bluuebunny/crossref_metadata_2025 huggingface dataset:
Cochlear Implants for Children with Unilateral Hearing Loss: Debunking the Myths
Authors: Park Lisa R.
Published: January 2024

Cochlear implants (CIs) have revolutionized the field of audiology, providing a life-changing solution for children with bilateral profound hearing loss. Expanding criteria has allowed children with significant unilateral hearing loss (UHL) to benefit from this technology as well. The practice is not without controversy, however. While we have known since 1984 that children with UHL face educational challenges (Bess & Tharpe, 1984, 1986), watchful waiting until a child is old enough to be fitted with a Contralateral Routing of Signal (CROS) device has been the status quo (Bagatto, 2020; Bagatto et al., 2019). While research has continued to establish the benefits of cochlear implantation in this population, it has yet to become the standard of care. As is inherent in controversial practices, several myths and misconceptions surrounding the use of CIs for children with UHL pervade clinical hearing care systems. Here, we will debunk these myths by examining the evidence-based benefits and considerations associated with cochlear implantation in children with UHL. Through an analysis of current research and clinical evidence, we will highlight the potential advantages of CIs as a viable treatment option, promoting informed decision-making and improving the quality of life for children with UHL.
Experimental and numerical investigation of heat transfer enhancement in double coil heat exchanger
Authors: NAJM Ali , D.J. AZZAWI Itimad , A. KARIM Abdul Mun'em
Published: January 2024

In the current work, a substantial research and cost-effective strategy has been conducted to enhance the thermal efficiency of shell and coil heat exchangers, and geometrical modifica-tion is one technique to improve the exchange of thermal energy between two or more fluids. Therefore, experimental and numerical analysis across a shell and single/double coil heat ex-changer at constant temperatures of 36 °C for cold water and 65 °C for hot water are studied. Various coil pitches (baseline pitch, P-2P-P and 2P-P-2P) and mass flow rates (1 L/min for hot water and 2, 4, 6, and 8 L / min for cold water) were studied. The present experimental results for single and double coil heat exchangers were in good agreement with previous research’s numerical study, with an error rate of 9% and 5%, respectively. Moreover, the numerical find-ings revealed that modifying the double coil pitch improves the heat transfer rate by 10% com-pared to a baseline case. Following the encouraging simulation findings, improving the heat exchanger’s performance by utilizing more than one pitch for the same coil is a novel method that has not yet been reported. Therefore, when comparing the modified pitch of a double coil heat exchanger to a conventional coil under the same conditions (400
Brownian motion models effect on the nanofluid fluid flow and heat transfer in the natural, mixed, and forced convection
Authors: MOZAFARY Behrooz , AKBAR Ali , ARANI Abbasian , SHEIKHZADEH NOOSHABADI Ghanbar Ali , SALIMI Mohammad
Published: January 2024

In this research, the effect of different models of thermal conductivity and dynamic viscosity has been investigated by considering the effect of Brownian motion of nanoparticles on the flow field and heat transfer of nanofluids. This study was performed numerically in a square cavity with water/aluminum-oxide nanofluid in three modes of natural, mixed and forced convection by changing the independent variable such as nanoparticle volume fraction, Rayleigh number, Richardson number, and Reynolds number. The governing equations with certain boundary conditions are solved using the finite volume method. Also, according to the obtained numerical results, Nusselt number has been investigated for different conditions with and without consid-ering Brownian motion. The results showed that for all the studied models, in all three modes of natural, mixed and forced convection, the average Nusselt number when the effect of Brownian motion is considered, is more than the case that the effect of this motion is not considered. In all cases, the Koo & Kleinstreuer and Li & Kleinstreuer models show approximately the same values for the maximum mean Nusselt number. The similar results are obtained employing the Wajjha & Das and Xiao et al. models. For mixed convection, the highest and lowest increases of Nusselt number, considering Brownian motion are 17.68% and 14.84%, respectively. While referred val-ues for forced convection are 30.46% and 17.94 %, respectively.
A comparative analysis of retrospective records of antibiotic usage in patients before and after surgery in a tertiary care government hospital in Delhi
Authors: Arora Tarun , Bhowmick Samya , Singh Jasbir
Published: January 2024

Background: Antimicrobial resistance (AMR) is major problem in most of countries worldwide. Antimicrobial Stewardship program (AMSP) encourages both government and private hospitals in country to bring out guidelines regarding antimicrobial usage and hospital infection control (HIC). However, it is still in nascent stage.  A retrospective study to generate lacking data about usage of antibiotics in inpatient settings in a government hospital.
Methods: Retrospective records of antibiotic usage in adult patients before and after surgery admitted in department of surgery, LHMC and Smt. Sucheta Kriplani hospital, New Delhi. The prescribed doses were converted to a number as per WHO defined daily dose (DDD) of each antibiotic and presented as per ATC/DDD methodology.
Results: The records of 121 patients admitted between June 2021 to February 2022 were retrieved. Ceftriaxone, was the leading choice of antibiotic both pre and post operatively, while co-amoxyclav was second most preferred antimicrobial. Mean ± SD for DDD pre-op and post-op was 3.345±1.602 with p<0.001 which was highly significant. Mean ± SD for average duration of stay pre-op and post-op was 3.041±1.179 with p<0.01 which was significant. Only 16 patients had complications before, during or after the procedure which prolonged their stay in hospital. There were no procedure related deaths till last follow up. 
Conclusions: Guidelines for selection of proper antimicrobial usage in peri-operative period were not consistent. We advocate evidence-based pre-operative and post-operative antibiotic prophylaxis practices and rational antibiotic usage depending on prevailing antibiogram.
Linezolid susceptibility in MRSA isolates: insights into resistance and concordance in phenotypic detection methods
Authors: Bawankar Neha Sunil , Agrawal Gopal N. , Zodpey Sunanda S.
Published: January 2024

