bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 7: Use of growth hormone therapy in short patients born small for gestational age: Data from real-life French clinical practice
Authors: Paulose Rinz , Coutant1 Régis , Leheup2 Bruno , Nicolino3 Marc , Salles4 Jean-Pierre
Published: August 2024

Background: A national French registry was created to address the absence of data on final height and safety following long-term exposure to supraphysiological doses of growth hormone (GH) in children born small for gestational age (SGA).

Methods: This observational, non-interventional study (NCT01578135) included GH-naïve and non-naïve SGA children treated with GH at 126 sites in France. The inclusion period was 2005–2010 with follow-up until 2018 or until final adult (FA) height (height velocity <2 cm/year). The primary endpoints were proportion of patients with normal (>–2) height standard deviation score (HSDS) at last visit, and with normal FA HSDS. Secondary endpoints included change from baseline in HSDS and safety. Multivariate logistic regression analysis with stepwise elimination was used to identify factors associated with achieving normal HSDS.

Results: Of the 1408 registered patients, every fifth child was randomly selected (n = 291) for inclusion in this long-term follow-up study. For the full population and subpopulation, mean (SD) baseline age was 8.79 (3.53) and 8.08 (3.32) years; HSDS was –2.55 (0.95) and –3.07 (0.86); 48.4% and 46.0% were female, respectively. Normal HSDS was reached in 193/291 children (66.3%). Among the 24.7% of patients who achieved FA height at last visit, 66.7% had FA HSDS >–2. Mean change from start of treatment to last visit in HSDS was +1.35 (0.97). Factors associated with reaching normal HSDS were baseline HSDS (taller better; odds ratio [95% confidence interval]: 5.65 [3.22;9.92], P < 0.0001); age at treatment start (younger better; 0.88 [0.79;0.98], P=0.0166); treatment duration excluding discontinuation periods (longer better; 1.20 [1.04;1.38], P=0.0166); and absence of a chronic disease (0.43 [0.21;0.87], P=0.0188). The majority (70.0%) of adverse events (AEs) were non-serious; 39.0% of all AEs and 7.0% of serious AEs were considered possibly/probably related to GH treatment. The most common AEs (% of patients) were increased insulin-like growth factor-I (IGF-I; 17.2%), headache (9.3%) and arthralgia (4.5%). Sixteen patients (5.5%) discontinued treatment prematurely, most commonly because of increased IGF-I (n = 4). One malignant tumour (nephroblastoma) with a fatal outcome was reported and considered unrelated to GH treatment.

Conclusions: GH therapy was effective in most short children born SGA. No new safety concerns were observed. The likelihood of achieving normal HSDS with GH therapy increased with greater baseline HSDS, longer duration of GH treatment, absence of a chronic disease and younger baseline age, reinforcing the importance of early identification and treatment of short patients born SGA.
Abstract 8: Thyroid amyloidosis presenting as persistent painless thyroiditis
Authors: Prabhakar Karthik , Dass Ashwitha Shruti , Siddini Vishwanath
Published: August 2024

Case Report: A 34-year-old patient with ESRF, found to have hereditary-amyloidosis, was referred with low TSH: 0.112 (0.340-4.250 micIU/mL), low FT3: 1.77 (2.40-4.20 pg/mL) and normal FT4:1.49 (0.80-2.30 ng/dL) in May 2018. Clinically asymptomatic, euthyroid and no goitre; was diagnosed “Sick-Euthyroid-Syndrome”. He underwent renal transplant in August 2018; his subsequent treatment included Prednisolone 20mg daily and immunosuppressants. On follow-up, his TSH was 0.303 in Oct 2018. Over next year, he had persistently low TSH: 0.005-0.196, with normal FT3, but elevated FT4: 2.39-5.21. His clinical-features varied from being asymptomatic to developing mild thyrotoxicosis. ESR: normal, Thyroid-antibodies negative, USG showed diffuse thyroid and repeated Technetium-99 scans revealed ‘gross thyroiditis’. He was managed on beta-blockers and ongoing Prednisolone. His health deteriorated since late 2019, with multiple episodes of pancreatitis due to pancreatic-duct-stones and stricture. He returned back in 2021 with neck-swelling; non-tender large-goitre with multiple nodules. TFT: low TSH, high FT4 and normal FT3. USG revealed bulky thyroid with few nodules; FNAC suggested Amyloid. He underwent Total Thyroidectomy; Histopathology confirmed ‘Amyloidosis’. Conclusion: Our patient had chronic painless thyroiditis and his steroid-therapy for post-transplant-immunosuppression probably masked the thyrotoxic-features. USG-thyroid indicated gradual structural changes, and TFT suggested possible impaired peripheral conversion of T4 to T3.
Abstract 4: Derived time-in-range is associated with major adverse cardiovascular event in T2D: Data from the DEVOTE trial
Authors: Pathan Muzammil Khan A , Bergenstal Richard M , Hachmann-Nielsen Elise , Kvist Kajsa , Buse John B
Published: August 2024

Background: There is a need to validate time-in-range (TIR; percentage of time with plasma glucose between 70 and 180 mg/dL (3.9-10.0 mmol/L) as a surrogate endpoint for long-term clinical outcomes.

Methods: We used data from patients with 8-point glucose profiles (8pp) from the double-blind cardiovascular outcomes trial, DEVOTE (NCT01959529). In total, 7637 patients with T2D and either established CVD or at high risk for CVD were included in the trial. The primary endpoint in DEVOTE was time to first MACE. The 8pp were collected at 1 year, 2 years and end-of-trial. Median length of follow-up was 2 years. For 5644 patients, 8pps with at least 7 points existed. Among the 681 major adverse cardiovascular events (MACEs) in DEVOTE, 360 were among patients with 8pps. Individual TIR was derived as the proportion of the 8pp within range. A Cox model was used to estimate the association between derived TIR and time to first MACE. Hazard ratios (HR) were estimated for patients with TIR>70% vs. TIR≤70%, and for TIR>70% and TIR 50 −70% vs. TIR≤50%.

