bluuebunny/crossref_metadata_2025 huggingface dataset:
Alleviation of Delay in Tele-Surgical Operations Using Markov Approach-Based Smith Predictor
Authors: Kumar Ratish , Kumar Rajiv , Nigam Madhav Ji
Published: December 2021

The acceptance of tele-robotics and teleoperations through networked control system (NCS) is increasing day-by-day. NCS involves the feedback control loop system wherein the control components such as actuators and sensors are controlled and allowed to share their feedback over real time network with distributed users spread geographically. The performance and surgical complications majorly depend upon time delay, packet dropout and jitter induced in the system. The delay of data packet to the receiving side not only causes instability but also affect the performance of the system. In this article, author designed and simulate the functionality of a model-based Smith predictive controller. The model and randomized error estimations are employed through Markov approach and Kalman techniques. The simulation results show a delay of 49.926ms from master controller to slave controller and 79.497ms of delay from sensor to controller results to a total delay of 129.423ms. This reduced delay improve the surgical accuracy and eliminate the risk factors to criticality of patients’ health.
Developing an Explainable Machine Learning-Based Thyroid Disease Prediction Model
Authors: Arjaria Siddhartha Kumar , Rathore Abhishek Singh , Chaubey Gyanendra
Published: December 2021

Healthcare and medicine are key areas where machine learning algorithms are widely used. The medical decision support systems thus created are accurate enough, however, they suffer from the lack of transparency in decision making and shows a black box behavior. However, transparency and trust are significant in the field of health and medicine and hence, a black box system is sub optimal in terms of widespread applicability and reach. Hence, the explainablility of the research make the system reliable and understandable, thereby enhancing its social acceptability. The presented work explores a thyroid disease diagnosis system. SHAP, a popular method based on coalition game theory is used for interpretability of results. The work explains the system behavior both locally and globally and shows how machine leaning can be used to ascertain the causality of the disease and support doctors to suggest the most effective treatment of the disease. The work not only demonstrates the results of machine learning algorithms but also explains related feature importance and model insights.
Impact of Corporate Social Responsibility, Green Intellectual Capital, and Green Innovation on Competitive Advantage
Authors: Mehmood Khawaja K. , Hanaysha Jalal Rajeh
Published: December 2021

The concept of green intellectual capital has gained substantial popularity in context of pressures from competition, environmental forces, and mounting stakeholders’ expectations for environment protection. Scholars have, investigated about the antecedents and consequences of green intellectual capital. However, those investigations look inexhaustive in terms of the research frameworks and contexts employed therein. Based on the systematic literature review, this paper builds a better model involving, both, antecedents and consequences of green intellectual capital. The model proposes that corporate social responsibility is a factor leading to green intellectual capital. Additionally, green intellectual capital leads to green innovation resulting in competitive advantage for firms. Importantly, the model acknowledges contingency theory and suggests that the relationship between corporate social responsibility and green innovation could be moderated by the extent to which a firm is visible to general public for its activities as well as the extent to which the firm is transparent.
Impacts of Age and Marital Status on the Elderly's Quality of Life in An Elderly Social Institution
Authors: Daely Susisusanti , Nuraini Tuti , Gayatri Dewi , Pujasari Hening
Published: December 2021

Background

Living a life of good quality is important for everyone. This research aimed to get an overview of the quality of life (QOL) of the elderly in an elderly social institution in Jakarta, Indonesia.

Design and Methods

This descriptive study with a cross-sectional design included 107 participants using simple random sampling technique. Data were collected using an abbreviated World Health Organization Quality of Life (WHOQOL-BREF) and analyzed using statistical software, Mann Whitney and Kruskal Wallis test.

Results

The mean quality of life of the elderly's was 66.09 (scale: 0–100), with a mean QOL of 67.58 in the physical domain, 66.26 in the psychological domain, 64.64 in the social relationships domain, and 65.88 in the environment domain. Regarding age and marital status, there was a significant difference in the mean QOL of the elderly living in the elderly social institution (p=0.017 and 0.001). In contrast, there was no significant difference in their mean QOL in terms of gender, level of education, and length of stay (p=0.323, 0.164, and 0.697).

Conclusions

The low quality of life of the elderly is our concern. The staff in the elderly social institution could develop some activities for the elderly to increase the elderly's QOL, such as making daily activities plans and the evaluation of those activities.
Neoproterozoic-Cambrian stratigraphy of the Mackenzie Mountains, northwestern Canada, part IV: a stratigraphic reference section for the Ediacaran-Cambrian transition in NTS 95-M (Wrigley Lake map area)
Authors: MacNaughton R B , Fallas K M
Published: December 2021

