bluuebunny/crossref_metadata_2025 huggingface dataset:
Adrenocortical Neoplasms in Children
Authors: Jain Vishesh , Sehgal Mehak , Dhua Anjan , Bakhshi Sameer , Kandasamy Devasenathipathy , Mani Kalaivani , Sharma Rajni , Jain Vandana , Tandon Nikhil , Agarwala Sandeep
Published: May 2024

Background:

Adrenocortical tumors are rare tumors in children with a paucity of outcome data, especially in a resource-challenged setting.

Materials and Methods:

A retrospective study was conducted to evaluate the presentation, management, and outcomes of children with adrenocortical tumors who presented to our institute from January 1992 to December 2019.

Results:

During the study period, 28 children were included. Adenoma was present in nine children and the remaining 19 children had adrenocortical carcinoma. The median age of presentation was 48 months. Nearly half of the children with carcinomas presented with a mass compared to only 10% adenomas (P = 0.049). Virilization was present in 60% of the patients and in most cases was associated with Cushingoid features. Three children (15.7%) had metastasis at presentation. All children underwent surgical excision with a spill in 6 and gross residue in two patients. Recurrence was observed in five patients after a mean duration of 11.8 months. The 4-year overall survival and event-free survival were 100% in patients with adenomas compared to 75% and 44%, respectively, in carcinoma. Children who underwent complete surgical excision without any spill had a relatively favorable outcome.

Conclusion:

Adrenocortical tumors are uncommon tumors in children. Adenomas have a favorable outcome. There was no disease-free survival in incompletely resected or metastatic tumors. Tumor spill may also have an adverse outcome in completely resected tumors.
Reverse Gastric Tube Esophagoplasty with and without Lower Esophageal Stump Wrap – Comparison of Outcome
Authors: Menon Prema , Narasimha Rao Katragadda Lakshmi , Samujh Ram , Yaddanapudi Sandhya
Published: May 2024

Aim and Objectives:

The aim of the study is to compare the outcome in children born with long-gap esophageal atresia following reverse gastric tube esophagoplasty (RGTE) with or without the lower esophageal stump as a “fundoplication” wrap.

Materials and Methods:

All children who underwent RGTE between 2008 and 2018 were retrospectively analyzed. Patients in whom the lower esophagus (LE) had been excised as is done routinely in RGTE (Group 1) were compared with those where the LE was wrapped partially or completely around the intraabdominal neo-esophagus (Group 2). Both vagal nerves were preserved to the extent possible. Complications and final outcome, including weight and height centiles were assessed. Follow-up upper gastrointestinal contrast study and reflux scans were studied.

Results:

Nineteen patients (mean age: 15.78 ± 5.02 months [range 10–30 months] at RGTE) were studied; nine in Group 1 and ten in Group 2. Both groups had similar early postoperative complications as well as the requirement of dilatation for anastomotic stricture. Dysphagia for solids was noticed in two patients with complete lower esophageal wrap (n = 4), one requiring removal. More patients in Group 2 had absent reflux (n = 7) compared to Group 1 (n = 3) (P = 0.118). At a mean follow-up period of 45.75 ± 18.77 months (14–84 months), Group 2 children reached better height and weight percentiles compared to Group 1.

Conclusion:

We have described a novel method of using the LE as a “fundoplication” wrap following RGTE. Vagi should be preserved. Those with complete esophageal wrap may develop dysphagia to solids and this is, therefore, not recommended. Lower esophageal wrap patients appeared to have a better outcome in terms of growth and less reflux.
Minimally Jointed Symmetrical Pygopagus Twins – Successful Surgical Separation
Authors: Ratan Simmi K. , Kumar Chiranjiv , Batra Radhika , Bhalotra Anju
Published: May 2024

Conjoined pygopagus accounts for about 17% of all conjoined twins and commonly share the gluteal region, terminal spine, lower gastrointestinal, urological, and reproductive tracts. This makes their separation a very challenging task. We report herein pygopagus twins who had minimal fusion in coccygeal region and could be separated without a complicated procedure. The case is being reported to add to the literature and emphasize that simple fusion in conjoined twins can be relatively easy to manage.
Rare Presentation of Inflammatory Myofibroblastic Tumor as Intussusception in a Child with Idiopathic Aplastic Anemia
Authors: Sharma Ashok Kumar , Katewa Satyendra
Published: May 2024

