bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of glycemic status among hypercholesterolemic patients on atorvastatin in a tertiary care hospital – A retrospective study
Authors: Nalini R. , Ramya J. Ezhil , Karthick R.
Published: May 2024

INTRODUCTION:

Statins are effective in reducing low-density lipoprotein cholesterol and are favorable in primary and secondary prevention of cardiovascular disease. Recent large trials have linked the use of statins and increased incidence of new-onset diabetes mellitus, the possibility of worsening of glucose level in individuals with diabetes following statin therapy, and this possibility is increased with the use of atorvastatin. This study was undertaken to analyze the possibility of the diabetogenic potential of atorvastatin among hypercholesterolemic patients.

MATERIALS AND METHODS:

This retrospective cohort study was conducted in the cardiology department from July 2019 to December 2019. Patients on atorvastatin for more than 6 months with normoglycemia on commencement of therapy were included. The occurrence of prediabetes or new-onset diabetes mellitus after atorvastatin therapy is the outcome of the study. Adverse drug effects to atorvastatin were also recorded and WHO-UMC causality assessment was performed. Descriptive statistics were performed for baseline and demographic characteristics.

RESULTS:

Sixty study participants were included in the study. Eighteen (30%) study participants developed prediabetes with an HbA1c value of 5.97 ± 0.22 and 17 (28%) of participants developed new-onset diabetes mellitus with an HbA1c value of 7.24 ± 0.50. Atorvastatin at dose of 40 mg was found to be the most frequently prescribed dose.

CONCLUSION:

Atorvastatin has a dose-dependent risk of developing new-onset diabetes mellitus. Hence, the following statin therapy glycemic status should be periodically monitored especially in patients with a large dose of atorvastatin and also in patients with higher risk factors for diabetes.
Pro-apoptotic, anti-metastatic, and anti-telomerase activity of Tinospora cordifolia and its active polysaccharide arabinogalactan during Benzo(a)pyrene-induced lung carcinogenesis
Authors: Mohan Vandana , Ashwani Koul
Published: May 2024

BACKGROUND:

The present study aims to unravel the pro-apoptotic, anti-metastatic, and anti-telomerase activity of aqueous extract of Tinospora cordifolia stem (Aq.Tc) and its active component arabinogalactan (AG) during Benzo(a)pyrene [B(a)P]-induced lung tumorigenesis in mice.

MATERIALS AND METHODS:

Lung tumors were induced in male BALB/c mice using B(a)P as a carcinogen. Animals were administered twice with 50 mg/kg b.wt (i.p.) dosage of B(a)P at the 2nd and 4th week of the study. Mice were orally treated with Aq.Tc and AG on alternate days at a dose of 200 mg/kg b.wt and 7.5 mg/kg b.wt, respectively, for continuous 22 weeks.

RESULTS:

Oral administration of animals with Aq.Tc and AG suppressed the development of lung carcinogenesis by modulating the mRNA and protein expressions of different apoptotic genes; bcl-2, bax, caspase 3, and caspase 9. The pro-apoptotic proficiency of Aq.Tc and AG was further confirmed by DNA agarose gel electrophoresis showing fragmentation in B(a)P + Aq.Tc group and smear formation in B(a)P + AG group. In contrast to the control group, an increase in tumor invasion factors such as matrix metalloproteinases-2 (MMP-2) and MMP-9 was also observed in B(a)P treated animals. Nevertheless, Aq.Tc and AG treatment effectively mitigated the B(a)P-induced upregulation of MMP-2 and MMP-9. The activity of the telomerase enzyme was also observed to be upregulated in B(a)P treated animals which consecutively found to get normalized with the parallel administration of Aq.Tc and AG.

CONCLUSION:

Aq.Tc and AG successfully mitigated the altered expression of apoptosis, metastasis, and telomerase activity-associated genes during pulmonary carcinogenesis.
Redefining the Role of Analgesic Adjuvants in Pain Management: A Narrative Review
Authors: Nwosu Arinze Duke George , Chukwu Leo C. , Onwuasoigwe Okechukwu , Nweze Sylvester O. , Nwadike Kenneth
Published: May 2024

Conventional analgesics have traditionally been the mainstay of pain management, but unsatisfactory pain relief and troubling side effects have led to continuing search for more efficacious and safer remedies. Adjuvant analgesics are drugs with beneficial analgesic effects despite not having been developed as analgesics. Adjuvants facilitate better pain control with a reduction in analgesic consumption, as well as the concomitant side effects. The opioid epidemic, deaths from opioid overdose, and several other complications of opioid-based analgesia have led to increasing interrogation of its use in both acute and chronic pain settings. The current trends in surgical practice, especially ambulatory surgery and enhanced recovery after surgery/fast-track care pathways have profoundly impacted the choices for acute pain management, with an increasing role for adjuvants. Medicinal cannabis and other adjuvants have also become increasingly popular for the management of intractable chronic pain and neuropathic pain owing to the inadequacy of conventional analgesics in these pain states. As clinical and research interest in patient safety and patient satisfaction evolve further development of adjuvant analgesics will be expected to fill the existing gaps in pain management. This review aims to examine the expanding role of analgesic adjuvants in the management of acute and chronic pains, and in the prevention of the transition to chronic pain. In doing so, we conducted an online search primarily on the PUBMED database using the term “analgesic adjuvant” for human studies published in peer-reviewed journals from 2000 to 2022.
Intraoperative Analgesic Requirement using Surgical Plethysmographic Index Guidance in Lumbar Spine Surgeries: A Comparative Study
Authors: Kshirsagar Sujit Jagannath , Butiyani Pallavi , Sarkar Adnanali , Dangat Geetanjali , Prakash Lisa , Girishkumar G. , Raut Prathmesh
Published: May 2024

Context:

The surgical plethysmographic index (SPI) has been introduced as a measure of the balance between nociception and anti-nociception. The SPI is proposed for the titration of intraoperative analgesic drugs during general anesthesia.

