bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence and the correlations of chronic widespread pain among loaders (Nattami) in Pettah, Sri Lanka
Authors: Prasanna M. A. , Kulathunga P. A. R. I. , Kariyawasam P. N. , De Silva P. V.
Published: December 2023

Introduction: Chronic widespread pain (CWP) is a cardinal symptom of fibromyalgia, which is a non-inflammatory condition of the musculoskeletal system. It has become a highly prevalent condition and a major health problem in the community and working population. Loaders are a vulnerable group of people engage in an occupation that has a higher risk of developing musculoskeletal pain. Psychological distress is also associated with CWP. The main aim of this study was to identify the prevalence and associated factors of CWP among loaders in Pettah, Sri Lanka. Further, the association of psychological distress and the health-seeking behaviors of loaders with CWP was assessed in this study.Methods: A cross sectional study was carried out in a convenience sample of 174 loaders in the main bazaar, Pettah, Sri Lanka. A criterion given in the “Manchester Definition” for CWP was used for the identification of CWP. Data were collected using a self-administered structured questionnaire and Perceived Stress Scale was used to identify the psychological distress. Descriptive and inferential statistics were used to analyze the data with SPSS version 21.Results: The mean age (SD) of the study participants was 42.65 (±12.21)ranged between 19 and 66 years. The level of education of the majority (61.5%) were between grade 6-11. The mean working years as a loader was 20.84 years and the mean weight that the participants carried per turn was 62kg. The prevalence of CWP was 18.4% (n=32) and the lower back pain was the most prevalent (64%) individual problem. High level of stress was perceived by 51.7% of the study participants. Age and the perceived stress were significantly associated with the CWP (p<0.05). Most of the participants (88%) used substances and among them 29.6 % used substances to relieve pain. High level of perceived stress was found in 51.7% of loaders.Conclusion: CWP is a significant occupational health issue which is associated with high level of stress among loaders in Pettah, Sri Lanka.
Acute myeloid leukaemia masquerading as transverse myelitis
Authors: Janya J. , Samarasingha S. A. P. N. , Serasinghe D. , Jayawardhana H. , Jayanaga W. W. L. A.
Published: December 2023

Acute myeloid leukaemia (AML) is known to cause paraneoplastic transverse myelitis. However, the direct invasion or extramedullary compression of the spinal cord is rare unlike in the case of chronic lymphocytic leukaemia. We report the case of a young man presenting with transverse myelitis who was found to have leukaemic infiltrates on neuroimaging. The uniqueness of this being the first presentation of the patient with AML in the form of epidural infiltrates in the absence of peripheral blood count abnormalities. This highlights the importance of neuroimaging to delineate associated conditions in a suspected patient with transverse myelitis.
A Quality-Assured Medico-Legal Service Through Human Resource Management in the Medico-Legal Unit of Sri Lanka
Authors: Appuhamy P.
Published: December 2023

A specialist in forensic medicine has a dual role in Sri Lanka. These are conducting autopsies on death and the medico-legal examination of living cases of physical and sexual assault, poisoning or alcohol intoxication, etc. To deliver a quality-assured forensic service human resources play a pivotal role. The present workforce of a medico-legal unit consists of a specialist in forensic medicine, a medical officer medico-legal, a development officer, a morgue assistant, and a female healthcare assistant. Due to the lack of necessary professional skills among non-medical staff members and the lack of proper job descriptions for the non-medical staff members some pivotal functions in the medico-legal unit are handled by the less qualified staff members. We suggest that the relevant professional bodies in collaboration with ministries, develop standardized job descriptions and allocation of roles for non-medical staff members across the medico-legal units in the country so that the institutions and all the stakeholders adhere to the duties specified to improve the desired quality of the medico-legal unit.
Lichen planus
Authors: Xie Meng-yu , Chen Chieh
Published: December 2023

Oral lichen planus is a chronic inflammatory autoimmune disease affecting the oral mucous membrane. Its causes may include chronic medication use, metal denture friction, stress, and emotional disturbance. It is characterized by swelling and irritation with slight desquamation of the membrane, as well as Wickham striae under dermoscopy. Another common benign condition of skin hyperplasia is lichenoid keratosis, which involves an erythematous rash in the trunk or upper limbs triggered by friction. Although the two aforementioned conditions may occur separately, simultaneous sighting of two to three lesions in the skin has been reported.
Erbium-doped yttrium–aluminum–garnet laser for the treatment of dentin hypersensitivity: A case report
Authors: Chung Yun-Ying , Ching Tong , Ho Albert Cheng-Sheng , Huang Liang-Gie
Published: December 2023

Studies have found that periodontal disease or acute periodontal inflammation may lead to dentin hypersensitivity (DHS) if left untreated. Moreover, periodontal treatments may result in DHS after initial treatment and surgical therapy. Several desensitizing methods and agents are used to relieve DHS. Recently, laser therapy has been proposed to treat DHS. In this report, we present a case of a 59-year-old woman who had lower left tooth sensitivity after air-blast test. The patient achieved complete recovery after erbium-doped yttrium–aluminum–garnet laser therapy. The findings provide a basis for further studies into the clinical effectiveness of laser therapy in reducing DHS.
Euglycemic diabetic ketoacidosis associated with sodium–glucose cotransporter-2 inhibitors after surgery: A case report and review of literature
Authors: Pai Mei-An , Wu Tsai-Kun , Chien Shiaw-Wen , Chen Chang-Hsu , Kuo Yuan-Chuan , Chen Hung-Ping , Tseng Tien-Yu , Lim Paik-Seong
Published: December 2023

