bluuebunny/crossref_metadata_2025 huggingface dataset:
Automated Detection and Tortuosity Characterization of Retinal Vascular Networks
Authors: Mapayi Temitope , Owolawi Pius Adewale , Adio Adedayo O.
Published: April 2021

Automated retinal vascular network detection and analysis using digital retinal images continue to play a major role in the field of biomedicine for the diagnosis and management of various forms of human ailments like hypertension, diabetic retinopathy, retinopathy of prematurity, glaucoma and cardiovascular diseases. Although several literature have implemented different automatic approaches of detecting blood vessels in the retinal and also determining their tortuous states, the results obtained show that there are needs for further investigation on more efficient ways to detect and characterize the blood vessel network tortuosity states. This paper implements the use of an adaptive thresholding method based on local spatial relational variance (LSRV) for the detection of the retinal vascular networks. The suitability of a multi-layer perceptron artificial neural network (MLP-ANN) technique for the tortuosity characterization of retinal blood vascular networks is also presented in this paper. Some vessel geometric features of detected vessels are fed into ANN classifier for the automatic classification of the retinal vascular networks as being tortuous vessels or normal vessels. Experimental studies conducted on DRIVE and STARE databases show that the vascular network detection results obtained from the method implemented in this paper detects large and thin vascular networks in the retina. In comparison to preious methods in the literature, the proposed method for vascular network segmentation achieved better performance than several methods in the literature with a mean accuracy value of 95.04% and mean sensitivity value of 75.16% on DRIVE and mean accuracy value of 94.02% and average sensitivity value of 76.55% on STARE with computational processing time of 4.5 seconds and 9.4 seconds on DRIVE and STARE respectively. The MLP-ANN method proposed for the vascular network tortuosity characterization achieves promising accuracy rates of 77.5%, 80%, 83.33%, 85%, 86.67% and 100% for varying training sample sizes.
“Fintech Services” and the Future of Financial Intermediation: A Review
Authors: Dharmadasa P. D. C. S.
Published: April 2021

The aim of this paper was to review existing literature on Fintech services and their potential impact on traditional financial intermediary practices. The review is significant and timely as banks and customers are gradually familiarizing with these services showing a significant growth of Fintech utilization in Sri Lanka in recent times. Utilizing a qualitative approach, the paper has examined two most significant usual practices of banks including: (a) banking practices on credit, deposits and capital raising and payment services, and (b) banking practices on clearing and settlement services, because of the emergence of two major Fintech services; namely, peer to peer (P2P) lending, and digital wallet and crypto currencies. The review considered both national and international studies on ‘Fintech’ adaptation in financial institutions. It is observed that there is no compelling threat from P2P lending to banking activities, in general, though there will be migration of lenders from banks to P2P platforms that will result in banks to lose some segments of customers in the future. The review also identified that growing usage of smartphones tends to replace physical wallets with digital wallets which will bring potential disruptions to traditional operations of the banking industry. Adoption of Fintech in the banking industry, however, will not result in a complete financial disintermediation given the monopolistic nature of money creation by the banks, and risky and unreliable nature of these innovations.
Social Media Addiction of Employees: Does it Affect Labor Supply?
Authors: Samaraweera G. R. S. R. C. , Wijesinghe M. D. J. W.
Published: April 2021

The main objective of this research is to identify the impact of social media addiction on the labour supply of employees in Sri Lanka. The study covers 390 employees through a questionnaire survey. The study used the endogenous switching regression model for modelling average working hours per week day of social media addicts and non-addicts comparatively.  Age, marital status, executive employment, type of social media and commuting distance to the workplace are the key factors associated with social media addiction of workers as in the selection function of the model. Working hours of social media addicts are affected by age, gender and executive employment while the working hours of non addicts are mainly affected by gender, marriage, executive employment, years of education and monthly net salary. Social media addiction of non addicts causes reduction of average hours of work per week day, while hours of work of social media addicts increase, if they have given up social media addiction. Institution specific policy insights are also proposed to increase the performance of employees.
Impacts of an extreme flood on the ecosystem of a headwater stream
Authors: Pažourková Eva , Křeček Josef , Bitušík Peter , Chvojka Pavel , Kamasová Lenka , Senoo Takaaki , Špaček Jan , Stuchlík Evžen
Published: April 2021

Headwater streams are the smallest parts of rivers but make up the majority of river miles. The chemistry and macroinvertebrate composition of such streams are among the most important indicators of their environmental health. Macroinvertebrates are affected namely by runoff genesis and, in many regions of the world, also by acid atmospheric deposition and its consequences. The aim of this paper is to evaluate the impacts of an extreme summer flash flood on the physical environment, chemistry and macroinvertebrates in a small headwater stream located in the Beech-woods National Nature Reserve of the Jizera Mts. (Northern Bohemia, Czech Republic). The studied stream is characterized by a pluvial hydrologic regime with perennial streamflow uniformly distributed within the year, with peak-flows originating mainly from summer rainstorms, and moderate current anthropogenic acidification. During the observed summer flash flood of the return period near 1,000 years, high currents (1-2.5 m s-1) flushed out 2.7 m3 of sand and gravel from the streambed, resulting in a devastating effect on macroinvertebrates. Both number of species/taxa and diversity were reduced by about 50% while the abundance of surviving taxa was reduced to about 10% compared with before the flood. The following spring after the event, both number of species/taxa, diversity and abundance increased, partially due to the temporary unsuccessful colonization of the site by several alien species creating a peak of biological diversity, but complete recovery of the original macroinvertebrate assemblages was not observed even during the subsequent two years. On the other hand, a significant drop in sulphate contents and rising alkalinity observed in stream waters during base flow conditions after the flood indicate positive effects on recovery of the aquatic environment by depleting the catchment sulphur pool. Thus, the flood did not significantly alter the long-term recovery of the studied headwater stream from acidification.
Hammering home the sickle: an instructive case of endobronchial anaplastic large cell lymphoma
Authors: Abu-Hishmeh Mohammad , Miranda Laura , Shakil Fouzia , Ahmed Tauseef , Epelbaum Oleg
Published: April 2021

