bluuebunny/crossref_metadata_2025 huggingface dataset:
Analysis of adverse drug reactions of imatinib in chronic myeloid leukemia patients
Authors: Swain Trupti Rekha , Goutam Siddhartha , Jena Rabindra Kumar , Rout Niranjan
Published: May 2024

BACKGROUND:

Imatinib mesylate is the cornerstone therapy in the management of chronic myeloid leukemia (CML). Monitoring of adverse drug reactions (ADRs) of imatinib in our patients is very important to ensure their safety. Aims and Objectives: The current study aims to monitor ADRs encountered in CML patients in the chronic phase with imatinib (400 mg/day).

MATERIALS AND METHODS:

This prospective, observational study was conducted from November 2011 to May 2015 on 310 patients presented to the Departments of Clinical Hematology and Pharmacology of SCB MCH, Cuttack, diagnosed with CML at chronic phase. Collected ADRs were entered in the ADR reporting form (PvPI) and were analyzed for causality and severity.

RESULTS:

Anemia was the most common hematological ADR, whereas hyperpigmentation and nausea were the most common nonhematological ADRs reported. Maximum ADRs were mild to moderate and required no change in the treatment course.

CONCLUSION:

The study revealed that imatinib mesylate, a well tolerated drug, has very few cases of severe ADRs in Indian patients at the chronic stable phase of CML.
Comparison of patients using lamivudine, entecavir, and tenofovir according to liver fibrosis markers fibrosis-4 and aspartate aminotransferase-to-platelet ratio index scores
Authors: Okan Huseyin Dogus , Karabay Oguz , Guclu Ertugrul , Inci Mustafa Baran , Ogutlu Aziz
Published: May 2024

OBJECTIVES:

It was intended to assess the efficacy of lamivudine, entecavir, and tenofovir regimens in the management of chronic hepatitis B (CHB) guided by Fibrosis-4 (FIB-4) and aspartate aminotransferase-to-platelet ratio index (APRI) scores.

MATERIALS AND METHODS:

Our study was conducted on patients who applied to the hepatitis outpatient clinic between 2008 and 2015 retrospectively. Lamivudine, entecavir, and tenofovir regimens used in the practice of CHB cases were compared by measuring noninvasive FIB tests.

RESULTS:

Entirely 199 patients involved in the research were evaluated in three treatment arms; 48 used lamivudine, 46 used entecavir, and 105 used tenofovir. Similar statistical characteristics were observed between research arms regarding age, gender, and alanine aminotransferase normalization by years (P > 0.05). Totally 5 (13.5%) of patients developed Hepatitis B e antigen (HBeAg) seroconversion among 36 HBeAg positivity, and similar statistical features were seen by comparing the groups (P > 0.05). In the entecavir and tenofovir arms, a significant decrease was seen in FIB-4, and APRI index values in the 1st year of treatment (P < 0.001). At the graph curve, a plateau was observed in the APRI test after the 1st year, and a plateau was observed in the FIB-4 test after the 2nd year.

CONCLUSION:

Consistent with the study outcome, when we consider FIB regression, tenofovir and entecavir regimens were found more effective than lamivudine. In addition, entecavir was more effective than the other two drugs after the 1st year.
Efficacy, safety, and dose-response effects of calcifediol supplementation on 25-hydroxyvitamin D, parathyroid hormone, and 1,25-dihydroxyvitamin D levels in healthy adults
Authors: Das Liza , Holick Michael F. , Sachdeva Naresh , Bhadada Sanjay Kumar , Singhmar Shallu , Thakur Neetika , Dutta Pinaki , Marwaha Raman Kumar
Published: May 2024

BACKGROUND:

Vitamin D deficiency (VDD) is highly prevalent across the globe. Cholecalciferol (Vitamin D3) fails to attain sufficient serum concentrations of 25-hydroxyvitamin D (25(OH)D) in a significant proportion of supplemented individuals. Calcifediol (25-hydroxyvitamin D3) is less studied in healthy adults and its effects on 25(OH)D, parathyroid hormone (PTH), and 1,25-dihydroxyvitamin D (1,25(OH)2D) at higher doses are not well known.

MATERIALS AND METHODS:

The study was an open-label, interventional trial recruiting consecutive participants with VDD who were allocated to receive either 2 capsules (50 μg-group) or 1 capsule (25 μg-group) daily doses of calcifediol. Baseline assessment included clinicodemographic parameters, dietary calcium, calcemic (calcium, inorganic phosphate, albumin, alkaline phosphatase, urine spot calcium/creatinine), and hormonal parameters (25(OH)D, PTH, and 1,25(OH)2D). Participants were followed up at 4 and 8 weeks with repeat assessments of calcemic and hormonal parameters.

RESULTS:

There were 64 participants, 35 (50 μg-group) and 29 (25 μg-group), without any significant difference in any of the baseline parameters. 97.1% participants in the 50 μg-group (at 4 and 8 weeks) and 93.1% (at 4 weeks) and 96.5% (at 8 weeks) in the 25 μg-group attained 25(OH)D sufficiency (≥30 ng/ml) with calcifediol. The mean serum 25(OH)D was 84.0 ± 27.7 ng/ml in the 50 μg-group and 58.0 ± 23.6 ng/ml in the 25 μg-group group at 4 weeks, which later rose to 94.3 ± 21.8 ng/ml and 76.0 ± 16.4 ng/ml, respectively, at 8 weeks. PTH levels decreased in both groups at both time points. 1,25(OH)2D rose significantly in both groups at 4 and 8 weeks but was not significantly different between both groups. There was no case of incident hypercalcemia or symptomatic nephrolithiasis.