Results: Derived TIR was >70% for 65% of the patients. Estimated rate of first MACE was lower for TIR >70% and TIR 50-70% vs. TIR≤50% [Figure 1] and for TIR>70% vs. TIR≤70% (HR: 0.74 [0.60;0.91]95% CI; p<0.01). The associations were maintained when analyses were adjusted for baseline characteristics.

JOURNAL/ijeam/04.03/02223308-202203001-00016/figure1/v/2022-10-03T190107Z/r/image-tiff

Conclusions: Derived TIR was associated with rate of first MACE for T2D patients in DEVOTE.
Association of Beverage Consumption with Cardio-metabolic Risk Factors and Alanine Transaminase Levels in Children and Adolescents: The CASPIAN-V Study
Authors: Khademian Majid , Shahsavari Ali , Qorbani Mostafa , Motlagh Mohammad Esmaeil , Heshmat Ramin , Khozani Elaheh Shams , Najafi Mohammad Amin , Mansourian Marjan , Kelishadi Roya
Published: August 2024

Background:

This study aims to evaluate the association of beverage consumption with cardiometabolic risk factors and alanine transaminase (ALT) levels in children and adolescents.

Materials and Methods:

This nationwide study is a part of the fifth survey of a national surveillance program in Iran. Overall, 4200 students, aged 7–18 years, were selected from 30 provinces by multi-stage cluster sampling. In addition to filling in questionnaires, blood sampling and biochemical tests were done. The weekly use of six different beverage types including milk, juice, tea, coffee, soda, and non-alcoholic beer, was documented by interview.

Results:

The participation rate was 91.5% (n = 3843), and data of 3733 students were complete for the current study. Beverages containing high levels of sugar such as soda and non-alcoholic beer were significantly associated with higher levels of ALT. Model coefficient of regression (SD) was 0.66 (0.31) (P value: 0.034). Healthy beverages such as milk and fresh juice and also beverages containing high levels of caffeine did not have significant association with ALT levels (P value = 0.32, P value = 0.60). Healthy beverages had a significant and inverse relationship with triglycerides (TG) (P value = 0.029), total cholesterol (TC) (P value = 0.008) and low-density lipoprotein (LDL) (P value = 0.008) levels.

Conclusion:

This study showed that consuming sugar-sweetened beverages is significantly associated with higher levels of ALT, whereas healthy beverages are associated with a better cardiometabolic profile meaning that consuming healthy beverages leads to lower TG, TC, and LDL levels. The effects of beverages on children’s health should be emphasized in health recommendations.
The Effect of Angiotensin II Type 1 Receptor Antagonist on Age-Related Differences in Renal Vascular Responses to Angiotensin II in Male and Female Rats
Authors: Eshraghi-Jazi Fatemeh , Nematbakhsh Mehdi
Published: August 2024

Background:

Advancing age could influence renin angiotensin system components, especially angiotensin type 1 receptor (AT1R). This study examined the effect of AT1R antagonist, losartan, on age-related differences in renal vascular responses to angiotensin II in male and female rats.

Materials and Methods:

Forty-eight anesthetized male and female rats (8–12 and 24–28 weeks age ranges) were subjected to catheterize. Then, the responses of mean arterial pressure (MAP), renal perfusion pressure (RPP), renal blood flow (RBF), and renal vascular resistance (RVR) to angiotensin II with or without losartan were determined and evaluated.

Results:

There were not significant differences in the basal values of MAP, RPP, RBF, and RVR in males. However, it was observed significant difference in RVR in females (P < 0.05). The blockade of AT1R attenuated basal MAP and RPP in all the groups (P < 0.05). The infusion of losartan altered basal RVR and RBF values in female groups (P < 0.05). Moreover, losartan eliminated vasoconstrictor responses to angiotensin II in female groups (P < 0.05). Also, losartan induced significant vascular responses to angiotensin II in male groups (P < 0.05).

Conclusions:

Losartan could maintain RBF changes in response to angiotensin II in both 8–12- and 24–28-week females. Losartan enhanced the RBF response to angiotensin II in 8–12-week males, but not in 24–28-week males. It seems that females (not males) in various age ranges are resistance against RBF changes by acutely increased angiotensin II.
The Effect of ZnO Nanoparticles Functionalized with Glutamine and Conjugated with Thiosemicarbazide on Triggering of Apoptosis in the Adenocarcinoma Gastric Cell Line
Authors: Beigi Sadaf , Salehzadeh Ali , Habibollahi Hadi , Shandiz Seyed Ataollah Sadat , Safa Fariba
Published: August 2024

Background:

Gastric carcinoma is the fourth most common malignancy worldwide. Conjugation of metal nanoparticles with thiosemicarbazones has shown considerable anti-cancer potential.

Materials and Methods:

Zinc oxide nanoparticles (ZnO NPs) were synthesized, functionalized by glutamine, and conjugated with thiosemicarbazide (ZnO@Gln-TSC). Fourier transform infrared spectroscopy, X-ray diffraction, scanning electron microscopy and transmission electron microscopy imaging, energy-dispersive X-ray, DLS, and zeta potential were used to characterize the NPs. The toxicity of ZnO NPs, TSC, ZnO@Gln-TSC NPs, and oxaliplatin in AGS cells and ZnO NPs and ZnO@Gln-TSC NPs in HEK293 cells was investigated by MTT assay. Cell apoptosis was evaluated by flow cytometry, caspase-3 activity, and Hoechst staining assays. The intra-cellular reactive oxygen species level and expression level of the CASP3 gene in AGS cells treated with ZnO@Gln-TSC NPs were evaluated.