It is extremely unusual for primary pulmonary lymphoma, an uncommon occurrence in any form, to be of T-cell origin and to manifest as an endobronchial lesion. Each of these characteristics is rare individually, so cases that combine them are exceptional. We report a patient in whom primary pulmonary anaplastic large cell lymphoma, a T-cell neoplasm, presented with obstruction of the left upper lobe bronchus, resulting in left upper lobe atelectasis and creating the radiographic luftsichel sign. We briefly discuss anaplastic large cell lymphoma as a whole, place our case in the context of previously published literature on endobronchial anaplastic large cell lymphoma, and review the genesis of the luftsichel sign.
Effect of smartphone applications on cardiopulmonary resuscitation quality metrics in a mannequin study
Authors: Sevil Hüseyin , Bastan Volga , Gültürk Esma , El Majzoub Imad , Göksu Erkan
Published: April 2021

OBJECTIVE:

The aim of this randomized, cross-over trial is to reveal the effect of smartphone cardio-pulmonary resuscitation (CPR) feedback applications (App) on a group of lay rescuers' chest compression-only CPR quality metrics. Quality metrics is measured initially and after 3 months.

METHODS:

A floor-based Resusci Anne mannequin (Laerdal Medical, Stavanger, Norway) was used. Three scenarios (CPR with device App-on [scenario-a], CPR with device App-off [scenario-b], and hands-only CPR [scenario-c]) were randomly allocated to all participants. All the participants performed 2 min of hands only-CPR for each scenario. Data of mean chest compression rate, mean chest compression depth, and recoil were recorded and compared for each scenario.

RESULTS:

One hundred and thirty-seven first-year students from the Vocational School of Health Services in Turkey participated in this study to mimic lay rescuers. Difference in the initial mean rate of chest compressions was statistically significant when CPR was performed with device App-on (scenario-a) compared to scenarios b and c (P < 0.001, P < 0.001). Furthermore, difference in the mean chest compression rate at the 3rd month was statistically significant among the scenarios when CPR was performed with device App-on (scenario-a) (P = 0.002, P = 0.001). The difference in initial and 3rd month mean compression depth and the percentage of recoil was not statistically significant among the scenarios.

CONCLUSION:

This study shows that the mean chest compression rate and percentage of compressions with adequate rate improved with smartphone App-on, and these results were persistent up to 3 months.
Effect of performance level on the longitudinal electromyographic activity of vastus medialis and vastus lateralis muscles after induced extreme fatigue with a workload of 30 repetition maximum
Authors: Shaw Dhananjoy , Singh Deepak , Kaur Manvinder , Ahlawat Umesh Kr. , Bhatia Dinesh
Published: April 2021

CONTEXT:

The study of longitudinal electromyographic (EMG) activity of the muscles under extreme fatigue conditions has been an inadequately explored area in muscle fatigue research.

AIMS:

The aim of this study was to assess the effect of performance level on the longitudinal EMG activity of the vastus medialis (VM) and vastus lateralis (VL) after induced extreme fatigue with a workload of 30 repetition maximum (RM).

DESIGN:

This was a cross-sectional study.

MATERIALS AND METHODS:

Eighteen healthy intercollegiate level male sportspersons (age: 19.84 ± 2.1 years, height: 171.38 ± 8.48 cm, and weight: 69.72 ± 13.85 kg) were randomly selected as participants. As fatigue protocol, 30 repetitions of leg extension exercise with 30 RM load were performed. Isometric contraction of VM and VL muscles at an angle of 0°–10° with 30 RM load was performed until failure as the postfatigue or extreme fatigue protocol. Both protocols were performed in Cybex VR1 leg curl exercise device. EMG activity was recorded from VL and VM during the postfatigue protocol. EMG data were acquired using a 4-Channel Wireless EMG BIOPAC Inc. MP150 system. A criterion called relative impulse (RI) was developed. Based on the magnitude of RI of participants, nine participants were enlisted and equally divided into high-performance (HP) group, mid-performance (MP) group, and low-performance (LP) group. The raw EMG signals were quantified through MATLAB to derive root mean square (RMS) and median frequency (MDF).

STATISTICAL ANALYSIS USED:

One-way ANOVA and least significant difference (at P < 0.05) were used to assess the influence of performance level, and independent two-tailed t-test (at P < 0.05) was applied to compare the EMG activities of VM and VL in regard to performance level.

RESULTS:

All the groups displayed a constant linear trend in regard to MDF and RMS except for the HP group in the VL and LP groups in VM. The EMG activities of all the groups were not significantly different from each other under extreme fatigue. However, muscle activation of VM and VL was significantly different from each other in the MP and LP groups.