Background: Methicillin-resistant staphylococcus aureus (MRSA) poses persistent threat, affecting both healthcare environment and communities, with substantial impact on infection rates, morbidity, mortality, and healthcare costs. Vancomycin, a longstanding cornerstone in MRSA treatment, but with the emergence of vancomycin resistant MRSA (VRSA), necessitating alternative antimicrobial solutions. Linezolid, stands out as a promising candidate. It has unique advantages such as an absence of renal toxicity and improved lung parenchymal diffusion compared to vancomycin, making it an appealing choice, especially for healthcare-acquired pneumonia by MRSA.
Methods: This cross-sectional study investigated linezolid susceptibility in 158 MRSA isolates using both disk diffusion and agar dilution method.
Results: Results indicated that the majority of isolates exhibited linezolid susceptibility, with 53.16% showing a minimum inhibitory concentration (MIC) of ≤2 µg/ml. However, two MRSA isolates, constituting 1.27% of the sample, displayed a MIC of 8 µg/ml, named them as a linezolid-resistant MRSA (LRSA). These findings align with previous research, mirroring resistance rates observed in different regions. Notably, vigilance against linezolid resistance is crucial, particularly due to its status as a last-resort MRSA treatment.
Conclusions: Remarkably, a 100% concordance was found between the disk diffusion and MIC methods for detecting linezolid resistance in MRSA, suggesting that the disk diffusion method may be practical choice for laboratories with heavy workloads. However, adherence to CLSI guidelines is essential, and cases of resistance by disk diffusion should be confirmed using MIC methods. Emergence of linezolid-resistant MRSA is a worrisome development, necessitating ongoing surveillance and vigilance.
Unraveling the mysteries of moyamoya: a rare case report of stroke in young
Authors: Ratan Piyush , P. Pandey Vaibhav O. , Kumar Ashok , Kumar Munish
Published: January 2024

Moyamoya disease is a unique cerebrovascular disease that is characterized by chronic progressive stenosis of distal part of internal carotid artery with consequent development of a network of collateral vessels in response to brain ischemia. It is mainly seen in individuals of Asian descent and is the most common cause of stroke in Asian children. However, it is rare in Indian subcontinent. Here we report a case of young adult who manifested with moyamoya disease, evident from acute onset ischemic stroke. The patient underwent a diagnostic cerebral angiogram that showed bilateral posterior cerebral artery stenosis with pathognomonic collateral moyamoya vessels. The patient subsequently underwent elective surgical intervention procedures to prevent further complications.
Primary hydatid cyst of erector spinae muscle of upper back
Authors: Illahi Mir Fazil , Gani Mubashir , Malik Ajaz Ahmad
Published: January 2024

Hydatid disease is a zoonosis caused by an infection with the larvae of the tapeworm Echinococcus granulosus, it mostly involves liver and lungs but it may exceptionally affect muscle. We report the case of a 29 years old man who was admitted to our surgical clinic with a primary hydatid cyst in erector spinae muscle of upper back diagnosed by clinic examination, imaging and serological testing. The treatment was a complete pericystectomy and chemotherapy by antiparasitic drugs. Hydatid disease is an endemic disease in sheep-producing regions. In human, this disease involves usually the liver and the lungs and exceptionally the muscle. The diagnosis may be challenging, as it should consider arguments such as history, physical examination, imaging and serological testing. The best treatment is pericystectomy with perioperative chemotherapy to reduce risk of occurrence. The hydatid cyst of erector spinae muscle is exceptional even in endemic area, the diagnosis may be challenging and the surgery is the gold standard of treatment.
Iron pill associated duodenitis: a less recognised clinical entity
Authors: Guha Jayjit , Taneja Vinus , Khosla Pooja , Dessai Rishikesh , Sondhi Manuj
Published: January 2024

Iron supplementation is a widely prescribed treatment for anemia, but its association with gastrointestinal complications, specifically duodenitis, remains inadequately acknowledged in clinical practice. One of the common oral iron preparations to treat iron deficiency anemia is ferrous sulphate. Iron preparations have been known to cause gastric side effects, including gastritis and duodenitis. This case report explores the emerging concern of iron pill-associated duodenitis, shedding light on the potential adverse effects of oral iron supplementation on the duodenal mucosa. Existing literature and clinical cases are reviewed to highlight the connection between iron pill consumption and duodenal inflammation. From asymptomatic cases to severe symptoms like abdominal pain and gastrointestinal bleeding, the clinical spectrum is diverse. Histopathological analysis of endoscopic biopsies reveals characteristic features of duodenitis linked with iron deposits, raising concerns about long-term consequences. In conclusion, this case underscores the significance of recognizing iron pill-associated duodenitis as a distinct clinical entity, necessitating further investigation for optimized patient care and the safe administration of iron supplements in managing anemia.
A rare case of symptomatic bilateral pheochromocytoma
Authors: Akre Ajinkya H. , Thorat Santosh D.
Published: January 2024