Results:

The NPs were in the size range of 20 to 70 nm. The DLS and zeta potential were 374 nm and -31.7 mV, respectively. In MTT, the IC50 of ZnO, TSC, oxaliplatin, and ZnO@Gln-TSC NPs for AGS cells were 130, 80.5, 67.7, and 9.8 μg/mL, respectively, and the IC50 of ZnO and ZnO@Gln-TSC NPs for HEK293 cells were 215 and 150.5 μg/mL, respectively. Flow cytometry showed higher apoptosis in the cell treated with the NPs and TSC. Apoptotic features, including cell shrinkage, were recognized. A significant increase of 5.9 folds in the level of ROS was noticed. The activity of caspase-3 and the expression level of the CASP3 gene were increased by1.83 and 1.6 folds after exposure to ZnO@Gln-TSC NPs, respectively.

Conclusion:

This study revealed the anti-cancer potential of ZnO@Gln-TSC NPs to be used for gastric cancer treatment after further in vitro and in vivo assays.
Evaluation of Tumor-Associated Macrophages and Micro-Vessel Density in Verrucous Carcinoma and Squamous Cell Carcinoma of the Oral Cavity
Authors: Kadeh Hamideh , Derakhshanfar Ghazal , Rezaei Mehr Omolbanin
Published: August 2024

Background:

Tumor-associated macrophages (TAMs) are a crucial cellular component of human tumors, but their exact roles in tumor growth and angiogenesis during cancer progression are still subject to debate. The present study aimed to explore the impact of TAMs on tumor progression and angiogenesis in oral squamous cell carcinoma (OSCC) and oral verrucous carcinoma (OVC).

Materials and Methods:

For this cross-sectional study, 60 samples consisting of 40 OSCC and 20 OVC samples were chosen. Immunohistochemical staining was performed on the samples using anti-CD68 and anti-CD31 monoclonal antibodies to evaluate the frequency of TAMs and micro-vessel density (MVD), respectively. The data were analyzed using statistical software SPSS (v. 23) and through the independent samples Student t-test, one-way analysis of variance, and Pearson’s correlation coefficient.

Results:

The results of our study revealed that the mean number of TAMs and MVD were significantly greater in OSCC samples compared to OVC samples (P = 0.001) (P = 0.004). Also, the average number of TAMs and MVD increased in the high grade of OSCC; however, the correlation between both parameters and histopathological grades of OSCC was significant only for MVD. Our study found no significant correlation between TAMs and MVD (P = 0.005).

Conclusion:

Based on the results of our study, both TAMs and MVD were found to be significantly higher in OSCC samples compared to OVC samples. These findings suggest that the progression of oral cancer is associated with an increase in TAMs and vascular density. Additionally, the use of CD68 and CD31 markers may help in differentiating between these two types of tumors.
Maximum surgical blood order schedule: A key component of perioperative blood management in neurosurgery
Authors: Kumatagi Shivanand Hemant , Rajendran Vinu , Nair Amita Radhakrishnan , Gupta Debasish
Published: August 2024

CONTEXT:

Institute specific protocols are needed to reduce unnecessary cross matches. Type and screen policies for surgical procedures which does not require blood and maximum surgical blood order schedule (MSBOS) for procedures which require blood units are the two protocols in use currently.

AIM:

To compare the effect of maximum surgical blood order schedule in neurosurgery between pre- and post-implementation.

SETTINGS AND DESIGN:

It is a study of 5 years’ duration (4 years retrospective and 1 year prospective) conducted at the departments of transfusion medicine, neurosurgery and neuroanesthesia.

SUBJECTS AND METHODS:

The patients above 18 years for whom blood requisition were sent were included, whereas those who underwent emergency procedures, massive transfusion, or had underlying bleeding disorders were excluded. The MSBOS was developed based on 4 years’ retrospective data and the new protocol was followed for 1 year. The transfusion indices were compared between preimplementation and postimplementation.

RESULTS:

A total of 2462 patients were included in the retrospective period, whereas it was 746 in the prospective group. Overall, reduction of crossmatch to transfused ratio from 3.6 to 2.4 and increase of blood utilization from 27.40% to 41.55% was observed. The patients for whom type and screen were performed increased from 18% in the retrospective period to 75% in the prospective period. Eighteen out of 30 common procedures were managed with T and S and seven of them did not require even a single unit of red blood cells intraoperatively.

CONCLUSIONS:

Our study highlights the importance of including both diagnosis and procedure to formulate MSBOS and the use of modified formulas “transfusion index for type and screen and transfusion probability for type and screen” for revision of MSBOS.
Refractory pruritus in cholestatic drug-induced liver injury secondary to androgenic anabolic steroids: Plasmapheresis to the rescue
Authors: Shastri Arpit , Paranthamaiah Ganesh Chandragiri , Gandhi Anuj , Gangadharappa Ramesha Chinakarihalli , Shastri Malvika , Mitra Suvradeep , Lamba Divjot Singh , Sharma Ratti Ram , De Arka
Published: August 2024

Anabolic androgenic steroids (AASs) have long been misused by professional athletes. Easy online and over-the-counter availability of AASs makes it an alluring option even among amateurs for their desired cosmetic and performance-enhancing effects. AASs have been associated with distinct forms of liver injury including transient transaminitis, peliosis hepatis, and hepatic tumors. An acute cholestatic syndrome with bland histology is another characteristic form of liver injury rarely reported with AASs. Plasmapheresis may provide a long-lasting relief of symptoms when conventional pharmacotherapeutic measures fail. Herein, we report a challenging case of a young male with refractory pruritus secondary to AASs, managed effectively with plasmapheresis.
Unraveling the complexity: Case reports of drug-induced hemolytic anemia due to ceftriaxone
Authors: Yadav Anshika , Agarwal Pankaj
Published: August 2024