CONCLUSIONS:

Findings are useful for further understanding muscle fatigue.
Complementary medicine utilization and practices of self-medication in the field practice areas of a medical college of district Dakshina Kannada, Karnataka, India
Authors: Kumar Saurabh , Shetty Achal , Bhat Sowmya , Prabhu Sudhir , Dsouza Oliver , Krishna K. Nishanth , Dsouza Moira , Narayana V.
Published: April 2021

INTRODUCTION:

Complementary modalities have been established globally but lack of sufficient data on their utilization patterns hinders the mainstreaming with the existing health care delivery system. The concerning issues are especially of self-medication and usage of complementary medicines with or without the usage of allopathic drugs.

AIM:

The study aims to find out the prevalence of complementary medicine utilization and prevalence of self-medication amongst the people in the field practice areas of the medical college.

MATERIALS AND METHODS:

Community-based cross-sectional study was conducted from November 2018 to January 2019. The International questionnaire for the use of Complementary and alternative systems of Medicine was used to interview the 451 study participants. The results were expressed in percentages and proportions. Chi-square test was used to find out the association of sociodemographic variables with the use of complementary medicine and self-medication practices.

RESULTS:

Overall prevalence of utilizing the complementary medicine services were found to be 17.7%. About 14.6% and 2.9% of the study participants visited ayurvedic and homeopathic practitioners, respectively for the past 12 months. A significantly higher proportion of the rural population was utilizing the services of the complementary system of medical practitioners. Other sociodemographic variables were not found to be associated with the utilization of complementary medicine services. The prevalence of self-medication practices was found to be 25.9%.

CONCLUSION:

The prevalence of complementary medicine utilization was lower than the prevalence of self-medication practices. Rural area study participants accessed more services of a complementary system of medical practitioners.
Phytochemical and high-performance thin-layer chromatography analysis of Ashawattha (Ficus religiosa Linn.) Kaanda Twaka (outer portion of stem bark) Churna (powder)
Authors: Jawanjal Pravin , Bedarkar Prashant , Patgiri Biswajit , Shukla V. J.
Published: April 2021

AIM:

The aim of this study was to evaluate phytochemical constituent and high-performance thin-layer chromatography (HPTLC) analysis of Ashawattha Kandatwaka (the outer portion of stem bark) Churna (powder).

INTRODUCTION:

Ashawattha Kandatwaka Churna is a major constituent of numerous ayurvedic formulations. The plant has possessed their various pharmacological activities such as antifungal, anthelmintic, hypoglycemic, antibacterial, antioxidant, anticonvulsant, hypolipidemic, immunomodulatory, and wound healing activities.

MATERIALS AND METHODS:

Experiments were performed on authenticated plant materials following standard procedures. The methanol extract of stem bark of Ficus religiosa Linn. was used for the HPTLC study. Toluene (9 ml) and ethyl acetate (1 ml) were used for stem bark of F. religiosa Linn. as a mobile phase.

RESULTS:

Identification of alkaloids, steroids, and amino acids was confirmed through the phytochemical parameter. In the HPTLC study, the Rf values obtained at 254 nm were 0.02 and at 366 nm were 0.01, 0.17, and 0.53, respectively.

CONCLUSION:

Physiochemical analysis including HPTLC of Ashawattha Kaanda Twaka Churna will help in further standardization.
Role of ureterolysis in the management of retroperitoneal fibrosis
Authors: Boulma Rami , Mestiri Akil , Khouni Hassen , Saidani Bilel , Chouchen Adnen
Published: April 2021

The purpose of the present study is to assess the outcome of ureterolysis in the management of ureteral entrapment secondary to retroperitoneal fibrosis (RPF). A literature search of online database PubMed for studies about ureterolysis was performed. The keywords used for this literature review were: “Retroperitoneal fibrosis” and “Ureterolysis.” Articles in English published between 1980 and 2019 were included. Articles published in non-English language, without full text or lacking of relevant data, were excluded. Clinical perioperative and outcome data were collected, analyzed, and compared between open, laparoscopic, and robotic ureterolysis subgroups. Postoperative complications were recorded according to the Clavien classification. One hundred and six articles were initially collected. After analysis, 37 articles were finally selected for the review. The number of patients was 402. The number of renal units was 554. The median age of our population was 54.55 years (36.5–71). The male/female ratio was 1.71. RPF was idiopathic in 312 patients (77.61%). Ureterolysis was bilateral in 131 cases. The mean success rate in open ureterolysis was 90.45% (77%–100%), the mean success rate in laparoscopic ureterolysis was 93.72% (77.8%–100%), and the success rate in robot-assisted ureterolysis was 100%. Most complications were Clavien I and II. Clavien V was noted in four patients. Ureterolysis is an effective treatment in the management of ureteral entrapment in RPF. It is a safe procedure with possible but manageable complications. It can be proposed in cases of medical therapy failure.
The WRITE physiology
Authors: Cheng Hwee-Ming , Hoe See-Ziau
Published: April 2021

Writing Physiology well is much more than a fine motor skill. The capacity to simplify mechanisms, use choice, meaningful words, and construct them in accurate sentences to explain an aspect of Physiology strengthens learning. Writing focuses the mind and sharpens the students' ability to define and describe Physiology. Medical faculties should not be tempted to lessen the role of writing tests even though evaluation is less time-consuming. The enjoyment of writing Physiology can be expanded to include creative activity like composing Physiology songs, rhymes, and comic dialogs.
Isolation, characterization and acyclovir susceptibility of herpes simplex virus isolates among immunocompromised patients
Authors: Nag Soumyabrata , Sengupta Mallika , Sarkar Soma , Ray Yogiraj , Chattopadhyay Debprasad , Sengupta Manideepa
Published: April 2021

Introduction:

Herpes simplex virus (HSV) Type 2 primarily causes genital herpes, while HSV Type 1 is responsible for oral and facial lesions. The objective of this study was to isolate and characterize HSV from herpetic lesions among human immunodeficiency virus (HIV) infected patients and to evaluate their acyclovir susceptibility pattern.