Euglycemic diabetic ketoacidosis is a rare, acute, and life-threatening complication of diabetes mellitus associated with several risk factors such as infection, surgery, pregnancy, fasting, alcohol intake, acute vascular events (acute coronary syndrome or stroke), and the use of sodium–glucose cotransporter 2 (SGLT2) inhibitors. It is characterized by euglycemia, high-anion-gap metabolic acidosis, and ketoacidosis. Herein, we report two patients who used SGLT2 inhibitors before surgery and presented with severe metabolic acidosis after surgery. Subsequently, one patient required intubation, and both patients received two cycles of hemodialysis despite normal renal parameters. This was done to correct the metabolic acidosis, which led to early recovery.
Clinical characteristics of anorectal malformations in Taiwan: A single-center retrospective chart review
Authors: Tsai Hsiu-Ching , Guo Min-Yung , Hu Shu-Wei , Yeh Win-Lin , Ko Chun-Hsiang , Tseng Shih-Ping , Fan Hueng-Chuen
Published: December 2023

Background:

Anorectal malformations (ARMs) are common neonatal congenital anomalies. The prognosis of ARM patients is highly variable, and the condition itself can exert substantial psychological burdens on the parents. Thus, it is of paramount importance to raise awareness about the disease and appropriate management.

Objectives:

To characterize the spectrum of clinical presentation and outcome of ARMs.

Methods:

The present retrospective study retrieved the records of patients with ARMs admitted at a teaching hospital in Taichung City, Taiwan, between January 1, 2010, and December 31, 2019.

Results:

Seven children (two were males [28.57%]) with ARMs were included. Of them, three and four patients had high (42.86%) and low (57.14%) defects, respectively. Four patients (57%) had associated congenital heart disease and urogenital anomalies, and two patients (28.57%) had developmental delays. Constipation was the main clinical presentation (100%). Overall, there were no associations between gestational age, delivery modes, birth weight, associated cardiac and urogenital anomalies, constipation, body weight <3rd percentile, abdominal pain, VACTERL syndrome, and Down syndrome, and the levels of ARM. Surgical correction was successful in all patients with an uneventful postoperative period.

Conclusion:

Patients with ARMs usually present with associated congenital anomalies, which can significantly impact the disease prognosis. Improvements in the surgical management of ARMs have led to a high success rate and optimal postoperative outcomes. Given the negative impact of the delayed diagnosis on ARM outcomes, it is crucial to increase the awareness of the presentation and adequate management of the condition, as well as the importance of perineal examination of all newborns at birth.
Indian Literature Review on Nonalcoholic Fatty Liver Disease
Authors: Rangachari Balamurali , Murugesan Manimaran , Shanmugam Chitra , Gopalsamy Sathya , Chinnadurai Krishna Kumar
Published: December 2023

Nonalcoholic fatty liver disease (NAFLD) is currently the most common chronic liver disease worldwide. The global prevalence of NAFLD has increased from 25.3% in 1990–2006 – 38.0% in 2016–2019. Easy access to calorie-dense food and a sedentary lifestyle together with the modern epidemics of diabetes mellitus and obesity have catapulted NAFLD into a substantial public health problem in India as in other parts of the world. NAFLD has emerged as one of the leading causes of hepatocellular carcinoma and liver transplant in India. In this review, we summarized the Indian perspective of NAFLD epidemiology, risk factors, assessment, spectrum, lifestyle interventions, treatment options, and transplant prospects.
Primary Gastric Actinomycosis: Case Reports and Literature Review
Authors: Zumu Mhasisielie , Lakshmanan Ilavarasi , Arun R. S. , Damle Aditi
Published: December 2023

Primary Gastric Actinomycosis is extremely rare. We report two cases of Primary Gastric Actinomycosis. First case, a 90-year-old gentleman with multiple co-morbidities came with post prandial non radiating epigastric pain for 2 weeks. Gastroscopy showed a submucosal gastric SOL. Endoscopic ultrasonography-guided Gastric SOL aspiration grew Actinomyces naeslundii. Second case, a 56 year old gentleman, known diabetic came with abdominal pain for 5 to 6 months and weight loss. Ultrasound abdomen revealed pyloric thickening. Upper gastrointestinal endoscopy showed gastric ulcer. Biopsies were suggestive of Actinomycosis. Cautious used of long term proton pump inhibitor in elderly and immunosuppressed individual. All efforts should be made to acquire the appropriate tissue sample for histopathology examination and culture. All actinomycosis infections need not have Sulphur pigments. Actinomycosis has a good prognosis with appropriate treatment.
Evaluation of Continuous Infusions of Dexmedetomidine versus Propofol as an Adjuvant to Ketamine in Patients Undergoing Elective Upper Limb Surgery under Brachial Plexus Block – A Randomized Control Trial
Authors: Harikrishnan Aishwarya , Prabhu Pavithra , Krishnan Rajarajeshwaran , Prasad T. Krishna , Priyadharsini K Soundarya
Published: December 2023

Background:

The use of anesthetic ketamine at usual doses has been limited by side effects such as sympathetic stimulation, treatment-emergent delirium, and prolonged recovery time. Recently, there has been a growing interest in combining subanesthetic doses of ketamine with subanesthetic doses of drugs such as propofol and dexmedetomidine to mitigate the unwanted effects of ketamine. Hence, we aimed to compare the effectiveness, in terms of postoperative Aldrete scores, intraoperative pain, sedation scores, hemodynamic changes, respiratory effects, surgeon satisfaction, and postoperative delirium, of continuous infusions of ketamine with adjuvant dexmedetomidine versus continuous infusions of ketamine with adjuvant propofol among patients undergoing elective upper limb surgery under brachial plexus block.