Pheochromocytoma with reported incidence of 2-8 per million, is a rare and special tumor with its own unique clinical and pathological features, originating from the amazingly intelligent neuroendocrine cells of chromaffin cells of the adrenal medulla. It may behave as ‘great masquerader’ and be sweet and predictable as a child, while at times act as a ‘treacherous murderer’ crashing and tearing everything in its path with fierce rage, the main cornerstone of the disease being surgical excision. Here, we report a rare case of middle aged female presenting with hypertensive crisis which necessitates intensive care unit (ICU) management where she responded well to anti-hypertensives and radiological investigations were suggestive of bilateral pheochromocytoma. The course of treatment consisted of array of investigations to ascertain the diagnosis before embarking on bilateral adrenalectomy keeping in mind the consequences of absence of adrenal and subsequent possibility of Nelsons syndrome, which we were able to treat successfully. Here we want to highlight the consideration of bilateral adrenal tumors as a differential diagnosis for suprarenal growths, subsequent surgical course and post-operative medical treatment highlighting the importance of mineralocorticoids and glucocorticoids for day to day functioning.
Fetal ultrasonography of Chiari II malformation
Authors: Sambhav Kumar , Dushyant Kumar , Jayaswal Shailza R.
Published: January 2024

Chiari II malformation is a complex hindbrain malformation, embryologically presenting as a neural tube closure defect comprising of downward herniation of cerebellum, pons, medulla and fourth ventricle into the spinal canal. We present a case of Chiari II malformation depicting essential sonographic observations at 20 weeks of gestation. Such fetuses have high morbidity and mortality and early diagnosis of such a disease is essential in terms of planning including pregnancy termination or neurosurgical procedures for follow-up pregnancy. Ultrasonography is an indispensable modality for the evaluation of fetal anatomy, growth, and such congenital anomalies.
Frailty associated with poor outcomes after emergency laparotomy
Authors: McMahon Matthew J.
Published: January 2024

Background: Emergency laparotomy is a morbid and mortal operation that is often performed as a lifesaving treatment in the acutely unwell surgical patient. This study assessed morbidity and mortality in patients undergoing emergency abdominal surgery in an Australian metropolitan hospital to improve our understanding of factors that are associated with perioperative outcome.
Methods: Patients were identified from a high-volume institution between 01 March 2018 and 01 February 2022. Baseline, operative and postoperative parameters were collected and analysed for associations with significant complications, defined as Clavien-Dindo (CD) scores of 3 or greater, using a binary logistic regression.
Results: Independent predictors of ≥CD 3 complications were female sex (p=0.02, OR: 2.36 (95% CI 1.10, 5.05)) and frailty (p=0.03, OR: 2.30 (95% CI 1.03, 5.13)). Mortality rate in our cohort was 3.5%. Twelve of 13 deceased patients were female, all were frail and were of advanced age (mean 83.1 years).
Conclusions: An improved recognition of frailty and the assessment of frailty in the acutely unwell surgical patient requiring an emergency laparotomy is required to aid perioperative assessment and decision making.
Periconceptional folic acid intake: a one year survey among mothers of patients with myelomeningocele in a regional neurosurgical centre in Northwestern Nigeria
Authors: Daibu Usman , Lasseini Ali , Usman Babagana , Babagana Mohammed , Muhammad Koko Aliyu , Jinjiri Ismail Nasiru , Bala Shehu Bello
Published: January 2024

Background: Management of myelomeningocele, the most common neural tube defect in our environment, is quite challenging, and the outcome is usually less pleasing to parents/caregivers. Periconceptional folic acid ingestion reduces the incidence, especially in developed countries with mandated policies for folic acid fortification of staple foods. Awareness of preventive role of folic acid and periconceptional intake has not been studied in our centre. This study aimed to assess the knowledge of the proper intake of folic acid in preventing Myelomeningocele among mothers of patients with myelomeningocele. 
Methods: This was a prospective cross-sectional study conducted at Usmanu Danfodiyo university teaching hospital (UDUTH) Sokoto state, Nigeria over 12 months period after obtaining ethical clearance and informed consent. Data of mothers of patients with myelomeningocele who presented to the neurosurgical outpatient clinic of our facility was entered into a well-designed proforma. Data was analyzed using simple descriptive statistics, and results were presented in tables and pie chart.
Results: Fifty-four mothers were recruited. The most common age range was 20-35 years (70%), with a mean age of 23.8 years±5.49 SD. Nineteen (35%) out of 54 mothers had heard prior information about folic acid, and only 16 (30%) were aware of its appropriate time of intake in preventing myelomeningocele. None of the mothers ingested folic acid in the periconceptional period.
Conclusions: There was poor awareness and knowledge of the appropriate timing of folic acid intake in preventing Myelomeningocele in our centre.
Patterns in flexor zone V injury: a retrospective study
Authors: Menedal Akshata , Attokaren Roshjo Roshan , T. M. Sheeja Rajan , Rajasubramanya Priyavrata , D. S. Aabha , Chandran Aswathy
Published: January 2024