Drug-induced hemolytic anemia (DIHA) is a rare but significant condition characterized by the premature destruction of red blood cells (RBCs) triggered by certain medications. Ceftriaxone, a commonly used antibiotic, has been linked to DIHA, presenting diagnostic challenges due to its diverse clinical manifestations. This study examines three cases of DIHA caused by ceftriaxone therapy at our center. The patients presented with symptoms such as fatigue, jaundice, and dark urine following ceftriaxone therapy. Laboratory tests indicated hemolytic anemia with decreased hemoglobin, elevated lactate dehydrogenase, and positive direct antiglobulin tests. Immunohematological workups confirmed ceftriaxone-induced antibodies targeting RBCs and guided management strategies, including discontinuation of ceftriaxone, supportive therapy, and corticosteroids. Timely diagnosis and collaboration between clinicians and laboratory specialists are crucial for optimal patient outcomes.
A false reactive hepatitis B surface antigen result due to dislodged gel from Vacutainer
Authors: Sawant Rajesh B. , Tanvi Yardi U. , Shaikh Raees A
Published: August 2024

Preanalytical variables play a key role in the correctness of laboratory test results. We report a false reactive result for hepatitis B surface antigen (HBsAg) on serological testing with a relatively low OD. The pilot sample was collected in yellow top BD Vacutainer® (SST™ II Advance 5 mL tube) with separator gel and was marked for serological testing. It was centrifuged at 7000 rpm for 30 min. Serological testing was performed by chemiluminescence on Abbott Architect Plus i1000SR with Abbott kits for HBsAg, anti-HIV, and anti-HCV. This particular sample tested reactive for HBsAg with S/CO of 1.91, S/CO for HBsAgQ2NC (Negative kit control) being 0.19 and that of HBsAgQ2PC (Positive kit control) being 3.65. Repeat testing from the same Vacutainer was also reactive for HBsAg with S/CO of 2.10. Nucleic acid testing was performed and was found to be nonreactive. We repeated serological testing with a sample from fresh frozen plasma of the same donor unit. It was nonreactive. Cross contamination was ruled out by repeat testing of two serial samples before and after this unit number. The serum showed an unusual appearance on visual inspection after centrifugation. By exclusion, we concluded that the gel probably got partially dislodged into the serum, giving a relatively low reading and false reactive result for HBsAg. This highlights the possibility of inert gel not always being inert, the importance of repeat testing from a different sample in case of low reading, the importance of visual inspection, a need for manufacturers and laboratory personnel to consider such preanalytical variables which, though not much mentioned in literature, can affect test results. These results have a multi-fold impact on the donor or patient’s mindset, treatment outcome and/or fate of blood donation. These are definitely preventable if more such guidelines are made available for handy reference in handling such results.
Prevalence and specificity of clinically significant red blood cell alloantibodies among hospitalized patients attending a tertiary care center in the southern part of India: A retrospective observational study
Authors: Kumar I. Suresh , Hariharan A. , Thangavel Gokhula Prasath , Kumar I. Praveen , Sukumaran Suma
Published: August 2024

BACKGROUND:

Alloimmunization due to red blood cell (RBC) transfusions may occur due to discrepancy between donor and recipient’s antigenic exposure on RBCs. A thorough literature search shows limited data pertaining to the rate of alloimmunization and specificity of alloantibodies in the general patient population. The main aim of our study is to find the prevalence of alloimmunization rate and specificity of RBC alloantibodies among the patients who were admitted under different clinical departments in a tertiary care hospital.

MATERIALS AND METHODS:

Our study was a retrospective observational study in which the patient data regarding their blood grouping status, alloimmunization status, and other relevant details were collected from the case records that were recorded between 2021 and 2022. Antibody screening of these patients was carried out using Bio-Rad ID DiaCell I, II, III Asia (Mia+), 3-cell panel with the lot number (45330.13.x). The specificity of these alloantibodies was identified using the 11-cell antibody identification panel Bio-Rad (ID-DiaPanel 11 × 4) which belongs to lot number (06171.47.x–06271.47.x).

RESULTS:

The overall prevalence of RBC alloimmunization in our study was found to be 1.3% (n = 137). The most prevalent alloantibody in our study was considered to be anti-D (30.65%), followed by anti-c (18.24%) and anti-Jkb (16.05%). Females had a more significant association with the development of alloantibodies than males with P = 0.001. Patients with a history of transfusion also had a significant association with alloantibody formation (P = 0.008).

CONCLUSION:

Since alloimmunization may result in drastic unforeseen responses in patients during transfusions, prior alloantibody screening may provide an additional safety layer in providing safe transfusions to patients. Hence, this study advocates the provision of antigen-matched RBC units for ABO, Rh, and Kell antigens.
A case report of plasma exchange in imidacloprid poisoning: A promising therapeutic approach for acute toxicity
Authors: Yadav Anshika , Gupta Gajendra Nath , Agarwal Pankaj , Sheemhar Akhil
Published: August 2024