Methods:

We performed a double-blind, randomized, controlled trial among 60 participants randomly allocated into two groups. Group A patients (n = 30) received ketamine 0.5 mg/kg mixed with dexmedetomidine 0.5 μg/kg in 100 mL/h lipid emulsion as an infusion, whereas Group B patients received ketamine 0.5 mg/kg mixed with propofol 1 mg/kg in 100 mL/h normal saline as an infusion.

Results:

The mean Aldrete score at 0 min, 30 min, and 1 h was significantly higher among Group B patients (P = 0.001, P = 0.001, and P = 0.043, respectively). The mean diastolic blood pressure at 2 h was significantly higher in Group A compared to Group B (87.8 vs. 77.8, P = 0.001). Similarly, the mean arterial pressure at 45 min and 90 min was significantly higher in Group A compared to Group B (97.1 ± 6.7 vs. 92.2 ± 6.0, P = 0.004; 95.5 ± 5.5 vs. 90.8 ± 6.3, P = 0.005, respectively). The mean sedation score was not significantly different between groups.

Conclusion:

Propofol, when used as an adjuvant to ketamine, provides better hemodynamic stability and better Aldrete score in patients who receive brachial plexus block for elective upper limb surgeries compared to adjuvant dexmedetomidine.
How to Write a Systematic Review Without Meta-analysis
Authors: Plakkal Nishad
Published: December 2023

Systematic reviews (SRs) are a way of synthesizing evidence from research and are extensively used in health care to inform clinical practice, research, and policy. In contrast to narrative reviews, they tend to be more rigorous and reproducible, with the added option of statistically synthesizing the results in a meta-analysis. SRs have historically focused on interventional studies; however, SRs currently cover a wide variety of study designs. The team conducting the review usually includes a librarian in addition to researchers. The first step of the review is formulating a focused research question. After registering the protocol, the team systematically searches medical databases for relevant literature using a predefined search strategy. Software tools and web-based platforms such as Covidence and Rayyan are available to assist researchers with the process of screening citations and managing the whole review workflow. Ineligible studies are discarded after screening. Eligible studies are then carefully assessed for quality and risk of bias (ROB) using quality assessment tools, like the Cochrane ROB tool (for randomized controlled trials). Once the data are extracted and summarized, the reviewers interpret the findings and prepare a report. The Preferred Reporting Items for SRs and Meta-analyses statement, last updated in 2020, is specifically designed to improve the quality of reporting of SRs. Scoping reviews, umbrella reviews, rapid reviews, and living reviews are relatively newer concepts related to SRs; these are beyond the scope of this article.
Early Branching of Bilateral Renal Arteries with Bilateral Accessory Renal Arteries: A Case Report of a Live-Related Donor Transplantation
Authors: Nerli Rajendra B. , Patel Priyeshkumar , Sharma Manas , Deole Sushant , Ghagane Shridhar C. , Nutalpati Sreeharsha , Patil Shashank , Mohan Shyam , Dixit Neeraj S.
Published: December 2023

Comprehensive preoperative evaluation of potential donors is crucial for selecting the right donor, with adequately functioning kidneys, and the best surgical approach for harvesting the organs to prevent donor-related complications and to assure good recipient graft function. Multidetector computed tomography is the choice of imaging in the preoperative evaluation of living renal donors with an accuracy of 95%–100%. The donor must retain one normal kidney. The left kidney is preferred for living donor nephrectomy because it has a longer renal vein and it is technically easier to remove. It is always preferable to choose kidneys with a single artery because both donor and recipient surgeries are less complicated and there is less risk for arterial thrombosis. We report in a case of successful transplantation wherein the donor had an early division of the main renal artery bilaterally as well as bilateral accessory renal arteries.
Histoplasmosis Disguised as Pyrexia of Unknown Origin in Kidney Transplant Recipients: Bone Marrow Biopsy was Key to Diagnosis
Authors: Patel Prem Shankar , Krishna Amresh , Singh Prit Pal , Bansal Shyam Bihari , Archana
Published: December 2023

Immunocompromised host commonly develops a disseminated form of histoplasmosis and may have diverse manifestations. We present a case of histoplasmosis in a kidney transplant recipient who presented with pyrexia of unknown origin and pancytopenia. Bronchoalveolar lavage fluid analysis and serum antigen were negative for histoplasmosis. Bone marrow biopsy showed periodic acid–Schiff-positive intra and extracellular yeast-like organisms and later confirmed as Histoplasma capsulatum. The patient was successfully treated with intravenous liposomal amphotericin B, followed by oral itraconazole. Thus, bone marrow examination proved as key to diagnosis in our case.
Immunoinformatic Evaluation of the Cross-presentation of Donor Major Histocompatibility Derived Epitopes by Recipient Major Histocompatibility Class I Molecules in Transplantation Rejection
Authors: Koothradan Suhana , Elyas K. K.
Published: December 2023

Aim:

The aim of this study was to analyze the cross-presentation of allopeptides derived from donor major histocompatibility (MHC) molecules by recipient class I MHC molecules in the context of transplantation rejection.