Background: Volar cut injuries to the wrist that range from simple to complex full house and are commonly encountered by plastic surgery residents. In this study we aim to recognize common clusters of structures injured together, to decipher patterns in presentation and to assert the role of superficial tendons in protecting the nerves, vessels and the deeper tendons in the flexor compartment. 
Methods: This is a retrospective cross-sectional study analyzing 322 patients with acute Zone V injuries. The patients were profiled based on demographic factors and etiology of injury. Detailed analysis of morphology of injury, structures involved was done and grouped into six common injury patterns.
Results: Majority of subjects were in the age group 21 to 30 years (33.9%), 81.1% were males and 18.9% were females. Both the sides flexor carpi radialis, Palmaris longus and flexor digitorum superficialis were commonly injured structures. Most common etiology was cutting tools. The median number of structures injured in cutting injuries was 3, in deliberate self-harm was 3, in Power tool was 6, in Shard injuries was 5 structures. Distribution of injuries was pattern 1 (98.2%), pattern 2 (36.2%), pattern 3 (40.5%), pattern 4 (80.1%), pattern 5 (15.6%) and pattern 6 (21.5%). Pattern 1 was seen commonly in all etiologies whereas power tools were responsible for serious pattern 6 types of injuries.
Conclusions: Cut injury to wrist occurs as clusters of specific structures and these patterns need to be looked for during surgical repair of hand. Superficial tendons have a role in protecting deeper tendons and neurovascular structures.
Study of alteration in testicular perfusion after Lichtenstein hernia repair
Authors: Ranga Hans Raj , Mishra Vinit , Vidit Vidit , Griwan Mahavir , Arora Bhavinder K.
Published: January 2024

Background: Inguinal hernia affects both men and women but is much more common in men who comprise over 90% of the operated patients. Considering both the operated and the non-operated inguinal hernias, the lifetime prevalence rate is 47% for men upto and including the age of 75. Repair of an inguinal hernia is one of the most common operations among adults in the western world today. Aims and objectives were to compare the alteration in testicular perfusion following Lichtenstein hernia repair.
Methods: Thirty patients diagnosed with inguinal hernia admitted in our hospital with study period of 12 months were included in the study. Color Doppler ultrasound evaluation of testicular blood flow was done for all cases. Comparisons of results between groups were done using independent t test and Pearson correlation test.
Results: The mean age of patients in the study was 46.10±17.27 years. Twenty three percent of patients had COPD as comorbidity. Mean peak systolic volume (PSV) of testicular artery in preop, at 24 hours, 1 week and 3 months are 18.36±2.21, 20.27±3.25, 19.21±2.31 and 18.98±2.06 respectively with a p=0.001. On further observations, no significant difference was found in the PSV of Capsular and intratesticular artery and EDV and RI of testicular, capsular and intratesticular artery.
Conclusions: Testicular perfusion following hernioplasty can be easily monitored and evaluated with Duplex ultrasonography; the flow in the spermatic artery and testicular artery and its branches is of low resistance, with a relatively broad systolic part and holodiastolic flow. There is no evidence for a significant impairment of cord structures after open hernia repair using tension free techniques. It is clear that fine surgical dissection
A case report: acute necrotizing pancreatitis secondary to hypercalcemia in case of parathyroid adenoma
Authors: Behera Binoy K. , Bhatt J. G. , Vagadiya J. G.
Published: January 2024

The incidence of primary hyperparathyroidism (PHPT) in India is 2.5/1000 individuals. The major cause for PHPT is parathyroid adenoma. To arrive at the correct diagnosis, clinical setting, biochemical and radiological investigations, the status of other glands assessed lntraoperatively and finally histopathological confirmation is essential. The association between acute pancreatitis and PHPT has widely been reported in literature, but a causal relationship remains controversial. This case report is about a patient admitted with acute pancreatitis as a first manifestation of a parathyroid adenoma. The purpose of this paper is to keep in mind the metabolic etiology, by evaluating calcium and parathyroid hormone (PTH) in the differential diagnosis of non-Biliary, non-alcoholic acute pancreatitis.
A rare case presentation of neurofibromatosis type 1 with multiple gastrointestinal stromal tumors: a case report
Authors: Pathak Aasit L. , Rajesh G. V. , Chavda Pankaj A. , Vadaliya Akshat K. , S. Prajapati Jeemy
Published: January 2024

