bluuebunny/crossref_metadata_2025 huggingface dataset:
L’apport des actions cyberélectroniques aux opérations de déception tactiques et opératives
Authors: Hémez Rémy , Namor Anthony
Published: October 2022

À l’heure du combat infovalorisé, jamais les technologies de l’information n’ont offert aux armées une telle capacité à réagir, se coordon­ner, collaborer en temps réel au combat. Paradoxalement, jamais leur em­preinte numérique et leur dépendance à l’information n’ont été aussi impor­tantes. Quelles en sont les conséquences pour l’art de la déception aux niveaux tactique et opératif ? Cet article propose une revue des apports de la manœuvre cyberélectronique aux procédés de déception. Ainsi la dissimulation repose désormais sur la maîtrise, voire la déformation de sa propre empreinte élec­tronique. Les capacités de leurrage cyberélectronique ouvrent quant à elles un large champ de possibilités pour altérer les perceptions et l’environnement informationnel de l’ennemi. Enfin, le jugement-même de l’ennemi peut être attaqué à l’aide d’outils numériques permettant de le cibler et de le tromper avec une efficacité redoutable. Les effets dans les champs immatériels seront sans conteste une arme essentielle du combat de demain.
Effect of boron treatment on the microstructure and toughness of Ti-containing steel weld metals
Authors: Cui Zhan-Hang , Wang Bing-Xin
Published: October 2022

Ti-containing steel weld metals with boron addition contents of 0-85 ppm were prepared, and their microstructural characteristics as well as the impact toughness were investigated. The results show that in these microstructures, compared to the weld metal without boron, the addition of 22-39 ppm boron results in a remarkable increase in the amount of acicular ferrite at the expense of grain boundary ferrite, idiomorphic ferrite and side-plate ferrite. However, with a further increase in the boron content up to 61-85 ppm, the bainitic ferrite is formed, accompanied with a drop in the amount of acicular ferrite. In the acicular ferrite, the size of martensite-austenite (M/A) islands is much smaller, and the amount is much lower than those found in the bainitic ferrite. In the case of the weld metals primarily composed of acicular ferrite, during the fracture of the impact specimens, the crack propagation path is more bent in comparison with the weld metals with large amounts of grain boundary ferrite, idiomorphic ferrite, side-plate ferrite or bainitic ferrite, which that the presence of acicular ferrite improves the toughness of the weld metals. The coarse martensite-austenite islands readily induce micro-cracks at the interface between martensite-austenite islands and ferrite matrix, deteriorating the toughness. The weld metals with B contents of 22-39 ppm exhibit outstanding impact toughness because of high amount of acicular ferrite, accompanied with fine martensite-austenite islands.
Efficient Hybrid Classification Approach for COVID-19 Based on Harris Hawks Optimization and Salp Swarm Optimization
Authors: Issa Abubakr , Ali Yossra , Rashid Tarik
Published: October 2022

Feature selection can be defined as one of the pre-processing steps that decreases the dimensionality of a dataset by identifying the most significant attributes while also boosting the accuracy of classification. For solving feature selection problems, this study presents a hybrid binary version of Harris Hawks Optimization algorithm (HHO) and Salp Swarm Optimization (SSA) (HHOSSA). The HHOSSA was tested against two well-known optimization algorithms, the Whale Optimization Algorithm (WOA) and the grey wolf optimizer (GWO), utilizing 280 2D X-ray images from the Posteroanterior (PA) chest view dataset for normal and covid-19 patients. A total of three performance metrics (Recall, Precision, F1) were employed in the studies with Support vector machines (SVMs), k-Nearest Neighbor (KNN), and XGBoost as classifiers. The suggested algorithm outperforms SVM by 96%, and two classifiers, XGboost and KNN, by 98%.
Life Expectancy Prediction through Analysis of Immunization and HDI Factors using Machine Learning Regression Algorithms
Authors: Lakshmanarao A , A Srisaila , T Srinivasa Ravi Kiran , G Lalitha , K Vasanth Kumar
Published: October 2022

One of the most crucial elements in end-of-life judgment is life expectancy. For example, good forecasting aids in determining the course of therapy and planning for the acquisition of wellness services and infrastructure. Physicians, on the other hand, tend to overestimate life expectancy, missing the window of opportunity to begin a plan of care. This study examines the feasibility of estimating life expectancy from a WHO dataset collected from Kaggle using machine learning techniques. Even though much research has been conducted in the past on factors influencing life expectancy, including demographic factors, economic distribution, and death rates. It was observed that the impact of immunizations on the standard of living was not previously considered. In this paper, we analyzed life expectancy based on various features, including immunization features (Polio, Hepatitis B, Diphtheria, etc..), HDI factors (schooling, GDP, etc.) of various countries for 15 years period. We also proposed machine learning algorithms for the prediction of life expectancy. We applied regression algorithms logistic regression, SVM, Decision Tree, and random forest regression and achieved a good r-squared value with the random forest algorithm.
« La tragédie des années 70 » : La nomination de la dictature argentine et ses enjeux discursifs et politiques
Authors: Montero Sol
Published: October 2022