A composite reference section for the upper Ediacaran and lower Cambrian is documented for a location near Moose Horn River in Wrigley Lake map area (NTS 95-M), Mackenzie Mountains, Northwest Territories. Four measured stratigraphic sections cover, in ascending
order: the uppermost Sheepbed Formation; the informal Sheepbed carbonate; the lower, middle, and upper members of the Backbone Ranges Formation; the Sekwi Formation; and the lowermost beds of the Rockslide Formation. The uppermost Sheepbed Formation is dominated by dark-weathering shale and
siltstone. The Sheepbed carbonate (440 m) lies conformably on the Sheepbed Formation and consists of limestone, dolostone, and dolomitic siltstone, including several horizons of rudstone with clasts up to boulder size. The upper surface of the Sheepbed carbonate has been eroded and the unit thins to
a zero edge to the east. The lower member of the Backbone Ranges Formation (253 m) is heterolithic, including interbedded quartzose siltstone and quartzose sandstone, quartz arenite (locally with horizons of quartz pebbles), and dolostone to dolomitic sandstone. The middle member of the Backbone
Ranges Formation (93 m) consists mainly of pink to grey-weathering limestone with red mudstone partings. The upper member (501.5 m) is dominated by quartz arenite, but also contains intervals of siltstone. Partway through the upper member there is a marker unit of dolostone to dolomitic sandstone
that previous work suggests is a tongue of the Ediacaran Risky Formation. Based on regional correlations, the top of this marker may approximate the Ediacaran-Cambrian boundary in this section. The Sekwi Formation lies abruptly upon the Backbone Ranges Formation. The contact is unconformable at this
locality and mapping in the area indicates eastward erosional removal of the upper member of the Backbone Ranges Formation beneath the Sekwi Formation. The Sekwi Formation here consists of variegated siltstone with lesser dolostone, limestone, and quartz sandstone. An abrupt contact with nodular
limestone and grey shale of the overlying Rockslide Formation approximates the base of Cambrian Series 3.
Piloting Mutual Health Association Establishment in Enugu State, Southeast Nigeria
Authors: Obikeze Eric , Uguru Nkoli , Ilika Frances , Iwuora Ijeoma , Ojiako Tobechi , Idoko Arthur , Chioke Jane Frances , Okoronkwo Ngozi , Yisa Ibrahim , Anyaehie Bond , Nwobodo Ed
Published: December 2021

Background:

Predominant out-of-pocket financing of health expenditures in low- and -middle-income countries (LMICs) remains a major setback to achieving universal health coverage (UHC). Nigeria has been attempting to bridge the gap through health insurance schemes targeting both the formal and informal sectors of the population.

Objective:

This paper aimed to provide a roadmap to assist in establishing community-based health insurance (CBHI) in any religious Nigerian Community.

Materials and Methods:

A cross-sectional descriptive design using qualitative methods was used for the study. The study areas were local government areas (LGAs) that make up the Catholic Diocese of Enugu. Extensive advocacies were used at various levels of the organizational structure of the Diocese to ensure buy-in. Organizational structure of the scheme was set up with nine major stakeholders who played active roles in the advocacies and the design of operational guidelines. Training of the stakeholders was conducted and two types of benefit package were adopted. A mutual health association (MHA), called Ndubuisi MHA, was approved and incorporated based on the NHIS model called intermediary method.

Results:

Nigeria's first faith-based CBHI-Ndubuisi MHA with over 3000 enrollees was set up, approved, and registered with Enugu North LGA, Enugu State Ministry of Health and Corporate Affairs Commission. The scheme is running conveniently with a purpose-built administrative structure, monitoring and evaluation plan, and benefit packages.

Conclusion:

Establishing CBHI through faith-based organizations is possible and sustainable with underlying equity principles. The model used in this study can be implemented in any organization that has an element of mutual solidarity and existing administrative structures that can be used as a platform.
Assessment of Fertility Behaviors Among Women of Reproductive Age in a Rural Community, Northwest Nigeria
Authors: Ibrahim Jimoh M. , Adamou Natalia , Olorukooba Abdulhakeem A. , Omole Nanben V.
Published: December 2021

Background:

High fertility is one of the primary determinants of rapid population growth, which can hinder socio-economic development. Age at first marriage is an important proximate determinant of fertility and one of the causes of high fertility level in developing countries where the practice of early marriage remains widespread.

Objective:

The objective was to assess the fertility behaviors among women of reproductive age in a rural community, in northwestern Nigeria.

Materials and Methods:

A cross-sectional descriptive community-based study with minimum sample size of 320 was conducted in 2019 using systematic sampling method.

Results:

The mean age (±SD) of females in the community was 26.9 (±SD 8.3) years. The mean age at first marriage was 15.31 (±SD 2.4) years, contraceptive use was 5.4%, and one-third of the women were in polygamous settings. The total fertility rate was 6.95 per woman. There was significant association between marriage type and number of marriages with the number of living children (P = 0.001).

Conclusion:

Majority of the women were under aged at first marriage, had very low rate of contraceptive use, and fertility rate was high among them. Marriage type of the respondents had a significant association with fertility. Policies and laws that prohibit child marriage are recommended, in order to encourage girl child education and improve female participation in decision-making with regard to fertility desire and behaviors.
Brainstem Stroke in a Nigerian Male with Prosthetic Heart Valves—A Case Report
Authors: Anakwue Ralph C. , Onwuekwe Ikenna O. , Nwutobo Rhoda C. , Onwuekwe Chinwendu J.
Published: December 2021

