate Insulin Sensitivity Index Cut-Offs for Detection of Metabolic Syndrome in Indian Adolescents with Type-1 Diabetes
Authors: Oza Chirantap , Khadilkar Anuradha , Mondkar Shruti , Amutha Anandakumar , Uppal Saurabh , De Hriday , Ghosh Apurba , Khadilkar Vaman , Mohan Viswanathan
Published: July 2023

Background:

A previous study compared insulin sensitivity indices for the detection of double diabetes (DD) in Indian adolescents with type-1 diabetes (T1D) and derived a cut-off to predict future risk for the development of metabolic syndrome (MS) in adolescents with T1D. We conducted the current study with the aim to validate these cut-offs for detecting DD among Indian subjects with T1D from various geographical locations.

Methods:

This multicentric cross-sectional study included 161 Indian adolescents with T1D. Demographic, anthropometric, clinical, and biochemical data were collected using standard protocols. Insulin sensitivity (IS) was calculated using various equations developed to determine insulin sensitivity in subjects with T1D. Metabolic syndrome was diagnosed using International Diabetes Federation (IDF) Consensus Definition 2017.

Results:

We report 4.3% prevalence of MS in Indian adolescents with T1D with an additional 29.8% of study participants at risk of development of MS. Low High density lipoprotein (HDL) (23.6%) was the commonest abnormal component of the MS definition. Insulin sensitivity calculated by an equation derived by the SEARCH group was the most appropriate index to identify MS and metabolic risk in Indian adolescents with T1D. The proposed cut-off of 5.48 had high specificity, positive predictive value, and negative predictive value in identifying the risk of the development of DD.

Conclusions:

Insulin sensitivity calculated by the equation proposed by the SEARCH group together with cut-offs derived in earlier study may be used effectively to identify risk of development of MS/DD in Indian adolescents with T1D from various geographical locations.
Study of Association of Serum Prolactin Levels with Insulin Resistance in Type 2 Diabetes Mellitus Patients
Authors: Sheoran Ankita , Agarwal Nagina , Mahto Subodh Kumar , Gupta Pulin Kumar , Gupta Kritika , Sharma Neera
Published: July 2023

Objective:

Prolactin (PRL) regulates glucose metabolism and insulin sensitivity. The study aimed to evaluate the role of PRL in glucose homeostasis and its association with insulin resistance in patients with diabetes mellitus (DM).

Methods and Materials:

This cross-sectional, observational study included 100 patients (25–60 years) with T2DM. Primary information including demographics, anthropometric measurements, and biochemical measures (complete blood count, glucose parameters, liver and kidney function test, lipid profile, thyroid function test, serum fasting insulin levels, serum PRL levels) was collected.

Results:

A total of 100 patients, 50 men and 50 women (25 premenopausal and 25 postmenopausal), were enrolled in this study. The correlation between serum cholesterol and PRL was found to be statistically non-significant (P = 0.129) in men and significant (P = 0.041) in women. There was an inverse relationship between fasting plasma glucose and serum PRL levels in both men (r = −0.88; P < 0.0001) and women patients (r = −0.768; P < 0.0001). Negative correlation between postprandial plasma glucose and PRL was found to be statistically significant (r = −0.398; P = 0.048) in postmenopausal women. The comparison in both men and women indicated an inverse correlation between serum PRL and glycated haemoglobin levels. There was a significant negative correlation between homeostasis model assessment-estimated insulin resistance (HOMA-IR) and PRL levels in both men (r = −0.362; P = 0.039) and women patients (r = −0.362; P = 0.003). Homeostasis model assessment of β cell function (HOMA-β), which directly correlates with residual pancreatic beta cell function, was positively correlated with prolactin levels, irrespective of gender and menopausal status of female subjects.

Conclusion:

Serum PRL levels correlate with improved glycaemic control.
Mental health literacy on youth depression and suicides for teachers and its impact on knowledge, attitudes and help facilitation: A preliminary study
Authors: Manjula Munivenkatappa , Roopesh Bangalore N. , Bhaskarapillai Binukumar , Mendon Gurucharan B.
Published: July 2023

Background:

Depression and suicide are among the most prevalent mental health problems among the adolescents in India. However, help seeking is very poor due to lack of knowledge on mental health among youth and significant individuals in their life. Imparting knowledge to teachers becomes important as youth spend most of their time in the educational set up. The present study aimed at examining the effect of mental health literacy on depression and suicidal behaviours on knowledge, attitudes and help facilitation of teachers.

Materials and Methods:

The study adopted a stratified sampling method and a sample (N = 102) of high school teachers (8th–12th standard) from both private and government institutions in Bangalore were included in the study. A pre- and post-assessment, single group design with a follow-up after 3 months was adopted. Data were collected using the socio-demographic data sheet and questionnaire prepared to assess the knowledge, attitudes and help facilitation.