Aims:

This study aimed to compare the requirement of intraoperative analgesic consumption between SPI-guided analgesia and conventional analgesia practices, requirement of rescue analgesics and to study recovery time.

Subjects and Methods:

In this double-blind, randomized control study, 64 patients undergoing lumbar spine surgery were randomly divided into SPI-guided analgesia group (SPI) and conventional practice group (control). In the SPI group, patients received injection fentanyl bolus of 0.5 μg/kg whenever SPI value increased above 50. While in the conventional group, injection fentanyl 0.5 μg/kg was administered according to conventional clinical practice.

Statistical Analysis Used:

The statistical significance of difference of various categorical variables across two groups was tested using the Chi-square test. For assessing intergroup statistical significance of difference of various continuous measurements, independent sample t-test was used.

Results:

Intraoperative fentanyl requirement was 119.53 ± 16.48 μg in the conventional group and 142.97 ± 24.78 μg in SPI-guided group (P < 0.05). The difference was statistically significant. The mean recovery time in conventional group was 13.03 ± 1.03 min, and for SPI group, it was 13.53 ± 1.14 min (P > 0.05).

Conclusions:

We can conclude that SPI guidance may not always help in decreasing the dose of intraoperative opioid consumption. It should be used in combination with hemodynamic parameters. SPI guidance may not affect recovery time.
Erector Spinae Plane Block for Cancer Pain – A Scoping Review of Current Evidence
Authors: Maurya Indubala , Saxena Ruchi , Maurya Ram Gopal
Published: May 2024

Cancer patients experience pain secondary to the disease process or due to treatment. Refractory cancer pain can present a clinical challenge for pain physicians, which significantly affects patients’ quality of life and increases disability. Erector spinae plane (ESP) blocks have rapidly been used in both acute and chronic pain practice. However, the use of ESP block for cancer pain management remains unclear. Thus, we conducted this scoping review to perform a comprehensive overview of current evidence on ESP block for cancer pain management. We searched the PubMed and Google Scholar databases for relevant articles published between January 2016 and March 2023 using the keywords “erector spinae plane block,” “ESP block,” and “cancer pain”. After excluding duplicate and irrelevant articles, we included a total of 26 studies, which were case reports, case series, cohort studies, and randomized control trials. Both neurolytic and non-neurolytic ESP blocks were used for cancer pain. The ESP blocks were performed in all patients with severe pain (Visual Analog Score or Numerical Rating Scale >7) and the majority of cases had some degree of pain relief. None of the studies has reported any serious complications related to procedure or drug used. There was heterogeneity in the type of drug, volume, and concentration used for ESP block. A definitive conclusion regarding the efficacy and safety of ESP block in cancer pain management was not possible. The current literature suggests that the ESP block can be helpful in cancer pain management. However, caution must be exercised not to overestimate the safety of either neurolytic or non-neurolytic ESP block as 88% (n = 23) of included studies were either case reports or case series. Randomized controlled clinical trials are warranted to establish the efficacy and safety of ESP block in cancer pain management.
Sympathetic Blocks for the Treatment of Chronic Pelvic/Perineal Pain Secondary to Recurrent Urinary Tract Infection
Authors: Pruthi Megha , Chanana Gaurav , Walia Meenu
Published: May 2024

Interventional management of pain has been described as the 4th step of the WHO analgesic ladder and proves immensely useful for many refractory and resistant pains. Recurrent urinary tract infection (UTI) can lead to chronic pelvic and perineal pain, which are often refractory to analgesics including strong opioids, and requires centrally acting neuropathic pain medications, along with psychological and behavioral therapies, and may need interventional pain management. Sympathetic nerve blocks are indicated and can be used in management of visceral pain/cancer pain. A patient with cancer may experience pain due to cancer, side effects of its treatment, or a noncancer pathology. They are prone to recurrent infections including urinary tract, respiratory tract, bloodstream infections, among others, which become a common cause of morbidity and mortality in patients with cancer. In this case report, the authors present a case with advanced cancer in whom recurrent UTI led to chronic debilitating perineal pain which was successfully managed with superior hypogastric plexus and ganglion impar block highlighting the potential utility of these underutilized blocks in challenging situations of complex pelvic and perineal pains.
Comparison among Intrathecal Nalbuphine and Fentanyl in Combination with Chloroprocaine 1% for Short Surgical Lower Limb Procedures – A Prospective Randomized Control Trial
Authors: Sherikar Priti , Osheen Minna J , Mitragotri Milon , Gangadhar Arunima
Published: May 2024

Background:

Preservative-free chloroprocaine (CP) 1% is being investigated for short surgeries but lacks immediate postoperative analgesia. Adding opioids to local anesthetic increases the quality of spinal anesthesia with prolongation of postoperative analgesia.