Le but de cet article est de réfléchir sur les opérations discursives mises en jeu dans l’espace public pour nommer les événements du passé, en l’occurrence la dictature militaire argentine. Ainsi, l’article s’attache à analyser l’émergence et la circulation d’un des noms historiques circulants (en cooccurrence avec d’autres, plus ou moins officiels), celui de « tragédie des années 70 », dans un corpus d’éditoriaux et d’articles d’opinion ainsi que d’un ensemble d’ouvrages de vulgarisation historique. J’identifie quatre représentations associées à ce nom, en en dégageant les enjeux sociaux et politiques : un double mouvement de référencement et d’indétermination chronologique ; une uniformisation des victimes et un effacement de l’agentivité et des responsabilités ; une image du passé dictatorial comme une « plaie béante » à suturer dans le présent ; une caractérisation de la période comme effrayante et sanglante.
Enjeux argumentatifs des structures énumératives longues : analyse d’un corpus de tribunes consacrées à la biodiversité
Authors: Chandelier Marie , Paissa Paola
Published: October 2022

Le caractère multifactoriel de la crise environnementale favorise le recours au procédé de l’énumération dans un contexte argumentatif. À travers un corpus de 131 tribunes publiées dans le quotidien Le Monde entre 2006 et 2018, contenant au moins une fois le mot « biodiversité », nous présentons une analyse des fonctions rhétoriques de l’énumération longue. Nous avons distingué les énumérations visant à alerter de la gravité de la crise environnementale de celles dont la vocation est d’inciter à l’action. Nous traitons enfin des cas où l’énumération amplificatrice, utilisée par l’énonciateur, s’accompagne d’une critique du procédé. Nous montrons que la fonction d’amplification est systématiquement renforcée par des nominations axiologiques en amorce ou en clôture. Ces nominations structurent l’énumération selon un principe de cohérence relevant de l’émotion, sans apporter d’information sémantique sur les liens existant entre les entités constitutives de la crise environnementale contemporaine.
Contribution of the Women’s Cooperative Societies for Living Standards of Rural Family Life
Authors: Jayawardena A. M. A. , Rathnasiri R. A.
Published: October 2022

Poverty has become a global women’s issue, as majority of the world’s poor are women due to various reasons. In Sri Lanka, poverty number refers to the percentage of individuals whose household per capita consumption below the official poverty line. Sri Lanka has among the lowest extreme poverty rates among countries in the region. The past studies exhibits the contribution of Micro Finance Institutions, Samurdhi Program and other government programs as means of poverty alleviation but, there are no research on the Women’s Co-operative Societies and their role in rural community . In the present study, the researcher is focusing on to capture the contribution of Women’s Cooperative Society on uplifting living standards of rural families of Sri Lanka. The purpose of the study is to identify the impact of Women’s Co-operative Society on standard of living of rural community of Sri Lanka. Hence, it is identified four independent variables namely, loan size available to members, size of savings kept at the society, number of dependents of the family and years of membership with the society to measure the impact of Women’s Cooperative Society and one dependent variable namely, average monthly expenditure of the family to measure the living standards of rural family life. The results of correlation analysis revealed that the correlation between all four variables and living standards of rural families were significant and the results of multiple regression analysis revealed that the loan size available to members and number dependents are only significant in determining the relationship between living standards of rural families and the women’s cooperative society. These findings can be helpful for policy makers in the field of cooperative societies in designing their services further in the future.
Farmer Perception, Environmental Awareness, and Overuse of Fertilizer in Kalpitiya: A Preliminary Investigation using Bayesian Econometrics
Authors: De Silva L. H. N. , Edirisinghe J. C. , Udayanga N. W. B. A. L. , Gimhani D. R.
Published: October 2022

Overuse of fertilizer has long been identified as a major issue in many parts of the world, including Sri Lanka. Sandy regosol soil and the shallow groundwater table in Kalpitiya, has aggravated the impacts of extensive fertigation, raising doubts on the long-term socioeconomic and environmental sustainability of intensive agricultural systems of the region. In this background, this study attempts to determine the driving factors influencing the overuse of fertilizer within the farming community in Kalpitiya. Primary data collected from face-toface interviews with 107 farmers from Kalpitya area using a pre-tested questionnaire was used to estimate a Bayesian probit model with sufficiently diffuse normally distributed priors. The model was estimated using a Random Walk Metropolis-Hastings sampling method, which iterated 125,000 times and 25,000 were discarded as burn-in. Results reveal that farmers who perceive that fertilizer has no effect on soil and groundwater tend to move away from fertilizer recommendations and are overusing. Farmers who are aware and believe that ground water is contaminated in the area tend to apply the recommended amount of fertilizer. In addition, larger farmers seem to apply recommended dosages than smaller farmers. Raising awareness through proper extension services and creating economic disutility by increased fertilizer costs coupled with the introduction of organic fertilizer could be recommended to circumvent the ill effects of overuse of fertilizer.
Evaluation of the Potential of Fungal Acid Proteases of Aspergillus flavus, Aspergillus niger and Penicillium sp. to Produce Shrimp-Waste Protein Hydrolysates with Degraded Antigenic Proteins
Authors: Gamage M. , Liyanage N. , Pathirana I. , Ediriweera S. , Prabodha L.
Published: October 2022

