bluuebunny/crossref_metadata_2025 huggingface dataset:
Significant response to transarterial chemoembolization combined with PD-1 inhibitor and apatinib for advanced intrahepatic cholangiocarcinoma: A case report and literature review
Authors: Zhang Haitao , Han Cuiping , Zheng Xiaohuan , Zhao Wenhua , Liu Yuanshui , Ye Xin
Published: August 2023

Intrahepatic cholangiocarcinoma (ICC) is a highly aggressive malignancy rising from the biliary tree with poor prognosis. We report the feasibility and efficacy of transarterial chemoembolization (TACE) combined with PD-1 inhibitor and apatinib for the treatment of a patient with unresectable ICC. A 70-year-old female presented with intermittent right upper abdominal distension, abdominal pain, and vomiting after eating for more than one month. Enhanced computed tomography (CT) and magnetic resonance imaging (MRI) scan revealed multiple intrahepatic lesions, retroperitoneal lymph node, and left lung metastasis. Based on the patient’s medical history and pathology, the diagnosis was confirmed as locally advanced unresectable ICC. Multimodal therapy was applied to the ICC. The therapy comprised TACE every three months, and a combination regimen of the PD-1 inhibitor camrelizumab and the antiangiogenic agent apatinib. The patient underwent microwave ablation for a lesion on the left lung that had not responded to systemic therapies. Enhanced CT scan after every 2–3 months was performed. After several sessions, the primary lesion reduced dramatically in size. At 20 months from diagnosis, the patient was alive, in good condition, and stable. The patient experienced no critical complications and toxicity associated with the administered therapies. This case suggests that treatment with TACE combined with systemic therapy of camrelizumab combined with apatinib may be a safe and effective treatment option for patients with inoperable ICC.
Clinical features and outcomes of infantile soft-tissue sarcoma: A multicenter retrospective study in Beijing
Authors: Zhu Shuai , Xu Na , Zhi Tian , Gao Yangxu , Zhong Dixiao , Zhang Weiling , Jin Mei , Sun Qing , Xie Yao , Zhang Xiaolun , Li Long , Wang Shengcai , Wang Huanmin , Liu Rong , Zhao Weihong , Huang Dongsheng , Ni Xin , Ma Xiaoli
Published: August 2023

Background:

Soft-tissue sarcomas during infancy are rare and understudied. With no data on this specific condition, we performed a retrospective study of infant-onset sarcomas based on a multi-institutional cohort in Beijing, China, collected over the past decade. We reviewed infantile soft-tissue sarcomas’ clinical characteristics, treatments, and outcomes.

Materials and Methods:

The patients with soft-tissue sarcoma diagnosed from 0 to 12 months in four primary children’s hospitals in Beijing from January 2010 to December 2019 were evaluated.

Results:

Fifty-one patients were enrolled, including 31 males and 20 females. The median age at the diagnosis was five months (range, 0-12), and seven (13.7%) patients were diagnosed in the first month of their life. Histologically, twenty-five patients were diagnosed with rhabdomyosarcoma (RMS), six were diagnosed with extraosseous Ewing sarcoma (EES), and twenty were diagnosed with nonrhabdomyosarcoma soft-tissue sarcoma (NRSTS). The treatment principles and details of RMS focused on reference to the Intergroup Rhabdomyosarcoma Study Group (IRSG) protocols. For EES and NRSTS, chemotherapy was prescribed according to children’s oncology group protocols. The five-year EFS/OS rates of RMS were 26.4% ± 19.5%/56.2 ± 17.8%, the five-year EFS/OS rate of EES was 50% ± 20.4%, and the five-year EFS/OS of NRSTS was 85.2% ± 9.8%/100%.

Conclusions:

Infant-onset soft-tissue sarcoma is heterogeneous. The primary location of the abdominal or pelvic cavity of RMS and EWS was at a later stage and had a poorer prognosis. Multimodal therapy resulted in successful disease control for the majority of patients. Standardization of treatment protocols will facilitate care for such challenging conditions.
A preliminary study on the establishment of a cyst and cystic neoplasm tissue-mimicking model
Authors: Li Bin , Li Xiaoguang
Published: August 2023

Context:

The present experimental models of cystic diseases are not adequate and require further investigation.

Aim:

In this study, a new way of producing a tissue-mimicking model of cysts and cystic neoplasms was evaluated.

Settings and Design:

To simulate cysts and cystic neoplasms, ex vivo rabbit normal bladders and VX2-implanted tumor bladders were produced, fixed, and embedded in agarose gel.

Methods and Materials:

The samples were classified into four groups based on tumor features and the maximal transverse diameter of the rabbit bladder, which were assessed using computer tomography (CT) imaging and statistically analyzed.

Statistical Analysis Used:

Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) software. The t-test was used for analyzing enumeration data.

Results:

Twenty-one rabbit bladders (21/24) were successfully removed and prepped for this experiment, comprising eleven normal bladders (11/24) and ten implanted with VX2 tumors (10/24). The gelling ingredient used to form the visualization and fixation matrix was agarose at a concentration of 4 g/200 mL. The temperature of the agarose solution was kept constant at 40-45°C, which is the optimal temperature range for ex vivo normal bladder and implanted VX2 tumor bladder insertion. The average time required to embed and fix the bladders in agarose gel was 45.0 ± 5.2 minutes per instance. The gel-fixing matrix’s strength and light transmittance were enough for building the models.