Inflammatory myofibroblastic tumor (IMT) is an uncommon mesenchymal solid tumor documented in children and young adults. A 7-year-old boy diagnosed case of acquired aplastic anemia, referred to our hospital for hematopoietic stem cell transplantation. He was admitted to the hospital with febrile neutropenia. Blood culture showed persistent Escherichia coli infection. During hospital stay, he had bilious vomiting with tender abdomen suggestive of subacute intestional obstruction. Computed tomography of the abdomen was suggestive of ileocolic intussusception. Emergency laparotomy done which revealed a large polypoid mass involving cecum and part of ascending colon with ileocolic intussusception, child underwent ileotransverse colon resection with end-to-side anastomosis. Immunohistochemistry was suggestive of IMT. The child had persistent fever and protracted course during hospital stay and finally died. E. coli sepsis is associated with IMT and leads to protracted course in immunosuppressed patients such as aplastic anemia. As the imaging and laboratory tests are nonspecific, it should be considered in an immunocompromised children who have E. coli sepsis and abdominal complaints and rare presentation as intussusception.
Serum Matrix Metalloproteinase 7 as a Diagnostic and Prognostic Biomarker for Extrahepatic Biliary Atresia
Authors: Singh Teg Rabab , Goel Prabudh , Bajpai Minu , Kandasamy Devasenathipathy , Malik Rohan , Yadav Rajni , Prakash Shyam , Mani Kalaivani , Tripathi Madhavi , Yadav Devendra Kumar , Dhua Anjan Kumar , Jain Vishesh , Agarwala Sandeep
Published: May 2024

Background:

Differentiation of neonatal cholestasis into neonatal hepatitis (NH) and extrahepatic biliary atresia (EHBA) is essential to formulate the treatment plan; promptness is indispensable for optimal outcomes. The clinical and nonoperative algorithms lack precision; the gold standard investigations (liver biopsy or per-operative cholangiogram) are invasive. There is a need for a noninvasive test which is both, sensitive and specific and has a high likelihood ratio.

Aim:

To study the (diagnostic) role of matrix metalloproteinase 7 (MMP-7) as a serum biomarker to differentiate between EHBA and NH and evaluate the prognostic significance in EHBA based on its correlation with liver histopathology and serological predictors of liver fibrosis – Aspartate-to-Platelet Ratio Index (APRI) and Fibrosis-4 (FIB-4).

Materials and Methods:

This was a prospective study conducted upon patients of neonatal cholestasis presenting with acholic stools (n = 46) with equal number of controls (n = 45) with no liver pathology. Observational parametric included disease-specific workup and serum MMP-7 levels (all participants); liver biopsyl and APRI-FIB-4 (EHBA).

Results:

(Diagnostic) Serum MMP-7 levels were significantly elevated in EHBA (n = 25; 28 ng/mL) as compared to those in NH (n = 21; 1.88 ng/mL) and normal infants (n = 45; 1.2 ng/mL) (P < 0.001 for both). Serum cutoff at 4.99 ng/mL differentiated EHBA-NH with a high sensitivity (96%), specificity (90.5%), and a negative predictive value (95%), with the number needed to misdiagnose being 23. (Prognostic) Inflammatory activity and fibrosis-stage on liver histopathology (METAVIR-and-Ishak scores) correlated with MMP-7 levels. APRI and FIB-4 scores also depicted a strong correlation with each other, age of the patient, and liver fibrosis.

Conclusions:

MMP-7 has a diagnostic value in differentiating EHBA from NH and may also be used as a prognostic biomarker in the follow-up of these patients. MMP-7 levels in controls may be used as a baseline for future studies.
Influence of Parental Awareness Drive on Preoperative Fasting Compliance in Pediatric Day Care Surgery
Authors: Puri Kriti , Kundal Raksha , Kundal Vijay , Pawar Jayadatta Gurudatta , Kumar Ajai , Choudhury Subhasis Roy
Published: May 2024

Context:

Optimum preoperative fasting is imperative for the prevention of aspiration in pediatric patients. The current guidelines advocate 2-4-6 rule for the same. However, direct supervision is lacking in large volume centers.

Aims:

Thus, we aimed to determine the fasting compliance of children preoperatively and to ascertain whether parents understood the significance and purpose of optimum fasting.

Materials and Methods:

Design - A prospective questionnaire-based study regarding preoperative fasting was performed in pediatric patients aged 1–10 years scheduled for “day care surgery” or “same day admission surgery” over 12 weeks. Thereafter, parental awareness drive was carried out, and a re-audit was performed with a questionnaire in the next cohort of patients.

Results:

The number of patients in the pre and postcounseling groups were 98 and 99. Thirteen percent of the patients were optimally fasted for solids initially. Re-audit confirmed compliance increased to 46%. Patients fasting adequately (2–3 h) for clear fluids increased from 22.4% to 51.5% postcounseling. The number for optimally breast-fed children increased postaudit (23.1%–39.1%). Consequent to the drive, parental awareness increased and 49.5% parents knew that only plain water was permitted during fasting. Number of parents considering preoperative fasting important increased from 39.8% to 79.7%. Initially, 27.6% of the parents did not know the reason for fasting, which reduced to 3% postaudit.