Imidacloprid, a neonicotinoid insecticide, is commonly used in agricultural and urban settings for pest control. However, its toxic effects on both target and nontarget organisms, including humans, have raised concerns. Imidacloprid poisoning can result in a wide range of symptoms, including neurological, gastrointestinal, and cardiovascular manifestations, and may even be fatal in severe cases. In recent years, plasma exchange has emerged as a potential therapeutic approach in cases of imidacloprid poisoning, with promising outcomes reported in a few published case reports. This article reviews the role of plasma exchange in imidacloprid poisoning, highlighting its mechanism of action, clinical indications, technical aspects, and potential benefits. The article also discusses the current evidence supporting the use of plasma exchange in imidacloprid poisoning, including relevant case reports and studies. While plasma exchange appears to be a promising adjunctive therapy in managing imidacloprid poisoning, further research and clinical experience are needed to establish its effectiveness and safety. This article emphasizes the importance of early recognition and management of imidacloprid poisoning, including considering plasma exchange as a potential treatment modality in severe cases.
Uptake and Determinants of Tetanus Vaccination among Female Clinical Medical Students in North-Western Nigeria
Authors: Abubakar Muhammad Shakur
Published: August 2024

Background and Aim:

Neonatal and maternal tetanus have remained endemic in tropical countries of Asia and Africa, with high fatality. Vaccination of women of childbearing age is the main strategy for their prevention/elimination. However, the uptake of these vaccines among these women has remained dismally low in these parts of the world. This study looked at the uptake and determinants of tetanus vaccination among the female clinical medical students of Bayero University, Kano, purposely looking at the interplay between knowledge and other factors on vaccine uptake.

Materials and Methods:

This was a cross-sectional study of female medical students aged 15–45 years, selected using probability proportionate to size and simple random sampling. The required information was collected using a validated semi-structured questionnaire. The data were analyzed using the Statistical Product and Service Solutions (SPSS) for Windows version 23. Prevalences of tetanus vaccination were calculated. The presence of a statistically significant difference in prevalence and other characteristics of the study groups were determined using appropriate tests. P
<0.05 was considered statistically significant.

Results:

The participants were 140 with the mean age and mean knowledge scores of 23.96 (±2.74) years and 6.61 (±2.47), respectively. Most of them (59.3%) had good knowledge score (>7). The prevalence of tetanus toxoid (TT)1 and TT2 was 20.7% and 17.1%, respectively. Being married, ever pregnant, and higher level of study were significantly associated with being vaccinated (χ2/P =59.093/P <0.001, P = 65.011/P <0.001, and P = 9.860/P =0.020, respectively).

Conclusions:

Despite the good knowledge of the vaccination, the uptake of TT vaccination among clinical female students was poor. Factors significantly associated with higher vaccine uptake were marital status, age of the participants, and their class of study.
Consumer’s Knowledge, Attitude, and Practices toward Self-medication: Questionnaire Development and Validation
Authors: Ansari Nahid , Dadhich Abhishek
Published: August 2024

Background and Aim:

Self-medication practices (SMPs) are a common phenomenon prevalent with both prescription and nonprescription medicines. Still, the availability of a valid and reliable instrument to assess the knowledge, attitude, and practices toward self-medication (SM) remains limited. The current pilot study aimed to develop and validate a tool that effectively evaluates these aspects among consumers in Delhi, India.

Materials and Methods:

The research involved 100 consumer participants from Delhi, India. Reliability and validity testing was conducted to assess reproducibility, internal consistency, and content validity. The questionnaire underwent validation by a panel of five experts to evaluate face and content validity.

Results:

Test–retest reliability was assessed using Karl Pearson’s correlation co-efficient yielding values of 0.841 (P = 0.002), 0.827 (P = 0.003), and 0.792 (P = 0.006) for the three domains of knowledge, attitude, and frequency of performing SM, respectively. Cronbach’s alpha statistics were used to determine internal consistency, yielding values of 0.775 and 0.839 for knowledge and attitude domains, respectively. The association between the demographic characteristics of respondents and knowledge, attitude, and frequency of SM was assessed using an independent sample t-test and one-way ANOVA, demonstrating satisfactory known group validity.

Conclusions:

The developed questionnaire proved valid and reliable for determining consumer’s knowledge, attitudes, and practices toward SM. The final tool could be valuable for future research and interventions to improve consumers’ understanding of SMP.
Intracholecystic Papillary Neoplasm of Gallbladder: A Rare Case Report with Review of the Literature
Authors: Raj Swati , Gupta Mamta , Thapliyal Naveen
Published: August 2024

Intracholecystic papillary neoplasm (ICPN) of the gallbladder is a relatively new concept and a rare neoplasm. ICPNs are found in 0.4% of cholecystectomies. ICPNs are commonly associated with low-to high-grade dysplasia and can be found with invasive foci. To the best of our research, <100 cases (n = 92) are reported worldwide and only 27 cases have been reported in India. We present a case of ICPN with a detailed review of the literature to illuminate the pitfalls of this entity, which is rarely encountered in routine reporting.
Re-establishing Facial Aesthetics - Patient-specific Orbital Implant for Post-traumatic Deformity
Authors: Shetty Sujeeth Kumar , Kale Revati , Kathuria Abhinav , Prakash Sonakshi , Makam Prajwal
Published: August 2024

Rationale:

Complex fractures of the maxillofacial region can require staged interventions to achieve optimal outcomes. A significant example of this are complex fractures of the orbital floor, which may be difficult to restore during primary treatment. The secondary correction is often required which can be using stock- or customised implants.

Patient Concerns:

A previously operated case of panfacial trauma presented with an aesthetic concern regarding the asymmetrical appearance of his eyes.

Diagnosis:

On clinical and radiological evaluation, the patient was diagnosed with enophthalmos of the left eye secondary to orbital floor fracture.

Treatment:

A patient-specific implant (PSI) was fabricated and placed for orbital floor reconstruction.

Outcomes:

Postoperatively, aesthetic and functional outcomes were satisfactory.