Neurofibromatosis type 1 (NF1), a hereditary cancer predisposing syndrome is an autosomal dominant disorder. Gastrointestinal stromal tumor (GIST) is the most prevalent non-neurological tumor in these individuals. In NF1-associated GIST, KIT and platelet-derived growth factor receptor α (PDGFRA) mutations might not be present, and Imatinib may not be effective. Surgical resection is the first-line treatment. The primary aim was to include the possibility of rare tumors including GIST in neurofibromatosis patients in the differential diagnosis of GIT pathology/presentation. A 50-year-old male with neurofibromatosis came with complaints of dull aching abdominal pain and on further investigation was found to have lesions in the distal small bowel, suspicious of nerve sheath tumors, in abdominal computed tomography. A laparotomy was performed and the jejunum containing nodular lesions was resected and pathologically diagnosed as GIST. The patient was then started on Imatinib. At the 6-month follow-up, no tumor recurrence was visible. The rare and unusual location of multiple GIST in neurofibromatosis patients underscores its importance in differential diagnosis, and our case report on the patient's therapy and the clinical outcome could aid in patient care.
Awareness of hemiplegic shoulder in hospital nurses: a cross-sectional study
Authors: Kankaria Rhea M. , Kundnani Twinkle
Published: January 2024

Background: The hemiplegic shoulder, characterized by pain, weakness, and limited range of motion, is a common complication affecting individuals who have experienced hemiplegia due to stroke or other neurological conditions. It significantly impacts the quality of life of patients and hampers their rehabilitation progress. In the context of healthcare, nurses play a pivotal role in the holistic care of patients with hemiplegia. Their knowledge, assessment skills, and interventions contribute to the prevention and management of hemiplegic shoulder, thereby aiding in the overall recovery of patients, awareness of this condition is crucial because early identification and timely interventions can prevent its progression and associated complications. Furthermore, comprehensive knowledge of hemiplegic shoulder management can contribute to patient comfort, better rehabilitation outcomes, and improved patient satisfaction.
Methods: A self-made questionnaire was validated and circulated via Google Forms to hospital nurses of all age groups. 60 participants who fit the inclusion criteria and gave consent to participate in the study were selected. Their responses were recorded, data analysis was done and results were obtained.
Results: 60 responses were recorded via Google Forms. The average age of the population was 32 years. Out of the entire population, only 30.77% of the entire population were aware of the hemiplegic shoulder condition.
Conclusions: According to this study there is a lack of awareness about the hemiplegic shoulder in the population of nurses in India, they need to be made more aware of the safe practices of handling stroke patients.
Disability, work status and deprivation among working age-group: shred of evidences from National Sample Survey 76th round data
Authors: Gupta Jagriti , Govil Dipti , Singh Angad
Published: January 2024

Background: In the Indian context, where a substantial portion of the population is of working age and 2.1% grapple with disabilities, as per the 2011 census, the emergence of diverse disability profiles within this demographic becomes a paramount concern. This issue holds profound consequences, directly impacting the nation's productivity and overall economic landscape. The focus of this study is a comprehensive examination of the repercussions of disability, honing in on the alteration and loss of occupational experiences among individuals in the working-age stratum.
Methods: The primary objective is the computation of a "disability deprivation index" for both India as a whole and its states, a multinomial logistic regression model is employed, seeking to elucidate the extent of the impact precipitated by the onset of disability in the working-age population. Multiple classification analysis is integral to determining adjusted percentages (probabilities) of changes of work, loss of work, and no loss or change of work, derived from multinomial logit regression, fostering a nuanced understanding of the issue.
Results: The study reveals that 2.2% of individuals previously gainfully employed experience disability, with a significant majority losing their livelihoods due to disabling conditions. The disability deprivation index provides insights into relative deprivation levels across states, highlighting Kerala as the least deprived and Bihar as the most deprived.
Conclusions: Despite commendable efforts by government and non-governmental organizations to address the needs of disabled population, the study underscores the stark reality that these provisions reach only a fraction of the disabled population, intensifying the severity of the situation concerning disability in India.
Impact of use of iron fortified iodised salt beyond 12 months on haemoglobin levels
Authors: Ramachandran Prema , Prabhakar Kamini , Kumari Honey , Kalaivani K.
Published: January 2024

Background: Use of iron fortified iodised salt (IS) for 12 months, resulted in improvement in haemoglobin (Hb) in women, children and men. There is no published data on impact of DFS use beyond 12 months on Hb levels.
Methods: A community based open randomised study to assess impact of use of DFS on Hb was discontinued after 12 months due to COVID 19 related lockdown. These families used IS for six months during lockdown; they were willing to continue using the salt provided for further one year. These families were re-randomized into three groups and given the assigned salt for further 12 months and Hb, ferritin and C-reactive protein (CRP) were estimated at 12 months.
Results: Improvement in the mean Hb was 0.5 g/dl in women who had used IS earlier and DFS under second randomisation and 0.3 g/dl in those who had used DFS under first and second randomisation. Mean Hb at 30 months was higher in those who had used DFS for 24 months as compared to those who had used IS for 18 months and DFS for 12 months. The deterioration in mean Hb following discontinuation of DFS for 6 and 18 months was small.
Conclusions: DFS use for the second year resulted in a further increase in Hb in those who had used DFS earlier. The relatively small deterioration in mean Hb following discontinuation of DFS might at least be in part due to the impact of nutrition and health education and access to health and nutrition services.
Unveiling the impact of COVID-19 on diabetics: vaccination status and infection rates in a North Indian state-insights from a primary healthcare centre-based non-communicable disease registry
Authors: Debnath Aninda , Nath Ravindra , Mondal Anubhav , Yadav Geeta , Lukhmana Shveta , Kishore Jugal
Published: January 2024