CONCLUSION:

Calcifediol is a safe and efficacious alternative for oral Vitamin D supplementation in young adults. Increment in 25(OH)D levels is rapid and dose-dependent.
Use of drugs not listed in the National List of Essential Medicines
Authors: Jhaj Ratinder , Banerjee Aditya , Kshirsagar Nilima Arun , Sadasivam Balakrishnan , Chandy Sujith J , Bright Heber Rew , Chugh Preetha Kaur , Tripathi C D , Badyal Dinesh Kumar , Samuel Madhulika Peter , Medhi Bikash , Prakash Ajay , Joshi Rupa , Kamat Sandhya , Tripathi Raakhi , Parmar Urwashi Indrakumar , Dikshit Harihar , Mishra Hitesh , Roy Sukalyan Saha , Trivedi Niyati , Chauhan Janki , Chatterjee Suparna , Bhattacharya Manjari , Desai Chetna K , Sheth Shamil , Gupta Pooja , Roy Atanu , Raveendran Ramasamy , Mathaiyan Jayanthi , Jeevitha G , Kaushal Sandeep , Gupta Kanchan , Jain Samriti , Kaul Rajni
Published: May 2024

BACKGROUND:

The concept of listing essential medicines can lead to improved supply and access, more rational prescribing, and lower costs of drugs. However, these benefits hinge on the prescription of drugs from an Essential Medicines List (EML). Several studies have highlighted the problem of underutilization of EMLs by prescribers. Therefore, as part of prescription research by the Indian Council of Medical Research-Rational Use of Medicines Centres Network, we evaluated the extent of prescription of drugs not listed in the National List of Essential Medicines (NLEM).

MATERIALS AND METHODS:

Prescriptions of outpatients from participating centers were included after obtaining verbal/written informed consent as approved by the Ethics Committee, and evaluated for prescription of drugs from the NLEM 2015.

RESULTS:

Analysis of 4838 prescriptions from 13 tertiary health-care institutes revealed that 2677 (55.33%) prescriptions had at least one non-NLEM drug prescribed. In all, 5215 (31.12%) of the total 16,758 drugs prescribed were not in NLEM. Of these, 2722 (16.24%) were single drugs and 2493 (14.88%) were fixed-dose combinations (FDCs). These comprised 700 different drug products – 346 single drugs and 354 FDCs. The average number of non-NLEM drugs prescribed per prescription was 1.08, while the average number of all drugs prescribed was 3.35 per prescription. It was also found that some of the non-NLEM drugs prescribed had the potential to result in increased cost (for example, levocetirizine), increased adverse effects (dextromethorphan), and less effectiveness (losartan) when compared to their NLEM counterparts. Nonavailability of an essential drug (oral hydroxocobalamin) was another important finding of our study.

CONCLUSION:

This study highlights the extent and pattern of drugs prescribed from outside the NLEM at the tertiary health-care level and the need for training and enhanced awareness among prescribers for greater utilization of the NLEM.
Lasmiditan abortive therapy for episodic migraine in Phase II/III randomized clinical trials
Authors: Ahsan Marya , Mallick Ayaz Khurram
Published: May 2024

OBJECTIVE:

Although migraine is common, there are very few treatment options. Recently, lasmiditan, a specific 5-HT1F agonist, has gained approval as abortive therapy for migraine. This meta-analysis and trial sequential analysis (TSA) was performed to analyze efficacy and tolerability of lasmiditan therapy for episodic migraine.

MATERIALS AND METHODS:

Phase II and Phase III double-blinded placebo-controlled randomized controlled trials (RCTs) evaluating lasmiditan for episodic migraine were searched for from electronic databases. The risk of bias was estimated, data were extracted, and relative risk (RR) were calculated for efficacy and safety outcomes with a fixed/random effect model. Forest plots and funnel plots were created. TSA graph was plotted. Therapeutic gain with lasmiditan was calculated.

RESULTS:

Six high-quality RCTs were included with 7122 patients. Compared to placebo, lasmiditan demonstrated a significant proportion of migraineurs reporting freedom from headache, most bothersome symptom, headache response, no disability, global impression “very much/much better” 2 h posttreatment and sustained pain freedom at 24 and 48 h with 50, 100, 200, and 400 mg doses (RR range = 1.26–2.50). 39.3% of patients in the lasmiditan group (RR = 2.43) reported one or more treatment-emergent adverse event (TEAE). Dizziness, somnolence, paresthesia, fatigue, nausea, vertigo, hypoesthesia, asthenia, muscular weakness, lethargy, and malaise had a high incidence (RR range = 3.16–12.77). Most TEAEs were mild to moderate. No vasoconstriction-related TEAE was reported.