Take-away Lessons:

This case report highlights the use of PSIs in orbital floor reconstruction, made possible due to the advent of virtual surgical planning and three-dimensional printing in the field of oral and maxillofacial surgery.
Observational Study with a New Portable Cryosurgery Device, HYDROZID®, in Superficial Epidermal Lesions: An Indian Experience
Authors: Bangaru H , Mishra Shivani , Sachan Sonam S. , Ramrakhiani Sonam
Published: August 2024

Background:

Cryosurgery remains an important treatment modality in dermatology practice. HYDROZID®, a new portable cryosurgery medical device using norflurane as a cryogen, was recently introduced in the Indian market. This paper reports the findings of the phase IV study conducted in India.

Aims:

This is a prospective phase IV study to evaluate its safety and efficacy in the treatment of superficial epidermal and dermal lesions.

Methods:

The study was conducted across 4 centres in India. The cryosurgery cycles were decided based on the skin lesion considered for the treatment. Safety and efficacy parameters were assessed at day 1, day 7, day 14, day 30 (±2) (end of treatment), and day 60 (±2) after the initial cryosurgery treatment. The local skin reactions scale, pain VAS scale, and Vancouver scale for assessment of pigmentation and scarring were used for the assessment of cutaneous reactions. Assessment of efficacy was done by evaluating the total disappearance of skin lesions at the end of the study visit.

Results:

Ninety-seven patients completed the study. The reported post-procedural pain was mild to moderate and subsided over the period of 24 hours. There was no pain observed in 84.76% of patients at the end of 24 hours. Complete disappearance of the lesion was seen in 47.4% of patients at the end of the study, while the reduction in the diameter of skin lesions by more than 50% was observed in 79.38% of patients.

Conclusion:

The data from this study support good clinical tolerability and safety of the Hydrozid® portable cryo device.
The Effect of Diabetes Mellitus on Outcomes of Patients Admitted with COVID-19
Authors: Mittal Naveen , Dhooria Harmeet Pal S. , Arora Saurabh , Kumar Vipin , Bansal Ekta , Singh Parminder , Kalra Sanjay , Goyal Saloni , Mittal Namit , Naved Khizar , Mohan Bishav
Published: August 2024

Background and Objectives:

Diabetes mellitus is associated with poor clinical outcomes in patients with coronavirus disease 2019 (COVID-19). This study aimed to explore the clinical characteristics of patients with type 2 diabetes with COVID-19, and to determine the impact of type 2 diabetes on clinical outcome of patients with COVID-19.

Material and Methods:

This single-center, retrospective, observational study enrolled patients admitted from March 2020 to June 2021 with COVID-19. The clinical and biochemical characteristics of patients with known type 2 diabetes, newly diagnosed diabetes, type 2 diabetes with comorbidities and those who succumbed to illness were analyzed.

Results:

Of 4,559 patients with COVID-19, 2,090 (45.8%) had type 2 diabetes. Patients with COVID-19 with diabetes were older, more likely to receive mechanical ventilation, had higher odds of mortality from COVID-19 as compared with patients without diabetes. In addition, patients with diabetes had significantly higher levels of serum creatinine, C-reactive protein, ferritin, lactate dehydrogenase, and D-dimer. Compared with previously diagnosed patients with diabetes, newly diagnosed patients had higher mortality (33% vs. 27%, P = 0.049). Among patients with COVID-19 and diabetes, nonsurvivors had significantly higher levels of inflammatory markers and had severe impairment of cardiac, renal, and coagulation parameters as opposed to survivors.

Conclusion:

Patients with COVID-19 with diabetes were more likely to have severe disease and had higher mortality. Presence of chronic kidney disease and coronary artery disease in patients with diabetes with COVID-19 was associated with adverse outcome. Patients with newly diagnosed diabetes had higher odds of severe disease at presentation and had higher mortality.
Twice or Thrice Weekly versus Daily Thyroxine in Hypothyroid Fasting Ramadan
Authors: Elsherbiny Tamer Mohamed
Published: August 2024

Context:

Hypothyroid patients require to take levothyroxine (L-T4) on an empty stomach, 60 min before next meal which is difficult to achieve while fasting Ramadan, on a daily basis. This pilot study aimed to assess the effect of twice or thrice weekly versus standard daily L-T4 dosing during Ramadan on adherence, post-Ramadan TSH, and thyroid status.

Methods and Materials:

The study included 2 groups; group 1 included 11 patients assigned to take L-T4 twice or thrice a week, and group 2 included 113 patients assigned to take L-T4 daily. Patients chose between three L-T4 regimens: regimen 1 – 60 min before Iftar; regimen 2 – 60 min before Suhor, on empty stomach for 3–4 h; regimen 3 – before the next fast, on empty stomach for 3–4 h. Thyroid status was assessed before and within 6 weeks after Ramadan. Only euthyroid patients were included.

Results:

No significant differences between the two groups regarding adherence, post-Ramadan TSH, or post-Ramadan thyroid status. 90.9% in group 1 and 88.5% in group 2 were adherent [p = 1.000]. Post-Ramadan TSH in group 1 was 1.9 ± 1.5 mIU/L, in group 2 was 2 ± 1.6 mIU/L [p = 0.809]. 81.8% in group 1 and 82.3% in group 2 were euthyroid post-Ramadan [p = 0.209].

Conclusions:

In this pilot study, taking L-T4 twice or thrice weekly during Ramadan achieved similar adherence and metabolic control to standard daily L-T4, making it an easier option for hypothyroid patients wishing to fast Ramadan.
Pharmacokinetic Similarity between Biosimilar Insulin Aspart Premix SAR341402 Mix 70/30 and Originator Insulin Aspart Mix 70/30 (NovoMix 30) in Indian Adults with Type 2 Diabetes
Authors: Mohan Viswanathan , Schmider Wolfgang , Singh Kiran P. , Rotthaeuser Baerbel , Mukherjee Bhaswati , Aravind S. R.
Published: August 2024

Background:

We compared the pharmacokinetic exposure, efficacy, safety and immunogenicity of biosimilar insulin aspart premix SAR341402 Mix 70/30 (SARAsp-Mix) with its originator NovoMix® 30 insulin aspart mix (NN-Mix) in adults with type 2 diabetes.