Results:

The mean age of the teachers was 41.74 years, with 80% female respondents and 58.8% of the sample with master’s degrees and diplomas in teaching. There was a significant increase in knowledge about the symptoms, consequences of depression and attitude toward depression and suicide. About 16% of the sample had taken steps to help students with distress and facilitated help seeking at 3-month follow-up.

Conclusion:

Mental health literacy programme has positive impact on the knowledge and helps in improving support and help facilitation behaviours among teachers.
Anxiety, depression, professional fulfilment and burnout: Public and private doctors’ differential response to CoVID-19 pandemic
Authors: Singh Virendra V. , Dutta Bikram K. , Singhal Ankit , Patra Priyadarshee , Gupta Anindya. K. , Mani Raghu N.
Published: July 2023

Introduction:

Covid-19 pandemic has been a challenge for healthcare system; the doctors in public and private setups are at the center of this challenge. Public and private doctors differ in personality and some occupational aspects. Do these differences reflect in their response to Covid?

Aim:

To study the difference in anxiety, depression, burnout, and professional fulfillment between doctors in public and private setup during Covid-19 second wave and to assess their coping strategies.

Methods:

A cross-sectional Internet-based observational study was conducted using Stanford PFI, GAD-7, PHQ-2, BFI-10, and brief COPE questionnaires.

Results:

A total of 114 public and 37 private doctors participated in the study. Doctors in private were older in age and deferred in personality profile. Significantly, more private doctors screened for anxiety disorder. 62.2% of private and 41.2% public doctors felt professionally fulfilled. Burnout and depression were not significantly different between groups. Active coping, acceptance, and planning coping were significantly more used by private doctors.

Conclusion:

There are differences how doctors in different setups respond to Covid-19, and there is need to understand these factors.
Content analysis of cyberbullying coverage in Newspapers- A study from Bengaluru, India
Authors: Vranda Mysore Narasimha , Doraiswamy Padmavathy , Prabhu James Ranjith , Ajayan Adhasa , Priyankadevi S
Published: July 2023

Cyberbullying affects the mental health of victims. Media especially print media plays a significant role in reporting of cyber-related crimes to the general public. A total of 549 leading English daily newspapers for a period of 6-months were reviewed. The data were content analyzed using frequently repeated themes/contents. Totally, 51 instances of individual cyberbullying stories were reported from 549 newspapers. Among the reported incidents of cyberbullying in the print media, online harassment and impersonation were the most common type of cyberbullying experienced by the people. The study highlights the need for framing local guidelines for reporting of cyberbullying incidents and preventive mechanisms in the print media.
Squamomelanocytic Tumor of the Plantar Aspect of the Foot: A Collision Tumor
Authors: Pandiaraja Jayabal , Ramya Natarajan
Published: July 2023

Collision tumors are two cancers that coexist in the same anatomical site. The etiopathogenesis of collision tumors remains controversial. Even though collision is uncommon, the association between squamous cell carcinoma and malignant melanoma is very rare compared to basal cell carcinoma and malignant melanoma. Here, we report a case of squamous cell carcinoma with malignant melanoma which was confirmed by histopathological examination and immunohistochemistry. The patient underwent wide local excision and flap cover. This case is reported due to the rarity.
Hypopigmented Pityriasis Lichenoides: A New Clinicopathological Type
Authors: Mahran Ayman M. , Younis Aya Allah H. , Ahmed Asmaa M. , Mekkawy Marwa M.
Published: July 2023

Pityriasis lichenoides (PL) presents a spectrum of uncommon inflammatory skin diseases that includes acute and chronic variants. The hypopigmented PL is a rare variant that was reported in dark-skinned individuals. It was proved histologically to be a variant of PL chronica (PLC). To our best knowledge, we report the first case of a hypopigmented variant of PL that shows histopathological features of PLC and PL et varioliformis acuta.
Adult-Onset Greither’s Disease: A Rare Report of Two Cases
Authors: Khan Hania Q. , Sharmeen Ayesha , Amin Syed S. , Siddiqui Bushra
Published: July 2023

Inherited palmoplantar keratodermas (PPKs) have onset in the late infancy or early childhood and have a positive family history. Sporadic cases and cases with onset in adulthood have been rarely reported. We describe two female cases with transgradiens and progradiens PPK, with onset in adulthood having clinical and histological features of Greither’s disease (GD). Only a single report of adult-onset GD has been reported in the literature. All patients presenting with palmoplantar keratoderma should be thoroughly evaluated, as it may be a late-onset inherited disorder, it adds to the spectrum of conditions to presenting with PPKs of late-onset.
Depression among Adolescents with Acne Vulgaris: A Cross-Sectional Assessment
Authors: Singh Inder P. , Masih Abhishek
Published: July 2023

Background:

The prevalence of depression among adolescents and young adults with acne vulgaris has varied widely in different studies.