CONCLUSION:

Lasmiditan demonstrated efficacy as abortive therapy for episodic migraine with central nervous system-related side effects.
Management of Linezolid-Induced Peripheral Neuropathy
Authors: Tambe Rituja , Doshi Preeti P.
Published: May 2024

As the incidence of extensively drug-resistant tuberculosis is increasing, more cases of linezolid-induced peripheral neuropathy are being noted. It is challenging to treat. In this case report, we describe the successful management of this painful neuropathy using a multimodal multidisciplinary approach.
Two-Arm Observational Study to Assess the Efficacy of Cooled versus Conventional Radiofrequency Ablation of Medial Branch Nerves in Patients with Lumbar Facet Joint Arthropathy
Authors: Saroha Swati , Bhattacharya Dipasri , Arya Prashant , Choudhury Arpita , Biswas Rajasree
Published: May 2024

Background:

Pain originating in the facet joint accounts for an estimated 15%–45% of cases of low back pain. Radiofrequency ablation (RFA) of the medial branch nerves (MBN) is used in refractory cases. However, very few studies have compared the clinical outcomes of cooled versus conventional/traditional RFA (T-RFA) for the treatment of lumbar facet joint pain.

Objective:

To determine the clinical outcomes of MBN cooled RFA (C-RFA) compared with T-RFA, as measured by improvements in pain and physical function.

Methodology:

Forty patients with positive diagnostic MBN blocks were allocated to C-RFA or T-RFA group. Reduction in pain (NRS “Numerical Rating Scale” score), improvement in quality of life (Oswestry Disability Index [ODI]), proportion of responders/successful treatment (≥50% NRS reduction, and or ≥30% or ≥15 point reduction in ODI at 6 months follow up) in the two groups were recorded.

Results:

Total 34 patients were analysed, C-RFA (n = 18) and T-RFA (n = 16). There was significant reduction in pain scores as well as improvement in quality of life in both the groups, but the difference between the two groups was not significant. NRS reduction of ≥50% was observed in 72.22% and 68.5% of participants in the C-RFA and T-RFA groups, respectively (P = 0.824). A ≥15-point or ≥30% reduction in ODI score was observed in 77.77% and 75% of participants in the C-RFA and T-RFA groups, respectively (P = 0.849).

Conclusions:

Both the groups showed significant improvement in pain scores and quality of life. C-RFA resulted in greater treatment success rate than conventional RFA, but the difference was not significant.
Immunogenicity of Covishield vaccine in patients with autoimmune rheumatic diseases
Authors: Gupta Vikas , Gupta Vikram Kumar , Bajwa Navjot Kaur , Sachdeva Ashi , Garg Rupali , Ghosh Abhra
Published: May 2024

ABSTRACT

Introduction:

The Coronavirus disease 2019 (COVID-19) pandemic has been the biggest threat to humankind during the last 3 years. It has caused the loss of more than 6.9 million precious lives across the world. The only method by which the massacre could be stopped was by mass vaccination or mass immunization. The patients suffering from autoimmune rheumatic disorders (AIRDs) and treated with immunosuppressants were the high-priority candidates for vaccination. However, the data regarding the efficacy of COVID-19 vaccines in this group of patients are very less. Hence, this study was planned to study the immunogenicity of Covishield in patients with AIRDs attending the rheumatology OPD at DMCH, Ludhiana.

Materials and Methods:

It was a prospective cohort study and was planned by the Department of Biochemistry and Department of Clinical Immunology and Rheumatology at Dayanand Medical College and Hospital, Ludhiana. Fifty patients with AIRDs attending the DMCH rheumatology OPD and 52 age and sex-matched healthy controls who had received two doses of Covishield vaccine were included in this study. Patients having any other immunosuppressive conditions like uncontrolled diabetes, hepatitis, malignancy or HIV were excluded. Patients who had suffered from previous laboratory-confirmed COVID-19 infection (by RT-PCR) were also excluded. Blood samples were collected following all aseptic precautions from patients and controls on the 28th day after administration of a second dose of Covishield vaccine and total antibodies to the severe acute respiratory syndrome coronavirus 2 spike (S) protein receptor binding domain was measured using Elecsys Anti-SARS-CoV-2 S kit from Roche.

Results:

It was observed that no significant difference was there in antibody titre between cases and controls (6213 ± 4418 vs. 8331 ± 7979, P = 0.1022). It was also observed that no statistically significant difference in antibody titre in cases without prednisolone and those taking treatment with prednisolone was found (P = 0.7058). A similar observation was found in terms of methotrexate also (P = 0.457). No significant difference in antibody titres was there when compared with controls (for prednisolone, P = 0.169, for methotrexate, P = 0.078). We found that only the patients receiving mycophenolate mofetil showed a statistically significant decrease in antibody titre in comparison to healthy controls (P = 0.03). Our study showed no statistically significant difference in antibody titres between patients suffering from different AIRDs.

Conclusion:

Our study supplements the fact that patients with AIRDs in India can receive Covishield as the primary vaccine against COVID-19 without concerns regarding decreased immunogenicity or increased adverse effects.
Impact of COVID-19 pandemic on online medical education – An online survey of students’ perspective
Authors: Kabi Ananya , Nayak Bikash C. , Ray Satyajit S. , Gupta Sandhya , Epari Venkatarao , Sahoo Jyotiranjan
Published: May 2024

ABSTRACT

Introduction:

The year 2020 brings in a paradigm shift in medical education with the emergence of the COVID-19 pandemic. Since the government of India initiated the first countrywide lockdown, educational institutions, including medical colleges, have adopted online mode for undergraduate teaching. Medical education is virtually incomplete without appropriate practical exposure. This study was conducted to understand the opinion of the medical students towards online classes as an impact of this pandemic on medical education.