Conclusion:

We created an experimental tissue-mimicking model of cysts and cystic neoplasms with stable physicochemical features, a safe manufacturing method, and high repeatability. These models may be used to assist with cystic lesion diagnosis and treatment techniques.
Development and validation of a nomogram for predicting operating time in laparoscopic anterior resection of rectal cancer
Authors: Yuan Wenguang , Wang Xiao , Wang Yi , Wang Haoran , Yan Chuanwang , Song Gesheng , Liu Chang , Li Aiyin , Yang Hui , Gao Chengsheng , Chen Jingbo
Published: August 2023

Aims:

The goal of this study is to create and verify a nomogram estimate operating time in rectal cancer (RC) patients based on clinicopathological factors and MRI/CT measurements before surgery.

Materials and Methods:

The nomogram was developed in a cohort of patients who underwent laparoscopic anterior resection (L-AR) for RC. The clinicopathological and pelvis parameters were collected. Risk factors for a long operating time were determined by univariate and multivariate logistic regression analyses, and a nomogram was established with independent risk factors. The performance of the nomogram was evaluated. An independent cohort of consecutive patients served as the validation dataset.

Results:

The development group recruited 159 RC patients, while 54 patients were enrolled in the validation group. Independent risk factors identified in multivariate analysis were a distance from the anal verge <5 cm (P = 0.024), the transverse diameter of the pelvic inlet (P < 0.001), mesorectal fat area (P = 0.017), and visceral fat area (P < 0.001). Then, a nomogram was built based on these four independent risk factors. The C-indexes of the nomogram in the development and validation group were 0.886 and 0.855, respectively. And values of AUC were the same with C-indexes in both groups. Besides, the calibration plots showed satisfactory consistency between actual observation and nomogram-predicted probabilities of long operating time.

Conclusions:

A nomogram for predicting the risk of long operating duration in L-AR of RC was developed. And the nomogram displayed a good prediction effect and can be utilized as a tool for evaluating operating time preoperatively.
Initial experience of the treatment of large glioma with microwave ablation-assisted surgical resection
Authors: Zhao Wenpeng , Chen Shichao , Shao Xihong , Du Hongliu , Li Peiliang , Wang Fang , Chen Jiamin , Feng Enshan , Li Changqing
Published: August 2023

Aim:

This study aimed to investigate the preliminary clinical outcomes of microwave ablation (MWA)-assisted surgical treatment for large glioma.

Materials and Methods:

In total, six cases of large glioma (diameter >4 cm) were described. All cases were treated with MWA-assisted surgical resection, which was performed using ultrasound to guide the accurate placement of the antenna in the central region of the tumor. The MWA power was 40–45 W, and 6 min was applied. Changes in the ablation area were observed using intraoperative Doppler ultrasound and contrast-enhanced ultrasound (CEUS). Ten patients treated with surgical resection alone were included in the control group. Data on surgical times (i.e., the time from the incision of the dura to the removal of the tumor), intraoperative blood loss, and complications were recorded.

Results:

The median patient age was 45 years (range: 36.5–60.3 years). The median lesion diameter was 4.9 cm (range: 4.3–5.8). The microwave power was 40–45 W, and the median ablation time was 240 s (range: 208–297 s). The intra-tumoral vascular flow was significantly reduced after MWA. The median surgical time was shorter (38.5 min [range: 34.3–42.8 min]) and the median intraoperative blood loss was less (400 mL, [range: 400–450 mL]) in the combination treatment group than in the surgery-alone group. During the ablation process, no obvious additional neurological deficits were detected; however, a tube-shaped carbonide was found after the operation.

Conclusion:

MWA may be a useful complement to conventional techniques for the surgical resection of large glioma.
Incomplete radiofrequency ablation following transarterial chemoembolization accelerates the progression of large hepatocellular carcinoma
Authors: Mu Shangdong , Chen Qingjuan , Li Shuo , Wang Dongfeng , Zhao Yongchang , Li Xiang , Fu Wei , Fan Zhigang , Tian Shan , Li Zeng
Published: August 2023

Purpose:

To examine post-operative progression and risk impact of insufficient radiofrequency ablation (RFA) following transarterial chemoembolization (TACE) for the prognosis of large hepatocellular carcinoma (HCC).

Materials and Methods:

From January 2014 to January 2021 were analyzed. A total of 343 patients with large HCC (diameter >5 cm) who received TACE combined with RFA were enrolled and were divided into two groups: complete ablation (CA, n = 172) and insufficient ablation (IA, n = 171). Overall survival (OS) and progression-free survival (PFS) were determined by the Kaplan-Meier curve and compared with the log-rank test. To find parameters influencing OS and PFS, clinicopathological variables underwent univariate and multivariate analysis.

Results:

The cumulative 1-, 3-, and 5-year OS and PFS rates of the CA group were significantly higher than that of the IA group (P < 0.001). 25 (41%) patients in local tumor progression (LTP), 36 (59%) in intrahepatic distant recurrence (IDR), and 0 (0%) in extrahepatic distant recurrence (EDR) in the CA group. 51 (32.1%) patients in LTP, 96 (60.4%) patients in IDR, and 12 (7.5%) cases in EDR in the IA group. The recurrence patterns of the two groups were statistically significant difference (P = 0.039). In multivariate analysis, inadequate ablation and conjunction with TKIs were both significant risk factors for OS and PFS. Apart from these, older age and >7 cm of tumor size were indicators of poor OS and multiple tumors were indicators of poor PFS.