Materials and Methods:

The MHC molecules were selected based on frequency distribution in the Kerala (India) population using the “allelefrequency. net” database. The most frequent alleles were chosen as donor and recipient alleles. Different immunoinformatics servers such as Netcytotoxic T lymphocyte, NetMHCpan, and Immune Epitope Database MHC I were used for predicting potential T-cell epitopes, and MHC class I epitopes, respectively, from the chosen donor MHC molecule. Three peptides with strong binding affinities in all three predictions were selected for further analysis. The binding of these peptides to the second MHC class I molecule, the recipient one, and transporter associated with antigen processing protein was confirmed by molecular docking using the “AutoDockVina” tool. The binding interactions were visualized using the “Discovery Studio Visualizer” platform.

Results:

The ability of the selected class I MHC molecule, human leukocyte antigens (HLAs)-A* 11:01, considered the donor allele, to act as an exogenous antigen and to get processed into peptides and presented on the second class I MHC molecule, HLA-A*02:01, considered the recipient allele was confirmed. This immunoinformatics approach could help us to identify potential epitopes from an HLA class I molecule and to measure its ability to get cross-presented on a second HLA class I molecule to trigger the process of cell-mediated rejection.

Conclusion:

This immunoinformatics approach could help us to identify potential epitopes from an HLA class I molecule and to measure its ability to get cross-presented on a second HLA class I molecule to trigger the process of cell-mediated rejection. Our study provides an easy in silico method for predicting the chances of cell mediated rejection in organ transplantations involving an unrelated donor. We hope that this computational analysis will pave the way for simplifying the process involved in organ rejection prediction.
COVID-19 and Renal Transplant: Experiences from the Past and Lesson for the Future – A Comprehensive Review
Authors: Giri Anant , Sadasukhi Nripesh , Sadasukhi Trilok Chand , Gupta Hotilal , Gupta Manish , Sharma Ashish , Goswami Sonia , Modi Ankit
Published: December 2023

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has distorted the health-care system at a global level. Organ donation being a life-saving procedure, it continued even in the COVID era, although at a slow pace. Irrespective of the increase in renal transplants in the later era of COVID-19, the scarcity of literature for a review article in this context resulted in the genesis of this study. A retrospective data collection was conducted over various databases in the English language. The databases were thoroughly searched with keywords COVID-19, Coronavirus, SARS-CoV-2, and renal transplant. The data from various sources including original articles comprising single- and multicenter studies were collected, analyzed, and compiled over various parameters. The data were framed as mean, median, percentage, and standard deviation. We analyzed 10 single-centered studies and 4 multicenter studies conducting renal transplantation during the COVID era. The mean age of donor and recipient in the analysis was 47.6 ± 6.01 years and 47.8 ± 6.65 years, respectively. Two transplant centers used deceased renal donors only and one centre was doing transplant only on live donors and the remaining of the centres were taking both live and deceased donors. We observed that four studies had no COVID-positive recipient in their follow-up and the maximum COVID-positivity rate was 50%. Among reviewed 14 studies, 8 studies had no mortality in recipients who were COVID positive and the maximum mortality was 54%. To reduce morbidity and mortality, strict criteria for COVID-19 workup in donor and recipient patients should be followed. The type of donor has no direct relation to the risk of acquiring COVID-19 infection. The vaccination program has been accepted worldwide to reduce the severity of COVID-19 infection even in transplant patients.
Comparative Evaluation of Skeletal and Dental Effects of Mini-Implant Assisted and Corticopuncture-Facilitated Rapid Palatal Expansion in Adults: A Randomized Clinical Study
Authors: Basu Sanjana , Goje Santosh Kumar
Published: December 2023

Introduction:

Conventional rapid maxillary expansion (RME) in adults is difficult due to increased skeletal maturity of the midpalatal suture. Surgically assisted rapid palatal expansion (SARPE) treatment is recommended for adults with strongly consolidated sutures but has lesser acceptance due to its invasive nature. Mini-implant-assisted rapid palatal expansion (MARPE) produced dentoalveolar side effects along with some skeletal effects in adults while being highly successful in adolescents and young adults. A lesser invasive technique combined with a purely bone-borne-rapid-maxillary-expansion appliance (BBRME) is suggested in this study to achieve maximum skeletal effects and minimize the dentoalveolar side effects of expansion in adults with completely fused midpalatal sutures as an alternative to SARPE.

Aim:

This study aims to evaluate and compare skeletal and dental effects of mini-implant assisted, and corticopuncture-facilitated rapid palatal expansion in adults.

Material and Methods:

A randomized clinical study was performed on 18 patients (mean age 20.77 years) who were randomly divided into two groups: Group A (Corticopuncture-facilitated BBRME) and Group B (conventional MARPE). Pretreatment (T0) and postexpansion (T1) skeletal and dental effects of both the groups were analyzed using cone-beam computed tomography imaging.