Aim:

The aim of this study is to compare the postoperative analgesic efficacy of intrathecal nalbuphine versus intrathecal fentanyl as an adjuvant to chlorprocaine 1% for short surgical lower limb procedures.

Materials and Methods:

After ethical committee approval, a prospective randomized double-blind comparative study was conducted on 90 patients of the American Society of Anesthesiologists classes 1 and 2, aged between 18 and 60 years who were scheduled for elective short surgical lower limb procedures. Group CP (n = 30) received CP 1% 40 mg (4 ml) plus saline (0.5 ml), Group CP with fentanyl (CF) (n = 30) received CP 1% 40 mg (4 ml) plus fentanyl 25 mcg (0.5 ml), and Group CP with nalbuphine (CN) (n = 30) received CP 1% 40 mg (4 ml) plus nalbuphine 0.8 mg (0.5 ml) intrathecally. After performing subarachnoid block, the parameters observed were – Onset, height, duration of sensory and motor blockade, duration of postoperative analgesia, hemodynamics, and adverse effects between the three groups noted.

Results:

The onset of sensory and motor block (min) is faster in Group CF (4.2 ± 0.2, 3.4 ± 0.4) compared to Group CN (4.8 ± 0.4, 3.7 ± 0.4) and Group CP (6.2 ± 0.4, 4 ± 0.4) (P < 0.001). The total sensory duration and motor duration are prolonged in Group CN (96.5 ± 5.2, 90 ± 3.9) compared to Group CF (94 ± 4, 87 ± 4.5) and Group CP (77 ± 3, 74 ± 4.5) (P < 0.001). The duration of postoperative analgesia was prolonged in Group CN (130 ± 5.3) compared to Group CF (111 ± 6.2) and Group C (93 ± 4.2) (P < 0.001).

Conclusion:

We conclude that intrathecal nalbuphine prolongs postoperative analgesia maximally compared to intrathecal fentanyl as an adjuvant to CP 1% for short surgical lower limb procedures.
Perception of human rights in health care: A cross-sectional study among tribal young adults of Puruliya, West Bengal
Authors: Khatoon Sajda , Johnson Annie , Bhattacharya Paramita , Mukherjee Nirmalya , John Denny , Jayanna Krishnamurthy
Published: May 2024

ABSTRACT

Background:

Human rights provide a universal foundation for pursuing justice in public health in order to achieve the dignity of all individuals. In spite of international attempts to promote human rights in the context of health, a significant portion of India’s indigenous population continues to have a limited understanding of these rights.

Objective:

This study aims to analyze tribal people’s attitudes towards human rights in health care. The population consists of tribal residents from Manbazar – I and Puncha Blocks in the Puruliya district of West Bengal, India. Tribal young adults between the ages of 18 and 35 were the subject of a cross-sectional study.

Methods:

A pretested questionnaire was used to collect data. MS Excel and SPSS 27 were used for analysis. A descriptive analysis was carried out.

Results:

The participants’ mean scores for awareness, accessibility and communication, autonomy and sexual and reproductive health and sexual and reproductive health rights (SRHR) were 8.06, 15.76, 7.35 and 32.52 revealing a moderate perception level among the young adult tribal population in the selected blocks.

Conclusion:

A holistic focus of the governmental and other non-governmental organizations towards the tribals is required. Introducing various aspects of human rights in healthcare in the education curriculum along with community outreach would by all likelihood improve the perception of ‘Human Rights’ and thus help in better utilization of various services including health among tribal populations in India.
A study to assess the effect of yoga and diet on Framingham risk score among high-risk cardiovascular subjects
Authors: Saboo Neha , Rao Aayushee , Kacker Sudhanshu
Published: May 2024

ABSTRACT

Introduction:

Cardiovascular diseases (CVDs) are a cluster of disorders of blood vessels and the heart. As a form of physical activity, yoga postures, and pranayama have been shown to be beneficial in various health conditions, i.e. hypertension, prediabetes, and diabetes among high-risk subjects. This study aimed to evaluate the impact of yoga and diet on the Framingham risk score (FRS) among high-risk cardiovascular subjects.

Materials and Methods:

The experimental interventional study was conducted at “RUHS College of Medical Sciences” and Associated Group of Hospitals”, Jaipur among high-risk cardiovascular subjects. FRS was used as a measurement for the outcome of interest at baseline and six months of yoga diet intervention in the study and control groups.

Results:

Mean age of participants was 48.43 ± 6.4 years. Baseline values (mean ± SD) of FRS 24.59 ± 10.15 after six months of yogic lifestyle 15.1 ± 7.05. After six months of yogic lifestyle FRS scores and estimated 10-year cardiovascular risk were statistically significantly (P < 0.0001) decreased. Pearson correlation analysis results depict that FRS correlation. There was a strong positive correlation between the FRS score and total cholesterol (r = 0.787; P < 0.001) and a negative strong correlation between the FRS score and high-density lipoprotein was observed (r =−0.621; P < 0.002).