Conclusion:

Insufficient ablation causes a poor survival outcome of TACE combined with RFA for large HCC, particularly, which can promote IDR.
Application of respiratory sensing technique in CT-guided radiofrequency ablation of liver malignancies
Authors: You Xiang , Huang Bingyu , Chen Jin , Lin Zhengyu
Published: August 2023

Objective:

This study aimed to examine the effectiveness and safety of respiratory sensing methods in nonvascular interventional therapy of liver tumors.

Materials and Methods:

In this study, 64 patients with primary liver cancer or liver metastasis were retrospectively analyzed. According to two widely used clinical techniques to limit respiratory movement—breath holding and respiratory sensing technology—they were randomly allocated into two groups: respiratory gated and respiratory training. We aimed to compare the application and effect of these two techniques in the nonvascular interventional therapy of liver tumors.

Results:

The puncture times of the respiratory-gated and respiratory training groups were 5.34 ± 2.47 and 8.41 ± 3.63 min, respectively. Puncture errors were 10.00 ± 2.65 and 12.81 ± 8.57 mm, respectively. Puncture adjustment times were 3.06 ± 1.26 and 4.87 ± 1.69 times, respectively, and the differences were statistically significant (P < 0.01).

Conclusions:

Respiratory sensing technology has been effectively used to assist in puncturing liver malignant tumors using a radiofrequency (RF) ablation (RFA) system that is guided by computed tomography (CT) scans. It is superior to the classical breath-holding step puncture technique in terms of puncture time, puncture error, and puncture needle adjustment times.
Dietary diversity and nutritional status of adolescents in Lagos, Nigeria
Authors: Olatona Foluke A. , Ogide Precious I. , Abikoye Ebunoluwa T. , Ilesanmi Oluwafemi T. , Nnoaham Kelechi E.
Published: August 2023

Background/Objectives:

Adolescents in low- and middle-income countries, such as Nigeria, are at increased risk of malnutrition, especially obesity, but there is limited data describing the risk. We assessed this risk by examining the nutritional status and associated factors such as dietary habits, dietary diversity, nutritional knowledge and sociodemographic characteristics among adolescents in Lagos, Nigeria.

Methods:

A descriptive cross-sectional study in which 682 adolescents were selected from their communities using a multistage sampling technique. Dietary habits were assessed using a food frequency questionnaire, and dietary diversity was assessed through nonquantifiable 24-h diet recall. Anthropometric measurements were taken to determine nutritional status. Data were analyzed using Epi-Info software version 7.2.3.1. Nutritional status was evaluated using WHO AnthroPlus software. Chi-square was used to test for an association between categorical variables, and P values ≤0.05 were considered statistically significant.

Results:

The mean age of the adolescents was 13.6 ± 2.3 years, and only 47.4% of them had good nutritional knowledge. Dietary habits were poor and dietary diversity was low. The prevalence of overweight and obesity was 13.4% and 7.0%. Eating dinner, dieting to control weight and daily consumption of foods outside the home were associated with overweight and obesity (P < 0.05).

Conclusions:

Dietary habits and diversity of the adolescents were poor, while overweight and obesity were high. Eating dinner and daily consumption of foods outside the home were factors associated with being overweight and obesity. Our findings emphasize the critical need for adolescent nutrition programs that address weight control, especially among those who eat outside their homes.
Malaria in newborn: A missed entity for primary care physician
Authors: Mohan Kriti , Omar Balram J. , Chacham Swathi
Published: August 2023

Neonatal malaria and congenital malaria, though thought to be a rare entity in non-endemic areas but incidences from epidemic countries are eye openers. It is still thought by primary care physicians that its existence among neonates is not common even in endemic areas due to a low index of suspicion. In order to attain the objective set out in the global technical strategy against malaria 2016–2030, it is important to have a gravity of this disease in all age groups, especially in children and neonates in which misconception of low burden of infection results in underestimation of its morbidity and mortality in these age groups. This disease is only the tip of the iceberg due to unidentified, underreported and neglected illness and being a pointer towards higher circulation among society and pregnant women. So this review article highlights pathophysiology, epidemiology, clinical features, complications, prognosis, treatment and prevention of malaria in newborns and intends to bring awareness among the caregivers to understand the need for attention towards this neglected disease of neonates so that they should be able to identify and manage the disease in this vulnerable age group.
A pilot study on the capability of artificial intelligence in preparation of patients’ educational materials for Indian public health issues
Authors: Mondal Himel , Panigrahi Muralidhar , Mishra Baidyanath , Behera Joshil K. , Mondal Shaikat
Published: August 2023

Background:

Patient education is an essential component of improving public health as it empowers individuals with the knowledge and skills necessary for making informed decisions about their health and well-being. Primary care physicians play a crucial role in patients’ education as they are the first contact between the patients and the healthcare system. However, they may not get adequate time to prepare educational material for their patients. An artificial intelligence-based writer like ChatGPT can help write the material for physicians.

Aim:

This study aimed to ascertain the capability of ChatGPT for generating patients’ educational materials for common public health issues in India.