Results:

A student’s paired t-test was used to evaluate the difference in expansion achieved between the two groups (T1-T0). Group A (BBRME with corticopunctures) showed increased transverse widths at the basal bone, nasal base, and jugal processes. Group B (conventional MARPE) showed increased inclination of the posterior teeth indicating dental tipping. Both groups were successfully treated with their respective protocols but dentoalveolar side effects were significantly less in group A (BBRME) suggesting a better prognosis in BBRME group.

Conclusions:

Greater skeletal changes were seen in group A (BBRME) (P < 0.05*) than in group B. Group B (MARPE) showed more dental side effects like dental tipping and lesser skeletal expansion. Corticopuncture-facilitated bone-borne RME (BBRME) is a viable and efficient method of maximizing skeletal expansion in adults with fully obliterated midpalatal sutures.
Role of Emotional Intelligence in Academic Performance among Dental Students of South India: A Cross-sectional Study
Authors: Swetha Pasupuleti , Ramesh KSV , Vanguru Raviteja , Sruthima Gottumukkala N. V. S. , Rajashekaraiah Premalatha Bidadi , Srinivas Sowmya
Published: December 2023

Background:

Emotional intelligence (EI) is potentially associated with higher academic performance. However, sparse evidence exists in the Southern region of India, in assessing EI and its relation to academic performance in dental students.

Objective:

The objective is to emphasize the need for the relationship between EI and academic achievement among dental students.

Methods:

A cross-sectional, observational questionnaire research was carried out on 248 dental students. A questionnaire with 47 elements about EI was created using Google Forms and disseminated over E-mail and WhatsApp. The data were statistically analyzed using the Statistical Package for Social Science (SPSS) software version 20.0. International Business Machines Corporation-United States of America (IBM-USA). The data were examined using the Chi-square test. A P < 0.05 was judged statistically significant.

Results:

EI is positively associated with high academic performance. A significantly association was identified between EI and gender (0.008). No statistical significance was found between EI and age, education. In multivariate analysis, females showed a significant association with EI in terms of gender. Low EI was observed in postgraduates compared to undergraduates and also with increasing age of the students.

Conclusion:

EI was found to be high in postgraduates and females. Primary data on the impact of EI on academic performance in dental students, and identified that its relationship with professional and lifestyle habits, gender were associated with EI, which in turn showed and academic performance. We hypothesized that the EI of students is associated with academic performance.
Implementation of Artificial Intelligence in Laboratory Medicine
Authors: Anjankar Ashish Prakash , Jha Roshan Kumar , Lambe Sandip
Published: December 2023

Introduction:

In advancing health care, the evolution of laboratory medicine is necessary to overcome the need for accurate, readily available, and relative data within the appropriate time window; we see artificial intelligence (AI) in laboratory medicine. The introduction of AI in the health-care sector has been believed as the practice of composite software and algorithms to compete with human intelligence in analysis, diagnosis, and research.

Materials and Methods:

A Google Form-based survey study on the use of AI in the laboratory setting was planned stepwise independently. First, 123 participants were shortlisted for an online discussion board; they were introduced to AI and its benefit and limitation in laboratory medicine. Content analysis was done directly using a close-ended questionnaire-based survey. In parallel, competent doctors and psychologists analyzed answers used for a further rough framework of themes.

Results:

Our participants with a positive attitude believe AI in the laboratory will have benefits with proper training and better information technology support. It is also time-saving, accurate, and cost-effective for diagnostic purposes.

Conclusion:

General practitioners and laboratory experts should uphold AI implementation. Attitude toward adopting AI was a significant factor in AI implementation and use. Further counseling of participants toward AI and its benefit in laboratory medicine will be helpful in better patient care and diagnosis.
Breath Malodor – A Review of the Fundamentals
Authors: Shenoy Nina , Shetty Akshatha
Published: December 2023

Recently, there has been an increased self-awareness of halitosis post the COVID-19 pandemic due to the continuous wearing of masks. Oral malodor, often known as foul/bad breath, is a foul odor that arises from the oral cavity. Numerous etiologic factors cause breath malodor, of which tongue coating is the most common intraoral cause. Extra-oral etiology, such as lung infections, diabetes, and kidney diseases, also plays a significant role. Halitosis is caused by anaerobic bacteria producing volatile sulfur compounds subsequent to protein degradation in the mouth. Intraoral etiology is the most common cause that can be efficiently treated with proper oral hygiene, mechanical, and chemical plaque control methods. Extra-oral etiology requires referral to a medical specialist. However, psychological causes such as halitophobia necessitate consultation with a clinical psychologist. Persistent oral malodor has a negative impact on social interactions and decreases the oral health-related quality of life. A literature search of review articles, systematic reviews, and studies on halitosis, using the mesh terms etiology, diagnosis, and management, was carried out using PubMed and Google Scholar search engines. This review addresses the basic concepts of oral malodor, its causes, pathophysiology, and management.
A Study to Assess Knowledge, Attitude, and Practices Regarding Exclusive Breastfeeding among Postnatal Mothers in Order to Develop Information Booklet at Krishna Hospital, Karad
Authors: Lalichan Liby K. , Karale Rajashri Bhagwat , Naregal Prakash Mallikarjun , Mohite Vaishali Rajsinh
Published: December 2023

Background:

World Health Organization and United Nations Children’s Fund recommended Exclusive breastfeeding for the first six months for new-borns. Still, the prevalence of exclusive breastfeeding is very low in many developing countries.