Materials and Methods:

A descriptive online survey was conducted using a google form among medical undergraduate students from across India. Snowball sampling was used to recruit study participants. The responses were analyzed using numbers and percentages. Continuous variables were expressed as the mean and standard deviation of the mean.

Results:

The mean age of the 1426 respondents was 20.46 years. The majority of the responses were from Karnataka (412), followed by Odisha (167). While fairly a good number of respondents agreed that online classes provided a conducive environment and independence in learning, a large proportion disagreed or remained neutral in terms of its usefulness. This could be attributed to several reasons, which may be categorized into three important groups: the technical competence of the students, the provision of an enabling environment and the ability of the teachers.

Conclusion:

Students had varying opinions on online classes, but most emphasized the need for redoing the lessons taught online.
The effect of aquatherapy on pain intensity and performance in patients with osteoarthritis
Authors: Karimi Saba , Derakhshan Mehrdad , Tondro Amirhossein
Published: May 2024

ABSTRACT

Introduction and Aim:

Osteoarthritis (OA) is a noninflammatory joint disease. If OA of the knee causes pain, decreased muscle strength and joint stiffness, exercise therapy is one of the most effective treatments for the disease. The aim of the present study was to evaluate the effect of aquatherapy on pain intensity and performance in women with OA with the assumption that it causes weightlessness.

Methods:

This is a quasiexperimental study. The sample size included 60 people who were randomly divided into experimental and control groups. The visual analogue scale was used to assess pain and timed up and go test (TUG), 30 Second Sit to Stand Test (30-S-CS), and 40-meter fast-paced walk test (40 MW) were used to assess performance. Data analysis was carried out using SPSS ver. 22.

Results:

The results of the present study showed a decrease in pain intensity from moderate to mild intensity. Also, physical performance dimensions in patients with OA were improved, so that the average TUG increased from 14.06 to 8.8 s. The average S-CS frequency increased from 4.86 to 8.4 s and 90 MW decreased from the average 93.43 to 72.66 s.

Discussion and Conclusion:

Lower limb muscle strength, and physical performance can be improved and pain intensity can be reduced in patients with OA by performing aquatherapy three times a week for 8 weeks.
Salivary and serum estrogen level assessment in oral lichen planus patients and its correlative analysis with OLP and stress
Authors: Agrawal Heena , Patil Ranjit Kumar , Singh Vandana , Tripathi Anurag , Khanna Vikram , Chaurasia Akhilanand , Arya Amit , Ali Wahid
Published: May 2024

ABSTRACT

Background:

Lichen planus is a chronic inflammatory disease of the skin and mucous membrane with higher predilection seen in the female population. Oral lichen planus (OLP) has been associated with various etiological factors, such as stress, hormonal imbalance, and immunological variation. The purpose of this study was to assess serum and salivary estrogen (E2) levels in OLP patients and correlate them with stress levels.

Objectives:

This study aimed to evaluate serum and salivary estrogen levels in female patients with OLP, along with the assessment of stress and its correlation with estrogen levels.

Methods:

A total of 78 females, 39 clinically diagnosed with OLP and 39 healthy females, were included in the study as the case and control groups, respectively. 2 ml each of salivary and serum samples was obtained from each participant to measure the estrogen levels. Stress levels in the study group patients were assessed using the Depression Anxiety Stress Scale (DASS-21) and the Perceived Stress Scale (PSS). The nonparametric Mann–Whitney test was used for intergroup comparisons.

Results:

Significantly higher serum estrogen levels with higher DASS-21 and PSS scores were noted in patients with OLP. Overall, significant positive correlations were observed between salivary E2 and serum E2 (r = 0.361, P = 0.001). There was a positive correlation between salivary and serum E2 and DASS score (r = 0.410, P < 0.001, and r = 0.768, P < 0.001, respectively), serum/salivary E2 and PSS score (r = 0.745, P < 0.001, and r = 0.410, P < 0.001, respectively), and DASS score and PSS score (r = 0.878, P < 0.001).

Conclusion:

Estrogen can be used as a useful biomarker for OLP in the future. Salivary samples can prove to be an accurate and feasible alternative to serum estrogen level determination. We also suggest that OLP patients must be given supportive psychological treatment for improved life quality and disease management.
Effectiveness of health education program on knowledge regarding health promotion strategies in the geriatric population of selected old age homes at Raipur, Chhattisgarh
Authors: Chander Prem
Published: May 2024

ABSTRACT

Background:

The elderly is defined as the person who is beyond middle age and approaching old age (60 or above), also called senior citizens. The number of older adults globally is expected to increase from 420 million in 2000 to 974 million in 2030. In 2017. The objectives of the study were to assess the existing level of knowledge regarding health promotion strategies and to determine the effectiveness of health education program on knowledge regarding health promotion among the elderly in old age home.

Materials and Methods:

The study employed one-group pretest and posttest preexperimental design without a control group. The sample size of 50 was selected using a non-probability convenient sampling technique. Baseline data were collected by a structured questionnaire, and a structured teaching program was given for 2 weeks, and after 15 days, a posttest was conducted with the same tool.

Statistical Analysis:

Data collected were analyzed by using both descriptive and inferential statistics.

Results:

The knowledge score increased significantly from baseline. The mean score of the pretest was 18.38, the mean score of the posttest was 21.78, the mean improvement was 3.40, and the paired value obtained for knowledge was 17.36, which was found significant at 0.05 level (P < 0.05). There was a significant improvement in the knowledge regarding health promotion strategies in the geriatric population.