Materials and Methods:

This observational study was conducted on the internet using the free research version of ChatGPT, a conversational artificial intelligence that can generate human-like text output. We conversed with the program with the question - ”prepare a patients’ education material for X in India.” In the X, we used the following words or phrases – ”air pollution,” “malnutrition,” “maternal and child health,” “mental health,” “noncommunicable diseases,” “road traffic accidents,” “tuberculosis,” and “water-borne diseases.” The textual response in the conversation was collected and stored for further analysis. The text was analyzed for readability, grammatical errors, and text similarity.

Result:

We generated a total of eight educational documents with a median of 26 (Q1-Q3: 21.5-34) sentences with a median of 349 (Q1-Q3: 329-450.5) words. The median Flesch Reading Ease Score was 48.2 (Q1-Q3: 39-50.65). It indicates that the text can be understood by a college student. The text was grammatically correct with very few (seven errors in 3415 words) errors. The text was very clear in the majority (8 out of 9) of documents with a median score of 85 (Q1-Q3: 82.5-85) in 100. The overall text similarity index was 18% (Q1-Q3: 7.5-26).

Conclusion:

The research version of the ChatGPT (January 30, 2023 version) is capable of generating patients’ educational materials for common public health issues in India with a difficulty level ideal for college students with high grammatical accuracy. However, the text similarity should be checked before using it. Primary care physicians can take the help of ChatGPT for generating text for materials used for patients’ education.
A cross-sectional study of anthropometry and immunization coverage of Anganwadi children in a rural area of Karnataka
Authors: Debata Ipsita , Ranganath T. S. , Priya K Josephine , Tejas J
Published: August 2023

Background:

Children are a supreme asset to a nation. Beginning six years of life is pivotal for the social, emotional, cognitive, physical, motor, and psychological upbringing of the child. National Family Health Survey (NFHS) 5 data shows 41.9% of children die before the age of five years, with greater mortality in the rural areas (45.7%). The present study was conducted to assess the anthropometric profile and immunization status of children in Anganwadi centers.

Materials and Methods:

A community-based cross-sectional study was conducted in 21 Anganwadi centers in a rural area in South India. The anthropometry (height, weight, mid-upper arm circumference), morbidity profile, and immunization status of the enrolled and available children were assessed with the help of WHO growth charts, Salter scale, clinical examination, immunization cards, and data from Anganwadi registers.

Statistical analysis:

Data were compiled and analyzed using SPSS software version 20. Descriptive data were interpreted as mean and percentages and associations were tested with the Chi-square test, and Fisher’s exact test. A P value of <0.05 was considered to be statistically significant.

Results:

Around 400 children, aged 0-6 years, participated in the study. The mean age of the study population was 42.08 ± 12.55 months. The overall prevalence of underweight, stunting, and wasting was 52%, 54%, and 47.5% respectively. The most common morbidity was upper respiratory tract infection (11.5%). A majority (97.5%) of children were found to be immunized appropriately as per age.

Conclusion:

The prevalence of malnutrition was alarmingly high which warrants urgent referral and follow-up. The ICDS services, although substantially beneficial, need focal strengthening with regard to the nutritional status of enrolled children.
Giant anterior abdominal wall desmoid tumor successfully managed with abdominal wall reconstruction
Authors: Dhivakar S , Huda Farhanul , Singh Sudhir K. , Kumar Arvind , Das Asish , Acharya Preeti
Published: August 2023

Anterior abdominal wall fibromatosis is a benign soft tissue tumor that is rare, but fast-growing with minimal chances of malignant change. We report a young female with a large abdominal swelling which on evaluation was provisionally diagnosed as anterior abdominal wall fibromatosis on imaging and confirmed by histopathology. She was successfully managed with resection of the tumor with a challenging abdominal wall reconstruction with bilateral inferiorly based external oblique muscle flap followed by a mesh repair. Though rare, these tumors are difficult to miss. The importance of this case report is that it describes the methods of multimodal management of a patient with surgery, reconstruction, and adjuvant therapy leading to better patient outcomes.
Barriers to mental health treatment in primary care practice in low- and middle-income countries in a post-covid era: A systematic review
Authors: Rameez Sahar , Nasir Almas
Published: August 2023

General primary care workers and family physicians are a crucial work force in managing the mental health of people in any given region. However, the barriers they face in low- and middle-income countries (LMICs) may be worsened by the pandemic. This review aims to bring together evidence about mental health treatment challenges experienced by people in LMICs in primary care settings. The review focuses on the shortage of essential mental healthcare services, stigma and lack of competent primary care professionals in establishing these services and their importance in the COVID-19 pandemic context. The systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and the search strategy included keyword search terms (MeSH) to perform a search across three electronic databases - Critical Appraisal Skills Program assessed PubMed, SpringerLink, and Cochrane and quality of the articles. The articles selected were analyzed through thematic analysis to identify the main themes and conclude our findings. Findings indicate that out of 1792 publications found, 14 studies matched the desired criteria for the studies. Endnotes, database search filters, and Covidence data extraction tools were used to generate the relevant articles in this study. This study shows that primary care institutions have financial and management issues in providing mental health services and a shortage of competent mental health experts in primary care, especially mental health–trained family physicians. The study also identifies community stigma as the most prevalent barrier to seeking mental health therapy, reflecting the lack of community health education in LMICs.
Efficacy and Safety of Topical Timolol for the Treatment of Facial Angiofibroma in Children with Tuberous Sclerosis Complex
Authors: Ghazavi Mohammadreza , Taheri Sareh , Sabzghabaee Ali Mohammad , Tavakolifard Negah , Yaghini Omid , Faghihi Gita , Afshar Kimia , Abtahi-Naeini Bahareh
Published: August 2023

ABSTRACT

Objective:

This study aimed to assess the efficacy and safety of topical timolol in treating facial angiofibromas (FAs) in pediatric patients with tuberous sclerosis complex (TSC).