Conclusion:

The findings of this study conclude that six months of yoga and diet lifestyle intervention significantly decreased FRS among high-risk CVD subjects compared to the control group.
Repurposing surgical wards in pandemics – An appraisal of outcomes of COVID-19 patients treated in Orthopaedic wards
Authors: Behera Prateek , Ahmad Zainab , Dubepuria Amol , Mishra Nitu , Chatterjee Anirban , Santoshi John A. , Haq Rehan Ul , Sharma Jai Prakash
Published: May 2024

ABSTRACT

Background:

The COVID-19 pandemic resulted in a shift in the way healthcare resources were used. While India faced limited effects in the first COVID wave primarily due to strict lockdown of the county, it was one of the worst affected in the second wave and at one time reported the highest number of daily cases. To address the lack of intensive care units (ICU) beds, the surgical wards of our institute were repurposed to take care of patients requiring supplementary oxygen and other supportive care till either they improved or an ICU bed was available. The medical personnel in charge of the surgical wards were entrusted with the care of patients with support from intensive care support teams (ICST).

Aims:

We aimed to examine the clinical details of patients admitted in the repurposed orthopaedic wards during the second COVID wave and to evaluate the factors that might affect the clinical outcomes in such patients.

Methods:

This was a retrospective review of records of patients admitted in the repurposed orthopaedic wards between 16 April 2021 and 20 May 2021. Details related to demography, COVID-19 presentation, COVID-19-related management and clinical course, including transfers to ICUs, and outcomes in terms of either discharge to home or death were recorded. They were analysed using statistical software.

Results:

One hundred and twenty three patients were treated during the said period. Twenty patients died during treatment, resulting in a mortality rate of 16.3%. Age, gender, RT-PCR status, pre-existing comorbidities, SpO2 at admission, method of supplemental oxygen supply, total leukocyte counts, haemoglobin values, serum C-reactive protein, Lactate dehydrogenase (LDH) and creatinine values had no statistically significant association with death of a patient during treatment.

Conclusion:

Based on the results, one can state that clinicians of surgical specialities having background knowledge of internal medicine from undergraduate education can manage patients of COVID-19 with support from ICST with reasonable outcomes. In case of future pandemics, surgical wards can be repurposed to tide over exigencies. Additionally, primary care physicians, who are often the first point of contact for patients, can allay their apprehensions adequately in future pandemics, thus preventing widespread panic and burdening of healthcare resources.
Contraceptive knowledge, prevalence of contraception use, and the association between sex education and contraception knowledge among university students in Michigan, USA
Authors: Jahanfar Shayesteh , Zendehdel Mozhgan
Published: May 2024

ABSTRACT

Background:

The danger of sexual activities among adolescents is worrisome worldwide. This study aimed to delineate total contraception knowledge of university students and the prevalence of contraceptive use, in addition to the association between sex education in school and the students’ contraception knowledge.

Materials and Methods:

A school-based cross-sectional study was carried out.

Results:

The mean total level of contraceptive knowledge was 16.53 ± 2.38, which ranged from 5 to 18. In response to which method was the most suitable for the youngsters, 36.3% responded pills, 49.2% condoms, 6.3% injection, 0.7% withdrawal, 0.5% periodic abstinence, and 5.9% other. Adjusted to sociodemographic characteristics and other confounders, students with a history of sex education in school tended to have a higher level of contraceptive knowledge than those without [AOR: 1.06; 95% CI: 0.15, 2.64]. Moreover, adjusted to the characteristics of one-night stands, students with a high level of contraceptive knowledge agreed that one-night stands were OK compared with those without the knowledge [AOR: 0.65; 95% CI: 0.16, 1.13].

Conclusion:

Although the total contraceptive knowledge was satisfactory, more attention should be paid to male students’ education. Modern and long-term effective contraceptive methods had better be included in the training program.
Etiological and clinical profiles of patients with dysphagia: A teaching institution experience
Authors: Goyal Sandeep , Jitender  , Garg Manjri , Bala Renu
Published: May 2024

ABSTRACT

Background:

Dysphagia can involve any structure from the mouth to the lower esophageal sphincter. The etiologies vary from benign causes to malignant lesions. There is dearth of data regarding dysphagia in our population.

Methods:

A total of 208 patients with complaints of dysphagia were screened for the study. After ruling out neurological/local oropharyngeal causes of dysphagia, 200 patients with suspected esophageal dysphagia (ED) were recruited in the study. Dysphagia was graded as per the dysphagia scoring system. All patients underwent upper gastro-intestinal endoscopy and were evaluated for the presence of mechanical and non-mechanical causes of ED.

Results:

The mean age of patients with dysphagia was 53.8 ± 15.4 years. with males and females being 82 and 118, respectively. The mean duration of the symptom was 7.2 ± 10.6 months (median 3 months). Ninety-eight patients (49%) having dysphagia were in the age group of 56–65 years. The dysphagia score was 0 among 58, and 4 among 26 subjects. Foreign body sensation was the most frequent chief complaint in 90 (45%) patients. Ninety-six (48%) and 104 (52%) patients had mechanical and non-mechanical causes of dysphagia, respectively. Among mechanical causes of dysphagia, 68 patients (70.8%) had esophageal growth and 28 (29.2%) had esophageal stricture. Sixty-seven patients had squamous cell carcinoma. Among non-mechanical causes, 50 (48.1%) had globus sensation, 24 (23.1%) had hiatus hernia, and 16 (15.4%) functional dysphagia.