The waste produced by the shrimp industry can be a great source for the recovery of important bioactive compounds with potential applications in food industry. The present study aimed to characterize extracted proteases of Aspergillus flavus, Aspergillus niger and Penicillium sp. to be utilized as potential sources to produce shrimp waste protein hydrolysates with degraded antigenic proteins. The extracellular fungal acid protease enzymes were extracted under solid substrate fermentation and partially characterized the enzyme activities, concerning the reaction temperature and pH of the reaction medium. Then, the capabilities of extracted fungal protease enzymes to reduce the potential allergens of shrimp waste protein hydrolysates were examined by SDS-PAGE. After incubation of all three fungal species at 37°C and pH 3.0 for 5 days, the highest protease yield, 527.40 μg/mL was achieved from A. flavus. The optimum temperature for A. flavus for the highest protease activity was 45°C, while for other two microorganisms the optimum temperature was 50°C. The optimum pH values for all three proteases were pH 3. According to the SDS-PAGE protein hydrolyzing patterns, the crude acid protease extracted from A. flavus was the best protease to degrade the potential antigenic proteins over the other two acid proteases extracted from A.niger and Penicillium sp., while all three enzymes had shown the potential to reduce the allergenic capacity of shrimp waste proteins through enzymatic hydrolysis.
Clinical Spectrum and Outcome of Guillain-Barré Syndrome with Plasmapheresis
Authors: Bano Safia , Sardar Zomer , Ahmar Muhammad , Liaquat Sumayyah , Shafiq Bilal , Numan Ahsan
Published: October 2022

Context:

Guillain-Barré syndrome (GBS) is an acute inflammatory neuropathy and has several electrophysiological subtypes and clinical variants. Treatment is mainly supportive and immunotherapy is given to shorten the disease course.

Aims:

The aim of this study was to define the outcome of GBS with plasmapheresis and to determine its clinical spectrum.

Materials and Methods:

The prospective study was done at Mayo Hospital, Lahore, for 1 year from November 2020 to November 2021. The diagnosis of GBS was made on Brighton criteria for GBS. The outcome of therapy was assessed at 3 and 6 months, using the Medical Research Council Scale and Hughes Functional Grading Scale (HFGS).

Results:

A total of 50 patients were enrolled in the study. Twenty-seven (54%) were males and 23 (46%) were females. Seventeen (34%) had acute motor axonal neuropathy, 16 (32%) had acute motor and sensory axonal neuropathy, 15 (30%) had acute inflammatory demyelinating polyradiculoneuropathy, and 2 (4%) had Miller-Fisher syndrome. Plasmapheresis was done in all patients. HFGS score was assessed at discharge, at 3 months, and after 6 months of illness onset. The improvement in mean HFGS score was 2.79 ± 0.41 at 3 months and 1.94 ± 0.25 at 6 months of symptoms onset from the mean score of 3.46 ± 0.93 at the time of discharge from the hospital.

Conclusion:

Excellent outcome was observed after plasmapheresis. Majority of participants were able to walk without support at the 6-month follow-up. Plasmapheresis should be initiated early in the management of GBS where intravenous immunoglobulins are costly.
Study of gonococcal and chlamydial urethritis: Old culprits with a new story
Authors: Bharara Tanisha , Bhalla Preena
Published: October 2022

Introduction:

Neisseria gonorrhoeae and Chlamydia trachomatis are the primary pathogens causing urethritis. A cross-sectional study was carried out in the Department of Microbiology in conjunction with the Department of Dermatology and STD of our hospital. The aim of the study was to detect N. gonorrhoeae and C. trachomatis among men with urethritis and to determine the anti-microbial susceptibility of the N. gonorrhoeae isolates.

Material and Methods:

All cases were subjected to direct Gram’s smear examination and culture of urethral discharge (N. gonorrhoeae), real-time polymerase chain reaction and direct fluorescent antibody test (C. trachomatis). All N. gonorrhoeae isolates were subjected to anti-microbial susceptibility testing and were tested for ß-lactamase production by chromogenic cephalosporin test.

Statistical Analysis Used:

Data were expressed as percentages. Fisher’s exact test was used to evaluate statistical significance in the case of unpaired categorical data. Agreement between the methods was assessed by using kappa statistics.

Results:

Gonococcal infection was detected in 58.1% cases, and C. trachomatis was detected in 14% cases. However, both were detected in 12% cases. The sensitivity, specificity, positive predictive value, and negative predictive value of direct Gram’s smear examination and culture of urethral discharge were found to be 100% when compared to culture for N. gonorrhoeae. Direct fluorescent antibody (DFA) test proved to be a valuable test aiding in the diagnosis of chlamydial urethritis with a majority of positive cases showing 20–30 elementary bodies. We detected our first gonococcal isolate with decreased susceptibility to third-generation cephalosporins, ceftriaxone, cefixime, and cefpodoxime (MIC for ceftriaxone = 0.19 mg/ml).

Conclusions:

Optimal management of urethritis and strategies to prevent its transmission depend on accurate detection of infected persons. Our study demonstrates the utility and limitations of different laboratory tests including anti-microbial sensitivity testing for N. gonorrhoeae and C. trachomatis.
Awareness, attitude, and practice of evidence-based medicine among primary healthcare physicians in Buraidah, Saudi Arabia
Authors: Almatrudi Thamer A. , Rabbani Unaib
Published: October 2022

Context:

Evidence-based medicine (EBM) is essential for safe and cost-effective care provision to the population.