Methods:

A prospective clinical trial was conducted involving 15 children diagnosed with TSC and presenting with FAs. The participants were administered topical timolol gel 0.5% twice daily. Prior to the intervention, the severity of FAs in each patient was evaluated using the FA severity index (FASI), which assessed erythema, size, and extent of lesions. Clinical response was assessed at weeks 2 and 4 during the intervention period as well as 1 month after discontinuation of treatment.

Findings:

Four weeks after discontinuing topical timolol 0.5%, statistically significant reductions were observed in the mean FASI score, erythema, size, and extent of lesions (P < 0.0001, P < 0.0001, P = 0.012, P = 0.008, respectively). FASI scores at 4 and 12 weeks postintervention, as well as 4 weeks after treatment cessation, demonstrated a significant decrease compared to baseline (P < 0.001). Erythema and extension scores also exhibited a significant decrease 1 month after treatment cessation compared to baseline (P < 0.05), while the mean size of lesions before and after the intervention did not show a statistically significant difference (P = 0.004).

Conclusion:

Topical timolol 0.5% represents a cost-effective and readily available treatment option for pediatric patients with FAs associated with tuberous sclerosis.
Efficacy and Safety Comparison of Two Different Doses of Dexamethasone in Hospitalized Patients with COVID-19: A Randomized Clinical Trial
Authors: Sadeghi Somayeh , Arezoomandi Nima , Ardestani Marzieh Mollaei , Ardestani Mohammad Emami , Ghiasi Farzin , Farajzadegan Ziba
Published: August 2023

ABSTRACT

Objective:

The current study aims to investigate high- versus low-dose dexamethasone administration to control the disease with minor complications.

Methods:

The current multicentric randomized clinical trial was conducted on 119 patients with COVID-19 pneumonia and assigned into two groups of low-dose (8 mg daily intravenous dose for at least 7 days or until discharge) (n = 61) versus high-dose dexamethasone (24 mg for 3 days followed by daily 8 mg for the at least 4 days later or until discharge) (n = 58) during 2020–2021. Oxygen saturation, dyspnea severity based on the Borg scale, and laboratory indices were assessed at 3, 5, and 7 days of corticosteroid therapy. Patients were compared regarding the length of hospitalization, intensive care unit (ICU) admission requirement, and noninvasive or invasive ventilation. The other investigations included corticosteroid-related adverse effects and mortality rates within a month after the medications.

Findings:

Oxygen saturation, Borg scale, and C-reactive protein levels were significantly altered by the time in both the groups (P < 0.05). In contrast, the trend of improvements in Borg scale (P = 0.007) and lactate dehydrogenase levels (P = 0.034) were superior in high-dose treated cases. Drug-related adverse (P = 0.809), mortality rate (P = 0.612), hospitalization duration (P = 0.312), ICU admission requirement (P = 0.483), and noninvasive (P = 0.396) and invasive ventilation (P = 0.420) did not differ between the groups.

Conclusion:

According to this study, low- versus high-dose dexamethasone therapy did not affect the outcomes, so low-dose dexamethasone is recommended for COVID-19 pneumonia to achieve optimal results and prevent potential adverse events.
Views and Perceptions of Medical Representatives and Physicians about the Role of Medical Representatives and Pharmaceutical Advertisement in Saudi Arabia – A Pilot Study
Authors: Faqeh Sultan , Alansari Safwan , Althagafi Abdulrahman , Abdulaziz Akrm , Alhajjaji Abdulrahman , Kurdi Ahmad , Allihyani Moayad , Qashlan Mutaz , Alhotirshi Raghad , Alhassani Rawan , Alsurayhi Suhail , Alshareef Omar , Ali Majid
Published: August 2023

ABSTRACT

Objective:

Medical representatives (MRs) frequently interact with physicians who may have different perceptions about and expectations from product promotional activities by pharmaceutical companies, especially through MRs. This can affect their prescribing practice. We explored the views and perceptions of MRs and physicians about the role of MRs and pharmaceutical advertisements in Saudi Arabia.

Methods:

Semi-structured interviews were conducted virtually through the ZOOM application with five MRs and five physicians from July to October 2022. The participants were recruited from the Makkah region in Saudi Arabia on a convenience sampling basis and through the snowballing method. The interviews were recorded with the consent of the participants, transcribed verbatim, and thematically analyzed.

Findings:

Data saturation was found to be achieved with four interviews from each group of participants. Thematic analysis generated 338 codes which were categorized into 31 subthemes. These subthemes were further categorized into 11 overarching themes: “MR daily work,” “Role of MRs in healthcare and their future,” “Value of MRs in healthcare,” “Pros and cons of the MR career,” “MRs in the COVID-19 pandemic,” “Differences between the pharmaceutical companies,” “Goods and not-so-goods about the MRs,” “Suggestions provided by physicians for MRs and pharmaceutical companies,” “Marketing strategies of different pharmaceutical companies,” “Experience of MRs” and “Support provided by pharmaceutical companies.”