Conclusion:

Dysphagia is a common problem with varied etiologies. The esophageal growth and globus sensation are among the predominant causes of ED. We stress that all patients of dysphagia must be meticulously investigated.
Reasons and extent of delay in the diagnosis of pulmonary tuberculosis after the appearance of symptoms
Authors: Ahmad Zuber , Zubair Ishma , Ahmad Shahbaz , Zuber Nibras , Salar Wamiq
Published: May 2024

ABSTRACT

Objective:

Delay in the diagnosis of tuberculosis (TB) is a significant problem at both individual and community levels. Delayed diagnosis of TB contributes to more severe disease manifestations, higher risk of death, and higher disease transmission in the community. We conducted this study to assess the extent and associated reasons for delay in diagnosis of pulmonary TB.

Methods:

This study was conducted in the Department of TB and Respiratory Diseases, J. N. Medical College, Aligarh, from June 2020 to May 2022. A total of 2053 new pulmonary TB patients, who first consulted any private healthcare provider (HCP) for treatment, were enrolled in the study. The required information was collected by interview technique using a predesigned questionnaire.

Results:

A total of 2053 patients were enrolled in the study. There was a significant delay of more than 2 weeks in the diagnosis of pulmonary TB after the onset of symptoms in 94% of patients. The extent of delay ranged from 8 days to 240 days with a mean of 36.33 days. The delay in visiting the HCPs by the patient was not significant. Only 5.85% of patients had a significant delay of more than 2 weeks in seeking any health care after the appearance of symptoms. A delay by HCP contributed to a greater portion of the total delay, with a mean of 31.77 days. The main reason for the delay by HCPs was not investigating TB. The hospital delay was not significant. The mean hospital delay was 5.82 days.

Conclusion:

The delay in the diagnosis of TB in India is very high. A delay by HCPs contributes to a greater portion of the total delay. Information, Education and Communication (IEC) activities will play an important role in reducing the delay. All HCPs should be actively involved in subjecting the suspects to TB diagnosis at the earliest possible as per National Tuberculosis Elimination Programme (NTEP) guidelines.
Comparison of the effect of intra-dermal injection of botulinum toxin and normal saline in the treatment of facial skin pores
Authors: Pazyar Nader , Ashoori Saeed , Mahdianrad Atefeh , Seyedtabib Maryam
Published: May 2024

ABSTRACT

Background and Purpose:

Skin pores (SPs) are normal and benign skin structures that are mostly located on the face (nose, cheeks, etc.) that cause many aesthetic concerns or complaints. One known effective treatment is botulinum toxin A (BTXA), which is also approved for the treatment of strabismus, blepharospasm, muscle spasm, cervical dystonia, glabella wrinkles, and primary axillary hyperhidrosis. Therefore, the aim of this study was to compare the effect of intra-dermal injection of botulinum toxin and normal saline serum (NSS) in the treatment of large facial pores.

Methods:

The study included 25 people who referred to the skin clinic of Imam Khomeini Hospital in Ahvaz from June 2021 to January 2022 for the treatment of large facial skin pores. Randomly, some subjects were injected with botulinum toxin at ten points, and each point was equivalent to 2.5 units of Masport (500 units vial of Masport diluted with 10 ml of NSS). Some other people were injected with 0.05 ml of NSS by intra-dermal injection at ten points. Finally, the data were analyzed using SPSS-Ver. 22 software.

Results:

Based on optical coherence tomography results, it was determined that the diameter of facial pores decreased significantly (P = 0.011). Dermoscopy showed a significant decrease in the average size of facial pores (P < 0.011), and also, the pore score decreased significantly (P = 0.021). In addition, the results showed that the size of skin pores and facial fat on both sides of the face did not decrease significantly from the patients’ point of view (P = 0.71).

Conclusion:

Based on the results of the present study, it can be concluded that intra-dermal injection of botulinum toxin is an effective and safe method to control facial pores, which showed acceptable results after 3 months.
A prospective study of endometrial histopathology in post-menopausal women in Jharkhand
Authors: Kumari Khusboo , Paswan Manoj Kumar , Kundan Meghraj , Ambedkar Shivlok N
Published: May 2024

ABSTRACT

Introduction:

Postmenopausal bleeding (PMB) refers to any uterine bleeding in a menopausal women. In the early menopausal years, endometrial hyperplasia, polyps and submucosal fibroids are common etiologies of post menopausal bleeding. The most common cause of postmenopausal bleeding is endometrial atrophy, comprises of 60-80%, while endometrial hyperplasia and endometrial cancer contribute to only 11% of Post menopausal bleeding. The aim of study is to analyses histomorphological pattern of endometrium in patients presenting with post-menopausal bleeding in Jharkhand.

Materials and Methods:

103 postmenopausal women presenting to tertiary center of Jharkhand in 2020-22 with bleeding were subjected to endometrial curettage for histopathology. Analysis is based on morphological criteria to assess endometrium. Endometrial histology is of four categories: Proliferative, Secretory, premalignant and carcinoma.

Results:

The highest incidence of postmenopausal bleeding was noticed in age group of < 60 years and incidence of malignancy was higher after 57 years of age. The majority of patients had parity between 1 and 3 (78.6%). Malignant & premalignant lesions comprises about 22.3% among that 77.7% were due to benign causes. Among the benign causes of postmenopausal bleeding, proliferative endometrium was the commonest finding. Types of hyperplasia encountered were simple hyperplasia without atypia (6.8%), Complex hyperplasia without atypia (3.9%),Complex hyperplasia with atypia (4.8%) and Simple hyperplasia with atypia (4.8%). 21.4% of cases of postmenopausal bleeding were associated with atrophic endometrium. Secretory endometrium seen in 17.5% of women. Endometrial carcinoma accounted for 12.6% of cases of postmenopausal bleeding. Out of these 69.2% were of endometroid type of endometrial carcinoma, 15.3% were of papillary serous carcinoma and 15.3% had clear cell carcinoma. The mean age of patients with endometrium carcinoma was 62.3 years. All cases of endometrial carcinoma were associated with 1 or more risk factor like diabetes/hypertension/Nulligravida.