Conclusions:

The result of the study concluded that health education program was effective in improving the knowledge regarding health promotion strategies in the geriatric population.
Morbidity pattern and impact of hydroxyurea therapy among sickle cell patients in Raipur district of Chhattisgarh
Authors: Vaibhav Divyansh , Panda Prem S. , Debata Ipsita , Sinha Ashish K.
Published: May 2024

ABSTRACT

Background:

Sickle cell disease (SCD) is a disorder marked by a single-point mutation in the beta-globin gene. Hydroxyurea is a globally accepted disease-modifying agent that sounds to be effective in managing clinically and probably preventing complications of SCD. The current study aims to document the morbidity pattern and impact of Hydroxyurea therapy in the Outpatient Department of Sickle Cell Institute, Raipur.

Materials and Methods:

This cross-sectional study was conducted among randomly selected sixty-five patients (adults and children above six years). After obtaining informed consent, relevant data were collected in a predesigned pretested questionnaire. The appropriate statistical exercise was applied for the interpretation of results and inferences.

Results:

Acute febrile illness 54 (83%) and 53 (81.5%) reported pain crisis observed to have the most common morbidity among the study subjects, followed by 55.4% (36), 33 (50.8%) jaundice and difficulty breathing, respectively. Joint pain was the most commonly observed complaint, particularly at the knee joint (76.9%). Other complaints such as hand-foot syndrome (24.6%), epistaxis (27.7%), and acute chest syndrome (21.5%). Vaso-occlusive crisis (72.4%), difficulty in walking (60.0%) and eyesight (35.4%), leg ulcers (9.2%), and dactylitis (3.1%) were also documented as clinical manifestations among study participants. Less than half (44.46%) had an awareness about SCD. Hydroxyurea therapy was highly significant in improving the patient’s clinical picture (P < 0.01), especially following the frequency of hospitalization and the requirement for blood transfusion.

Conclusion:

Pain crisis is the most common morbidity among study participants with a low level of knowledge about SCD with febrile illness. Hydroxyurea therapy was found to be quite effective as a disease-modifying therapy, especially for reducing the frequency of blood transfusion and lowering hospitalization rates among SCD patients.
Utilization of adolescent-friendly health services and its determinants in a rural area of Maharashtra
Authors: Sundaram Hemamalini , Jogdand Mohini S. , Sambutwad Rajesh C. , Sirsulwar Ganesh K.
Published: May 2024

ABSTRACT

Context:

Adolescent phase is a very crucial period in one’s life, much emotional and psychological support is needed for an adolescent to bloom into a responsible adult. But unfortunately adolescents do not get the support or they fail to seek support due to lack of awareness. Government of India, to address this issue has established dedicated adolescent friendly health services (AFHS). This study estimates the utilisation of adolescent friendly health clinics in a rural area of Maharashtra.

Aims:

Aim is to the study the utilisation of adolescent friendly health services and its various determinants in a rural area of Maharashtra.

Objectives:

Objectives of this study were to assess the sociodemographic profile of study participants, to study the utilisation of adolescent friendly health services among them and to determine the factors associated with utilisation of adolescent friendly health services.

Settings and Design:

A community based cross-sectional study was conducted among 290 late adolescents from a rural area of Maharashtra from October 2022 to December 2022.

Methods and Material:

With the help of data from Gram panchayat about residing adolescents in the rural field practice area of tertiary care hospital, all late adolescents were included in this study after obtaining informed consent. Data was collected with and Statistical analysis was done using ‘Open Epi Info’ software.

Results:

Out of 290 adolescents, 35% (102) were aware of adolescent friendly health clinics (AFHS), 20% (58) utilised AFHS, the significant sociodemographic components for utilisation were found to be females (AOR: 2.161,95% CI: 1.088-4.295), Bauddha religion (AOR: 2.465,95% CI: 0.585-10.383), socioeconomic class I and II- B.G Prasad classification (AOR: 1.544,95% CI: 0.786-3.030), higher secondary education (AOR: 8.025,95% CI: 1.434-44.916) and Government schooling (AOR:0.389,95% CI: 0.080-1.889).

Conclusions:

Though initiatives are taken from the Government to lend a helping hand to the adolescents, awareness and utilisation seems to be minimal.
Copeptin as a potential biomarker of chronic kidney disease to predict the disease progression in children with chronic kidney disease
Authors: Dawman Lesa , Rawat Amit , Meena Jitendra , Tiewsoh Karalanglin
Published: May 2024

ABSTRACT

Background:

Biomarkers to predict the onset and progression of chronic kidney disease (CKD) in children are lacking, and no such definite biomarkers have been implicated in the diagnosis of CKD. We conducted this study to evaluate copeptin as a CKD marker and predict the disease progression by estimating the copeptin levels at baseline and 12 months follow-up in children with CKD stage 2 and above.

Materials and Methods:

This prospective single-centre cohort study was conducted in children under 14 years with CKD stages 2-4. Blood and urine samples were collected at enrolment and 1-year follow-up for routine investigations and serum copeptin, cystatin C and urinary neutrophil gelatinase-associated lipocalcin (uNGAL) estimation.