Conclusion:

Parents are misinformed and ignorant about optimum preoperative fasting. Adequate education and awareness to improve their knowledge was associated with increased compliance for optimal fasting.
Muscle-Sparing Skin Crease Incision Posterolateral Thoracotomies in Pediatric Patients
Authors: Gupta Rahul , Mathur Praveen , Bhandari Anu
Published: May 2024

Context:

Standard posterolateral muscle cutting thoracotomies in pediatric patients are associated with morbidities in terms of poor motor and esthetic outcomes and also more postoperative analgesia requirement, when compared with muscle-sparing technique.

Aims:

The aim of this study is to evaluate the outcomes of muscle-sparing skin crease incision posterolateral thoracotomies in pediatric patients in terms of abovementioned variables.

Settings and Design:

This prospective observational study was conducted over a period from January 2016 to July 2020 in a tertiary care teaching institute.

Materials and Methods:

All patients of stage 3 empyema and pulmonary hydatidosis were included in the study.

Results:

Thirty-nine patients fulfilled the inclusion criteria. There were 38 children with organized (Stage 3) empyema and one patient with bilateral lung hydatid. There were 24 males and 15 females; age ranging from 6 months to 15 years. Right thoracotomy was performed in 28, left in 10, and bilateral in one patient with lung hydatid. Adequate exposure was achieved in all cases. Decortication with complete excision of thickened parietal pleura with stripping of the visceral peel and release of the entrapped lung was performed in all 38 patients. In 5 children along with decortication, repair of bronchopleural fistula due to necrotizing pneumonia was performed. Bilateral thoracotomies with pericystectomies were performed with a gap of 3 weeks for lung hydatid. Lung expansion assessment at 3 months was satisfactory. Ultrasound assessment of the latissimus dorsi muscle and serratus anterior muscle at 4 weeks revealed complete integrity in all the cases. Most of the patients achieved satisfactory motor and esthetic outcomes.

Conclusions:

Muscle-sparing skin crease incision posterolateral thoracotomy is a viable alternative to standard posterolateral muscle cutting thoracotomy, especially in a resource-challenged setting. The technique is easy to perform with satisfactory exposure.
Comparison of Cisplatin Monotherapy and PLADO in the Management in Children with Standard-Risk Hepatoblastoma in a Resource-Challenged Nation
Authors: Agarwala Sandeep , Jain Vishesh , Dhua Anjan , Srinivas Madur , Goel Prabudh , Bakhshi Sameer , Iyer Venkateswaran K , Yadav Rajni , Jana Manisha , Naranje Priyanka , Bhatnagar Veereshwar
Published: May 2024

Background :

Recent SIOPEL studies have shown cisplatin monotherapy to be equally effective in management of Standard risk Hepatoblastoma (SRHB)as compared to PLADO.

Aims and Objectives:

To study the chemotherapy, response and outcomes in children with SRHB.

Material and Methods:

A retrospective study was conducted and all children with SRHB who presented to us from June 2007 to December 2017 were included. All patients with standard risk hepatoblastoma who had received at least 2 cycles of chemotherapy were included. Data regarding the demographics, PRETEXT stage, chemotherapy, response to chemotherapy and outcomes were recorded. Kaplan Meier survival analysis was performed to calculate 5 year overall survival (OS) and event free survival (EFS).

Results:

Thirty two children were included in the study. The disease was PRETEXT I in 5 (15.6%), II in 9 (28.1%) and 18 (56.2%). Nineteen children (59.4%) received Cisplatin monotherapy and of these 6 patients (all PREXT III) had poor response and the chemotherapy was upgraded to PLADO. The remaining 13 (40.6%) received upfront PLADO chemotherapy. Only 31 patients could be operated. Tumor recurred in 5 patients, 2 who had upfront PLADO and 3 patients had been upgraded to PLADO. The 5 year OS and EFS was 100% in the monotherapy group (n=13), 92% and 69% in the upfront PLADO group (n=13), and 62% and 22% in the upgraded to PLADO group (n=6). Patients with PRETEXT III disease in whom chemotherapy was upgraded to PLADO had significantly lower survival (p=0.036) compared to those who received upfront PLADO chemotherapy.