Conclusion:

Proliferative Endometrium was a major cause of postmenopausal bleeding. Among the malignant causes, endometrial adenocarcinoma of endometroid type was most frequent with a lower mean age at presentation than other high grade cancers like papillary serous carcinoma & clear cell carcinoma.
Thiamine deficiency in diabetes, obesity and bariatric surgery: Recipes for diabetic ketoacidosis
Authors: Panda Akhila , Heidari Amirmohammad , Borumand Maryam , Ahmed Musaab , Hassan Ahmed , Ahmed Mohamed H
Published: May 2024

ABSTRACT

Diabetic ketoacidosis (DKA) is a life-threatening condition affecting individuals with diabetes characterised by hyperglycaemia, metabolic acidosis and ketonemia. The incidence and financial burden of DKA is still high. Thiamine deficiency is well documented in patients with DKA and could be associated with cardiac dysfunction in those patients. Thiamine deficiency leads to cardiac dysfunction, neuronal death and worsens the prognosis of DKA. There is an existing metabolic relationship between thiamine deficiency in diabetes, obesity and bariatric surgery. Careful monitoring of thiamine, along with other vitamins, is essential for diabetic patients, obese individuals and postbariatric surgery. Further research and clinical studies are urgently needed to assess the following: (1) Whether diabetes, obesity and bariatric surgery make individuals more prone to have DKA related to thiamine deficiency and (2) Whether supplementation of thiamine can protect diabetic patients, obese subjects and individuals undergoing bariatric surgery from DKA. This review summarises the biochemistry of thiamine and the existing metabolic relationships between thiamine deficiency in DKA, diabetes, obesity and bariatric surgery. Primary and family physicians have an important role in ensuring adequate replacement of thiamine in individuals with diabetes, obesity and bariatric surgery.
Understanding metabolic patterns in polycystic ovary syndrome: Comparing lean and obese women at a family medicine clinic
Authors: Arunachalam Ragunathan , Priya Kalidhas , Brindha Rathnasabapathy , Parthiban Kumaresan
Published: May 2024

ABSTRACT

Background:

Polycystic ovary syndrome (PCOS) is a heterogeneous disorder and various phenotypes have been described. While most women with PCOS are obese, women who are lean also suffer from PCOS. Metabolic derangements often accompany this syndrome. Family physicians, being the first point of contact in the healthcare system, play a vital role in the early diagnosis and management of this condition through diet and lifestyle modifications. The present study was conducted at the Diet and Lifestyle Diseases Management Division of a Family Medicine Clinic.

Methods:

We conducted a retrospective analysis of the correlation between body mass index (BMI) and metabolic parameters in women diagnosed with PCOS. The case records of women with PCOS, diagnosed as per modified Rotterdam criteria and who attended the outpatient clinic from January 2020 to December 2022, were chosen. Data on BMI and metabolic parameters were retrieved and statistically analyzed.

Results:

Upon analysis of 51 case records, 25.49% of women were in the lean group and 74.51% were overweight or obese. Triglycerides/HDL ratio (1.91 ± 0.47 vs 3.97 ± 5.89) and Vitamin D levels (Median 14.12 vs 16.10 ng/ml) were abnormal in both the obese and the lean women groups. However, there was no significant difference between the groups. Other metabolic parameters were within normal ranges.

Conclusion:

The present study indicates that metabolic derangements are associated with PCOS, irrespective of BMI. More robust studies in larger population samples are needed to elucidate the role of metabolic derangements and mainly insulin resistance in the pathophysiology of PCOS and its different phenotypes.
Quality of life among community-dwelling elderly in rural and urban areas of Himalayan region, Northeast India: An analysis of factors affecting well-being
Authors: Engheepi Frieda Bokali P. , Sonowal Nikita J. , Visi Vizovonuo , Rai Ajoy Daniel
Published: May 2024

ABSTRACT

Background:

There is a dearth of literature on the quality of life (QOL) experienced by the elderly population in the hilly terrains of the Himalayan region. The objective of this study was to highlight the QOL among community-dwelling elderly residing in rural and urban areas of the Himalayan region, Northeast India.

Materials and Method:

A cross-sectional study was conducted involving 450 participants (324 in rural and 126 in urban areas) aged 60 years and above. The QOL score was assessed with the help of the World Health Organisation Quality of Life-Brief Questionnaire (WHOQOL-BREF). Mann–Whitney U test was performed to find out the difference in QOL between rural and urban areas. Binary logistic regression was conducted to find the association of QOL with demographic variables.

Results:

The total mean QOL scores of elderlies in rural areas (39.4 ± 11.3) were significantly lower compared to urban areas (51.1 ± 11.5). QOL scores in all four domains were found to be low among elderly living in rural areas as compared to urban areas. Among the four domains, environmental QOL was found to be the lowest in both rural (29.5 ± 16.0) and urban areas (46.5 ± 17.2). Determinants of QOL differ in urban and rural areas.