Results:

A total of 110 children (60 cases and 50 controls) were enrolled in the study. The mean estimated glomerular filtration rate (eGFR) of cases was 58.3 ± 18.7 ml/min/1.73 m2. Among the cases, there was a significant rise in the serum copeptin levels from baseline 483.08 ± 319.2 pg/ml to follow-up at 1 year, that is, 1046.82 ± 823.53 pg/ml (P < 0.0001). A significant difference was noted in the baseline values of serum cystatin C, that is, 1512.98 ± 643.77 ng/ml and 719.68 ± 106.96 ng/ml (P < 0.0001), and uNGAL, that is, 13.53 ± 11.72 and 1.76 ± 2.37 ng/ml (P < 0.0001) between the cases and controls. There was no significant correlation (correlation coefficient = 0.10) between change in eGFR and copeptin levels during 12 months of follow-up.

Conclusion:

No significant correlation was found between the change in eGFR and copeptin levels during 12 months of follow-up. This can be due to the slow deterioration of renal functions, as most of the cases had underlying congenital anomalies of the kidney and urinary tract (CAKUT), which is known to have a slow progression of CKD and a small sample size.
Evaluation of an online “Train the Trainers” course for family physicians in Pakistan: Expectations vs reality
Authors: Ata Madiha , Amin Faridah , Saghir Shaista , Sultana Shafaq , Imran Muhammad , Mehdi Salima
Published: May 2024

ABSTRACT

Aim:

Pakistan is in dire need of trained family physicians to enhance the quality of primary health care. To build capacity, there is a need to train the trainers on a large scale through a feasible and accessible program. Therefore, for the first time, a three-month online course was designed and piloted, in collaboration with national and international family medicine faculty. The aim of this study was to determine the gap between the pre-course expectations and the post-program perceptions of the participants for* a unique family medicine “Train the Trainers” course.

Methods:

A longitudinal-observational study was conducted at a private college of Karachi after approval from the Institutional Review Board. The expectations and perceptions of all (31) participants were recorded through a pre- and post-course questionnaire. Data were analyzed through descriptive and analytical statistics on SPSS-26. The responses to the open-ended questions were analyzed by content analytical approach.

Results:

Out of 20 quantitative items on the questionnaire, four were associated with a positive gap between the expectations and perceptions. One item showed a negative gap, while the rest did not show any significant difference. The majority of the participants expressed that they expected to see an improvement in their teaching skills because of the online course.

Conclusion:

The online course was successful in meeting the participants’ expectations. The course delivery can be revisited to further improve its quality according to the participant’s feedback, including an opportunity to ask questions and incorporating some face-to-face sessions.
WHO and its transformation – A journey from 1978 to 2024
Authors: Bhattacharya Jayanta
Published: May 2024

ABSTRACT

The Alma-Ata Declaration of 1978 was a historic hallmark in the history of public health of the 20th century. It stressed on comprehensive primary health care and led to the slogan of “Health for All by 2000 A.D.” The Conference documents made it clear that primary health care was essential health care based on practical, scientifically sound, and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country could afford to maintain at every stage of their development in the spirit of self-reliance and self-determination. It was proclaimed to form an integral part of a country’s health system. In addition, as a consequence, the overall social and economic development of the community depended on its survival. It was regarded as the first level of contact of individuals, the family, and community with the national health system bringing health care as close as possible to where people live and work. Instead of disease-centred vertical programs, it emphasised to adopt the horizontal community-based programs. Though the worldwide stir caused by the historic Alma-Ata Conference (1978), giant MNCs of the world remained hibernated for some time but never gave up to turn “health” into “health care” as commodity. Intriguingly enough, health was “forgotten” when the Covenant of the League of Nations was drafted after the First World War. Only at the last moment, world health was included, leading to the Health Section of the League of Nations. Recently, Intergovernmental Negotiating Body has drafted a new Pandemic Treaty which might become disastrous for general well-being and rightful living for citizens in future. All these observations are very much relevant if family medicine and primary care are given due importance at the present moment.
Transplant Renal Artery Stenosis with Varied Clinical Presentations
Authors: Muske Sravani , Aralapuram Kishan , Jayaprakash Shilpa , Gurusiddaiah Sreedhara C. , Nagesh CM , Shankar Mythri
Published: May 2024

Renal vascular complications constitute a clinically significant cause of morbidity following renal transplantation. Transplant renal artery stenosis (TRAS) is a well-recognized complication accounting for ~75% of posttransplant vascular complications. Early recognition and prompt correction of TRAS can prevent adverse outcomes, including graft loss. This series is a summary of four renal transplant recipients who developed TRAS at varied time periods and with varied clinical presentations. A 23-year-old male who presented after 1½ months of renal transplantation with accelerated hypertension was diagnosed with TRAS and was treated successfully with percutaneous transluminal angioplasty with stenting. A 26-year-old male with acute allograft dysfunction after 1 month of transplantation without worsening hypertension was diagnosed with TRAS, which was treated successfully with angioplasty and stenting. A 49-year-old male who presented to the emergency with pulmonary edema secondary to accelerated hypertension (Pickering syndrome) after 2 months of transplantation was diagnosed to have TRAS, which was treated successfully with angioplasty with stenting. A 44-year-old male with an incidentally detected TRAS-like clinical picture secondary to kinking in the transplant renal artery in the immediate posttransplant period was successfully treated with re-exploration and repair. All the patients were screened with Doppler ultrasonogram and computed tomogram-angiography supported the diagnosis in three of the cases. None of the cases developed procedure-related complications including contrast-associated nephropathy. All the patients on follow-up after 6 months of the intervention are normotensive with normal renal function. A high index of suspicion is required in the early identification of TRAS, which is a reversible cause of hypertension and graft dysfunction. The risk of contrast-associated nephropathy cannot hinder or delay the diagnosis especially, in emerging transplant centers. The endovascular procedures used today for the treatment of TRAS are safe with high technical success rates.
Successful Management of Accidental Tracheal Tear using an Adaptation of an Endotracheal Tube
Authors: Paul Shamik Kumar , Kiran S , Guha Deborshi , Kaur Kaminder , Paul Debashish
Published: May 2024