Conclusion:

Two thirds of patients with PRETEXT stage III who received cisplatin monotherapy showed poor response and were upgraded to PLADO chemotherapy. These patients had a significantly poorer outcome compared to the rest of the cohort. PRETEXT stage III standard-risk hepatoblastoma may benefit from PLADO chemotherapy instead of cisplatin monotherapy.
Dog Bite Causing Intestinal Perforation in a Child
Authors: Garnaik Deepak Kumar , Jain Jaydeep , Yhoshu Enono
Published: May 2024

Dog bite injuries are common in children. They are a major cause of morbidity and mortality involving commonly the extremities, head, and neck. Injuries to the torso represent only 10% of injuries. Visceral injury by a dog bite in children is a rare clinical scenario with very few cases reported. We present a 2-year-old female child who suffered a severe dog bite injury causing colonic perforation.
Kluth Type I-2 Variant of Pure Esophageal Atresia – First Case Report and Challenges in its Management
Authors: Kapoor Rohit , Gupta Amit , Chadha Rajiv
Published: May 2024

This is the first case report of the Kluth type I-2 variant of esophageal atresia. The peculiar anatomy of this variant does not suit (1) esophageal substitution via posterior mediastinal route, (2) esophageal lengthening for preserving native esophagus and (3) distal esophageal stump stoma for gastric feeds.
Is Ultrasound-Guided Transversus Abdominis Plane Block Superior to a Caudal Epidural or Wound Infiltration for Intraoperative and Postoperative Analgesia in Children Undergoing Unilateral Infraumbilical Surgery? A Double-blind Randomized Trial
Authors: Rautela Mukesh Singh , Sahni Ameeta , Dalal Niti
Published: May 2024

Background and Aim:

Caudal block (CB) is the standard of care in pediatric surgeries. Ultrasound (USG) transversus abdominis plane (TAP) block has also been used as an effective regional anesthesia technique. We compared the duration of postoperative and intraoperative analgesia between TAP block, CB, and local wound infiltration (LI) in children undergoing unilateral infraumbilical abdominal surgery.

Materials and Methods:

One hundred and twenty children, 3–10 years old and American Society of Anesthesiologists Grade I and II, undergoing elective unilateral infraumbilical abdominal surgery were allocated to three groups. Group TAP: USG-guided TAP block with 0.5 ml/kg of 0.25% bupivacaine; Group CB: CB with 0.75 ml/kg of 0.25% bupivacaine; and Group LI: Local wound infiltration along the incision with 0.5 ml/kg of 0.25% bupivacaine. The primary outcome was the efficacy of postoperative analgesia using modified objective pain score (MOPS), and the secondary outcome was to determine intraoperative analgesia with fentanyl requirement and minimum alveolar concentration (MAC) hour of isoflurane among the three groups.

Results:

The MOPS was statistically better in Group TAP compared to group CB and group LI at 8 and 24 h postoperatively. The mean ± standard deviation duration of postoperative analgesia in groups CB, LI, and TAP was 6.84 ± 0.47, 2.3 ± 1.26, and 9.78 ± 1.02 h, respectively. The intraoperative requirement of fentanyl and MAC hour was least in Group CB.

Conclusion:

We found that USG-guided TAP block is a good alternative, with longer and effective postoperative analgesia compared to CB. However, the quality of intraoperative analgesia was best in group CB. Local infiltration was a poor alternative.
Pediatric PseudoTumoral Hepatic Tuberculosis. A Great Mimicker!!
Authors: Peters Nitin James , Samujh Ram , Gunasekaran Vidhya , Sodhi K. S. , Duseja Ritambara
Published: May 2024

Pediatric liver masses are rare and difficult to treat. Common liver masses in children include hepatoblastoma, hemangiomas, liver abscesses, and hydatid disease. Isolated liver tuberculosis (TB) is rare in children and can have variable clinical presentations. We report a child with isolated liver TB masquerading as a liver tumor.
Frozen Section Biopsy and Nephron-Sparing Surgery for a Multiloculated Cyst of the Kidney; Is this the Ideal Approach?
Authors: Aditya M. , Chowdhary Sujit K. , Kashyap Vikas
Published: May 2024

Multiloculated cystic renal masses are uncommon in the pediatric population. The presentation may be as an asymptomatic incidental finding on imaging, abdominal mass, abdominal pain, or urinary tract infection. The differentiation between benign and malignant causes of a cystic lesion by clinical and radiological examination is difficult. Tru-cut biopsy is not recommended due to fear of upgrading a malignant tumor. A definitive diagnosis is confirmed histopathologically only after surgery. Based on certain imaging characteristics, benign nature can be suspected and a conservative approach to surgery can be contemplated to save the kidney. Frozen section biopsy is useful in ruling out malignancy while doing nephron-sparing surgery (NSS) in these patients. NSS may be done by an open or minimally invasive approach. After histological confirmation of cystic nephroma, no other adjuvant treatment is necessary, but long-term surveillance is strongly recommended.
Correlation between Excessive Smartphone usage, Basic Psychological Needs, and Mental Health of University Students
Authors: Putchavayala Krishna Chaitanya , Sasidharan K. Rajesh , Krishna Dwivedi , Deepeshwar Singh
Published: May 2024

Objectives:

The primary aim of the current study was to examine the unique contribution of psychological need frustration and need satisfaction in the prediction of excessive usage of smartphones and its relation to psychological distress and mindfulness.