Objective:

In present study we assessed knowledge, attitude and practices regarding Exclusive breastfeeding among postnatal mothers at Krishna Hospital, Karad, Maharashtra, India. Materials and Methods: A Descriptive survey research design utilized to assess knowledge, attitude and practices regarding exclusive breastfeeding among 100 postnatal mothers. A structured questionnaire used to assess knowledge, attitude and practices regarding Exclusive breastfeeding. Ethical clearance obtained from Ethical committee, Krishna Institute of Medical Sciences, Deemed to Be University, Karad and informed consent obtained from participants in local language.

Results:

The result showed that, among 100 postnatal mothers, around 20(20%) of postnatal mother had poor knowledge on exclusive breastfeeding, 73(73%) had average knowledge and 7(7%) had good knowledge. The practice score of postnatal mothers regarding exclusive breastfeeding showed that 18(18%) mother had poor practice, 73 (73%) had average practice and 9 (9%) had good practice. Attitude toward exclusive breastfeeding were rated as positive by 11(11%) , majority of samples 76(76%) had a neutral opinion regarding exclusive breastfeeding, while roughly 13(13%) had a negative perspective. There was extremely significant association for knowledge and practices with demographic variables (P<0.0001). Also there was highly significant correlation found between attitude with demographic variables.

Conclusion:

Study findings conclude that most of the mother’s lack awareness on exclusively breastfeeding, thus researchers need to increase mothers’ knowledge by developing and distributing them information booklets.
“PEEP-ZEEP” Maneuver for Airway Clearance in Mechanically Ventilated Patients: A Scoping Review
Authors: Yadav Vaishnavi , Vardhan Vishnu , Deshpande Hemant , Acharya Sourya
Published: December 2023

A mechanical ventilator is the standard care to manage airways in intensive care unit (ICU). The inherent complications associated with mechanical ventilation are easy to prevent and control. Ventilator events, including ventilator-associated pneumonia, are crucial issues to manage in critically ill patients. Secretion retention due to compromised mucociliary function and altered lung internal milieu plays a significant concern in ICU outcomes. Physiotherapy involved in ICU plays an essential role in maintaining lung hygiene. Conventional chest physiotherapy is an extrapulmonary technique to remove secretion and maintain bronchial hygiene. Manual hyperinflation and suctioning are the methods that are highly at risk of transmitting lung infection. Generating flow bias through modification in various ventilator parameters is recently in trend to prevent bronchial hygiene-related complications. PEEP-ZEEP maneuver causes the expiratory flow bias by increasing peak expiratory flow. The present scoping review explores the safety and efficacy of the PEEP-ZEEP maneuver for airway clearance in mechanically ventilated patients. The current scoping review aims to identify the use and safety of the PEEP-ZEEP maneuver applied in mechanically ventilated patients for airway clearance. The five databases, i.e., PubMed, PEDro, Google Scholar, Cochrane, and Web of Science, have been searched till October 2022. The published experimental studies included in the review was searched using Boolean operators (“AND” and “OR”) and keywords, i.e., PEEP-ZEEP, Mechanical Ventilator, and Airway Clearance technique. PEEP-ZEEP is a safe and efficient for airway clearance in mechanically ventilated patients, with the need to explore further with a larger sample size and more defined outcomes and population.
Metal release and cytotoxicity of different orthodontic bracket-wire combinations: An in vitro study
Authors: Aiswareya Gunaseelan , Verma Sanjeev K , Khan Saba , Owais Mohammad , Farooqi Izharul H , Naseem Sufia
Published: December 2023

Abstract

Aim:

To quantify and compare the metal ions released from different bracket-wire combinations and to assess their cytotoxicity.

Materials and Methods:

A total of 360 fabricated sectional fixed orthodontic appliances were divided into 6 groups. The first three groups consisted of stainless-steel brackets with stainless-steel, snickel-titanium (NiTi), and titanium-molybdenum alloy (TMA) archwires, and the other three groups were fabricated using ceramic brackets (polycrystalline alumina) with stainless-steel, NiTi, and TMA archwires. These appliances were immersed in artificial saliva (pH 6.5 ± 0.5, 37°C), for 1 week, 2 weeks, and 1 month. The nickel and chromium ions released in the artificial saliva were quantified using a flame atomic absorption spectrometer, and cytotoxicity assessment was performed using a 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyl tetrazolium bromide (MTT) assay on human cervical cancer cell line.

Results:

The stainless-steel bracket groups displayed a significantly greater release of nickel and chromium ions compared to the ceramic bracket groups (P < 0.05). However, no significant differences were identified when comparing the three archwire types within the stainless-steel/ceramic bracket groups. At the end of 1 month, the % cell viability demonstrated by the appliances was in the decreasing order of stainless-steel-TMA > ceramic-stainless steel > stainless-steel-NiTi > ceramic-NiTi > stainless-steel-stainless steel > ceramic-TMA.