Aims:

To assess the awareness, attitude and practices and barriers among primary care physicians about EBM in Buraidah, Qassim.

Settings and Design:

Cross-sectional study in Primary Health Care centers (PHCCs) of Buraidah, Qassim.

Materials and Methods:

The study was conducted among physicians working in PHCCs of Buraidah. Data were collected online through Google forms.

Statistical Analysis Used:

Descriptive analysis was carried out to measure the frequencies and proportions. Chi-square test was used to compare barriers based on gender, academic degree, and experience categories.

Results:

A total of 96 out of 144 physicians (66.7%) responded to the invitation. About 82.3% of the participants welcomed the promotion of EBM and 92% of the physicians knew about concept of EBM. About 94.8% of the physicians agreed that EBM will improve patient outcomes. The reported barriers were; patient load (87.5%), time availability (70.8%), computer availability (33.3%), internet availability (45.8%), and 56.3% stated updated clinical letters, journals, or guidelines are not available.

Conclusions:

This study found that there was high self-reported knowledge about the EBM concept; however, the knowledge about tools was poor. A number of barriers were found such as patient load, time, availability of clinical guidelines and journals and other resources such as internet and computers. Primary care physicians should be trained and facilitated for EBM.
‘Daily 2-only meals and exercise’ lifestyle modification for remission of type 2 diabetes mellitus: A therapeutic approach
Authors: Dixit Jagannath V. , Giri Purushottam A. , Badgujar Shraddha Y.
Published: October 2022

This case series has documented five patients diagnosed with type 2 diabetes (T2D), referred to the various Diabetes Reversal Centers of the ‘World free of obesity and diabetes’ campaign in Maharashtra, India. It demonstrates the therapeutic effects of lifestyle modification for remission of diabetes along with weight reduction and reversal of insulin resistance. This resulted in reduction of their glycated haemoglobin level, which signified the long-term effects of this lifestyle modification. Diabetes reversal by lifestyle modification is a healthier option and must be encouraged in all the patients in the pre-diabetes group (HbA1c- 5.7–6.4%) and those with newly diagnosed type 2 diabetes mellitus (HbA1c- >6.5%) without any complications, thus promoting good health seeking behaviour. There are pieces of evidence of complete diabetes reversal of the patients with HbA1c ranging from 8 to 15% by just lifestyle modification and also without any complications among the patients registered under the ‘World free of obesity and diabetes’ campaign. India is a low-middle-income country with prevalence of T2D on rise. It is thus necessary to provide the community with a cost-effective and sustainable solution for primary and secondary prevention of this lifestyle disease.
Post COVID-19 clinical manifestations and its risk factors among patients in a Northern District in Kerala, India
Authors: Raj Aswathy S. V , Jacob Abraham , Ambu V , Wilson Tom , Renuka R
Published: October 2022

Background:

The novel virus SARS-CoV-2 has caused a pandemic of coronavirus disease 2019 (COVID-19). There is emerging evidence of post-COVID-19 manifestations among patients who sustain acute COVID-19. Most studies report fatigue, dyspnea, and myalgia as the common symptoms; however, currently, there is limited knowledge of these post-COVID manifestations and their risk factors, especially in India.

Methods:

A descriptive cross-sectional study was conducted among patients who had attended the district post-COVID clinic, Wayanad district, Kerala, from October 2020 to June 2021. Data were collected by direct/telephonic patient interviews and from their existing case records, using a pretested semi-structured proforma.

Results:

The sample size was 667. The mean age of the study population was 45 years (standard deviation [SD]: 14.55). The majority of the population presented with dyspnea (48%), fatigue (32%), and cough (25.6%). Mental health problems were also reported in 6% of participants. The respiratory system was commonly involved (61.2%). Around one-third of the patients (36.4%) had dyspnea on exertion and 11.8% had dyspnea at rest. One-fifth of the population reported aggravation of pre-existing co-morbidity and half of the respondents had persistence of at least one symptom after 6 months. There exist statistically significant associations between identified risk factors, especially gender, increasing age, the severity of COVID-19 infection, history of tobacco/alcohol use, and co-morbidities with outcomes.

Conclusion:

As post-COVID syndrome is a multisystem disease, integrated rehabilitation is required with targeted intervention for survivors based on their symptoms and needs.
Occurrence and clinical features of HIV and malaria in co-infected individuals in Osun State, Nigeria
Authors: Adeola Oyeniran O. , Kolawole Oladipo E. , Yemi Abiodun F. , Hilda Awoyelu E. , Samson Adu T. , Kola Oloke J.
Published: October 2022

Introduction:

Human immunodeficiency virus (HIV) and malaria infections are among the major public health concerns in sub-Saharan Africa, where they are associated with high morbidity and mortality. The study was conducted to assess the occurrence and clinical features of HIV and malaria in co-infected individuals in Osun State, Nigeria.

Methods:

The study was cross-sectional, which involved 422 participants who were administered structured questionnaires for socio-demographic and clinical data. Venous blood was collected for malaria parasite detection and count from One hundred and seventy-four HIV seropositive individuals. They were re-examined clinically for HIV diagnosis, CD4
+ T cell counts, and packed cell volume (PCV).