Methods:

We conducted a correlational study using the smartphone addiction scale – shorter version, basic psychological needs satisfaction and frustration scale, psychological distress, and mindfulness among 423 graduate and postgraduate engineering students from Bengaluru, South India.

Results:

The results showed that excessive usage of smartphones is positively correlated with the time spent on the phone r = 0.19, P ≤ 0.05; and basic psychological needs frustration r = 0.18, P ≤ 0.05; and negatively correlated with basic psychological needs satisfaction r = −0.19, P ≤ 0.05 and mindfulness r = −0.39, P ≤ 0.001. However, among the optimal users of the smartphone group, time spent is positively correlated with satisfaction at r = 0.13, P ≤ 0.05, and further, basic psychological needs satisfaction is negatively correlated with frustration at r = 0.30, P ≤ 0.001 and also found a positive correlation between mindfulness and basic psychological needs satisfaction at r = 0.31, P ≤ 0.001.

Conclusion:

The results suggest that excessive usage of smartphones is associated with frustration, psychological distress, and time spent on the mobile. However, there is a positive trend in the time spent on the phone among the optimal users of smartphones suggests that smartphones are used as a coping mechanism to gain momentary satisfaction.
Psychosocial Health and Stigma among Health-care Workers Involved in COVID19 Management during the First Wave of the Pandemic in Mumbai: A Qualitative Study
Authors: Prusty Ranjan Kumar , Kulkarni Ragini , Gawai Priyanka , Velhal Gajanan , Sadawarte Deepika , Kharnare Swapnil , Thomas Beena E , Menon Geetha , Aggarwal Sumit , Chakma Tapas
Published: May 2024

Background:

The unprecedented onset of coronavirus disease 2019 (COVID-19) had a huge impact on health-care facilities, leading to different psychosocial challenges among health-care workers (HCWs) during this pandemic.

Aim:

This study aimed to explore the impact of COVID-19 on the work, family, and personal life of HCWs engaged in COVID-19 duties during the first wave in India and gain insights on the coping strategies.

Materials and Methods:

The findings from 12 qualitative in-depth interviews were analyzed and presented in this article. This study is a part of a mix-method design study conducted at two hospitals and one community site in Mumbai, Maharashtra. The present qualitative sample was drawn conveniently from the randomly selected quantitative sample chosen from the three sites.

Results:

This study highlights that in the early stage of the COVID-19 pandemic, HCWs experienced transition in work life, burnout, disruption in family life, negative emotions such as fear, and experiences of stigma. The findings also reveal that while institutional workers faced discrimination and stigma outside their workplace, noninstitutional workers faced discrimination at multiple sites during traveling and at in their residential places and additionally faced harassment while working in the community. The findings also suggest that despite numerous challenges faced by HCWs, they were driven by a sense of responsibility and displayed resilience.

Conclusion:

Considering the HCWs as the backbone of the health-care system, it is crucial to boost and maintain the mental well-being of HCWs by providing timely and tailored interventions to sustain their resilience and build better responses to future pandemic.
Pattern and Severity of Substance Use in Help-Seeking Adolescents of North-East Part of India
Authors: Rabha Anju Moni , Deka Kamala
Published: May 2024

Background:

Adolescence is a transitional phase between childhood and adulthood, in which both physical and psychological aspects are involved in the process of growth and development. Drug dependence among adolescents is rising everywhere in the world. According to studies, adolescents who live in slums in India have a 46% of tobacco use rate.

Objective:

This study aims to evaluate the pattern and severity of substance use in help-seeking adolescents.

Materials and Methods:

On the Teen Addiction Severity Index Scale (T-ASI), 43 adolescents seeking help were interviewed to assess the severity of substance use.

Results:

The mean age of adolescents interviewed was 17 years. Male preponderance was noted 95.3%. The majority of the adolescents were students 76.7%, belonged to a nuclear family setup. The adolescents reported the mean age for starting substances to be 13 years. About 42% of adolescents reported the use of multiple substances during the interview. On the T-ASI scale, adolescents reported difficulty in different domains such as chemical use 6 (1.8), school status 6 (1.8), employment 3.72 (3.7), family support 12.46 (3.63), peer relations 2.9 (1.2), legal problems 0.28 (1.26), and psychiatric problem 6.44 (1.42) due to substance use.