Background: Patients with diabetes are at an increased risk of severe infection and mortality due to COVID-19. Absence of effective pharmacological treatments, vaccination remains one of the most effective means of controlling the pandemic. Our study aims to investigate the prevalence of COVID-19 infection among patients with diabetes mellitus and assess the coverage of COVID-19 vaccination among these patients.
Methods: The patients were identified from a primary healthcare centre (PHC) based non-communicable disease (NCD) registry at PHC Najafgarh, New Delhi. A total of 480 patients were included in this study. The data was retrieved from NCD registry and vaccination status was confirmed from their vaccination certificates.
Results: In our study 91.3% (438) of diabetic patients had received the first dose of COVID-19 vaccine and the coverage for second dose and third dose among these same patients are 84.6% and 27.3% respectively.
Conclusions: Only a quarter of all the patients have received precautionary dose (3rd dose), and almost a tenth of all the patients have not even received a single dose of COVID-19 vaccine, the patients should be counselled and encouraged for vaccination. Also, it is recommended to take COVID-19 vaccination into consideration while taking the medical history of diabetics.
Establishing and streamlining the communication and coordination through emergency control room in a tertiary care hospital by upgrading the available resources in the pandemic of COVID-19
Authors: Chugh Latika T. , Chawada Bansari L. , Patel Sangita V.
Published: January 2024

As the COVID-19 pandemic started, a tertiary care hospital of central Gujarat faced problems in developing communication and coordination between the doctors as there was a lack of emergency control room (ECR) set up. This article documents the process of establishing ECR using locally available resources. The department of Community Medicine (CM) was made in-charge of ECR. All information technology (IT) equipment were supplied by hospital administration as per the demand. Various challenges experienced by the staff of CM were discussed with the authorities and specialists from respective departments and quick intermediate solutions were adopted. In July-2020, ECR was established with IT support which accelerated the sharing of laboratory findings and patient details to the treating physician. Dedicated smart phones were assigned to each floor providing real time patient updates through Whatsapp groups and video calling feature was used to establish effective communication between patients and relatives. The hospital also collaborated with a local NGO that provided manpower to address queries at ECR. This study concludes that focusing on utilising local resources and manpower and training the available personnel to handle the problems in the best possible ways made the system work properly at the time of crisis.
Barriers to comprehensive nutrition care for cancer patients: a review
Authors: K. P. Bavika , B. S. Anantha Krishna , M. Mithesh , K. S. Praveen
Published: January 2024

This comprehensive review studies the multifaceted barriers that delay cancer patients from accessing adequate nutrition throughout their cancer journey. Addressing these barriers is paramount, considering their profound implications on treatment efficacy, patient well-being, and overall outcomes. The analysis encompasses a range of obstacles comprises physiological, psychological, economic, social, and healthcare system factors, highlighting their intricate impact on nutritional intake and patient care. The exploration of nutritional barriers reveals a landscape encompassing challenges such as malnutrition, treatment-related side effects, psychological distress, physical limitations, lack of knowledge, cultural influences, financial constraints, and limited access to specialised nutritional support. These hurdles, if left unaddressed, can lead to adverse consequences including malnutrition, weakened immunity, impaired treatment response, decreased quality of life, and ultimately, poorer prognosis. The intricate interplay between inadequate nutrition and cancer outcomes is underscored, emphasising the pivotal role of proper nutrition in boosting the immune system, supporting treatment effectiveness, and hastening recovery. Strategies to overcome these barriers emerge through multidisciplinary approaches integrating medical and nutritional needs, personalised dietary plans, psychosocial support, and the integration of yoga and wellness practices to foster mindful eating and holistic well-being. This review provides valuable insights into the complexities of nutritional barriers in cancer care and emphasizes the critical need for comprehensive strategies to ensure cancer patients receive the vital nutritional support necessary for optimizing their journey through treatment and recovery.
Immunohistochemical analysis of cdx2 and its correlation with histopathological parameters of gastric enteric and colorectal epithelial malignancies
Authors: G Roopashree , Kumar M Pavan , D Vani , G Nataraju
Published: January 2024

:Gastrointestinal tract cancers have become the leading causes of death worldwide. In India, the incidence of gastrointestinal carcinomas is increasing due to urbanization, change in food habits and life style. According to National Cancer Registry, gastro-intestinal carcinomas are more common in men than women and more commonly seen in elderly age group. CDX2 is a caudal type Homeo-box gene, encoding a transcription factor that plays an important role in differentiation, proliferation, cell adhesion and migration. CDX2 is often deregulated in cancer and might have oncogenic and tumour suppressor potential.

1) To know the expression of CDX2 in gastric, enteric and colo-rectal epithelial. malignancies. 2) To observe and analyse the staining pattern in various grades and stages of tumour.