Stroke following cardiac surgery particularly valvular implantation is an anticipated complication. This is due to the prosthetic valve as well as possible associated comorbid conditions. There is dearth of published data on stroke post valve replacement surgery in Nigeria. There is no general consensus on the role of antiplatelet agents in combination with anticoagulant therapy in at-risk patients. Our paper documents the case of a 46-year-old male hypertensive, who in 2016 had mitral and aortic valve replacement surgery in a Tertiary Teaching Hospital and presented in May 2020 with sudden onset abnormal tongue sensation and double vision. A left internuclear ophthalmoplegia with bilateral torsional nystagmus was evident. Brain magnetic resonance imaging confirmed pontine lacunar infarction. There were no intracardiac clots on echocardiography. He had full resolution of deficits following treatment with anticoagulants. This case report demonstrates that ischemic stroke can occur in people with prosthetic heart valve and that other comorbid risk factors may be contributory. Anticoagulation therapy is important, though there is no consensus on time of starting therapy and the role of adjunctive antiplatelet combination therapy in such patients. Individualized therapy should be based on the type of implant, numbers, and location of valve replaced, comorbid clinical conditions, and the risk of hemorrhagic transformation.
Knowledge and Preventive Practices Against Malaria Among Pregnant Women in Urban and Rural Public Healthcare Facilities in Nigeria’s Federal Capital Territory
Authors: Esomonu Sabastine N. , Ossai Edmund N. , Gadzama Apagu D. , Ashikeni Matthew A. , Uzochukwu Benjamin S.
Published: December 2021

Background:

Malaria is a life-threatening parasitic disease, and pregnant women are at risk of its adverse consequences.

Objectives:

The study aimed to determine knowledge and preventive practices against malaria among pregnant women at urban and rural public health facilities in Abuja, Nigeria.

Materials and Methods:

A cross-sectional study design was used. The two-stage sampling method was used to select 520 pregnant women in 16 health facilities. A structured questionnaire was used for data collection. Data analysis was done using SPSS statistical software version 22.0, and the level of statistical significance was determined at P-value of less than 0.05.

Results:

The mean age of respondents was 29.6±4.6 and 27.9±4.9 years in urban and rural areas, respectively (P≤0.001). A significantly higher proportion of women in the urban area (44.2%) had good knowledge of malaria than those in the rural area (26.2%) (P < 0.001). Comparable proportions of respondents in urban (13.1%) and rural (23.1%) areas had good preventive practices against malaria (P = 0.218). The predictor of good knowledge of malaria in the urban area was using secondary health facilities for antenatal care [95% confidence interval (CI): 1.3–4.4], whereas tertiary education (95% CI=1.1–2.3) and utilizing secondary health facilities (95% CI=1.2–2.8) were predictors in the rural area. Predictors of good preventive practice included being self-employed (95% CI=1.5–11.6) and having good knowledge of malaria (95% CI=1.3–6.4) in the urban area.

Conclusion:

Minor proportions of respondents in the study area had good knowledge of, and good preventive practices against, malaria. There is a need for relevant authorities to enlighten women on malaria and its preventive practices and to motivate them to practice malaria prevention throughout pregnancies.
Outcome of Treatment of Children with Epilepsy in a Nigerian Tertiary Hospital
Authors: Okike Clifford O. , Emeagui Diana O. , Ajaegbu Obinna C. , Muoneke Uzoamaka V.
Published: December 2021

Background:

Epilepsy, the most predominant noncontagious neurologic disorder affecting children and carrying profound levels of social stigma, is an important cause of childhood morbidity globally.

Objectives:

This study aims at describing the prevalence, etiological risk factors, seizure pattern/associated comorbidities, and outcome of treatment with antiepiletic drugs (AEDs) among patients with epilepsy attending the neurology clinic of Federal Medical Center, Asaba, Delta State, Nigeria.

Materials and Methods:

A 10-year review of all patients seen at the neurology clinic of the tertiary institution. Information including history/physical examination, socio-demographic variables, and electroencephalogram (EEG) findings was collected from the clinic records of the patients between January 2009 and December 2019. A total of 105 patients presented with clinical features of epilepsy classified based on the 2017 International League Against Epilepsy classification. All data obtained from the clinic records were analyzed using the SPSS, Version 23.0, software.

Results:

Of the 302 patients seen with different neurologic morbidities, 105 had epilepsy, giving a prevalence rate of 34.7%, occurring more in children aged 6 months to 3 years with a male predisposition (55.2%). Generalized tonic-clonic (GTC) seizure was identified as the most predominant type 9/105(8.6%), severe birth asphyxia and cerebral palsy were the most common cause, and comorbidity of epilepsy, respectively. Sodium valproate was the commonly used AED with 55.8% good outcome.

Conclusion:

Epilepsy is still an underreported childhood neurologic morbidity in our environment. Good outcome recorded can be attributed to high levels of adherence to medication and absence of associated metabolic disorders or intracranial structural lesions.
Sun exposure as a strategy for acquiring vitamin D in developing countries of tropical region
Authors: Augustine Little Flower , Nair K. Madhavan , Kulkarni Bharati
Published: December 2021