Conclusion:

The present study suggests marked substance use severity in adolescents in help-seeking group. Higher severity of substance use in adolescents is associated with impairment in different domains of adolescent’s lives.
Cyberbullying: A Narrative Review
Authors: Grover Sandeep , Raju V. Venkatesh
Published: May 2024

Background:

With the rapidly expanding digital world over the past decade and more to the current context of the coronavirus disease 2019 pandemic, where online activities have replaced most of the offline activities, it is important to understand bullying, which has crossed from its traditional domain of offline to online and is understood as cyberbullying.

Aim:

This review aims to assess the concept, types of cyberbullying, prevalence, risk and protective factors, conceptual models explaining cyberbullying, psychological impact, and preventive strategies for cyberbullying.

Methodology:

Internet sources (PubMed and Google Scholar) were searched for the available literature, and a narrative review was synthesized. Different types of cyberbullying are defined in the literature. The prevalence rates vary depending on the time frame of assessment being considered. The mean prevalence of victimization is 10%–40%, and the prevalence of perpetration is 3%–20%.

Results:

Different risk and protective factors have been identified for being a victim of cyberbullying and becoming a cyberbully. Cyberbullying can have a significant negative psychological impact on the victims. Prevention of cyberbullying involves guidance for parents, advice for schools, and guidance for the health-care providers. Cyberbullying is becoming a major issue for many teenagers, resulting in unforeseen deviances and negative effects in their lives.

Conclusions:

Efforts should be taken to successfully avoid and respond to it, as well as to provide kids with tools to lessen their own risk of victimization.
Psychiatric Morbidity and its Impact on Quality of Life in Patients of Chronic Kidney Disease Undergoing Hemodialysis
Authors: Singla Himanshu , Avasthi Ajit , Gupta Krishan Lal , Grover Sandeep
Published: May 2024

Aim:

This study aims to evaluate the prevalence of psychiatric morbidity and suicidal behavior by using a structured diagnostic interview in patients of chronic kidney disease currently on dialysis. An additional aim of the study was to evaluate the impact of psychiatric morbidity on quality of life (QOL).

Methodology:

One hundred and ten patients undergoing hemodialysis were evaluated, at least 24 h after the last dialysis on Mini International Neuropsychiatric Interview PLUS (MINI PLUS), Columbia Suicide Severity Rating Scale (C-SSRS), and Beck Depression Inventory Second Edition.

Results:

On MINI-PLUS, about two-thirds (67.3%) of the study sample fulfilled at least one-lifetime psychiatric diagnosis and half of the study participants fulfilled a current psychiatric diagnosis. More than one-fourth (29.1%) of the study participants had more than one psychiatric diagnosis. Among various psychiatric disorders, depressive disorders were the most common (45.5%). About one-third of the participants had suicidality, as assessed on MINI-PLUS and C-SSRS. Compared to those without psychiatric morbidity, those with psychiatric morbidity had a poor QOL.

Conclusions:

In view of the high psychiatric morbidity and its negative impact on the QOL of patients undergoing hemodialysis, there is a need for close liaison between nephrologists, transplant surgeons and mental health professionals.
An Exploratory Case Study on the Use of Rational Emotive Behavior Therapy for Treatment of Illness Anxiety
Authors: Nandini J
Published: May 2024

Illness anxiety disorder is characterized by preoccupation with having or developing a serious illness accompanied by maladaptive safety or avoidance behavior that impairs the persons everyday functioning. It deteriorates the quality of life of the individual. Cognitive behavior therapy is often a good treatment choice. Here, I present the efficacy of rational emotive behavior therapy in addressing the irrational beliefs of the client and its effectiveness in alleviating behavioral and cognitive symptoms of illness anxiety.
A Study to Assess the Level of Burnout and Its Determinants among Medical Practitioners Working in a Tertiary Care Center in South India
Authors: Krishna G. Ananda , Chittooru Chandra Sekhar , Chittem Sravana Deepthi , Darivemula Surendra Babu , Bheemisetty Niharika
Published: May 2024

Background:

Burnout is defined as a feeling of hopelessness and inability in carrying out one's job effectively. Burnout in the life of medical practitioners is a term used to describe a psychological state, which appears after a long period of exposure to psychosocial risk factors such as high patient load, long working hours, and unreasonable demands from patients. The objective was to study the prevalence of burnout among medical practitioners and factors associated with burnout.

Methodology:

The study was a descriptive cross-sectional study conducted among medical practitioners of tertiary care hospital with a sample of 102. The study was conducted using the Maslach Burnout Inventory with additional questions on demographic factors, work experience, hours of work, and specialty. Data were entered in MS Excel 2007 and analyzed with IBM SPSS statistics 21 version.