Materials and Methods:

Blister fluid and swabs from ulcers were collected from patients with clinical diagnosis of HSV infection among patients attending the HIV clinic of two tertiary care centers – Medical College, Kolkata, and School of Tropical Medicine, Kolkata. These samples were cultured in the Vero cell line. Growth of virus was noted by observing the characteristic cytopathic effect of HSV, which was further confirmed by immunofluorescence and polymerase chain reaction (PCR). These isolates were then subjected to the Vero cells with serial dilutions of acyclovir for determining the susceptibility pattern.

Results:

Among the 52 samples received, 8 (15.38%) showed growth of HSV. After confirmation by immunofluorescence and PCR, all seven isolates from genital samples were identified as HSV-2 and the lone isolate from oral lesion was confirmed as HSV 1. Out of the eight isolates, 25% showed resistance to acyclovir. The overall isolation rate was more from genital blister than genital ulcer which was 46.15% and 2.86%, respectively.

Conclusion:

HSV was isolated in 15.38% of cases of clinical herpes. There was a higher isolation rate of virus from blister fluid as compared to ulcer scrapings. Acyclovir resistance in 25% of cases is alarmingly high.
Upper tract transitional cell carcinoma clinically mimicking inflammatory renal pathology
Authors: Jena Rahul , Sureka Sanjoy Kumar , Singh Uday Pratap
Published: April 2021

Upper tract urothelial carcinoma (UTUC) of the renal pelvis and the ureter is incidentally detected in a small proportion of cases. However, the majority of UTUC cases present with hematuria, flank pain, and clot colic. Typical imaging features include hydronephrosis of the kidney (s) due to obstruction by the mass with a soft-tissue lesion that typically shows low-grade enhancement with or without a filling defect. Rarely, such a tumor may present with signs and symptoms mimicking an inflammatory or infective pathology of the kidney and is diagnosed only on biopsy or on nephrectomy. We present three such patients and cite another similar case we have published earlier. All three of these patients presented with signs and symptoms of an obstructed infected kidney with long-standing renal calculi and a forgotten DJ stent in one instance. Nephrectomy for the presumed infected kidney in all three cases revealed high-grade UTUC. In patients presenting with equivocal findings on cross-sectional imaging with a history of renal calculi or foreign bodies, we should have a high index of suspicion for malignancy.
Glucagon-producing mucinous tubular and spindle cell variant of renal cell carcinoma with paraneoplastic diabetes
Authors: Khanna Ashish , Singh Sharwan Kumar , Nada Ritambara
Published: April 2021

Renal cell carcinoma (RCC) is known as the internist tumor because of the myriad paraneoplastic manifestations associated with it. One of the rarely described paraneoplastic manifestations associated with this malignancy is hyperglycemia. Only 11 cases in the English and Japanese literature have been reported. We report the occurrence of paraneoplastic hyperglycemia with a rare variant: mucinous tubular and spindle cell variant of RCC. To the best of our knowledge, the association of paraneoplastic hyperglycemia with this variant has not been reported earlier.
Drain fluid creatinine-to-serum creatinine ratio as an initial test to detect urine leakage following cystectomy
Authors: Regmi Subodh Kumar , Bearrick Elizabeth N. , Hannah Peter T. F. , Sathianathen Niranjan , Kalapara Arveen , Konety Badrinath R.
Published: April 2021

Introduction:

Urine leak following radical cystectomy is a known complication. Among the various methods to diagnose this, assessment of drain fluid creatinine is a relatively easy procedure. We aimed to ascertain the validity of the drain fluid creatinine-to-serum creatinine ratio (DCSCR) as an initial indicator of urinary leak in patients undergoing radical cystectomy.

Methods:

We retrospectively identified consecutive patients with documentation of drain fluid creatinine in the postoperative period following cystectomy and urinary diversion at our institution between January 2009 and December 2018. All continent diversions and any patient with a DCSCR >1.5:1 underwent contrast study postoperatively. A diagnosis of urine leak was made following confirmatory imaging. Receiver operative characteristic curves were created, and Youden's index was used to determine the strength and clinical utility of DCSCR as a diagnostic test.

Results:

Two hundred forty-four of the 340 patients included in the study underwent cystectomy with conduit and 81 underwent neobladder creation. Sixteen out of 340 (4.7%) patients had radiologically confirmed urinary leak. DCSCR was elevated in all ureteric anastomotic leaks and in 1 out of the 7 neobladder-urethral anastomotic (NUA) leaks. The sensitivity and specificity of DCSCR to predict all urinary leaks were 68.8% and 80.9% at 1.12 (area under the curve [AUC] = 0.838), whereas at a value of 1.18 (AUC = 0.876) and with the exclusion of NUA leaks, the sensitivity was 77.8% and specificity was 87.6%.