The resected specimens of gastric, enteric and colo-rectal carcinomas were collected from the Department of Pathology, Mysore Medical College and Research Institute, during the year December 2019 to May 2021. Standard protocol for grossing and histopathological techniques were followed by immunohistochemical staining with CDX2 antibody. Expression of CDX2 marker and its staining pattern in various grades and stages of tumour were recorded and compared with patient’s clinicopathological parameters.

A total of 67 cases of Gastrointestinal carcinomas were taken for the study. Positive CDX2 expression was seen in 58 out of 67 cases but the intensity of expression varied. There was significant statistical correlation between the CDX2 expression and histopathological grade (p value <0.05).

The present study showed consistent expression of CDX2 in gastrointestinal carcinomas. The CDX2 expression decreased with increase in grade of the carcinoma.

Therefore, CDX2 can be used as one of the prognostic indicators in intestinal variants gastrointestinal carcinoma.
Evaluation of expression of immunohistochemical markers high molecular weight cytokeratin (HMWCK) and alpha-methylacyl coa racemose (AMACR) in prostatic needle biopsies and transurethral resection of prostate (TURP) specimen – A one year observational study
Authors: Kapoor Raghav , Bannur Hema Basappa
Published: January 2024

In view of increasing incidence of Prostate cancer with age, its early detection and management is of utmost importance. Digital rectal examination, clinical picture and USG findings are non-specific. In prostatic lesions having a suspicious morphology, IHC staining (HMWCK and AMACR) is done to distinguish benign from malignant lesions. Absence of myoepithelial layer (HMWCK negative) along with cytoplasmic granular staining in glands (AMACR positive) is consistent with malignant diagnosis.

To evaluate the utility of IHC markers HMWCK and AMACR in resolving morphologically suspicious foci on Prostatic needle core biopsies and TURP specimens.

Observational Study

A total of 30 cases of prostatic lesions were studied. The specimens were fixed in 10% formalin and routinely processed. Haematoxylin-Eosin (H&E) and IHC staining (HMWCK and AMACR) was done in all 30 cases.

Data collected was analyzed using appropriate statistical test.

A total of 30 cases including 19 cases prostatic needle core biopsies and 11 cases of TURP specimens were included in our study. Histopathological diagnosis included 1 case each of Adenosis, Atypical adenomatous hyperplasia and Transitional cell metaplasia; 9 cases of BPH with suspicious foci, 4 cases of LGPIN, 3 cases of HGPIN and 11 cases Prostatic adenocarcinoma. In 5 cases including 3 cases of BPH with suspicious foci and 1 case each of adenosis and AAH, the diagnosis was changed to Prostatic Adenocarcinoma after IHC analysis.

We conclude that IHC staining should be done in cases where routine H&E sections have an ambiguous morphology. HMWCK along with AMACR is a good marker combination to differentiate Benign from Malignant lesions.
Correlation of RBC indices and RBC histogram obtained by automated hematology analyser with peripheral smear in the diagnosis of anemia
Authors: Thomas Rose Maria , Chavan S Sateesh
Published: January 2024

: The impact of early diagnosis and management of anemia on patient outcome has been tremendous. Although conventional microscopic examination of blood using peripheral smear is unequivocal, the advent of automated hematology analyzer has revolutionized the field of clinical hematology and its practice. This study highlights the efficiency and utility of specific parameters obtained by hematology analyzer and its comparison with peripheral smear in the diagnosis of anemia, also determines the sensitivity of the same.

: 501 Ethylenediamine tetra acetic acid blood samples collected at a tertiary care teaching hospital in Karnataka during one and half years from February 2021 to August 2022, were run on the Sysmex 6-part automated hematology analyzer and simultaneous peripheral smears were prepared and stained using Leishman stain based on standard operating procedures. The histogram and peripheral smear findings were noted.

: Among the 501 cases, there were 269(53.7%) cases of Normocytic Normochromic Anemia in which 82.9% showed normal curve, 145(28.9%) cases of Microcytic Hypochromic Anemia in which 92.4% showed shift to left, 31(6.2%) cases of Dimorphic Anemia in which 61.3% showed normal curve contrary to the expected double peak, 24(4.8%) cases of Macrocytic Anemia in which 83.3% showed shift to right, 23(4.6%) cases of Pancytopenia in which 39.1% showed normal curve and 9 cases of Normocytic Hypochromic Anemia.

: The Automated hematology Analyzer provides highly valuable information with limited sample and is an essential tool in diagnosis, classification and management of anemia.
Cutaneous metastasis masquerading an internal malignancy, hilar cholangiocarcinoma – A case report and review of literature
Authors: S Radhika , S Ilavendiran , RT Narendhran , Vijayakumar Kavita , Kumar Anand Selva
Published: January 2024