Results:

Out of 102 subjects, 26 (25.5%) members were suffering from burnout in any one of the three dimensions. In the emotional exhaustion, 15 (14.7%) were experiencing high scores, 14 (13.7%) members, and 73 (71.6%) members were experiencing moderate and low scores, respectively. However, in the depersonalization dimension, just 1 (1%) member was experiencing high score, whereas 11 (10.8%) members and 90 (88.2%) members were experiencing moderate and low scores, respectively. In the personal accomplishment dimension, 16 (15.7%) members were experiencing high scores, whereas 13 (12.7%) members and 73 (71.6%) members were experiencing moderate and low scores, respectively.

Conclusions:

Burnout exists among medical practitioners, and measures should be taken to identify causes and take remedial actions.
Pediatric bee sting envenomation with multiorgan challenge: A case report
Authors: Kulshrestha Shriyansh , Khan Niha , Poddar Banani , Azim Afzal
Published: May 2024

Bee stings commonly result in minor reactions, but severe cases can lead to systemic complications including anaphylaxis and multiorgan dysfunction. We present a case of an 8-year-old child experiencing severe bee sting envenomation, manifesting as various organ dysfunctions including acute kidney injury and acute pancreatitis. Renal replacement therapy was effective in managing renal dysfunction. Further research is warranted to explore targeted antivenom therapies for severe bee sting reactions. Prompt recognition and a multidisciplinary approach are crucial for successful management. Further research into specific treatments is needed to improve outcomes in such cases.
Fluid overload in critically ill children: A narrative review
Authors: Charaya Shubham , Angurana Suresh Kumar
Published: May 2024

Fluid overload (FO) is a common and challenging complication encountered among critically ill children admitted to pediatric intensive care unit (PICU), posing significant risks for morbidity and mortality. The pathophysiology of FO involves disruptions in fluid balance, exacerbated by underlying medical conditions, critical illness, and therapeutic interventions. Assessment of fluid status relies on a combination of clinical evaluation, laboratory tests, and imaging studies, with a focus on early detection and intervention to prevent complications. Management strategies for FO in the PICU encompass both preventive and therapeutic approaches. Prevention involves judicious fluid resuscitation, dynamic fluid assessment, advanced hemodynamic monitoring, careful monitoring of fluid input and output, early recognition of at-risk patients, and individualized approach. Therapeutic interventions may include diuretic therapy, optimization of hemodynamic support, and renal replacement therapy tailored to individual patient needs. Challenges in managing FO in PICU include balancing the need for adequate tissue perfusion with the risk of exacerbating FO and preventing complications such as electrolyte disturbances and organ dysfunction. Multidisciplinary collaboration, evidence-based practices, and continuous monitoring are essential for successful fluid management in critically ill children. This review aims to provide a comprehensive overview of the current understanding and management strategies for FO among critically ill children.
Evaluation of Interleukin-1β and Tumor Necrosis Factor Alpha Concentration in a Sample of Endodontic Patients in Hillah City, Iraq
Authors: Kadhum Nora Hassan , Al-Khafaji Thulficar Ghali , Hassan Hanan Selman
Published: May 2024

Background:

Endodontic illness, one of the most common chronic infectious diseases in the world, is brought on by an infected and inflamed dental pulp, which results in bone destruction around the tooth root, excruciating pain, and tooth loss.

Objectives:

This study aimed to determine levels of pro-inflammatory (interleukin-1β [IL-1β] and tumor necrosis factor alpha [TNF-α]) by enzyme-linked immune sorbent assay in the saliva of patients with endodontic infection against the gender and age groups.

Materials and Methods:

From November 2021 to March 2022, 60 patients (n = 60) were referred to specialized dentistry centers and private clinics in Hillah City, Iraq, with 32 (53.33%) females and 28 (46.67%) males, and 20 (n = 20) healthy adults serving as study controls, all of whom were between the ages of 20 and 50.

Results:

There were no major differences between girls and males in both groups, according to the findings of this study. In comparison to the control group, however, patients showed higher significant differences in measuring (IL-1β) and (TNF-α) concentrations (180.8), (119.44) (P ≤ 0.05), respectively. Furthermore, the amounts of IL-1β and TNF-α in female saliva were substantially greater than in male saliva.

Conclusion:

Pro-inflammatory IL-1β and TNF-α were shown to be higher in patients with primary endodontic disease than in normal subjects.
Sociodemographic characteristics and fate of hospitalized burned patients in Al-Hilla city
Authors: Hasan Hiba Khaleel , Al-Humairi Ameer Kadhim
Published: May 2024

Background:

A burn is defined as a damage to the tissues due to high temperatures or heat, cold, electrical, chemical, friction, or irradiation. In developing countries such as Iraq, burn injuries are widespread, particularly in low-income and rural regions. Burns are considered the fourth most prevalent type of injuries worldwide.

Objectives:

The aim of this study is to assess the sociodemographic characteristics of hospitalized burned patients, as well as patients’ fate and related risk factors.