Conclusion:

Our pilot study sheds light on the role of MRs and pharmaceutical advertisement from MRs’ and physicians perspectives. Several recommendations can be drawn from our findings to make the interactions between MRs and physicians more effective and improve pharmaceutical advertisement, prescribing practices, and patient care.
A cross sectional observational study on uncontrolled bronchial asthma and inhaler technique among out patients in a tertiary care centre in Western Maharashtra
Authors: Shrinath V , Thatikonda Akshitha , Pandey Indramani , Marwah Vikas , Deshpande Samruddhi , Tentu Ajai Kumar , Kishore Kislay , Tyagi Rahul , Yadav Aseem , Choudhary Robin
Published: August 2023

Background:

The 2014 Asia Pacific – Asthma Insight and Management (AP-AIM) study showed that none of the Indian asthmatics had controlled asthma when evaluated objectively. Our study aims to detect through objective measurements, uncontrolled asthma in OPD patients, the adequacy of their inhaler technique, and their awareness regarding the importance of inhaler technique.

Method:

The asthma Control Test (ACT) score was used to screen for uncontrolled asthma. A validated objective questionnaire and scoring were used to objectively assess the correctness and awareness of the inhalation technique.

Result:

The study was carried out over 2 month period and 80 patients meeting the inclusion criteria were enrolled. Out of 80 patients; 47 (58.75%) had well-controlled asthma and 33 (41.25%) had uncontrolled asthma. 64 (80%) patients had good, and 16 (20%) had poor inhalation techniques. Among the 64 patients with good inhalation technique 43 (67.18%) had well-controlled asthma and 21 (32.82%) had uncontrolled asthma. Among the 16 patients with poor inhalation technique 4 (25%) had well-controlled asthma and 12 (75%) had uncontrolled asthma. There was a statistically significant association between asthma control and inhaler technique (P value 0.002). In the study population 56 (70%) patients were aware of the inhalation technique and 24 (30%) were unaware of the inhalation technique. Out of the 56 patients who were aware of the inhalation technique 53 (94.64%) had good inhaler technique and 3 (5.36%) had poor inhalation technique. Among the 24 patients who were unaware of the inhaler technique 11 (45.83%) had good inhaler technique and 13 (54.17%) had poor inhaler technique. There was a statistically significant association between awareness of inhaler technique and good inhaler technique (P value 0.001).

Conclusion:

There is a statistically significant association between asthma control and inhaler technique and between inhaler technique and inhaler awareness. Improving the awareness regarding inhaler technique among bronchial asthma patients is the way forward to improve asthma control in our country.
The Impact of Politics, Security and Health on the Escalation of Road Traffic Accidents and their Consequences in Iraq for the Period 2015–2020
Authors: Alkhudhairy Miaad K. , Aldhalemi Ali A.
Published: August 2023

Background:

This study aimed to detect the impact of politics, security and health on the escalation of road traffic accidents (RTAs) and their consequences in Iraq for the period 2015–2020.

Methodology:

The data of this cross-sectional study were obtained from the annual reports of RTA statistics from the Central Statistical Organisation of the Iraqi Ministry of Planning. The statistical analysis of data was done using the Statistical Package for the Social Sciences.

Results:

In this study, it was noted that the rate of RTAs, injuries and deaths increased from 16% to 19.5%, from 16.5% to 17.3% and from 16.2% to 20%, respectively, for the years 2015–2019, while the rates of RTAs, injuries and deaths in 2020 recorded a clear decrease compared to the rest of the years under study, and the rates were as follows: 14.8%, 14.4% and 14.1%, respectively. According to the types of traffic accidents, the rate of crashes recorded the highest rate of 51% in all years of the study compared to the run over, overturn and other unclassified accidents, which were 37%, 10% and 2%, respectively, and it was revealed that crashes, run over and other unclassified incidents increased from 5% to 20%, from 17% to 19% and from 18% to 26%, respectively, for the years 2015–2019, whereas all types of RTAs in 2020 were recorded the lowest rates compared to other years under study. Al-Basra, Baghdad, Al-Najaf and Babylon were recorded the highest rates of traffic accidents for the 6 years under study, with a rate of 13.3%, 11.7%, 11.1% and 10.4%, respectively.

Conclusions:

Although traffic accidents were not recorded in the years 2015, 2016 and 2017 for the governorates of Nineveh and Anbar due to the occupation of the terrorist Islamic State, traffic accidents maintained their levels due to internal migration. It was also noted that the rate of road accidents was the highest in 2019 compared to the years under study due to the liberation of occupied cities, the return of safety and the return of recording accident data again, while the year 2020 recorded a clear decrease in the rate of road accidents, especially in the first half of it due to the October protests that led to the suspension of all government institutions, universities and schools. The second reason for the decrease in the second half of 2020 is attributed to the lockdown of corona. It seems that the political, security, military and health factors have an effective impact on the traffic reality.
Neurological Soft Signs in First Episode Psychosis among Psychiatric Hospital Patients and its Relationship with Dimensions of Psychopathology: A Comparative Study
Authors: Nwiyi Obumneme Kenechukwu , Ohaeri Jude Uzoma , Jidda Mohammed Said , Danjuma Ishiak Abioda , Onu Justus Uchenna , Oriji Sunday Onyemaechi , Uwakwe Richard
Published: August 2023

Background:

Neurological soft signs (NSS), as subtle, nonlocalising neurological abnormalities, are considered as the potential markers of psychosis. However, comparative studies of antipsychotic-naïve patients with first-episode psychosis (FEP) and first degree relatives (FDRs) are uncommon. We compared the prevalence and pattern of NSS in FEPs, their healthy FDRs and a healthy non-relatives’ control group (HC), highlighted the relationship between NSS and psychopathology and proposed cut-off scores for prevalence studies.