Purpose:

The purpose of this study is to assess the prevalence of depression among adolescents with acne vulgaris as compared to age and gender-matched healthy adolescents. The effects of the severity of acne (and postacne scars), duration of acne, and treatment on the severity of depression among adolescents with acne have also been assessed in this study.

Methods:

The patient health questionnaire-9 was completed by each one of 1502 adolescents with acne vulgaris and 1500 age and gender-matched controls in this cross-sectional study. The association of prevalence and severity of depression with gender, duration of acne, grade of acne, treatments received, and presence and severity of postacne scars was explored by Chi-square test for categorical variables and t-test for quantitative variables.

Results:

One hundred and thirty (8.65%) adolescents with acne vulgaris were diagnosed with depression, while only 5 (0.33%) healthy adolescents were diagnosed with depression (P = 0.005). Among adolescents with acne vulgaris, 2 (0.13%) had severe depression, 4 (0.27%) had moderately severe depression, 11 (0.73%) had moderate depression, and 113 (7.52%) had mild depression. There was no association of severity of depression with gender, grade of acne (and postacne scars), duration of acne, and treatment received.

Conclusion:

Acne and postacne scars are associated with a significant prevalence of depression among adolescents with acne independent of treatment received. Clinicians should consider incorporating depression screening and referral system in their workflow with adolescents who access them for acne treatment to achieve better clinical outcomes.
Early Neonatal Dermatoses: An Epidemiological Study from a Tertiary Care Center in Western Rajasthan
Authors: Choudhary Paras , Mehta Rajesh D. , Singh Kamaldeep , Mahla Vikas , Ghiya Bhikam C. , Sharma Divya , Dhanwal Ashok
Published: July 2023

Background:

The spectrum of cutaneous manifestations during the neonatal period varies from transient self-limiting conditions to serious life-threatening ones. Transient and pathological neonatal dermatoses should be differentiated from physiological changes to avoid unnecessary treatment and to relieve parent’s stress.

Purpose:

The aim of this study was to determine the incidence and patterns of various dermatoses in early neonates and correlate these changes with maternal or neonatal factors; in the west region of Rajasthan, India.

Methods:

This hospital-based prospective study at a tertiary-level referral teaching medical center entailed recording detailed dermatological examination of 5000 early neonates having any physiological and/or pathological cutaneous changes.

Results:

A total of 5000 newborns were observed, there were 3248 (64.96%) male and 1752 (35.04%) female. Out of the total, 67.36% were full-term birth, whereas 30.44% were preterm and 2.2% were postterm newborns. Physiological skin changes (92.42%) were more commonly observed as compared to pathological changes (45.1%). The physiological skin changes observed in the order of frequency were sebaceous hyperplasia (65.32%), milia (51.12%), and physiological scaling (41.02%). Cutis marmorata (2.06%) and harlequin skin changes (1.06%) were seen more in preterms, weighing <2.5 kg. Miliaria was observed in 39% of neonates, due to the hot and humid environment at our place. Bullous impetigo was the most common infection observed in 199 neonates. The most common iatrogenic complication was caput succedaneum; noted in 160 neonates.

Conclusion:

Neonatal dermatoses are mostly transient and physiological, but these innocent dermatoses need to be differentiated from serious and aggressive pathological dermatoses to avoid unnecessary therapy.
Clinicopathologic features, chronic renal damage, and short-term outcomes of glomerular diseases in a middle east tertiary care center
Authors: Abdulaziz Hoda M.M. , Sayed-Ahmed Nagy , Atwa Dina A.I. , Nassar Mohammed K.
Published: July 2023

Background

Glomerular diseases (GDs) place a significant burden on patients and health care systems, and they are a leading cause of end-stage renal disease (ESRD) globally. There is no national register for GDs in Egypt, and the outcomes of GDs are not extensively examined. As a result, studying GD patterns and outcomes, as well as the association between chronic renal injury at presentation and GD outcomes, was of great interest.

Patients and methods

Patients with biopsy-proven GDs presenting to an Egyptian tertiary care center were enrolled and prospectively followed up for 6 months, until death or reaching ESRD. Chronic renal damage was assessed at diagnosis by calculating the total renal chronicity.

Results

A total of 66 individuals with biopsy-confirmed GDs were enrolled in the study. Unexplained decrease in kidney function (62%), subnephrotic (23%), and nephrotic presentation (15%) were the most common reasons for a renal biopsy. The most common histological patterns were diffuse proliferative glomerulonephritis (GN), membranoproliferative GN, and sclerosing GN. Primary and secondary GDs made up 30.3 and 69.7% of the cases, respectively. At the end of the 6-month follow-up, 28 patients had recovered their renal function, 19 had advanced to ESRD, and seven had died. Hemoglobin level and the total renal chronicity score were the best ways to predict how well the kidneys would get better.