Adopting sun exposure as a low-cost sustainable strategy in tropical countries needs critical analysis for its feasibility and inclusion in national policy. This review explores the opportunities and challenges associated with sun exposure in tropical countries and discusses potential strategies that may be adopted for promoting sun exposure. For this, two strands of evidence were reviewed; trials on sun exposure, analysed for risk of bias and, the environmental factors that influence acquisition of vitamin D from sun exposure in the context of on-going ecological and nutritional transition. Compilation of data from available databases in terms of deficiency, per cent rural population, status of fortification, air pollution, ultraviolet index, skin reflectance and skin cancer prevalence were done. In the context of environmental and lifestyle-related challenges, opportunities go hand-in-hand in terms of built environment, variability in air pollution and personal factors such as skin pigmentation, precursor availability and general nutritional status. Contextual policy decisions should consider urban and rural development planning, control of air pollution, targeted guidelines for indigenous and immigrant population and use of space technology in educating general population for balanced sun exposure as essential components for a sustainable strategy. Important opportunities exist for tropical countries to develop sun exposure as a strategy for acquiring vitamin D and these need to be explored.
Novel approach in the evaluation of ultrasound BI-RADS 3 & 4 breast masses with a combination method of elastography & Doppler
Authors: Reghunath Anjuna , Mittal Mahesh Kumar , Chintamani Chintamani , Prasad Rajni
Published: December 2021

Background & objectives:

Ultrasound BI-RADS categories 3 and 4 constitute those breast masses which cannot be confidently classified as benign or malignant, owing to their morphological characteristics. These masses are further managed by follow up and biopsy, respectively. This study aims to evaluate the role of strain elastography and Doppler in better characterization of these sonographically indeterminate breast masses as benign or malignant.

Methods:

Fifty female patients with ultrasound BI-RADS 3 or 4 were evaluated with strain elastography and color Doppler including spectral analysis. Eight variables were assessed by elastography and Doppler, including a new phenomenon called bidirectional arterial flow (BAF). The findings were correlated with the gold standard diagnostic method of histopathology/cytology. Based on findings of combined elastography and Doppler method, the initial ultrasound BI-RADS categories of masses were re-categorized by up-gradation or down-gradation. Sensitivity, specificity, accuracy, positive predictive value, negative predictive value and receiver operating characteristic (ROC) curves were used to estimate the diagnostic performance of the combination method.

Results:

Using ROC analysis, the positivity of ≥3 among the total eight variables correlated with malignancy on histopathology. Sensitivity, specificity and accuracy of the combination method using cut-off score ≥3 (i.e. at least three out of the eight parameters in the combination method being positive) for the prediction of malignancy was 100, 76.47 and 92 per cent, respectively, with the area under curve being 0.967. In addition, BAF was found predictive of malignancy with a diagnostic accuracy of 70 per cent.

Interpretation & conclusions:

This non-invasive, cheaper and readily accessible combination method of strain elastography and Doppler imaging can improve the diagnostic characterization of sonographically indeterminate breast masses and may obviate the need of magnetic resonance imaging and unnecessary biopsies, thus proving helpful in resource-poor countries.
Surgery for cervical cancer
Authors: Poddar Pabashi , Maheshwari Amita
Published: December 2021

Surgery plays an important role in the management of early-stage cervical cancer. Type III radical hysterectomy with bilateral pelvic lymph node dissection using open route is the standard surgical procedure. There is level I evidence against the use of laparoscopic/robotic approach for radical hysterectomy for cervical cancer. Emerging data support the use of sentinel lymph node biopsy and nerve sparing radical hysterectomy in carefully selected patients with early-stage disease. In locally advanced cervical cancer patients, the use of neoadjuvant chemotherapy (NACT) followed by radical surgery yields inferior disease-free survival compared to definitive concurrent chemoradiation therapy. Therefore, definitive concurrent chemoradiation is the standard treatment for locally advanced disease. Fertility preserving surgery is feasible in highly selected young patients. Role of less-radical surgical procedures in patients’ with low-stage disease with good prognostic factors is under evaluation.
A qualitative analysis of the Parliamentary questions on the issue of obesity raised over the past two decades in India
Authors: Gauthaman Jeevitha
Published: December 2021

Background:

Obesity is a major health issue that is drastically affecting the Indian population in the recent years. It is a major predisposing factor for non-communicable diseases.

Introduction:

The parliament is a powerful organization that holds sessions on regular basis and allows a question hour at the end of each session. Members ask varied questions on major issues and these documented questions are a valuable source of data for policy analysis.

Material and Methods:

Questions on obesity were collected from the official websites of Lok Sabha and Rajya Sabha and thematic analysis was done with inductive reasoning. Themes and subthemes were categorized and questions were coded into nodes using N Vivo software.

Results:

A total of 134 questions on obesity were asked in both the houses, out of which 101 questions were from Lok Sabha and 33 questions were from Rajya Sabha. Majority of the questions were asked to the ministry of health and family welfare. Only a total of 48 unique parliamentarians from 13 states have asked questions on obesity in the past two decades.