Conclusion:

Considerably greater release of nickel and chromium ions was observed from the appliances utilizing stainless-steel brackets compared to those employing ceramic brackets. However, no remarkable difference in the levels of nickel and chromium ions was observed when comparing the three archwires: stainless steel, NiTi, and TMA. In the cytotoxicity assessment, the ceramic-TMA combination displayed the highest level of cytotoxicity, while the stainless-steel-TMA combination displayed the least cytotoxicity.
Knowledge of xerostomia and angular cheilitis in geriatric population among clinical dental students: An institutional cross-sectional study
Authors: Mahdani Fatma Y , Jati Galuh D , Febrine Erine T , Cahyaningrum Karina W , Radithia Desiana , Wicaksono Satutya
Published: December 2023

Abstract

Aim:

Assessing the knowledge of clinical dental students regarding prevalent geriatric oral diseases is crucial in evaluating their clinical competency. This study focuses on analyzing dental students’ knowledge of angular cheilitis (AC) and xerostomia in elderly patients.

Materials and Methods:

In this analytical cross-sectional investigation, clinical dental students from Universitas Airlangga were involved. We employed simple random sampling to select a minimum of 76 students and gathered data, including demographic information and knowledge about AC and xerostomia, through an online questionnaire. Respondents were then categorized into three groups based on their knowledge level: poor, moderate, and good. We utilized coefficient contingency and odds ratio analysis to explore relationships and effects between demographic factors and knowledge levels.

Results:

The study findings indicated that a significant majority of respondents demonstrated a high level of comprehension regarding AC (58.4%). Conversely, a notable proportion of respondents exhibited limited knowledge regarding xerostomia (66.3%). Furthermore, our correlation analysis, which aimed to identify potential associations between knowledge levels and intrinsic factors such as gender, clinical interest, and proximity to geriatric individuals, did not reveal any statistically significant relationships (P > 0.05).

Conclusion:

Within the population of clinical dental students, there is a commendable level of knowledge concerning AC in the geriatric demographic. However, a substantial segment of students lacks adequate understanding when it comes to xerostomia.
Pattern of Care of Recurrent Cervical Cancer in Low-resource Settings: Challenges and Patient-initiated Follow-up as a Novel Opportunity
Authors: Barmon Debabrata , Tak Apoorva , Baruah Upasana , Begum Dimpy , Gupta Sakshi , Khanikar Duncan , Nath Jyotiman , Yadav Garima
Published: December 2023

Introduction:

The availability of optimum diagnostic strategies remains a major problem in resource-constraint countries. This technique of patient-initiated follow-up (PIFU) has been recently adopted in the UK for gynecological cancers and has proven cost benefits. However, no study from the Indian subcontinent has ever been reported.

Aims and Objectives:

The primary objective was to study the pattern of care of recurrent cervical cancer in low-resource settings. The secondary objective was to compare the reliability of symptomatology/clinical evaluation and imaging methods on follow-up to detect recurrence and thus explore the feasibility of symptom-based PIFU.

Materials and Methods:

This was a single-institutional retrospective analysis of recurrent cervical cancer cases for a period of 3 years from January 2019 to January 2022. Patients who followed up for minimum of 6 months were included in the study.

Results:

In 57 of the total 69 patients, symptoms alone were the index diagnostic method. Interestingly, neither of the methods of recurrence detection had impact on overall survival (OS). Cox regression analysis revealed adverse impact of erratic/lost to follow-up (hazard ratio [HR] = 3.8) and pelvic side wall disease (HR = 1.33) on survival. Patients with positive para-aortic nodes had significantly shorter disease-free interval of 11 months, so adding systemic therapy to adjuvant treatment in this cohort needs to be further investigated.

Conclusion:

Our analysis showed that patients with recurrence who were diagnosed with clinical manifestations alone vis-à-vis the ones who were diagnosed primarily on routine follow-up visit by some imaging or diagnostic test had comparable oncologic outcomes. PIFU can be a “practice changing modality” in patient management system, especially in low-resource settings. It will prove to be a simple cost-effective method to detect recurrence and prevent fallouts. Our study points to the feasibility of PIFU in Indian scenario.
Metabolic Syndrome and Its Association with Menopausal Symptoms among Postmenopausal Women: A Cross-sectional Study
Authors: Mundhra Rajlaxmi , Kumari Purvashi , Bahadur Anupama , Khoiwal Kavita , Naithani Manisha
Published: December 2023

Background:

With increase in postmenopausal population, screening for MetS and its relationship with menopausal symptoms needs evaluation.

Objective:

To identify the frequency of metabolic syndrome (MetS) and assess its relationship with menopausal symptoms in postmenopausal women.

Methods:

This was a cross sectional study performed at a tertiary care centre in Uttarakhand India over a period of 18 months. All postmenopausal women >40 years with natural menopause included in the study sample. We used the Consensus Definition IDF and AHA/NHLBI (2009) criteria to classify subjects as having metabolic syndrome. Menopausal symptoms were assessed using Menopause Rating Scale (MRS) questionnaire.

Results:

The frequency of metabolic syndrome in our study was 34.38% (55 out of 160 patients). We observed sleeping problems (36.88%) followed by physical & mental exhaustion (33.75%) and hot flushes (33.13%) to be the commonest menopausal symptoms. Significant association was seen for MRS along with its subscales in women with metabolic syndrome (P value <.05). Significant positive correlation was observed between total Menopause rating scale scores as well as all three subscales for triglycerides in patients with metabolic syndrome.