Conclusion:

QOL was found to be significantly lower among the elderly residing in rural areas as compared to urban areas. Targeted interventions and policies are necessary to address environmental challenges to improve the overall QOL of the elderly.
Prevalence of persistent pneumonia among severe pneumonia and nutritional status as its associated risk factor: A prospective observational study among under-five children
Authors: Srivastava Akanksha D , Awasthi Shally , Jauhari Sugandha
Published: May 2024

ABSTRACT

Background:

Malnourishment is a risk factor for persistent pneumonia among under-five children with severe pneumonia. This study aims to determine the prevalence of persistent pneumonia and the association between nutritional status and pneumonia severity in children under 5 years of age.

Methodology:

A prospective observational hospital-based study was conducted in the Department of Paediatrics, King George’s Medical University (KGMU) from May 2019 to April 2020 among children aged 1 month to 5 years admitted with a diagnosis of severe pneumonia. An anthropometric assessment along with general and systemic examination was conducted. Weight for age, height for age and weight for height were calculated to assess the nutritional status. Children with severe pneumonia were followed for 4–6 weeks to assess the prevalence of persistent pneumonia.

Results:

The prevalence of persistent pneumonia was 6.8%, while 32 (31.1%) and 64 (62.1%) patients had recurrent and severe pneumonia, respectively. No statistically significant distribution was observed in age, sex, residential area, parent’s education or occupation of the child. The statistically significant distribution was seen on assessing nutritional status based on weight for age, height for age and weight for height (P value- 0.001, 0.001, 0.0001). Those with weight for age ≤ 3SD were anaemics and up to 1 year of age had 5.21, 3.52 and 2.83 times more odds of having persistent pneumonia, respectively.

Conclusion:

The prevalence of persistent pneumonia among children less than 5 years of age was 6.8%. Malnutrition can be considered a major determinant of persistent pneumonia among children under 5 years of age.
Serosurveillance of COVID-19 amongst health care workers in a teaching institution – A prospective cohort study in Puducherry district
Authors: Kamaludeen Muhamed , Ranganadin Pajanivel , Pillai Agieshkumar Balakrishna , Sugumaran Arun
Published: May 2024

ABSTRACT

Introduction:

The rapid spread and mutation rate of severe acute respiratory syndrome corona virus (SARS-CoV2) demands continuous monitoring in terms of genomic and serosurvival. The current study is designed to track the seroprevalence of health care workers (HCWs) postvaccination, as they may be more susceptible to contracting the SARS-CoV-2 infection compared to the general population.

Objective:

The objective was to identify the seroprevalence rate for SARS-CoV-2 immunoglobulin G (IgG) antibody (N, S1, S2) amongst HCWs of various levels of exposure working in a tertiary care teaching hospital in Puducherry.

Materials and Methods:

The present study followed a nonprobability consecutive sampling technique, which involved 216 study participants HCWs from the hospital. IgG antibody levels were measured using EUROIMMUNE Anti SARS-COV-2 ELISA KIT (IG g) ELISA at two points: firstly, 2 weeks after the second dose of vaccination, followed by 2 weeks after the booster dose.

Results:

Out of the total 216 participants enrolled in the survey, there were 140 males and 76 females, and the maximum number of candidates studied were in the 41–50 age group. Almost 46.7% of the HCWs who participated in the study were seropositive for SARS-CoV-2 in the case of those who were high-risk exposed, while only 30.4% were amongst those who were low-risk exposed. The proportion of study participants who became seropositive increased considerably after the booster dose (65.7%), from 38.0% when tested three months after infection.

Conclusion:

A significant increase in antibody titres amongst high-risk HCWs postboost vaccination demands continuous monitoring of soluble IgG levels for recommendations of vaccination schedules.
Effectiveness of the health and wellness centers in improving identification and primary care of non-communicable diseases in Chhattisgarh State of India
Authors: Garg Samir , Tripathi Narayan , Bebarta Kirtti K. , Sinha Narendra , Tiwari Ankita
Published: May 2024

ABSTRACT

Introduction:

India launched a national initiative named Health and Wellness Centres (HWCs) in 2018 to provide population-based primary care including for the non-communicable diseases (NCDs) in rural areas. The current study assesses whether operationalization of HWCs improved the detection of NCDs and increased the share of public sector facilities in providing NCD services.

Methods:

Two rounds of household surveys were conducted in rural Chhattisgarh in 2019 and 2022. With a focus on NCDs, the household survey covered a representative sample of individuals above the age of 30 years – 2760 individuals in 2019 and 2638 in 2022. Multi-variate regression analysis was carried out to determine effects of HWCs on identification of NCDs and utilization of public sector services.

Results:

The population covered by HWCs had 25% greater chance of being identified with NCDs as compared to the population without HWCs (AOR = 1.25, P = 0.03). The NCD patients living in areas covered by HWCs had 70% greater chance of utilizing the public healthcare facilities (AOR = 1.70, P = 0.01). In the population covered by HWCs, the share of the public sector in NCD care increased from 41.2% in 2019 to 62.1% in 2022, whereas the share of informal private providers dropped from 23.5% in 2019 to 8.4% in 2022.