Methods:

This was a randomized, open-label, parallel-group, substudy of the phase 3 GEMELLI M trial performed in three Indian centres. Totally 13 Indian participants previously treated with premix insulin received a single subcutaneous 0.3 U/kg dose of each treatment and underwent pharmacokinetic sampling for 16 h after dosing. Participants were then treated for 26 weeks as per the main GEMELLI M trial with efficacy, safety and immunogenicity compared between groups.

Results:

The extent of exposure (area under the plasma concentration-time curve and maximum insulin aspart concentration) to SAR341402 insulin aspart in SARAsp-Mix and to insulin aspart in NN-Mix was similar following single doses of the allocated treatment. After 26 weeks, the mean ± SD [median] change in HbA1c from baseline was similar in both treatment groups (SARAsp-Mix −0.38% ± 1.54 [−1.00%]; NN-Mix −0.18% ± 1.97 [−0.80%]). Other efficacy endpoints, insulin dosages, anti-insulin aspart antibody response, hypoglycemia and adverse events were similar between groups.

Conclusions:

Our results support the findings from previous studies, that SARAsp-Mix has a similar pharmacokinetic profile to NN-Mix and provides effective glycemic control with similar safety and immunogenicity profile in Indian adults with type 2 diabetes.
Electrocardiogram (ECG) Diagnosis of Left Ventricular Hypertrophy and its Associations in Patients Living with Diabetes
Authors: Chetty Rushern R. , Pillay Somasundram
Published: August 2024

Background:

Macrovascular complications of diabetes mellitus (DM) include cardiac manifestations such as left ventricular hypertrophy (LVH), which can increase the risk of heart failure and death.

Objectives:

To determine associations between LVH and other variables in patients living with DM (PLWD).

Methods:

A retrospective study over 1 year was conducted on patients who attended the DM clinic at Edendale Hospital in South Africa. Electrocardiographs (ECGs) and standardised data sheets were analysed. The Sokolov–Lyon, Cornell and Romhilt–Estes methods were utilised for diagnosing LVH on ECGs.

Results:

There were 609 PLWD included in the study, with 80 PLWD (13.1%) having LVH (LVH+), whereas 529 PLWD (86.9%) had no LVH (LVH−). The Sokolov–Lyon method proved to be the best method of diagnosing LVH based on ECG (100% of patients diagnosed), with an ‘R wave in Augmented Vector Left (AVL) ≥11 mm’ being the best approach for determining LVH. LVH + patients were significantly younger than LVH − patients (27.22 years vs. 58.98 years, P < 0.001) and had lower systolic blood pressure (SBP) (118.62 mmHg vs. 139.77 mmHg, P < 0.001). Type 1 DM (DM1+) comprised the majority (77.5%) of LVH + patients. LVH + patients had significantly better high-density lipoproteins (1.36 mmol/L vs. 1.25 mmol/L, P = 0.024) and triglycerides (1.40 mmol/L vs. 1.85 mmol/L, P = 0.010) than LVH − patients.

Conclusion:

LVH was seen more frequently in younger patients who often had DM1+, lower SBP, higher HDL, and lower triglycerides. Most cases of LVH were diagnosed using the Sokolov–Lyon method. LVH should be screened for frequently in PLWD, irrespective of whether patients are hypertensive or not, and this should be done at all ages.
C-Reactive Protein Level can be a Better Indicator than Erythrocyte Sedimentation Rate in Assessing the Severity of Inflammation and Guiding Glucocorticoid Therapy in Subacute Thyroiditis
Authors: Baruah Manash P. , Bhattacharya Bhaskar , Baruah Upasana M.
Published: August 2024

Background:

Despite the widespread use of several diagnostic tests in subacute thyroiditis (SAT), their usage remains largely subjective. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are useful indicators of inflammation in patients with SAT. The purpose of this study was to compare the scope for utilising CRP and ESR objectively in deciding the requirement of glucocorticoid therapy.

Methods:

A total of 28 patients with SAT were included in this study. Serum CRP and ESR were measured in all the patients. The characteristics of these tests were assessed firstly by using previously accepted positivity criterion for the particular diagnostic test. The area under the receiver operating characteristics (ROC) curve was obtained to provide an index of the overall discriminative ability of both tests.

Results:

Fifteen out of 28 patients were found to have features of significant thyroid inflammation eventually requiring glucocorticoid based on the current recommendations. The mean CRP value was significantly higher in patients requiring glucocorticoids. The ROC curves indicated that the optimal positivity criterion was 19.3 mg/L for the CRP level and 46 mm at the 1st hour for ESR. CRP with a sensitivity of 0.67, a specificity of 0.92, a positive likelihood ratio of 8.67, and an accuracy of 0.64 appeared better than ESR, which showed a sensitivity of 0.93, a specificity of 0.53, a positive likelihood ratio of 2.02, and an accuracy of 0.60.