Conclusions:

DCSCR is a good preliminary test for identifying patients who need prompt confirmatory testing for localizing urinary leaks. A drain creatinine level just 18% higher than the serum creatinine level can signify a urine leak. This is different from general assumptions of a higher DCSCR.
Application and comparison of Fuhrman nuclear grading system with the novel tumor grading system for chromophobe renal cell carcinoma and its correlation with disease-specific events
Authors: Sali Akash Pramod , Bahirwade Ganesh K. , Bakshi Ganesh , Prakash Gagan , Joshi Amit , Desai Sangeeta B. , Menon Santosh
Published: April 2021

Introduction:

The grading system of chromophobe renal cell carcinoma (ChRCC) is not well established. In this study, we aimed to compare the application of Fuhrman nuclear grade (FNG) with the novel chromophobe tumor grade (CTG). We also evaluated the correlation of these two grading systems with the clinical outcome.

Materials and Methods:

Consecutive cases of ChRCC diagnosed on nephrectomy during 2005–2014 were identified. The clinical details of the patients were retrieved. Histopathology slides were reviewed and the nuclear grading was assigned using standard FNG and the CTG system. The CTG and FNG gradings were correlated with clinical outcome.

Results:

A total of 80 cases were retrieved. Distribution of FNG was as follows: FNG-1, 1 (1.3%); FNG-2, 23 (28.3%); FNG-3, 44 (55.0%); and FNG-4, 12 (15%). CTG distribution was as follows: CTG-1, 48 (60.0%); CTG-2, 20 (25.0%); and CTG-3 12 (15.0%). Follow-up data was available in 46 cases; the median follow-up was 23.9 months (range 1–96.4 months). The median time to recurrence/metastasis was 17.2 months (range 3.2–31.2 months). Mean disease-free survival (DFS) was 68.5 months. Both CTG (P < 0.001) and FNG (P = 0.001) correlated with DFS; however, only CTG retained this significance when only the nonsarcomatous cases were analyzed. On receiver operating characteristics curve analysis, CTG had higher predictive accuracy for DFS for the entire group, while FNG lost the statistical significance when the nonsarcomatous cases were analyzed. CTG (P = 0.001) but not FNG (P = 0.106) correlated with the disease-specific adverse events in non-sarcomatous cases.

Conclusions:

It is possible to apply CTG in ChRCC. It is a better predictor of DFS and disease-specific adverse events. CTG is more appropriate and applicable than the FNG in grading ChRCC.
Association of Paternal Individual Deprivation Measure with General Anthropometric Data and Dental Caries among 12 to 15 year old school going children, in Tiruvallur District - A cross sectional study
Authors: Sasikala M. , Prabu D. , Manipal Sunayana , Bharathwaj V. V. , Rajmohan M.
Published: April 2021

Aim:

To determine General anthropometric data and dental caries and their association of paternal Individual Deprivation Measure among 12- to 15-year-old school going children in Tiruvallur District.

Methods and Material:

The Anthropometric data such as Body mass index, Skin fold thickness and mid arm circumference was assessed. The study was also conducted to assess children's paternal deprivation using individual deprivation index (IDM). Paternal deprivation was calculated using Individual deprivation index which comprises of 15 dimensions. Pilot study was done to calculate sample size which is found to be 800.

Results:

Dimension of paternal individual deprivation measure in parent Education, Housing, toileting, family planning, problem in visiting doctor between Government and Private School children was significant with P value of 0.0005. Interpretation of Paternal individual deprivation measure was found to be significant among Government and private school children. There was no association of individual deprivation measure with dental caries, but there was an association of Individual paternal deprivation measure with one of the anthropometric measure was mid arm circumference. In paternal deprivation index 21.8% of the children's parent were not deprived, 45.8% were somewhat deprived, 22.6% were deprived, 7.3% were very deprived, 2.6 were extremely deprived among school children.
Role of mini-invasive bridge plate in the complex femoral fracture in school going children
Authors: Lakhani Amit , Bhatnagar SM , Singh Gobind Pratap , Gupta Nikunj , Sharma Ena
Published: April 2021

Objective:

Pediatric femoral fracture including supracondylar and subtrochanteric fracture constitutes 1.6% of all paediatric fracture. Elastic nails remain the standard treatment of choice in a midshaft transverse femoral fracture in children weighing less than 45 kg. But in subtrochanteric and spiral femoral fracture, the failure rate of elastic nails are quite high. Hence, in accordance with AAOS guidelines, we treated complex femoral fracture in children with submuscular mini-invasive bridge plate because of its advantage of minimal incision, early union with proper alignment and lower failure.

Material and Methods:

We retrospectively reviewed 30 complex femur fracture in children treated with Submuscular bridge plate by mini-invasive approach. Patients were analysed according to their age, type of fracture, time of union in weeks, complication and results were evaluated with modified Flynn's criteria.

Result:

Out of 30 patients 28 were boys and 2 were females, with an average age of 11.5 years in which Spiral fracture (n = 12), subtrochanteric fracture (n = 9), Complex Shaft fracture (n = 10). All fracture united well on an average of 11 weeks. And 29 patients has excellent results and in 1 patient there is Acceptable result. The single complication was 3 mm limb lengthening but it didn't change gait of the patient.