Discussion:

The questions were of competing interests with majority of questions on incidence of obesity. A number of questions on school and community based interventions were asked and new suggestions were given by members. Questions on BMI documentation of individuals and gender predisposition showed presence of awareness and knowledge among the members on obesity. Most of the existing policies are malnutrition based and obesity has not been adequately addressed. More questions with stronger representation from all states of the country can help in effective policy planning and implementation of programs to eliminate obesity.
Magnitude and causes of routine immunization disruptions during COVID-19 pandemic in developing countries
Authors: Sharma Mohit , Singh Snehil K. , Sharma Lokesh , Dwiwedi Manish K. , Agarwal Deepika , Gupta Gajendra K. , Dhiman Ranjit
Published: December 2021

The ongoing pandemic of COVID-19 is a threat to various routine healthcare services. India’s routine immunization (RI) campaign is one of largest ever known. In this review, we discuss the magnitude of disruption of RI activities due to COVID-19 pandemic, various causes of it and recommend ways to reduce the disruptions. Prominent literature databases were searched till April 30, 2021 for articles reporting disruptions of RI due to COVID-19. One study from India and numerous from outside India reported significant declines in the vaccine coverage rates during the lockdown period, which ranged from March 2020 till August 2020 in different regions of the world. Some reported disruptions for all vaccines, while a few reported sparing of birth doses. Shortage of healthcare workers due for them being diverted to patient care services and their reduced movement due to lockdowns and non-availability of public transport were prominent causes. Parents avoided RI sessions as they feared them or their children getting infected. They also faced travel restrictions, just like the healthcare workers. Children of school entry age and those from poorer socio-demographic profile appeared to miss the doses more frequently. Ministry of Health and Family Welfare, India has issued guidelines for conducting fixed and outreach RI sessions while following COVID-appropriate behavior. Promptly identifying missed out children and scheduling catch-up sessions is required to sustain the gains made over the decades by the immunization program of India.
Home management scheme for patients with severe covid-19 in Duhok city, Kurdistan region of Iraq
Authors: Hussein Nawfal R. , Saleem Zana Sidiq M. , Rashad Brisik H. , Naqid Ibrahim A. , Ibrahim Nashwan , Musa Dildar H. , Khezaqia Nina D. , Yousif Ahmed H.
Published: December 2021

Aim:

This study investigated the clinical characteristics and outcomes of patients with severe coronavirus disease 2019 (COVID-19) who were involved in the home management scheme in Duhok city.

Materials and Methods:

This prospective descriptive study enrolled Kurdish patients diagnosed with severe COVID-19 between June 1 and November 1, 2020, and were treated at home.

Results:

The average age of the patients was 59.77 ± 14 years and 51 (56.04%) of them were males. Seven of these patients (7.69%) were smokers. Most patients (72.52%) had one or more comorbidities. Fever (87.1%) was the most commonly presented symptom in older patients. The case fatality rate was 3/91 (3.29%). This rate was not found to be associated with sex, history of smoking, or comorbidities. The age of deceased patients (40 ± 25 years) was significantly lower than that of cured patients (60 ± 13 years) (p = -0.025).

Conclusions:

The case fatality rate of patients enrolled in this scheme was comparable to those who received treatment in hospitals. Therefore, this scheme could provide a good alternative for treating patients with severe COVID-19 and family physicians could lead the scheme through the primary care network.
Community perception regarding diarrhoea management practices in a tribal predominant aspirational district of Odisha
Authors: Behera Priyamadhaba , Bhatia Vikas , Sahu Dinesh P. , Sahoo Durgesh P. , Kamble Raviraj U. , Panda Prem S. , Singh Arvind K.
Published: December 2021

Context:

Childhood diarrhea is still a major problem in developing countries, and the condition is worse in tribal areas.

Aims:

The study aims to assess the community perception related to diarrhea management in an aspirational district of Odisha, India.

Subjects and Methods:

A mixed-method study was conducted in Kandhamal, an aspirational district of Odisha, Eastern India, from June to October 2018. An in-depth interview was conducted among community health workers, and a cross-sectional survey was done for the household interview. The data were collected in a mobile-based application, Epicollect5, and in-depth interviews were recorded digitally.

Statistical Analysis Used:

The data were analyzed in the Statistical Package for Social Sciences (SPSS) version 22.0. Categorical variables are presented in proportions. Force-field analysis was conducted to assess the driving and restraining forces of diarrhea. Content analysis was done for the digitally recorded data.

Results:

Nine out of ten people were aware of the benefit of breastfeeding during diarrheal episodes in children aged under 5 years, and <50% were aware of zinc benefit. Poor sanitation, lack of safe water, poor hygiene practices, socioeconomic status, and illiteracy are the major challenges in diarrheal control in the tribal area.

Conclusions:

Improving the demand by creating community awareness regarding management of diarrhea, availability of essential drugs (ORS and zinc) at the community level, and capacity building of community health workers for management of diarrhea can reduce diarrhea-related morbidity and mortality in tribal areas of India. Handwashing, hygiene practices, and availability of safe water need to be promoted in the tribal region. In the long term, the socioeconomic determinants have to be addressed.
Handling the pandemic our way
Authors: George T Jisa , Shafqat Naseema , Verma Ranjana , Bali Surya
Published: December 2021

Introduction:

The Coronavirus disease 2019 (COVID-19) pandemic created havoc within a few weeks of its outbreak affecting over 100 countries. The rapid increase in the established cases urged for the prevention and control of COVID-19 belligerently on both national and worldwide fronts to prevent the healthcare systems from collapsing. For the sake of successfully preventing and restricting a fatal pandemic outbreak such as COVID-19, it requires the apex health institutions to have a uniform, urgent, flexible and effective policy response framework ensuring strict adherence too. In this regard, the Apex Institutes of National Importance in India (INIs) have released a series of documents on COVID-19 prevention and management.