Results:

The mean age of the participants was 28.48 ± 15.38 while the overall predominance of malaria among the HIV-positive patients was 11.5% (20/174). The malaria prevalence was significantly higher in female patients (P = 0.0088) and occupational status among students (P = 0.0001). Malaria/HIV co-infected patients had a significantly lower mean value of PCV (P = 0.0001), CD4
+ cell count (0.0001), and temperature (0.0001) compared to HIV-infected patients having no malaria.

Conclusion:

The study showed that females had relatively higher malaria infection compared to their male counterparts. To achieve better management of HIV patients against malaria infection, proper preventive measures, antiretroviral therapy (ART), and chemoprophylaxis are a useful strategy to put in place. Also, the monitoring of CD4
+ cell count, viral load, and some hematology indices on a regular basis is crucial.
Multi-organ system involvement in coronavirus disease 2019 (COVID-19): A mega review
Authors: Moslehi Naghmeh , Jahromy Mahsa Hadipour , Ashrafi Pegah , Vatani Kimia , H. Nemati Mohammad A. , Moghadam Parnian A. , Rostamian Fatemeh , Jahromi Mana H.
Published: October 2022

Since the pandemic of the coronavirus disease 2019 (COVID-19) infection, many people have been affected in different ways. The majority of infected people experience mild to moderate symptoms and recover without the need for hospitalization. However, in some affected people, it may lead to catastrophic disease. The severity of COVID-19 infection is widely influenced by co-morbidities, immune system functions, and extra-pulmonary organ injuries. Since the emergence of COVID-19, multi-organ involvement has been documented. In order to implement preventative and protective measures, full attention to potential organ injuries is required. Most existing articles and review papers are focused on a specific organ system, and their numbers are growing. In this review paper, attempts were made to collect review papers and articles published on seven organ system involvements in COVID-19 infection published till 15 July and highlight conclusions and managements of all affected organs. We tried to add to the medical knowledge on COVID-19, pointing out its multi-organ system impact. Finally, we tried to facilitate access to organized information and optimum conclusion by representing review tables for each organ system. Besides, this review article can clarify and magnify the empty research space easily for future investigations.
Computer vision syndrome: Symptoms, risk factors, and practices
Authors: Alamri Abdulrahman , Amer Khaled A. , Aldosari Abdulrahman A. , Althubait Basel M. S. , Alqahtani Mushary S. , AL Mudawi Abdulrahman A. M. , AL Mudawi Bandar A. M. , Alqahtani Faisal A. M. , Alhamoud Nawaf S. Y.
Published: October 2022

Background:

According to computer vision syndrome (CVS). Due to constant use of computers by the students, it has become one of the growing health risks associated with technology (cell phones and tablets). CVS is a combination of eye and vision disorders associated with activities that affect near vision and is experienced in relation to or during the use of computers. The main aim of the study was to find the risk factors of CVS, its symptoms, and other factors associated with CVS.

Materials and Methods:

In this cross-sectional study, data was collected using a purposely constructed E-questionnaire. The questionnaire consisted of demographic items and items related to the usage of E-devices and the symptoms of eye problems. After data collection, data was coded and entered in the Statistical Package for the Social Sciences (SPSS) ver. 20 software for analyses. Descriptive statistics (mean and standard deviation, frequencies and percentages) were computed. To measure the significant differences, Chi-square test was used at 5% level of significance.

Results:

The mean (SD) age of 400 respondents was 22.5 (11.5) years. We computed the internal consistency, and the overall Cronbach alpha was 0.81. Also, 40% of the respondents were females, while 60% were males. Results showed that 20% of the respondents had multiple symptoms of eye problems, while 9% had no symptoms, 9% had eye pain, 8% had dryness of eye, and 6% had watering of eyes and redness of eye symptoms. The rest of the symptoms was found in less than 5% of the respondents.

Conclusion:

This worldwide issue requires immediate attention. Long-term computer use has been linked to significant visual impairments, particularly in people who use computers and similar gadgets for extended periods of time.
Prevalence and determinants of hypertension and associated comorbidities in non-pregnant women of reproductive age group (15–49 years): Evidence from National Family Health Survey (NFHS-4), India
Authors: Virk Amrit , Samdarshi Narottam , Saini Parmal , Mohapatra Archisman , Sahoo Soumya , Goel Sonu
Published: October 2022

Background:

Hypertension in women is generally underestimated and undiagnosed as women are considered to be at a lower risk of cardiovascular disease than men in addition to gender-related differences in healthcare seeking behaviour and access to healthcare. As hypertension extends a substantial impact on the cardiovascular health of women and can pose an enormous burden on the healthcare systems in India, identification of its risk factors along with co-morbidities becomes necessary for planning of cardiovascular risk prevention, reduction and mitigation interventions.

Aim:

This study aimed at estimating the prevalence and associated demographic and lifestyle risk factors of hypertension (HT) along with examining comorbidity patterns in women of reproductive age (15–49 years) in India.

Material and Methods:

We analyzed data of 667,258 non-pregnant women of the reproductive age group (15–49 years) from the National Family Health Survey (NFHS)-4 dataset. We used maps to present the spatial patterns of HT in women across states and union territories and logistic regression modelling to identify associated factors.