Conclusion:

Mini invasive bridge plating is an easy and soft tissue preserving procedure for managing complex femoral fracture in children. It has shown promising results in achieving union without any major complication. We strongly recommend the SBP in a complex femoral fracture in children.
Public knowledge, attitudes, and practices toward COVID-19
Authors: Gupta Chandani , Gupta Riya , Kumari Rashmi , Gupta Rajiv Kumar , Bhagat Preeti , Mir Mehak T , Nazir Heena , Raina Sunil Kumar
Published: April 2021

Background:

COVID-19, since its emergence, has become a global health problem with countries adopting unprecedented measures to control the spread of this pandemic. Adherence of the populations to control measures is affected by their knowledge, attitude, and practices (KAP) towards the disease. It was with this aim that the present study was conducted among the residents of UT of J&K to assess their KAP toward COVID-19.

Methodology:

A cross-sectional online survey of 464 J&K residents was conducted between 1st May and 10th May 2020. Survey Monkey tool was used to develop a link and KAP questionnaire was used for data collection. The survey instrument consisted of demographic characteristics, 11 items on knowledge, 5 items on attitudes, and 7 items on practices. Data collected was represented in descriptive statistics, and one-way analysis of variance was the test of significance.

Results:

Mean knowledge, attitude, and practice scores were 7.69 ± 0.74, 4.70 ± 0.57, and 4.32 ± 0.68, respectively, among the respondents. Majority (99%) knew the sign and symptoms, mode of transmission of the disease and avoided attending large gatherings. Use of mask was almost universal and about 38% were taking supplements like vitamins or herbal medicines. Good knowledge, positive attitude, and appropriate practices among the respondents about COVID-19 suggest that community based health education programs play a key role in containment and mitigation of this disease.

Conclusion:

Sustained messaging and updates from the national and local health authorities on COVID-19 to the public are likely to help control the transmission of the disease.
Impact of nutritional education in malnourished elderly patients with the comparison of Mini nutritional assessment (MNA) score
Authors: Karthikeyan Megha S. , Vijaykumar Priya , Chandana Linqalla , Paul Alex Baby
Published: April 2021

Introduction:

Prevalnce of malnutrition is high in the elderly. Very few studies exists mentioning the prevalnce of malmutrtion in elderly. In india around 7.7% of the total population belong to elderly age group and in kerala older adults constitute 13% of its population. The health of the elderly contributes to the health status of the population. Malnutrition is commonly seen in elders. There are multiple factors contributing to malnutrtion in this age group.

Material and Methods:

A sample of 30 patients, 60 years and above fulfilling the inclusion criteria are enrolled in the study. Malnutrition was assessed by MNA score. The score ranges from 0 to 30 points. The score above 24 show patient that are healthy with no nutritional problem, scores within range 17-23.5 indicate patients vulnerable to malnutrition and score below 17 as malnourished. MNA scoring was repeated after 3 months giving the dietary education.

Results:

29 patients were found to be at risk of malnutrition and 1 patient was found to be malnourished After 3 months of dietary intervention, 23 attained normal.

Conclusion:

MNA is a very accurate and effective tool for identifying malnutrition in elderly. Nutrition is an important area that need to be addressed in elder population.
Pattern of Tobacco consumption among urban slum population in Jammu region
Authors: Choudhary Neha , Sangra Sonika
Published: April 2021

Introduction:

Consumption of tobacco leads to a myriad of ill effects among the smokers as well as those in their proximity. The study related to tobacco consumption was conducted among individuals over 15 years of age, residing in urban slums.

Objective:

To assess the pattern of tobacco consumption in urban slum population, using WHO standardized questionnaire which is Global Tobacco Surveillance System (GTSS); questions related to tobacco from the surveys, which are the subset of GATS 2nd Edition key questions.

Materials and Methods:

The present study was observational cross-sectional in nature which was conducted over a period of 6 months i.e., from September 2019 to February 2020 in urban slums of Trikuta Nagar, urban health training centre which is a field practice area of Postgraduate Department of Community Medicine, GMC Jammu. The information about the tobacco consumption was gathered by interview sessions after taking consent from all the participants. Totally, 718 individuals were met, out of which, 539 were over 15 years of age and 510 agreed to participate in the study.

Results:

36% (maximum) belonged to 36-45 year age group and lowest (3%) among individuals >66 years. 48% prevalence of active smoking; maximum indulgence (53%) observed in 36-55 year group. Highest exposure to passive smoking seen in 56-65 year group (75%). 45% prevalence of smokeless tobacco consumption, highest in 56-65 year group (72%), lowest in 15-25 year age group (17%).

Conclusion:

Regular conducting of IEC activities for generating awareness with the strict implementation of tobacco control measures by the government needs to be carried out as urban slum population is a vulnerable group and most susceptible to the vicious cycle of disease and poverty.
Impact of structured educational interventions on the prevention of pressure ulcers in immobile orthopedic patients in India
Authors: Kathirvel Soundappan , Kaur Sukhpal , Dhillon Mandeep Singh , Singh Amarjeet
Published: April 2021

Background:

Pressure ulcer (PU) is one of the common, neglected and avoidable complications among bedridden patients. Despite the potential to reduce PU incidence, the evidence on the effect of patient/caregiver education is low. This pragmatic randomized controlled trial (CTRI/2011/07/001862) compared the impact of two structured educational interventions to patients and caregivers on prevention of PU in immobile orthopaedic patients.