Methods:

Documents regarding COVID-19 preparedness and management were retrieved from the official websites of the INIs in India. The general population and healthcare workers’ guidelines, standard operating procedures (SOPs) on COVID-19 prevention and management, action and response plans were included in the study. The full text of each document was analysed in detail and themes and subthemes were derived through content analysis.

Results:

A total of 68 documents was included in the study. Five major themes and 12 subthemes were formulated after content analysis. A major similarity was found across all INIs on screening and testing and infection prevention control measures. The INIs formulated guidelines adhering to the World Health Organization, Indian Council of Medical Research and Ministry of Health and Family Welfare Recommendations.

Conclusion:

Common measures like quarantine, social distancing, travel bans and mass gathering restrictions were adopted to prevent the spread of COVID-19 during the initial period. The INIs have developed policies and standard operating protocols on COVID-19 management based on the Government of India guidelines. Better understanding of these guidelines will help in effective implementation of the nationwide pandemic management.
Efficacy of external cold and a vibrating device in reducing pain and anxiety during local anaesthesia
Authors: Jain Nivedita , Juneja Preene , Masih Updesh , Bhushan A.K. Bharath , Bhaduaria Upendra Singh , Badjatya Khushboo
Published: December 2021

Background and Aim:

To evaluate and compare the efficacy of external cold and a vibrating device in reducing the pain and anxiety amidst children receiving maxillary infiltration anaesthesia over conventional methods.

Method:

A sum of thirty subjects aged between 5 and 10 years who had undergone dental procedures requiring maxillary infiltration were enrolled in the current split-mouth randomised control study. The control intervention constitutes infiltration of 1.8 mL of 2% lignocaine in addition to 1:100,000 adrenaline (Lox, Neon Laboratories Mumbai, India) whereas, the experimental group used external cold and a vibrating device (Buzzy®, MMJ Labs, Atlanta, GA, USA) in annexation to the control protocol. Simultaneous to LA administration, pulse rate was employed as an objective measure and the subjective measure was recorded using RMS Pictorial Scale (RMS-PS) for the child’s discomfort. To document the child’s pain as anticipated by the dentist the revised face, limbs, arms, cry and consolability (FLACC-R) scale was employed.

Result:

Lower pain sensation and anxiety was recorded in the experimental group using Buzzy when compared to control.

Conclusion:

External cold in adjacent with vibrations might be efficient in lowering pain as well as anxiety in children experiencing infiltration dental anaesthesia though further research work is requisite with a larger sample size.
Pattern of inflicted injuries to motorcyclists referred to Hazrat-E-Rasoul Akram hospital in Tehran during 2015 – 2016
Authors: Memarian Azadeh , Aghakhani Kamran , Sani Sahar Rismantab , Abdolkarimi Leyla , Soltani Siamak
Published: December 2021

Introduction:

In recent years, road accidents have been one of the leading causes of death in Iran, with the majority of victims being motorcyclists. Accurate knowledge of the pattern of injuries to those injured is a strategy to reduce the consequences of these fatal accidents. The aim of this study was to investigate the pattern of injuries to motorcyclists.

Methods:

The present study was a cross-sectional study that was performed in Rasoul Akram (PBUH) Educational and Medical Center in Tehran. The information was extracted from 500 hospital records of the patients admitted due to motorcycle accidents from September 2015 to September 2016, which was recorded in the data collection checklist.

Results:

About 67.9% of the injured did not have head injuries and 32.0% of the sample group suffered head injuries. Out of 160 people from the head injury group, 7.2% have Abbreviated Injury Scale (AIS) index = 1 and 93.8% have AIS ≥ 2. A total of 82% of the injured had no neck injuries and 18.0% of the sample group had neck injuries. Of these, 72.2% had AIS = 1 and 17.8% had AIS ≥ 2. About 65.0% of the injured did not have facial injuries and 35.0% of the sample group suffered facial injuries.

Conclusion:

An accurate knowledge of the pattern of injuries to this group of injured, providing pre-hospital services, timely diagnosis and treatment and the use of corrective and effective factors, has an effective role in reducing the incidence and consequences of this deadly accident.
Study of organophosphorus compound poisoning in a tertiary care hospital and the role of Peradeniya Organophosphorus Poisoning scale as a prognostic marker of the outcome
Authors: Kamath Sangita D. , Gautam Vinit K.
Published: December 2021

Introduction:

Organophosphate compounds (OPC) cause most self-poisoning deaths in India due to their easy availability and lack of stringent laws.

Aim:

To evaluate the clinical profile and outcome of the patients presenting with OPC poisoning and to study the prognostic value of Peradeniya Organophosphorus Poisoning Scale (POPS) in predicting the clinical outcomes.

Methods and Materials:

This was a prospective study involving 100 patients of OPC poisoning admitted to Tata Main Hospital from June 2018 to May 2020 based on the inclusion criteria. Demographic profile, clinical features, treatment details, and need for ventilatory support were noted. POPS was applied on admission, and the patients were followed up for the outcome in terms of morbidity and mortality.

Observations:

Of the 100 patients, most patients were between 20 and 29 years with male to female ratio being 1.2:1. Vomiting (94%), followed by excessive secretions (84%) were the most common symptoms. Overall mortality was 22%. On grading of severity as per the POP scale, 27% of the patients had mild poisoning, 37% patients had moderate, whereas 36% had severe poisoning. Only 11.11% of the patients with POPS 0–3 required ventilator support, whereas 16.2% of the patients with POPS 4–7, and 100% of patients with POPS 8–11 required ventilator assistance (P < 0.0001). Similarly, the total dose of atropine required (P < 0.0001), length of intensive care unit (ICU) stay, complications, and mortality (P < 0.0001) were significantly associated with higher POPS.