Materials and Methods:

Two hundred and two participants per group were recruited. The FEPs were consecutive attendees; FDRs were accompanying caregivers; while the HC were from hospital staff. The Brief Psychiatric Rating Scale and the Neurological Evaluation Scale were used to assess psychopathology dimensions and NSS, respectively.

Results:

Using an item score of two (‘substantial impairment’), the prevalence of at least one NSS was: 91.5% (95% confidence interval [CI]: 86.7%–94.9%), 16.8% (95% CI: 11.8%–22.7%) and 6.5% (95% CI: 3.5%–10.9%), respectively, for FEP, FDRs and HC. FEPs were impaired in a broad range of signs. The noteworthy relationships were as follows: (i) a significant correlation between the negative symptoms’ dimension versus number of NSS (r = 0.4), and NSS total score (r = 0.3), (ii) the anxiety/depression dimension correlated negatively with number of NSS (r = −0.3) and (iii) NSS cut across psychosis categories. We propose a cut-off score of ≥ 4 for the number of signs signifying probable impairment.

Conclusion:

The findings indicate that, subject to further studies, NSS could be regarded as a broader phenotype of neurologic dysfunction associated with psychosis proness.
Burden, Socio-demographic and Other Risk Factors Associated with Haemodialysis in North-west Nigeria: A Retrospective Multicentre Analysis
Authors: Ibrahim Usman Muhammad , Jibo Abubakar Mohammed , Garba Rayyan Muhammad , Jalo Rabiu Ibrahim , Tsiga-Ahmed Fatimah Ismail , Musa Abubakar , Muazu Salisu , Lisanework Serawit , Buba Luka Fitto , Sidi Kamalu Shehu , Babatunde Ademola Lawrence , Abdulsalam Kabiru , Karkarna Mustapha Zakariyya
Published: August 2023

Background:

Kidney diseases requiring haemodialysis are becoming an emerging public health problem. This study aimed to determine the burden, socio-demographic and other risk factors associated with haemodialysis in Northwest Nigeria.

Methodology:

The study was a retrospective multicentre review of secondary data from the dialysis centres of public hospitals in northwestern Nigeria. Risk factors for renal failure were examined in 1329 patients who were enrolled for haemodialysis between 2019 and 2022 in the four public dialysis centres in Kano and Jigawa state. Data were analysed using IBM SPSS Statistics for Windows, version 22.0, with statistical significance set at P ≤ 0.05.

Results:

The minimum age of the patients was 2 years and the maximum was 100 years with a median of 48 (interquartile range = 31, 60) years. Chronic kidney disease (CKD) was found amongst more than two-thirds 998 (75.1%) of the patients. Up to 51 (3.8%), 62 (4.7%) and 10 (0.8%) were seropositive for HIV, hepatitis B and hepatitis C, respectively. Acute kidney injury (AKI) was significantly higher (67.9%, P < 0.001) amongst patients with post-partum haemorrhage (PPH), and were 24 times more likely to develop AKI when compared with those with no PPH (adjusted odds ratio [aOR] =24, 95% confidence interval [CI] = [13.5–44.5]). CKD was significantly higher amongst patients with hypertension (HTN) (84.9%, P < 0.001), and were 3.2 times more likely to develop CKD compared with non-hypertensives (aOR = 3.2, 95% CI = [2.4–4.1]). Acute on CKD (AOCCKD) was significantly higher amongst patients with chronic glomerulonephritis (CGN) (28.1%, P < 0.001), and were three times more likely to develop AOCCKD than those without CGN (aOR = 3, 95% CI = [2.1–4.2]).

Conclusion:

PPH was the major reason for AKI related haemodialysis while diabetes and HTN were the major causes of CKD-requiring haemodialysis. CGN was more amongst patients who had dialysis due to acute exacerbation of CKD. The government and relevant stakeholders should ensure a favourable policy for the screening and management of patients.
Xanthogranulomatous Hypophysitis Masquerading as Pituitary Macroadenoma
Authors: Senapati Debadutta , Mishra Sudhansu Sekhar , Mishra Sanjib , Behera Tapaprakash
Published: August 2023

Xanthogranulomatous hypophysitis (XGH) is an inflammatory disease of the pituitary gland that has clinical presentation and radiologic features similar to a neoplastic lesion. We report a rare case of XGH in an elderly male of 61-year-old age presenting with features of a pituitary macroadenoma with apoplexy. Clinical features and radiologic findings can be confusing and misleading. Surgical resection is the preferred method for treatment and establishing the final diagnosis from biopsy. Attention should be paid to the management of hypopituitarism and diabetes insipidus. Preoperative diagnosis is difficult and a high level of clinical suspicion of inflammatory disorders is necessary for correct diagnosis and optimal management.
CD8-positive T-cell Lymphoma of the Thyroid: A Rare Case
Authors: Nayyar Ankush , Kaushik Eshaan , Jugpal Tejeshwar Singh , Thakur Ajay
Published: August 2023