Results:

The overall prevalence of HT was 10.9% among women (15–49 years), with 60.7% of these having at least one comorbidity. While the prevalence of ‘HT only’ was higher in women 15-29 years of age (48.0%), the prevalence of HT with co-morbidities was higher in women aged ≥30 years (63.3%). Logistic regression analysis showed higher odds of ‘HT and ³ two comorbidities’ with age ³30 years (AOR 3.46, 95% CI 3.23–3.72), higher odds of ‘HT only’ with alcohol consumption (AOR 1.32, 95%CI 1.23–1.42), and higher odds of ‘HT and one comorbidity’ with BMI ³23 Kg/m2 (AOR 1.17, 95%CI 1.14–1.21). Also, region-wise, the prevalence of HT was highest in the states of Uttar Pradesh (11.6%), Madhya Pradesh (8.0%), and Assam (6.9%).

Conclusion:

The high prevalence of HT among women aged 15–49 years has serious medical, socio-economic, implications that warrant urgent and immediate gender-specific healthcare interventions. Along with lifestyle modifications, early and timely screening of HT, increasing awareness among young school-going girls, including rural areas, could flatten the HT population curve in India.
Hypertension and its association with body mass index among the Indian population. Findings from a nationwide survey (NFHS-4), 2015-16
Authors: Sharma Shailja , Singh Harshvardhan , Mehta Kedar , Verma Madhur , Goel Sonu
Published: October 2022

Background:

Globally, hypertension (HTN) and obesity are two cardinal causes of morbidity and mortality. The Asian population shows comorbidities associated with obesity at a much lower body mass index (BMI) than the western population.

Aim:

The primary objective of the present study was to evaluate the association between BMI and HTN among the adult population.

Material and Methods:

We did a cross-sectional secondary data analysis of the NFHS-4 datasets, conducted during 2015–16. We included the adult population, that is, ≥19 years of age (93,040 men and 5,46,066 women), and excluded adolescents and pregnant women from our analysis. HTN was the primary dependent variable, while BMI was the primary predictor variable. Other covariates included age, education, place of residence, wealth index, use of alcohol and tobacco, and diabetes. Weighted analysis was done to depict our results.

Results:

Around 18.7% of men and 13.5% of women were hypertensive, of which 53.86% of males and 38.7% females were either overweight or obese. The odds of living with HTN among obese men and women increased with age, wealth, use of alcohol and tobacco, and comorbidities such as diabetes. The prevalence of HTN was higher even among the underweight adults living with diabetes and those consuming alcohol and tobacco.

Conclusion:

We reaffirm the significant association between BMI and HTN among adults. The use of the Asian classification of BMI for India and its neighboring countries to assess the burden of obesity would help in planning better interventions. A community-based targeted approach would help in controlling and reducing the prevalence of HTN.
The effect of disruption due to COVID-19 on operating room utilization: Experience from a secondary care hospital in Riyadh, Saudi Arabia
Authors: Althaqeel Mamdouh F. , Alshanwani Mohammad N. , Alqahtani Khalid , Khan Mohammad Shibly , Zeidan Zeidan A. , Mohaideen Noorulzaman K. , Albahooth Khalid , Altassan Walid , Alzoman Assem S. A. , Alkhaldi Abdulaziz S.
Published: October 2022

Introduction/Background:

The disruption caused due to corona virus disease-2019 (Covid-19) has affected the overall health care delivery worldwide. The elective services were foremost to face the restrictions and closure, subsequently they were resumed only after adoption on newer protocols.

Aims:

We aimed to estimate the effect of COVID-19 restrictions on operative room utilization.

Methodology:

This is a retrospective descriptive study. The surgical volume indicators were calculated and a comparison was made between pre-COVID-19 (April–June 2019) and COVID-19 phase (April–June, 2020). Pre-operative covid assessment through the RT-PCR test among the cases waiting for elective surgeries.

Results:

Overall surgical volume decreased by 53%, which included 87% decrease in elective procedures and 8% decrease in emergency procedures. The overall OR utilization reduced by 63%. Highest reduction in the surgical volume was noted in bariatric surgery (no surgeries conducted in the COVID-19 phase), ophthalmology (99% reduction), and Ear, Nose and Throat surgery (ENT) surgery (92% reduction). Six patients tested positive for pre-operative RT–PCR from the sample of 261 cases posted for elective surgery during resumption phase of elective services, thereby giving the positivity rate of about 2.2%.

Conclusion:

We found a high level of reduction in the operating room utilization in a secondary care public sector hospital. The pre-operative assessment has enabled to find out the COVID-19 cases and hence preventing the unwanted spread of infection during the surgical procedures.
Geospatial epidemiology of hypertension and its risk factors in India: Findings from National Family Health Survey (2015–2016)
Authors: Saleem Sheikh Mohd , Singh Gurpreet , Zaidi Ilham , Haq Inaamul , Singh Ijyaa , Anjum Sahifa , Singh Mahendra P. , Goel Sonu
Published: October 2022

Background:

The fourth round of National Family Health Survey (2015–2016) measured blood pressure for the first time and provided a unique opportunity of exploring trends in hypertension prevalence across states and districts for the first time.

Aim:

This study will be the first in India to estimate the geospatial variation of hypertension among those in the 15–49 years age group in India.