Methodology:

Ninety-two orthopedically immobile patients (Braden score ≤12 or stage I PU) and their caregivers were (block) randomized into two equal groups. One group was offered Prevention Package 1 (PP1), i.e., self-instruction manual (SIM), one to one training and counselling on PU care practices. The second group (PP2) was given SIM only. Patients were followed equally at the hospital and home after discharge. Intention to treat analysis was conducted.

Results:

The cumulative incidence of PU was 8.7% in PP1 and 21.7% in PP2 for the entire study period. PU incidence rate in PP1 and PP2 was 0.9 and 2.41 per 1000 person-days, respectively. Incidence rate ratio was 2.67 (95% CI: 0.89, 8.02, p-0.04). The Kaplan-Meier survival curves of PP1 and PP2 were statistically significantly different (p-0.043). PP1 also showed statistically significant improvement in knowledge on the prevention and management of PU compared to PP2 at post-intervention (p < 0.001).

Conclusion:

Individualized, structured education of patients and caregiver is effective in improving the knowledge and preventing the PU in immobile orthopaedic patients. A comprehensive approach involving hospital administrators, health care professionals, patients and caregivers may be further researched upon for a sustainable reduction in PU.
Determinants of smoking cessation counseling favorable practice for primary care physicians
Authors: Maraqa Beesan , Nazzal Zaher , Jabareen Jurouh , Al-Shakhrah Kamal
Published: April 2021

Background:

Smoking cessation counseling is not well established in Middle East countries including Palestine. This study assesses the practice of smoking cessation counseling among primary healthcare (PHC) physicians in Palestine and its determinants.

Methods:

Over the period from April to September 2019, general practitioners, family medicine physicians, obstetricians and gynecologists, and dentists working at the PHC Centers in Palestine were approached through a cross-sectional design using a self-reported questionnaire. Proportionate stratified random sampling approach has been used. Sociodemographic, medical background, smoking cessation counseling training, smoking history, practice, knowledge, attitude, and confidence were evaluated. The proportion of favorable practice has been determined and its relationship with all variables has been evaluated. Ethical approval was received from the National University of An-Najah.

Results:

295 physicians were enrolled in the study with an 86% response rate. 75.5% (n = 222) were males with a mean age of 39.9 ± 9 years. The majority were General Practitioners (76.5%, n = 252). Most of them (84.3%, n = 215) had not received any training. The favorable practice was seen in 36.6% (95% CI 31–41%). Attitude is the main predictor of favorable practice (P value = 0.002, adjusted OR = 1.1).

Conclusion:

Palestinian PHC physicians have a low level of counseling for smoking cessation. Given the efficacy of counseling for smoking cessation and the high level of the tobacco epidemic in the area, health policy to ensure all healthcare personnel-especially physicians-receive training in cessation counseling and call for a public health campaign for control of tobacco should be taken into account.
Changing trend in the pattern of ocular diseases in patients attending ophthalmology department of a teaching institute in North India during COVID-19 pandemic
Authors: Kauser Hina , Khan Taskin
Published: April 2021

Purpose:

The objective of this study is to report the changing trend in ocular diseases during COVID-19 pandemic.

Methods:

A retrospective review of patients attending the ophthalmology department of a teaching institute was conducted. We studied the 3 months of the COVID period from April 2020 to June 2020. For comparison, we took the corresponding period of April 2019 to June 2019. Data were collected from the medical record section of the Hospital.

Results:

Overall, 876 patients presented during the 2020 period compared to 7,242 patients in the 2019 period. Percentage of female patients decreased from 53.1% to 49.1% in the 2020 period (P = 0.0251). There is significant decrease in pediatric group in the 2020 period (P < 0.0001). In the 2019 period, refractive errors was the most common (57.6%) followed by cataract (12.29%), allergic conjunctivitis (3.82%), diabetic retinopathy (3.37%). While in the 2020 period refractive errors, constitute 22.37%, followed by allergic conjunctivitis (8.56%), scleritis/episcleritis (7.19%), dry eyes (7.08%), infective conjunctivitis 6.85%), anterior uveitis (6.74%). In the 2020 period, there was significant decrease (P < 0.00001) in the percentage of refractive errors, cataract and diabetic retinopathy, and significant increase in painful symptomatic conditions. The features of ocular trauma in the two study periods were also quite different.

Conclusion:

There is significant decrease in patients of curable/avoidable blindness. We should be ready for the increase burden of curable/avoidable blindness and should plan various strategies to overcome the potential backlog of blindness.
Rare but not Abdicated
Authors: Rathaur Vyas K. , V. Vigneshwar N. K. , Imran Ayesha , Pathania Monika , Agrawal Sonam , Chacham Swathi , Verma Prashant K. , Bhat Nowneet K.
Published: April 2021

Background:

Haemophilia is one of the bleeding disorders, which is inherited, in an xlinked recessive pattern. The diagnosis is by estimation of factor levels of 8 and 9. Timebound treatment for people living with Haemophilia (PWH) is factor replacement during bleeding manifestation. The prevalence of Haemophilia was mostly underestimated, and it is more so in hilly terrains like the state of Uttarakhand.

Materials and Method:

This is a crosssectional study by compiling the data of PWH visiting the tertiary care centre for Haemophilia in Uttarakhand. We collected data from the patients with bleeding disorder reporting to the Haemophilia centre from July 2017 to December 2018. In this manuscript, we try to describe the pattern of Haemophilia and the degree of severity and incidence of inhibitors among the sample population of PWH who represent the population of Uttarakhand. The magnitude of problems faced by PWH from this hilly terrain to assess basic treatment in case of emergency is also being depicted.