Although tracheal injury during esophagectomy is a rare complication, it is a dreaded one when encountered in the intraoperative period. It can be managed conservatively or by primary repair. We report an incident and successful management of tracheal injury during transhiatal esophagectomy performed in a case of carcinoma esophagus (upper one-third). The tracheal rent of the posterior wall of the trachea was repaired with bovine pericardial patch through a right thoracotomy we added one endotracheal tube (ETT), cut at 19 cm mark from its patient end, reversed to another ETT with a refashioned ETT connector. This innovation gave us enough length to place the tube comfortably inside the left main bronchus without making the ETT cuff herniate inside the tracheal tear. The tracheal rent was repaired with bovine pericardial patch hitched with pledgeted sutures through a right thoracotomy. Postrepair, the patient was electively ventilated; gastric pull-up was postponed pending the healing of the trachea. At the time of second surgery, we had to take all the precautions not to disrupt the repaired wall. The tracheal wall was found intact with some permanent deformity but functionally competent.
A Case Series of Mycobacterium kansasii Pulmonary Infection in a Tertiary Care Private Hospital
Authors: Vashisht Rohit , Panchatcharam Senthur Nambi , Sethuraman Nandini
Published: May 2024

Background:

Mycobacterium kansasii is being increasingly recognized as an important pathogen mimicking clinically Mycobacterium tuberculosis (MTB). We describe here a series of cases due to M. kansasii lung disease from a tertiary care private hospital from South India.

Methods:

A retrospective chart review of patients diagnosed with M. kansasii pulmonary infection at a tertiary care referral center between January 2017 and April 2019 was conducted. Positive bronchoalveolar lavage (BAL) cultures were included in the study.

Results:

Seven patients with majority having underlying predisposing conditions presented with respiratory symptoms and radiological features resembling pulmonary tuberculosis. Smear acid fast bacillus (AFB) positivity was seen in 3 out of 7 cases. M. kansasii was isolated from bronchial culture in all of them with negative GeneXpert MTB reports. Five patients showed clinical improvement after starting treatment, while two were lost to follow up.

Conclusion:

M. kansasii should be suspected in AFB smear positive but GeneXpert MTB negative patients. Getting AFB cultures done is crucial in such patients to make an appropriate etiological diagnosis.
Compliance to enhanced recovery program in liver resection surgery: A retrospective cohort study
Authors: Pradhan Abiya , Sarkar Anshuman , Haldar Srimanta , Chakraborty Arunangshu , Pal Angshuman Rudra
Published: May 2024

Background and Aims:

Liver resection is a complex surgery, and optimizing recovery is critical to ensure that patients can promptly regain their health and quality of life. The authors present a retrospective cohort study on Enhanced Recovery After Surgery (ERAS) in liver resection aimed at correlating compliance with ERAS elements to length of stay (LOS) and the incidence of complications in a tertiary-level cancer hospital in Eastern India.

Material and Methods:

In total, 44 hepatectomy patients were assessed retrospectively from June 2022 to May 2023. Data were collected from electronic medical records and patient charts.

Results:

The overall compliance was 77.7%. Individual component compliance varied. Lower compliance rates were seen with some aspects such as fasting and carbohydrate loading, minimally invasive surgical techniques used, and avoidance or early removal of the drain. The cohort was divided into two groups. Group 1 had compliance to ≥75% of 21 elements of ERAS, and group 2 had compliance to <75%. Statistical analysis showed higher ERAS compliance and reduced complications, although LOS differences were not statistically significant (group 1 and group 2 with an LOS difference of 1 day). Severe complications such as re-exploration and death were noted in the group of patients with compliance to less than 75% of the components.

Conclusion:

With increased ERAS compliance, the patients benefited clinically and financially.
Ophthalmic Practice in Current COVID Crisis
Authors: Potti Sudhakar , Sakare Eswar
Published: May 2024

Corona virus (covid-19) pandemic has shaken the entire world, its wide spread transmission has restricted everybody's day to day life, ophthalmologists are no exception, but in greater danger, as most of ophthalmologic examinations include close contact between patient and doctor, increasing the risk of transmission of deadly covid-19 virus. Adopting certain measures in ophthalmic practice reduces the transmission risk. Various ophthalmic manifestations of covid 19 includes follicular conjunctivitis, viral keratoconjunctivitis, hemorrhagic and pseudomembranous conjunctivitis, Central retinal vein occlusion (CRVO), Central retinal artery occlusion (CRAO) Cerebrovascular accident (CVA) with vision loss, Mucormycosis etc. For this review, literature search was conducted in PubMed and Google Scholar databases by using terms coronavirus, SARS-CoV-2, COVID-19, ophthalmology, ophthalmologist, telemedicine in ophthalmology and their combinations to gather efficient information that can enhance the daily practice. Most important modifications include personal protective equipment, environmental measures (air ventilation, instrument handling), administrative measures (physical distancing, triage setup). Vaccination plays a crucial role in hampering the effect of covid crisis, it should be given significant importance and extensive awareness. Telemedicine can change the entire scenario in doctor-patient relationship and everyone should have thorough knowledge about its guidelines. All these measures need gigantic efforts in reducing the covid-19 effect, paving the path for the “NEW-NORMAL”.
Unusual Extraconal Presentation of Orbital Cavernous Hemangioma
Authors: Marappan Harikrishnan , Makam Deepika , Ballela Keerthi
Published: May 2024