Conclusion

In this tertiary care center Egyptian cohort, secondary GDs appeared to be more frequent than primary GDs, diffuse proliferative GN was the most common histopathological pattern, and rapid renal recovery was not the rule in this short period. The renal chronicity score could accurately predict the renal outcome.
Fibronectin type-III domain-containing protein 5 genetic polymorphism and serum irisin-level change in relation to type-2 diabetes mellitus with diabetic nephropathy
Authors: Kamel Samar M. , Ahmed Nagwa S. , El Moety Muhammed A.A. , El Hameed Nayel A.
Published: July 2023

Background

Diabetes mellitus (DM) is a group of metabolic disorders that are defined by the presence of levels over a prolonged period. Many complications arise from the long-term standing of hyperglycemia, among which is diabetic nephropathy. Irisin is a newly described exercise-mediated myokine that regulates energy metabolism by converting white into brown fat. Irisin is produced upon cleavage of the precursor plasma membrane protein fibronectin type-III domain-containing protein 5 (FNDC5) and enters the circulation. Irisin was found to be associated with renal functions in chronic kidney disease patients and diabetic nephropathy patients.

Patients and methods

This study was conducted on 69 Egyptian adult patients (50 females and 19 males), including 53 patients of type-2 diabetics (38 diabetics only and 15 diabetic nephropathy) and 16 healthy controls matched with the patients for the ethnic and demographic characteristics. Serum irisin and insulin were evaluated by enzyme-linked immunosorbent assay. Genomic DNA was genotyped for FNDC5 rs3480 polymorphism using TaqMan genotyping assay.

Results

We found that irisin level was lower in T2DM (mean±SD=13.11 + 38.14) and diabetic nephropathy (mean±SD=24.99 ± 48.8) patients than controls (mean±SD=13.39 + 26.2) with no significance. The results of our study showed no association between the FNDC5 rs3480 genotype AG [in comparison between control and diabetic nephropathy odds ratio=0.5 (0.1–2.2) with P=0.5]. Also, the AA genotype [odds ratio=2.6 (0.59–11.06), P=0.2] did not show a significant effect on nephropathy in T2DM.

Conclusion

This study demonstrated that FNDC5 gene rs3480 A>G polymorphism provides a weak risk with no apparent significance of nephropathy on T2DM without effect on serum irisin level. T2DM is associated with decreased levels of circulating irisin, but it was increased in diabetic patients with nephropathy.
Current approaches in managing pregnancy in kidney transplant recipients
Authors: Alalawi Fakhriya , Belal Dawlat , Sharma Ajay , Halawa Ahmed
Published: July 2023

End-stage renal disease impacts fertility, causing functional menopause in female patients. Within 3 months of successful renal transplant, menstrual function normalizes, ovulation recommences due to improved hypothalamic–pituitary–ovarian axis function, and, thereby, fertility is restored in 80–90% of women in the childbearing age group. In such circumstances, any unplanned pregnancy poses a significant risk to the mother and the child, and the allograft. Pregnancy, in general, does not negatively impact long-term allograft function or survival if the baseline function of the allograft is excellent. Risk predictors of clinical adverse outcomes and graft loss during pregnancy include short transplant–pregnancy interval, preconception graft function, hypertension, preconception proteinuria, and preeclampsia. The recommended and safer maintenance immunosuppressive regimen during pregnancy is calcineurin inhibitors (CNI) (tacrolimus/cyclosporine), azathioprine, and steroids. Sirolimus/everolimus and mycophenolate mofetil should be withdrawn 6 weeks before planned conception. To avoid acute rejections, drug levels should be monitored closely, and the dosage should be modified to reach the recommended target level. Addressing contraception must be a crucial component of the pretransplant counseling process to prevent premature unplanned pregnancies. Mechanical contraceptives are safe for transplant recipients, convenient, and easy to use, with no concerns regarding interaction with immune suppressants; nevertheless, their efficacy depends on user compliance which is difficult to achieve in most cases. However, combined oral contraceptives and progestin-only contraceptives have an inhibitory effect on P 450 3A4, thus increasing the concentration of CNIs particularly cyclosporine. Furthermore, CNIs, in particular, tacrolimus, have an inductive effect on P 450 3A4, potentially reducing the contraceptive efficacy. Therefore, successful pregnancy depends on thorough prepregnancy counseling, careful family planning, and multidisciplinary teamwork. Breastfeeding is not contraindicated and should not be discouraged.