Result:

We reported Haemophilia A contributing about 80% of the PWH in our centre. Average distance a PWH has to travel to obtain treatment was about 131.5 km (SD ± 83.7 km). Incidence of inhibitors was about 5%.

Conclusion:

We infer from our study that Hemophilia A is more common than Hemophilia B. Through this manuscript we hope to spread awareness of the Haemophilia care that is ongoing, the role of prophylaxis therapy and the future role of primary care physicians that may change the care of PWH in future.
A qualitative study on attitude towards smoking, quitting and tobacco control policies among current smokers of different socio-economic status
Authors: Chellappa Lalitha Rani , Balasubramaniam Arthi , Indiran Meignana Arumugham , Rathinavelu Pradeep Kumar
Published: April 2021

Introduction:

Tobacco consumed as smoke and smokeless forms is an important preventable public health issue projected to be the single largest cause of mortality worldwide. The aim of the study was to qualitatively assess the attitudes towards smoking, quitting and tobacco control policies among current smokers of different socio-economic status.

Materials and Methods:

An in-depth interview for 10 current smokers and a focus group discussion comprising of 10 current smokers was conducted with a guide and moderator which was audio recorded. About 6, 8 and 6 subjects from white collar, blue collar, and black collar employee status participated in the study. Their tobacco consumption and dependence using the Fagerstrom Test for Nicotine Dependence scale (FTNDS) was assessed.

Results:

About 50% of the participants had low; 30% had moderate and 20% had high nicotine dependency. Most of the participants started smoking by peer influence and continued as it made them to socialize. Relapses during their quit attempt was mainly due to work stress. Participants heard about the control of tobacco act but were unsure of the features in it. They perceived that no changes will happen if government bans production and selling of tobacco products. Also anti-tobacco commercials in social media will have no use. Nicotine replacement therapy may help in quitting the habit.

Conclusion:

The study concluded that people in low socio-economic status had high nicotine dependency with inadequate knowledge on tobacco control policies. They strongly believe that an individual's self-restrain only can succeed him in quitting the habit.
Assessment of knowledge, attitude, and practice of child abuse amongst health care professionals working in tertiary care hospitals of Karachi, Pakistan
Authors: Nihan Khuld , Makda Aamir , Salat Huzaifah , Khursheed Munawar , Fayyaz Jabeen , Khan Uzma Rahim
Published: April 2021

Introduction:

UNICEF report (2004) states that a significant percentage of total child population under the age of 5 years suffered malnutrition. Child sexual abuse remains undiscussed across Pakistan. Health care professionals (HCPs) are usually the first notifiers of child abuse and are ethically obliged to manage and report it.

Objective:

This study was conducted to assess HCPs' response in dealing with patients of child abuse. With a better understanding, we can have a better outcome for the victims.

Methods:

A total of 101 participants filled out a structured questionnaire by HCPs working in three tertiary hospitals of Karachi i.e., Aga Khan University, National Institute of Child Health (NICH), and Civil Hospital. Data were entered into SPSS 19.0.

Results:

HCPs believed that young male relatives were thought to be most likely the offender, and that every child regardless of class is prone to get abused triggered by financial stressors and the absence of parents. Proper physical exams helped identify cases. A proper system of reporting was required in hospitals, but HCPs were reluctant to report the cases to authorities. There was a significant difference noted between public and private hospitals.

Conclusion:

Our findings indicate that HCPs have limited knowledge in defining various types of abuse and most were unaware of any reporting facility in hospitals. Senior HCPs as consultants have a better understanding of child abuse than nurses or interns. Mandatory reporting should be implicated so that prompt action could be taken. There could be a more successful outcome of managing a child abuse victim with proper training.
Prevalence of erectile dysfunction and associated factors among males visiting family medicine clinics in a Tertiary Care Hospital in Karachi, Pakistan
Authors: Saeed Rabeeya , Amin Faridah , Durrani Noureen , Ali. Saif Syed M. , Zafar Muhammad Talha
Published: April 2021

Background:

The burden of erectile dysfunction (ED) among the developed countries is found to be quite high. However, there is a paucity of data among developing countries to know its actual burden and factors associated with it.

Methods:

The current study is cross-sectional and was conducted in Family Medicine clinics of Liaquat National Hospital during May 2017–January 2018. A total of 450 males participated in this study with the age range of 24–77 years. More than half of the participants were graduates or above.

Results:

On multivariable analysis, age (aOR = 5.47, 95% CI: 2.74–10.89), alcohol use (aOR = 5.23, 95% CI: 1.45–18.84), diabetes (aOR = 6.61, 95% CI: 3.27–13.36), and current smoking (OR = 2.41, 95% CI: 1.35–4.31) were significantly associated with ED. ED risk was significantly lower in those who either attended secondary school (aOR = 0.33, 95% CI: 0.13–0.88) or were at least graduates (aOR = 0.40, 95% CI: 0.17–0.96) than illiterate when model was adjusted for other covariates.

Conclusion:

Erectile dysfunction in a Pakistani male population highlights the need for routine screening at the primary care level. There is a possibility that the actual burden is underreported due to cultural stigmatization; hence, further research is warranted to validate the findings.