A 27-year-old male patient complained of dull aching pain in the right eye (RE) for 3 months. On examination, the patient had mild proptosis of RE with downward displacement and fullness in superotemporal quadrant. No palpable mass was felt, and finger insinuation was possible, the swelling did not change in size on bending, coughing, and not pulsatile, and no bruit was heard. Visual acuity, color vision, and confrontation were normal. Mild ptosis with minimal abduction and elevation restriction was noted. MRI orbits revealed well defined fusiform, lobulated, extraconal soft tissue lesion in the superotemporal aspect causing abaxial proptosis with scalloping and thinning of bony orbital roof. Histopathology reveals features suggestive of cavernous hemangioma. Even though the most common location of cavernous hemangioma is intra-conal, its extra- conal occurrence also possible and needs high suspicion.
The denervation or activation of renal sympathetic nerve and renal blood flow
Authors: Kharazmi Fatemeh , Hosseini-Dastgerdi Hajaralsadat , Pourshanazari Ali-Asghar , Nematbakhsh Mehdi
Published: May 2024

The denervation or activation of the sympathetic nerve in the kidney can affect renal hemodynamics. The sympathetic nervous system regulates the physiological functions of the kidneys. Stimulation of sympathetic efferent nerves affects various parameters related to renal hemodynamics, including sodium excretion, renin secretion, and renal blood flow (RBF). Hence, renal sympathetic fibers may also play an essential role in regulating systemic vascular resistance and controlling blood pressure. In the absence of renal nerves, the hemodynamics response to stimuli is negligible or absent. The effect of renal sympathetic denervation on RBF is dependent on several factors such as interspecies differences, the basic level of nerve activity in the vessels or local density of adrenergic receptor in the vascular bed. The role of renal denervation has been investigated therapeutically in hypertension and related disorders. Hence, the dynamic impact of renal nerves on RBF enables using RBF dynamic criteria as a marker for renal denervation therapy.
Diabetes and diabesity in the view of proteomics, drug, and plant-derived remedies
Authors: Haeri Mohammad Reza
Published: May 2024

Diabetes and obesity are highly prevalent in the world. Proteomics is a promising approach to better understanding enzymes, proteins, and signaling molecules involved in diabetes processes which help recognize the basis of the disease better and find suitable new treatments. This study aimed to summarize the molecular mechanisms from the beginning of insulin secretion in response to stimuli to the pathology of the insulin signaling pathway and, finally, the mechanisms of drugs/chemicals remedies that affect this process. The titles and subtitles of this process were determined, and then for each of them, the articles searched in PubMed and ScienceDirect were used. This review article starts the discussion with the molecular basis of insulin biosynthesis, secretion, insulin’s mechanism of action, and molecular aspect of diabetes and diabesity (a new term showing the relation between diabetes and obesity) and ends with the drug and plant-derived intervention for hyperglycemia.
To Study the Diagnostic Accuracy of Diabetes in Pregnancy Study Group of India (DIPSI) as Compared with International Association of Diabetes in Pregnancy Study Group (IADPSG) Criteria in Pregnancy
Authors: Chaudhary Vaidehi Pradip , Dixit Prachi
Published: May 2024

Background:

Hyperglycemia in pregnancy is associated with adverse maternal and perinatal outcomes. Hence, it is essential to diagnose early and treat to prevent adverse complications. The study aims to ascertain the diagnostic accuracy of the Diabetes in Pregnancy Study Group of India (DIPSI) versus the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria.

Methods:

Women (n = 200) attending the outpatient or inpatient department of obstetrics and gynecology with gestational age 24–28 weeks were included. As per the DIPSI and IADPSG criteria, all women underwent nonfasting oral glucose tolerance test irrespective of the last meal and after an overnight fast of at least 8 h. A venous blood sample was drawn after glucose administration and was measured by hexokinase technique using an autoanalyzer.

Results:

Out of 200 women, 47 (23.5%) were diagnosed with gestational diabetes mellitus (GDM) by the IADPSG, whereas 15 (7.5%) were diagnosed with GDM by DIPSI test. Sociodemographic and obstetric characteristics were comparable between the two groups. Women with a history of polycystic ovarian syndrome (odds ratio [OR]: 13.51), family history of DM (OR: 7.02), GDM (OR: 5.8), and perinatal mortality (OR: 4.27) had higher odds of developing GDM. The sensitivity and specificity of DIPSI were 27.66% and 98.69%, respectively, and diagnostic accuracy was 82%. IADPSG test can be recommended as a primary modality of screening GDM in all pregnant women. DIPSI test can be recommended for screening of the patient in non-fasting condition. Hence, by routine IADPSG test and selective DIPSI test, the whole of the antenatal population can be screened without jeopardizing the sensitivity for detection of true cases.