Malignant lymphoma of the thyroid gland is a rare entity, and the frequency of T-cell lymphoma is even rarer. We present a case of malignant T-cell lymphoma of the thyroid gland that developed in a 73-year-old woman. The patient with a history of Hashimoto’s thyroiditis presented to us with the chief complaint of rapidly increasing neck swelling and breathing difficulty. Computed tomography (CT) of the neck showed a large thyroid gland with marked mass effect on the airway and the surrounding structures and was extending into the superior mediastinum. Cytology gave a diagnosis of Bethesda Category VI, positive for malignancy lymphoma. The diagnosis was confirmed on histopathological examination and immunohistochemical examination. Further, positron emission tomography CT scan ruled out any involvement beyond the locoregional region and hence suggested thyroid lymphoma as the primary disease.
Nasal Sebaceous Carcinoma: A Case Treated at a Tertiary Care Center
Authors: Shah Setu Hitesh , Shah Isha Bhupendra Bhai , Dash Niranjankumar , Shivhare Vinay , Parikh Ankita
Published: August 2023

Sebaceous gland malignancies represent one of the rare and potentially aggressive types of skin neoplasms arising from the sebaceous gland’s epithelium. Sebaceous carcinoma of nasal location is an extremely rare site of presentation as well as a rare cutaneous malignancy. Herein, we present a case of a 50-year-old female with sebaceous carcinoma of the nose that came to our hospital with a mass in her left nasal cavity and was operated as well as received adjuvant therapy for the same. The patient is doing well at 24 months of follow-up without any evidence of disease recurrence or residual. We discuss the clinical, pathological, radiological findings, and management of the same. Careful clinical history, histopathological examination, and radiologic findings are all important for the correct diagnosis of sebaceous carcinoma of the nasal cavity. Since there is no standard treatment available for this tumor, one needs to be aware about the treatment options available.
Semantic Coherence Analysis of English Texts Based on Sentence Semantic Graphs
Authors: Deng Nanxiao , Wang Yabing , Huang Guimin , Zhou Ya , Li Yiqun
Published: August 2023

With the reform of China's education industry, more and more universities are using computers to conduct examinations. For the automatic correction of essays as subjective questions, existing automatic English text scoring systems suffer from insufficient extraction of coherence information and low accuracy when analysing text coherence. Therefore, this paper proposes an unsupervised semantic coherence analysis model for English texts based on sentence semantic graphs, taking Chinese students' English compositions as the research context. Guided by the semantic coherence theory, the English text is represented as a sentence semantic graph, and an improved VF2 subgraph matching algorithm is used to mine the frequently occurring subgraph patterns in the sentence semantic graph. After that, the set of frequent subgraphs is generated by filtering the subgraph patterns according to their frequencies, and the subgraph frequency of each frequent subgraph is calculated separately. Finally, the distribution characteristics of frequent subgraphs and the semantic values of subgraphs in the sentence semantic graphs are extracted to quantify the overall coherence quality of English texts. The experimental results show that the model proposed in this paper has higher accuracy and practical value compared with the current methods of coherence analysis.
mHealth Monitoring of Treatment of Cutaneous Leishmaniasis Patients: A Community-Based Implementation Study
Authors: Cossio Alexandra , Bautista-Gomez Martha Milena , Alexander Neal , del Castillo Alejandra María , Castro María del Mar , Castaño-Grajales Patricia Yaneth , Gutiérrez-Poloche Yeison Hawer , Zuluaga Laura Sofía , Vargas-Bernal Leonardo , Navarro Andrés , Saravia Nancy Gore
Published: August 2023

Cutaneous leishmaniasis (CL) remains a global health problem. Compelled by the protracted healing process, initial and final outcomes of treatment are determined at 90 and 180 days, respectively, after initiation of treatment. Loss to follow-up during these intervals is substantial. Consequently, the effectiveness of treatment is largely unknown. We conducted an effectiveness-implementation hybrid design study of a community-based mobile health (mHealth) strategy to monitor adherence to anti-leishmanial treatment, adverse drug reactions, and therapeutic response compared with standard of care in two rural communities of Colombia. Three implementation outcomes were evaluated: usability and acceptability by qualitative methods and fidelity using quantitative methods. Fifty-seven patients were prospectively included in the mHealth intervention and 48 in the standard-of-care group. In addition, 24 community health leaders (CHLs), health workers, and patients participated in qualitative evaluations. The intervention significantly increased the proportion of patients having follow-up of therapeutic outcomes 90 and 180 days after initiating treatment from 4.2% (standard of care) to 82.5% (intervention), P < 0.001. The proportion of patients having records of treatment adherence, adverse drug reactions, and therapeutic response also increased significantly (P < 0.001). Fidelity to the intervention (recording of treatment adherence, adverse drug reactions, lesion photographs, and evaluation of therapeutic response) was 70–100%. The app was highly accepted by CHLs, health workers, and patients, who perceived that the app improved case identification and follow-up and met a public health need. Although usability was high, low connectivity affected real-time transmission of data. This community-based mHealth strategy facilitated access to health care for CL in rural areas and knowledge of treatment effectiveness.