Materials and Methods:

Out of a total of 616,346 selected occupied households, 601,509 were successfully interviewed, giving a response rate of 98%. We adjusted the proportion of hypertension obtained by using national sample weights. We built a multivariable logistic regression model to assess the determinants of hypertension.

Results:

The overall weighted prevalence of hypertension was 11.7%, and the prevalence was 11.1% in females and 11.0% in males. Urban areas had a higher prevalence (13.0%) compared to rural areas (11.0%). Those with no education (14.4%) and those who reported smoking (16.5%) had hypertension. Consumption of alcohol, fruits, and eggs was also found to be significantly related to hypertension.

Conclusion:

Hypertension epidemic is spreading alarmingly in India across rural and urban populations. Disturbingly, the hypertension prevalence is now becoming more concentrated among the poor. This phenomenon has serious implications for the country’s social and economic well-being. Urgent preventive measures need to be taken at a multidisciplinary level.
Association of single nucleotide polymorphism rs113420705 of CASP3 in children with Kawasaki disease from North India
Authors: Das K Gokul , Bhattarai Dharmagat , Kaur Anupriya , Kaur Anit , Kumrah Rajni , Srivastava Priyanka , Rawat Amit , Singh Surjit
Published: October 2022

Background:

Kawasaki disease is a pediatric, systemic, vasculitic disorder. Its exact etiology is still unknown. Genetic polymorphisms are being investigated as susceptibility factor for this disorder. These are likely to vary among different populations.

Aim:

To investigate the association of single nucleotide polymorphism (SNP) rs113420705 of CASP3 in Kawasaki disease (KD) from North India.

Settings and Design:

Observational, case–control study.

Methods:

Polymerase chain reaction and bidirectional Sanger sequencing was used for determining genotypes of SNP rs113420705 in 45 cases of KD and 50 healthy age- and sex-matched controls. Allele and genotype frequencies were assessed and compared between the groups.

Results:

Among 45 cases, 32 had TT (71.1%), 13 had CT (28.9%) and none had CC genotype of SNP rs113420705. No significant differences in allele, genotype, or carrier frequencies of rs113420705 were found between the two groups. A comparison was also made between subgroups of KD with coronary abnormality (7 children; 15.5%) and KD with normal coronaries (38 children; 84.4%). The C allele was significantly overexpressed in KD with coronary abnormality group (P = 0.005). However, no difference was noted in the genotype frequencies.

Conclusion:

CT genotype of rs113420705 of CASP3 showed a trend to significance with the occurrence of KD in children in North India. However, we could not establish any association between minor allele C and susceptibility to KD. C allele appeared to be over expressed in children with KD with coronary abnormalities. Larger studies will help us to reach conclusive evidence applicable to all ethnicities.
Scrub typhus presenting as cryptogenic organizing pneumonia in a young female: A first case report
Authors: Khanna Shivam , Talwar Dhruv , Kumar Sunil , Acharya Sourya , Hulkoti Vidyashree
Published: October 2022

We report the case of a young female suffering from fever and generalized weakness on presentation and was diagnosed to be a case of cryptogenic organizing pneumonia (COP). She developed breathlessness on rest and required oxygen support and on further evaluation diagnosed with Scrub typhus IgM positive status. This case report highlights the importance of a rare presentation of Scrub typhus in a young female presenting with clinically silent chest changes initially and preventable worse outcomes if detected and managed for scrub typhus infection early in the course of disease.
Development and implementation of a sustainable COVID-19 training package for healthcare workers: Experience from a teaching hospital of North India
Authors: Khan Amir Maroof , Patra Somdatta , Jain Anil K. , Madhu SV , Saxena Ashok , Aggarwal Anju , Suneja Amita , Tyagi Asha , Avasthi Rajnish , Singh Narendra P. , Shah Dheeraj , Dhall Anjana , Kalra Rajesh , Arora Rajesh , Gupta Sanjay , Vaney Neelam
Published: October 2022

Background:

With the impending threat of future COVID-19 waves, it is imperative that teaching hospitals develop, implement, and evaluate a systematic training program to render HCW elastic in delivering COVID-19 related services. We present our experience in developing, implementing, and evaluating a sustainable and scalable COVID-19 patient management training package for healthcare workers.

Materials and Methods:

A mixed-methods study design was used. Rapid assessment to understand the need of the trainees and identify the available resources was done followed by planning of the training module and its implementation. The program was evaluated for effectiveness and sustainability. Data analysis was done using descriptive statistics and qualitative data generated from open-ended questions in the feedback forms and the discussions were analyzed using rapid content analysis.

Results:

A total of 66.8% of the doctors and 18.9% of the nurses were trained by online synchronous mode while 55.0% of the nursing officers and 47.1% of the nursing orderlies and paramedical staff were trained in onsite skill development sessions. Need assessment identified that healthcare workers were ill-prepared to use medical devices such as Bipap machines, ventilators, and oxygen delivery devices. The participants mentioned that the multidisciplinary approach and video-based demonstrations facilitated their online learning while the incremental learning approach, easy-to-understand terminology and hands-on experience facilitated their onsite skill development sessions.