Cutaneous metastases can be a masquerade of an internal malignancy and is rare accounting for 0.7-0.9% of cancer patients. Cutaneous metastasis of adenocarcinoma histologic subtype indicates widespread disease and poor prognosis. Herein, we report an exceedingly rare case of cutaneous metastasis, possibly of pancreaticobiliary origin and review of literature on cutaneous metastasis. A 48-year-old woman presented with massive ascites since 4 months. Multiple asymptomatic skin nodules were noted. PET- CT showed extensive ill defined skeletal metastasis and low grade metabolically active ill-defined lesions in the bilateral adnexal region – suspicious for metastatic deposits. Upper gastrointestinal tract (GI) endoscopy and colonoscopy did not reveal any specific lesion. Biopsy from the nodule in the left forearm showed cords, a few vague acinar structures and singly lying cells including a few signet ring cells consistent with poorly differentiated adenocarcinoma with few signet ring cell features. On Immunostaining, the neoplastic cells showed diffuse membranous positivity for Cytokeratin (CK), Cytokeratin 7 (CK 7), CK19 , CDX-2 and negative for TTF-1, CK20, PAX 8 and WT-1. This immunohistochemical profile favours an adenocarcinoma possibly of pancreaticobiliary origin. MR Cholangiopancreaticogram showed ill-defined T2 hypointense diffusion restriction at perihilar region involving the confluence, cystic duct and common hepatic ducts – likely neoplastic etiology (Hilar cholangiocarcinoma – Bismuth – Corlette type II). Palliative chemotherapy and radiotherapy was initiated and the patient is on follow-up. This case emphasis that there should be a strong suspicion of cutaneous metastases in case of any skin nodule with non pinchability of skin especially in old age as it could be the initial presentation of an underlying malignancy and it requires a multidisciplinary approach.
Malignant mural nodule in ovarian mucinous neoplasms - Needle in a haystack
Authors: Selvaraj Sivaranjani , Amirtham Usha
Published: January 2024

Ovarian mucinous tumors with mural nodules are very rare surface epithelial-stromal tumors. The mural nodules are divergent neoplasms that may be benign or malignant. The latter may be in the form of a sarcoma, carcinosarcoma, anaplastic carcinoma, or a variety of other recognized histotypes of carcinoma. They represent the part of the tumor which is undergoing divergent differentiation or collision tumors. Here, we report two such cases to discuss the histo-morphological and immunohistochemical features with prognosis. Case 1 is a 15-year-old female presented with right sided abdominal mass for 4 months. She underwent right salphingo-oophorectomy. On histopathological examination -borderline mucinous neoplasm of ovary with a mural nodule showing rhabdoid differentiation. On immunohistochemistry – malignant mural nodule confirmed to be an anaplastic carcinoma, rhabdoid type. Case 2 is a 16-year-old female presented with abdominal mass associated with pain for the past 1 year. She underwent a left salphingo- oophorectomy with left groin node debulking and abdominal wall deposits excision. On histopathological examination – mucinous carcinoma of ovary with a malignant mural nodule showing morphological features of carcinosarcoma. On immunohistochemistry – malignant mural nodule confirmed to be a sarcoma-like mural nodule, pleomorphic and spindle cell type. A malignant mural nodule can be associated with poor prognosis regardless of the benignity of the associated mucinous tumor. Hence, careful and meticulous examination of this rare lesion within a mucinous cystic tumor supplemented by immunohistochemistry aids in the sometimes, difficult differential diagnosis among these types of mural nodules.
Educación literaria y redes sociales
Authors: Pérez-Rodríguez Amor , Delgado-Ponce Águeda , Bonilla-del-Río Mónica
Published: January 2024

Las redes sociales se han convertido en los últimos años en los espacios de relación y comunicación más habituales, sobre todo para los jóvenes, condicionando sus hábitos de expresión. En consecuencia, los autores literarios, la literatura, su enseñanza y las prácticas que de ello se derivan se hacen eco de esa influencia e impacto. El objeto de este trabajo es analizar la producción científica en español, en revistas especializadas, indexadas en Dialnet, en relación con la literatura y las redes sociales, desde el año 2016 hasta la actualidad. Se pretende identificar las prácticas vinculadas a la educación literaria en el contexto educativo español, determinando los aspectos más relevantes de estas. Se aplica una metodología sistematizada de selección, usando los estándares PRISMA y un análisis de contenido. Los resultados evidencian la escasez de estudios sobre el tema, pese al uso cada vez más generalizado de las redes, la necesidad de formación y alfabetización, y la utilización de las redes como recursos en Secundaria, en prácticas relacionadas con la literatura, la lectura y la escritura creativa. Especialmente destacan las experiencias con YouTube para el fomento de la lectura, y la escritura y narrativa con Instagram y Twitter.
Student Response to the Application of Augmented Reality Media with RME Approach
Authors: Ahmad Budi Sutrisno  , Hamzah Upu  , Dr. Rusli, MS
Published: January 2024

The use of technology in learning is increasingly becoming a major concern in the world of education. One innovation that attracts attention is the application of Augmented Reality (AR) Media with a Realistic Mathematics Education (RME) approach in mathematics learning. This study aims to investigate the response of students to the application of AR media with the RME Approach in the context of mathematics learning. Qualitative quantitative research methods are used with experiments that accept learning with AR media and the RME Approach. Data collection instrument questionnaire student response to the media used. The results of the study are expected to provide a deeper understanding of how students respond to the application of AR media with the RME Approach. The implications of these findings can be used to improve the design of mathematics learning that is more interactive and relevant to the needs of learners in this technological era. In conclusion, the application of AR media with the RME approach has the potential to improve student response and the effectiveness of mathematics learning