Conclusion:

POPS at admission, correlated well with the need for ventilator support, the total dose of atropine required, length of stay in the ICU, complications, and mortality. It can thus be used for prognostication and risk stratification of patients with OPC poisoning.
The Bobath Concept (NDT) as rehabilitation in stroke patients
Authors: Pathak Abhishek , Gyanpuri Vyom , Dev Priya , Dhiman Neetu Rani
Published: December 2021

Background and Objectives:

The Bobath approach, also known as neurodevelopmental treatment (NDT), is a widely used concept in the rehabilitation of stroke patients with hemiparesis in many countries. This technique is being used since years all over the world; however, strong evidence of its usefulness is still not present. This review is aimed to find out its effectiveness based on the randomized controlled trials in the rehabilitation of stroke patients with motor disability and to compare it with other therapeutic techniques.

Materials and Methods:

A systematic literature search on PubMed Central, Science-Direct, Cochrane, Scopus, Clinical Trial Database, and Indian Clinical Trial Registry in English till 31st July 2021 was undertaken. The review is published in Prospective Register of Systematic Reviews (PROSPERO) with registration number “CRD42019125400.” Physiotherapy Evidence-based Database (PEDro) score has been used for the quality assessment of the studies. Randomized clinical trials that studied the comparative effect of the NDT/Bobath concept on motor activity outcomes and cognition/behavior in stroke patients in comparison with other rehabilitative techniques were included.

Results:

No strong documentation describing the effectiveness of this neuro-developmental treatment or its supporting neuro-developmental treatment in comparison with other advanced neuro-physiotherapeutic techniques has been found so as to consider it as the recommended treatment for post-stroke hemiplegia/hemiparesis. Methodological aspects of selected studies for further research are suggested.

Interpretation and Conclusions:

This study is inconclusive in determining the effectiveness of the Bobath approach for the movement rehabilitation of stroke patients. These results are similar to the results of previous reviews done on the same topic.
Attitude towards COVID-19 vaccination among the public in Kerala
Authors: Leelavathy Manju , Messaline Sunitha , Ramachandran Divija , Sukumaran Anilbindu , Jose Regi , Noufel Ahmed N.
Published: December 2021

Context:

As COVID-19 spread across the world, vaccines were developed to fight against the spread of the new disease. Negative attitude and unwillingness to vaccinate when available may be a major hurdle in attaining effective vaccination coverage.

Aims:

The aim of this study was to assess the attitudes towards the COVID-19 vaccine and identify the predictors of negative attitudes towards the vaccine and identify groups most at risk of uncertainty and unwillingness to receive a COVID-19 vaccine.

Settings and Design:

General public of Kerala, cross-sectional survey.

Methods and Material:

The study was conducted in Kerala during the period from 16 January 2021 to 22 February 2021. An online semi-structured questionnaire was sent via google forms with a consent form appended to it. Attitude towards vaccination was measured using a 20-item scale.

Statistical Analysis Used:

Collected data were analysed using SPSS software version 16. Ordinary least-squares (OLS) regressions were carried out to examine socio-demographic predictors of attitude towards vaccination. Multinomial logistic regression model was fitted to examine associations of socio-demographic with uncertainty and disagree to vaccinate against COVID-19.

Results:

In this study, 1345 subjects participated. Mean attitude score was 48.68 with SD 13.55. Most of the study subjects were agreeable to take the vaccine once it is available (88.8%). Religion, occupation, and monthly income were found to be the predictors of attitude towards vaccination.

Conclusions:

The willingness for vaccine uptake was found to be high in our study. However, other aspects such as doubt regarding its safety, effectiveness and duration of protection are considerable and need to be addressed.
Nicotine dependence, perceived stress, and self-efficacy among primary health care professionals during the times of Covid-19 pandemic – A cross-sectional descriptive study
Authors: Gaur Tarun , Rao Dhanesh Singh , Jadhav Atul Ashok , Dagur Lokendra Singh , Dhaka Harinarayan , Pathak Prakhar , Chhabra Kumar Gaurav
Published: December 2021

Background:

Nicotine dependency would have increased during the times of COVID-19 among the primary health professionals, which would can be attributed to perceived stress and can also be influenced by self-efficacy; hence, the aim of the present study was to determine the relationship between nicotine dependence with perceived stress, self-efficacy among primary health care professionals during the times of covid-19 pandemic.

Materials and Methods:

The present study was a cross-sectional descriptive questionnaire study. The study was conducted among primary health workers of Ajmer district; stratified random sampling technique was used to collect data. A questionnaire was prepared that consists of demographic details, questions on perceived stress, self-efficacy, and nicotine dependence.

Results:

Perceived stress and nicotine dependence was high among study participants. Self-efficacy was low. There was significant (P ≤ 0.05) association between high nicotine dependence and high perceived stress. It was also reported that majority of study participants {58 (30.4%)} with high self-efficacy significantly (P ≤ 0.05) was associated with low nicotine dependence.