Conclusion:

The COVID-19 training package developed was multidisciplinary, effective, sustainable, and scalable in a resource-limited setting. We suggest that this model can be adapted by healthcare organizations to develop and implement such training packages for their healthcare workers.
Association between high-sensitivity-CRP and liver elastography and cardiac ischemic diseases in patients with fatty liver
Authors: Nayebi Morteza , Seyedian Seyed Saeed , Hashemi Seyed Jalal , Parsi Abazar , Hajiani Eskandar
Published: October 2022

Objective:

Inflammatory markers are among the possible contributing factors with a proposed role in hepatic and ischemic heart disease. The present study aimed to determine the association between high-sensitivity-C-reactive protein (hs-CRP), liver elastography, and cardiac ischemic diseases in patients with fatty liver.

Methods:

In this cross-sectional comparative study, 103 consecutive patients with fatty liver were enrolled to undergo angiography. They were divided into groups with and without cardiac ischemia.

Results:

The results demonstrated that the mean hs-CRP was 2.3 and 10.9 mg/L in normal and ischemic angiography groups, respectively (P = 0.001). According to the receiver operating characteristic (ROC) analysis, the predictive role for hs-CRP was 94.5% that had sensitivity and specificity of 95.2% and 90%, respectively, with a cut-off point of 3.1.

Conclusion:

This study showed that there is an association between the fatty liver, cardiac ischemia, and hs-CRP level.
Self-health assessments in Saudi Arabia: Directions for an integrated primary healthcare
Authors: Salam Asharaf Abdul
Published: October 2022

Background:

Public health data for dissemination and discussion in Saudi Arabia, for the purposes of primary healthcare, are limited but the new initiatives of General Authority of Statistics creates many national surveys. One of the most recent one, the Family/Household Health Survey - 2017 aims to fill the gaps, at the same time, aids in discussions on primary healthcare.

Objectives:

Analyses done in this research are aimed at appraising the self-assessed health and to examine age-sex and geographic differentials and their probable interconnections with chronic diseases, injuries, and periodic examinations.

Data and Methods:

This survey conducted in October–December, 2017 covered both native and foreigner households from all the 13 administrative areas through a random sample procedure involving primary sampling units and secondary sampling units. A portion of the published data on self-assessment of health, chronic diseases, injuries, and periodic medical examinations were analyzed.

Results:

More than half of the persons in the Kingdom, reportedly, are in good health; more so among females than males: proportions decreased with increasing age up to 40 years, thereafter increased sharply. Moreover, the major regions have lesser proportion of people with good health. Prevalence of chronic diseases increases with age, in both total and native population, but with variations across specific diseases – hypertension, diabetes, cancer, and cardiovascular diseases (CVDs) and with geographic differentials. On the other hand, there are injuries (from traffic accidents and others) occurred at house, work/school, public place, and other places; pertinent with geographic variations. Moreover, age, sex, and regional differences in periodic health examinations have a contributing effect on health assessments. Moreover, the median age shows a pattern resembling adults assessing good health; chronic diseases after 50s; injuries before 40s; periodic medical examinations in 50s; with females at a lower age, in both groups of population.

Conclusions:

The national health system played an important role not only in health status and health assessments but also in building confidence and trust and thereby enhancing optimism, realism, recognition, self-awareness, and acceptance of physical condition. Thus, age, sex, and regional variations in health assessment are born out of chronic diseases, injuries, and periodic medical examinations and also of expectations and experiences. Generation of such information, effective dissemination, and regular discussions at various levels followed by in-depth analyses raise the primary healthcare and thus the population health.
Elder care: The need for interprofessional collaboration between Family Physicians, Clinical Pharmacists, and Physiotherapists in home-based primary care teams
Authors: Anwari Colis , Balasubramanian Swaathi , Sawant Prathamesh S. , Kuri Ushnaa , Anand Ashoojit K. , Rao B. C. , Prasad Ramakrishna
Published: October 2022

Background:

Elderly patients with pain and falls are commonly seen in family practice.

Aims:

(1) Highlight the role of a physiotherapist in the primary care team; (2) Discuss the collaboration between a family physician clinical pharmacist dyad and the physiotherapist that emerged; and (3) Share practice tools that emerged from our teamwork.

Settings and Design:

Home Based Primary Care Practice (a core component of family practice). We have described our home based primary care practice model in earlier publications. Our model utilizes a team based approach to address the prevention of diseases, promotion of health, provision of care for acute and chronic conditions (especially concurrent multi morbidity), and delivery of rehabilitation services in the home setting.

Methods and Materials:

Selection of three cases from our daily practice. Reflective discussion and learning towards arriving at novel insights and improving our care model.

Results:

Case discussion from the perspectives of the family physician, clinical pharmacist, and physiotherapist reveal important insights on the roles, responsibilities, benefits and tensions. A process flow to facilitate team based care is also outlined along with a referral communication tool.

Conclusion:

For our population of the elderly with falls and pain, there was a need for a physiotherapist, as part of the team, instead of a mere referral service. This was felt because of the growing needs of patients, multiple gaps in communication with external referrals, mismatch of values and approaches, and missed opportunities for high quality care. This enhances access, optimizes clinical outcomes, delivers patient centred care, reduces unnecessary hospitalizations, and avoids catastrophic and unwarranted costs. The paper highlights the critical need for interprofessional collaboration between family physicians, clinical pharmacists and Physiotherapist in elder care.