Conclusion:

The HWCs showed effectiveness in increasing detection of NCDs at the population level and bringing a larger share of NCD patients to utilize public sector services. They can prove to be a crucial architectural correction for improving primary care service delivery for NCDs and other population health needs in India.
Burden of frailty and its correlates among the elderly: a cross-sectional study in a rural community of West Bengal
Authors: Ghose Sauryadripta , Pal Dipak , Paul Bobby , Dasgupta Aparajita , Ghosh Pritam , Maurya Neelam
Published: May 2024

ABSTRACT

Context:

With the ageing of Indian society, providing a healthy life among older people is a public health precedence. Therefore, beforehand discovery and possible forestalment of frailty may help promote healthy ageing and dwindle the social, mental and financial burden of their families and caregivers.

Aims:

The study aimed to assess the proportion of frailty and its associated factors among the elderly aged 65 years and above in a rural community of West Bengal.

Settings and Design:

A community-based cross-sectional study was conducted among 270 elderlies selected from 15 villages out of a total 64 villages of Singur under the Hooghly District of West Bengal from January 2019 to February 2020.

Materials and Methods:

Cluster sampling technique was used. Data was collected using a pre-designed, pre-tested structured schedule including Fried frailty phenotype (FFP), geriatric depression scale short form (GDS 15) and mini nutritional assessment (MNA) tool.

Statistical Analysis Used:

Associated factors of frailty were assessed by univariate and multivariable logistic regression using SPSS version 16 software and MS Excel 2019.

Results:

The proportion of frailty was observed to be 23.7% and that of prefrailty 40.7%. Frailty was significantly associated with increasing age [AOR(CI) 1.2(1.1-1.3)], decreasing years of schooling [AOR(CI) 1.3(1.1-1.5)], loss of spouse [AOR(CI) 4.2(1.2-15.2)], financial dependency [AOR(CI) 19.3(2.7-139.0)], staying at home [AOR(CI) 16.3(2.7-98.2)], presence of anaemia [AOR(CI) 3.6(1.3-9.5)], at risk of malnutrition [AOR(CI) 6.5(1.9-22.3)], increasing number of falls in the last 1 year [AOR(CI) 4.3(1.2-15.6)], presence of 3 or more chronic diseases [AOR(CI) 154.7(12.1-1981.9)] and depression [AOR(CI) 8.3(2.5-27.0)].

Conclusion:

The burden of frailty among the study population is relatively high. It’s an intimidating situation that needs bettered screening provisions for early discovery with special stress on nutritive upliftment. Screening for depression should also be done regularly.
Impact of high-salt diet in health and diseases and its role in pursuit of cancer immunotherapy by modulating gut microbiome
Authors: Balan Yuvaraj , Sundaramurthy Raja , Gaur Archana , Varatharajan Sakthivadivel , Raj Gerard Marshall
Published: May 2024

ABSTRACT

Cancer chemotherapy remains an area of concern, as many of the therapies are uncomfortable involving side effects and unpleasant experiences. These factors could further reduce patient’s quality of life, and even endanger their life. Many therapeutic strategies have been tried to reduce the unpleasant side effects and increase the treatment effectiveness; however, none have shown to have promising effects. One of the main hindrances to cancer therapy is the escape strategies by tumor cells to the immune attack. Promoting inflammation in the tumor microenvironment is the cornerstone and key therapeutic target in cancer chemotherapy. High-salt diet (HSD) intake, though it has deleterious effects on human health by promoting chronic inflammation, is found to be advantageous in the tumor microenvironment. Studies identified HSD favors an increased abundance ofBifidobacteriumspecies in the tumor environment due to gut barrier alteration, which, in turn, promotes inflammation and favors improved response to cancer chemotherapy. A review of the literature was carried out to find out the effects of an HSD on health and diseases, with special mention of its effect on cancer chemotherapy. Studies emphasized HSD would block the myeloid-derived suppressor cells which will enhance the tumor immunity. Exploration of the precise mechanism of simple HSD regime/ingestion of specific bacterial species as probiotics will be effective and essential to formulate the game-changing cancer chemotherapy. With the modern era of healthcare moving toward precision medicine where the physician can choose the treatment option suitable for the individual, HSD regime/ingestion of specific bacterial species can be considered.
Lack of documentation in animal bite cases and its impact on rabies biologicals utilization
Authors: Batish Rohit , Oberoi Simmi , Verma Virender , Rai Sunvir , Singh Aman D. , Kaur Japneet
Published: May 2024

ABSTRACT

Introduction:

Rabies has significant health and economic consequences for both humans and animals. Annually, India witnesses 17.4 million dog bites, yet only 3 million individuals receive post-exposure prophylaxis (PEP). There is a shortage of anti-rabies vaccine in India as quoted in many news reports. In India, lack of documentation of previous vaccination against animal bites is there, hence resulting in the re-administration of the anti-rabies vaccine, leading to a significant biological loss (anti-rabies vaccine)

Material and Methods:

A cross-sectional, retrospective study was conducted. Data was collected, and analyzed from June 2021 to June 2023 a period of 2 years.

Results:

Majority of the patients reported within the first 24 hours after being bitten while approximately one-third reported after 24 hours. Majority were Category 3 bites and unprovoked. Males, lower-middle class, and bites on lower extremities were common among 4291 patients attending the clinic. Out of 217 re-exposure cases, 185 did not have any documentation regarding their previous treatment of animal bites.

Conclusion:

Among 4291 patients attending the clinic, majority were Category 3 bites on the lower extremities. 85.25% of re-exposure cases had to be administered a full course of treatment due to a lack of documentation leading to rabies as a biological wastage. This avoidable wastage can be a resource for treating more patients.