Conclusion:

High nicotine dependence was significantly associated with high perceived stress, while low nicotine dependence was significantly lower among primary health care workers’ low perceived stress. Low nicotine dependence was significantly associated among study participants with high self-efficacy.
A study of dengue encephalitis with laboratory and clinical parameters in Tertiary Center of North India
Authors: Mehta Vinod Kumar , Verma Rajesh , Jain Ayushi , Sharma Neha , Mahdi Abbas Ali
Published: December 2021

Introduction:

With expanding clinical spectrum of dengue fever, encephalitis has been documented with increasing frequency. The aim of this study was to investigate the incidence, predictors and prognostic factors of dengue encephalitis (DE) in the setting of dengue viruses (DENV) infection.

Materials and Methods:

A hospital-based prospective cohort study was carried out, which included laboratory confirmed dengue positive cases. All dengue cases were categorized into nonencephalitis or encephalitis group. We estimated DE incidence and analyzed clinical, laboratory and neuroimaging data on admission, discharge and follow-up for 3 months to assess its predictors and prognostic factors.

Results:

Out of the enrolled 540 confirmed dengue cases, 27 patients had DE, representing 5% incidence. Two third of the DE patients were 20 years of age or younger, with male preponderance (81.5%). Fever, headache, and altered sensorium were present in >90% on admission. Significant predictors of encephalitis were mean body temperature during fever (P < 0.001), headache (P = 0.015), secondary dengue (P = 0.005), dengue hemorrhagic fever (P < 0.001), elevated hematocrit (P < 0.001), liver function test derangement (P < 0.05), and low platelet count (P = 0.006). Poor outcome factors for DE patients were prolonged duration of fever (P < 0.001), seizure (P = 0.002), and cerebrospinal fluid (CSF) DENV positivity (P = 0.049). One third patients died and the remainder of them recovered. An increasingly higher incidence rate with high mortality of DE is reported.

Conclusion:

Clinical and laboratory parameter along with DENV positivity in CSF can predict and prognosticate dengue encephalitis.
Vitamin A and its dervatives effect on bone mineral density, a systematic review
Authors: Khojah Qamar , AlRumaihi Shorowk , AlRajeh Ghadah , Aburas AlHanouf , AlOthman AlAnoud , Ferwana Mazen
Published: December 2021

Background:

Even though vitamin A (Vit A) is one of the essential vitamins required for bone growth and development, it is still uncertain whether its effect on bone mineral density (BMD) is beneficial or harmful.

Aim:

To assess Vit A’s effect and its derivatives on BMD and the risk of developing osteoporosis.

Data sources:

PubMed, Cochrane Library, Science Direct, Embase, and Google Scholar were searched in February 2019 and updated in November 2020.

Methods:

Conducted following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines.

Results:

A total of 13 studies were included in this report out of 9,124 citations. Five of them were cross-sectional studies, and nine were cohort studies. Three out of five cross-sectional studies showed an increase in BMD, while two showed a decrease in BMD. Four out of eight cohort studies found an increase in BMD; two studies found no association between vitamin A level and BMD; one showed an inverse U-shape association of vitamin A with BMD, suggesting that both the increase or decrease levels of vitamin A affect BMD, while only one study showed a decrease in BMD.

Conclusion:

Although most of the included studies showed a favorable effect of Vit A on BMD, Vit A’s role or its derivatives on BMD change remains unclear.
APRI and FIB-4 performance to assess liver fibrosis against predefined Fibroscan values in chronic hepatitis C virus infection
Authors: Rungta Sumit , Kumari Shweta , Deep Amar , Verma Kamlendra , Swaroop Suchit
Published: December 2021

Backgrounds and Aims:

Chronic hepatitis C (CHC) infection can leads to chronic liver disease, fibrosis, then cirrhosis, and, finally, hepatocellular carcinoma (HCC); moreover, it is the most common indication for liver transplantation. Liver biopsy is still the gold standard method for the staging of liver fibrosis as it is an invasive procedure with complications. There are some noninvasive methods such as fibroscan that are now the investigation of choice; FIB-4 and aminotransferase to platelet ratio index (APRI) are other noninvasive tools to assess liver fibrosis by using aspartate aminotransferase (AST), alanine aminotransferase (ALT), platelet count, and age. This study aims to evaluate the efficacy and performance of FIB-4 and APRI against fibroscan in patients infected with the hepatitis C virus.

Method:

It is a cross-sectional study that was conducted in a tertiary health care center in Uttar Pradesh, India, from January 2017 to January 2020. Fibroscan was done for all patients. A blood sample was used to determine AST, ALT, and platelet count. FIB-4 and APRI were calculated from laboratory data.

Result:

187 of the 487 patients in the study have F0-F1 fibrosis, 69 have F2, 53 have F3 fibrosis, and 178 have cirrhosis. Based on receiver operating characteristic (ROC) analysis, single optimum cut-offs for diagnosing significant fibrosis and cirrhosis were 1.2 for APRI and 2.25 for FIB-4.

Conclusions:

Compared with Fibroscan, APRI and FIB-4 showed good performance in detecting the patients without liver fibrosis as well as satisfactory performance in detecting significant fibrosis. These scores should be used in combination with other noninvasive scores for an accurate assessment of liver fibrosis.