Conclusion:

Hyper triglyceridemia was associated with severe menopausal symptoms among postmenopausal women with MetS in our study.
The Efficacy of Virtual-based Nutritional Interventions on Knowledge, Attitude, and Practices of Individuals with Hypertension: A Comparative Study Analysis
Authors: Vasanthakumari P , Kumarakuru K , Yousuff Noorain
Published: December 2023

Introduction:

Hypertension (HTN) is multifactorial, complex disorder predictable to affect all genders and foremost preventable risk factor for blood pressure and cardiovascular diseases.

Objectives:

The present study was assessing the knowledge, attitude, and practices (KAPs) regarding HTN and creating the awareness of its better management among the hypertensive population through nutrition education intervention.

Methodology:

A total of 82 participants were selected and questionnaire was used to elicit sociodemographic profile and KAP regarding HTN and its management. Nutrition education intervention was carried out through the online mode.

Results and Discussion:

Results observed in preintervention between knowledge with attitude in experimental group and control group (r =+0.273 and r =+0.271), practice (r =+0.275 and r =+0.263), and attitude with practice (r =+0.521 and r =+0.186) were positive correlation similarly postintervention of both group obtained significant positive correlation. The statistical analysis of various sociodemographic factors of pre and postintervention in the experimental group and control group revealed a significant improvement in the mean posttest scores of KAP. Meanwhile, various sociodemographic factors obtained had nonsignificant (P > 0.005) in experimental group; a control group of pretest and posttest reported significant differences (P < 0.05). The posttest total mean score on nutritional knowledge and practice in the experimental group also showed a large significant (P < 0.05) increase when compared to the pretest mean score. There was no significant improvement in the total mean scores in any dimensions of the control group.

Conclusion:

The study therefore helped the experimental group subjects in improving their overall knowledge about the importance of nutrition in HTN and also instilled positive attitude and practices toward the management of HTN through lifestyle modifications.
Menopausal Symptoms and Menopausal Rating Scale among Midlife Women: A Hospital-based Study
Authors: Nandan Neetha , Mohan Adithi
Published: December 2023

Background:

Menopausal transition phase is a difficult time in a woman’s life. Many factors such as age, socioeconomic status, education, ethnic cultural, and body physique determine the presence of menopausal symptoms. This study helps us to understand the severity and perseverance of menopausal symptoms in women of this locality.

Aims and Objectives:

The aim of the study was to find distribution and severity of menopausal symptoms by self-rated Menopause Rating Scale (MRS) through different transition phases of menopause in women aged between 40 and 60 years.

Methodology:

It is a hospital-based observational study. All the participants answered an 11-item MRS questionnaire.

Results:

Out of 300 participants, 106 belonged to premenopausal state, 111 to perimenopausal state, and 83 were postmenopause. Overall, 47% of participants had one or the other menopausal symptoms. Most of them had mild-to-moderate symptoms. Only 3% had severe symptoms. Somatic subscale was the maximum reported symptoms in our study group. The most common symptom was physical and mental exhaustion (55%) and the least common was sexual problems (8%). Difficulty in sleeping and bladder symptoms were more and statistically significant in postmenopausal group where as hot flushes and irritability were more common in perimenopausal group.

Conclusion:

Somatic subscale symptoms are more common than urogenital or psychosocial subscales. Postmenopause women manifested higher symptoms than premenopause or perimenopause group women and most were mild to moderate in severity in women visiting our hospital.
Mucormycosis: Cytomorphological Spectrum in Fine-Needle Aspiration Cytology
Authors: Shastri Malvika , Srinivasan Radhika , Kundu Reetu , Dey Pranab , Gupta Nalini , Gupta Parikshaa , Rohilla Manish , Kang Mandeep , Kalra Naveen , Kaur Harsimran , Rudramurthy Shivaprakash M.
Published: December 2023

Background:

Mucormycosis is a fungal infection that can affect multiple organs. The role of fine-needle aspiration cytology (FNAC) in its diagnosis is not well documented.

Aim:

The objective of this study was to describe the detailed cytomorphologic features of mucormycosis on FNAC samples.

Materials and Methods:

A retrospective analysis of all cases diagnosed as mucormycosis on FNAC between January 2014 and July 2021 was performed for detailed cytomorphological evaluation and correlation to clinical data and microbiological studies wherever available. FNA was computed tomography-guided (n = 38), ultrasonography-guided (n = 31) or palpation-guided (n = 12), and slides were reviewed in two cases.

Results:

A total of 83 cases of mucormycosis were evaluated. An immunocompromised setting was observed in 48 cases. The most common site of FNA was the lung (n = 57) followed by liver, soft tissue, palate, mediastinum, orbital/ocular region, and lymph node. Isolated renal involvement, a unique feature, was seen in seven cases. The aspirates were necrotic to pus-like or blood-mixed particulate. Broad, nonseptate, foldable, ribbon-like fungal hyphae showing right-angled branching were seen. The tissue reaction was predominantly necro-inflammatory (n = 36), bland necrotic (n = 22), mixed inflammatory (n = 16), suppurative (n = 5), necrotizing granulomatous (n = 3), and granulomatous (n = 1). Immunocompromised patients showed mixed inflammatory responses more frequently. Fungal culture was positive for Rhizopus species in 2/13 cases and molecular testing in two additional cases corresponding to Rhizopus and Syncephalastrum spp.

Conclusion:

FNA provides quick and conclusive diagnosis of mucormycosis from varied anatomic sites enabling prompt institution of therapy. The tissue response is variable and to some extent dependent on the immune status of the patient.