Conclusions:

The serum CRP level provided a clear advantage over ESR in the assessment of the severity of inflammation before initiation of glucocorticoid therapy in SAT. However, a well-powered study is needed to examine the clinical relevance of such a role for CRP in thyroidology.
The Glucocorticoid Taper: A Primer for the Clinicians
Authors: Priya Gagan , Laway Bashir A. , Ayyagari Mythili , Gupta Milinda , Bhat Ganesh H. K. , Dutta Deep
Published: August 2024

Glucocorticoid (GC) therapy can ameliorate debilitating and life-threatening symptoms in several inflammatory/immunological disorders. However, it can also cause significant side effects, especially with higher doses and longer duration of use. Therefore, GCs should be used at the lowest effective dose for the shortest possible time to minimise adverse effects. GC therapy may cause suppression of the endogenous hypothalamic-pituitary-adrenal (HPA) axis and abrupt discontinuation predisposes patients to features of GC-induced adrenal insufficiency. The practice of tapering GC therapy allows for recovery of the HPA axis while minimising the risk of a disease flare-up or symptoms of AI. Moderate-to-high dose GC therapy may be tapered rapidly to near-physiological doses while watching for features of disease reactivation. Once close to the physiological dose, tapering is slower and at longer intervals to allow for recovery of the HPA axis. It is important to use short- or intermediate-acting GC preparations such as hydrocortisone or prednisolone in physiological doses, administered in the morning to mimic the endogenous cortisol rhythm. A general principle to follow is that HPA axis recovery takes longer if the period of suppression has been long. In such cases, tapering should be slower over a few months to even a year. In select cases at high risk of AI or if symptoms appear during tapering, the decision to further taper and discontinue steroids may be based on testing of HPA axis function using basal and/or stimulated serum cortisol. All patients on exogenous steroids should be advised about the need for an appropriate increase in GC doses during acute medical or surgical illness and should carry a steroid alert card to avoid adrenal crisis.
A Comparative Study of Bone-Health and Associated Factors in Healthy Indian Adolescents and Young Women
Authors: Kajale Neha A. , Oza Chirantap , Ladkat Dipali , Gondhalekar Ketan , Katapally Tarun R. , Bhawra Jasmin , Mansukhani Nina , Bapat Anita , Khadilkar Vaman , Khadilkar Anuradha
Published: August 2024

Introduction:

Adolescence is a critical period for the accrual of bone mass. However, few studies have assessed the bone geometry in slum-dwelling girls/young women. We thus conducted this study: (1) to assess bone health in Indian adolescent girls and young women residing in slum vs nonslum (NS) areas and (2) to identify factors associated with poor bone health.

Methods:

This cross-sectional case–control study was performed on 110 apparently healthy unmarried, nonpregnant, nonlactating, postmenarchal adolescent girls and young women aged 11 to 24 years residing in urban slums with the same number of age-matched controls from NS areas. Anthropometric, dietary, physical-activity and bone-health parameters (using dual-energy X-ray absorptiometry and peripheral quantitative computed tomography—DXA and pQCT—respectively) were evaluated using standard protocols. A P value of < 0.05 was considered statistically significant.

Results:

Slum girls were significantly shorter and lighter and had lower dietary intakes of calcium and protein after adjusting for total daily calorie intake than NS girls (P < 0.05). Areal bone-mineral density (BMD) at lumber spine (0.940 ± 0.13 vs1.042 ± 0.15 g/cm2), femur and total body (less-head), bone-mineral apparent density adjusted for volume at the lumbar spine (0.295 ± 0.04 vs 0.319 ± 0.04 g/cm3) and height-adjusted bone density at femur (0.862 ± 0.011 vs 0.905 ± 0.011 g/cm2) were significantly lower in slum dwelling participants as compared to their NS counterparts (P < 0.05). After adjusting for confounders like sunlight exposure, anthropometric parameters and dietary calcium intake, area of dwelling was still a significant factor for the difference in BMD.

Conclusions:

The potential determinants of poor bone density and geometry in girls and young women residing in slums include residential location, dietary habits, and physical activity levels. Despite adjustments for confounding factors, differences in bone health between those in slum and nonslum areas suggest adaptations developed over generations of deprivation in these individuals, necessitating urgent intervention.
Evaluation of Prevalence of PCOS and Associated Depression, Nutrition, and Family History
Authors: Vishnubhotla Deepa Switha , Tenali Shouni Niveditha , Fernandez Mini , Madireddi Sujatha
Published: August 2024

Context:

Polycystic ovarian syndrome (PCOS) is a common condition affecting women in the prime of reproductive age. The symptoms include infertility, amenorrhea, hirsutism, obesity, and androgenic alopecia. It is a socially stigmatizing condition and is often associated with depression, poor mental health, and quality of life.

Settings and Design:

We carried out a questionnaire based cross sectional study that assessed the prevalence of PCOS, collected information on the nutritional and life style related factors. A questionnaire was used to collect information with an intention to assess the prevalence of PCOS and to understand the contribution of life style/nutrition to the risk of PCOS. Student’s t test and Z proportion test were used to assess significance and a ‘p’ value of ≤ 0.05 was considered significant.

Results:

A total of 972 females completed the questionnaire (mean age:24.37±8.37 years). Majority were from Telangana (n=823;84.67%) and students (690;70.98%). The mean weight was 60.58±13.03 kg and height was 1.78±2.56 m. Sizeable proportion reported irregular menstrual cycle (n=289;29.73%), that they get easily depressed: 283/972 (29.11%), low self-esteem:242/972 (24.90%), insomnia:223/972 (22.94%). A higher proportion of females were diabetic (8/243;3.29%Vs.10/706;1.42%;p=0.02) and non-vegetarian (69/243;28.40%Vs.119/706;16.86%;p=0.0002). No difference in the consumption of processed/fast food, carbonated drinks and lifestyle were noted. A significantly (p=0.0001) higher proportion of females had a positive family history (32/243;13.17%Vs.26/706;3.68%).

Conclusion:

Higher prevalence of PCOS was noted in young female population. Identifying at-risk individuals and imparting life style, nutrition-based modifications would be beneficial. Furthermore, regular counseling sessions might help tackle depression leading to a better overall physical and mental health.