Materials and Methods:

This was a cross-sectional study. The data were collected by interviewing patients who admitted in the burns ward center of Al-Imam Al-Sadiq Teaching Hospital or their companions, for a 3-month period from February 1, 2022 to May 1, 2022. Statistical analysis was done by SPSS version 27.

Results:

We collected data from 73 burned patients, which showed that most of them were males 53.4%, the mean age ± standard deviation was 18.76 ± 16.81 years, 65.8% living in rural areas, most patients had scald burn 43.9%, with second degree of burns and total body surface area (TBSA) <50%. About the outcome, 38.3% died. We found a significant (P-value >0.05) association between the fate of burned patients and the age, gender, place of burn, degree of burns, TBSA involved, and the presence of inhalational injury.

Conclusion:

The majority of the burned patients were male children, with scald burns, second-degree burns, and TBSA more than 50%. The mean age was 18.67 ± 16.81 years. The mortality rate was 38.3% and increased with age, female gender, flame burn, TBSA more than 50%, and with inhalation injuries.
Assessment the risk factors of congenital heart disease among children below 5 years age in Babylon province
Authors: Mohammed Noor Ibraheem , Al-ghanimi Khudhair Shukur
Published: May 2024

Background:

Congenital heart diseases (CHDs) account for 25% of all congenital malformations. CHDs are an important cause of morbidity and mortality in children. Prevention of CHDs can be achieved by preventing exposure to modifiable risk factors that affect the cardiac development during pregnancy.

Objectives:

To assess the sociodemographic and medical risk factors of congenital heart diseases among children below five years in Babylon city, Iraq.

Materials and Methods:

A retrospective case control study conducted from 1st of February to 1st of May, 2022, at Shaheed Al-Mehrab center, Babylon Maternity/Pediatric Hospital and Al-Imam Al-Sadik General Teaching Hospital, consisted of 100 participants classified to 50 CHDs cases and 50 controls by Echocardiogram, the mother/caregiver of each child was interviewed using a pre-tested questionnaire.

Results:

The age of the participants ranged from one day to 4.5 years, with a mean age (10.4 ± 13.2) months. (52%) of CHDs cases were females, (68%) of them were below one year age and (54%) of them reside in urban area, 28% of CHDs was VSD and 42% of the cases present with chest infection. BMI percentile was significantly lower in cases of CHDs (P = 0.008) and there was a significant relationship between CHDs and family history of CHDs (P = 0.013).

Conclusion:

Majority of the cases were females, below one year age and reside in urban area, presented with VSD and chest infection. BMI percentile was lower in cases of CHDs and there was a significant relationship between CHDs and family history of CHDs.
Clinical Characteristics and Spectrum of Cyanotic Congenital Heart Diseases Diagnosed in Pediatric Age Group
Authors: Azeez Dana Majeed , Habeeb Mudhafar Abdurrahman
Published: May 2024

Background:

It is necessary as early as possible to diagnose and treat cyanotic congenital heart defects (CCHDs) because survival of them is highly related to the time of diagnosis. But not all serious congenital heart diseases (CHDs) clinically appear with cyanosis during the first few days of life. There are several types of CCHD, some of them are more common like tetralogy of fallot (TOF), transposition of great arteries (TGA), and tricuspid atresia.

Aim:

This study was conducted to determine various types of cyanotic CHDs and clinical presentations of cyanotic CHDs and different procedures were done for them in children at Erbil.

Materials and Methods:

This was prospective, cross-sectional study, carried out in Pediatric Cardiac Department of Hawler Surgical Specialty Hospital-Cardiac Centre. All patients aged 0-18 years were included in the study.

Results:

During the study period, 124 cases were diagnosed with cyanotic CHDs. The common CHD type was TOF (46.8%), followed by D-TGA (12.1%), DORV (10.5%), tricuspid atresia (9.7%), and single ventricle (8.9%). Interventional management was done in 44.4% of studied children with CCHDs, total surgical repair was main procedure (14.5%). The common symptoms of cyanotic CHDs were commonly murmur (90.3%), shortness of breath (85.5%), cyanosis (76.6%), and fatigue (76.5%).

Conclusion:

TOF was the most common CCHD noted in our study. Ebstein anomaly, truncus arteriosus, and PPH were the least prevalence CCHD. Heart murmur was the most common presenting sign while shortness of breath and central cyanosis were the most common presenting symptoms.
Histological Changes in Liver and Cardiac Rat Tissues after Exposure to Chitosan Nanoparticles Orally
Authors: Ali Liqaa Oday , Khalfa Hydar M. , Al Sahlanee Rasha , Almsaid Hayder L. F.
Published: May 2024

Background:

As safe natural biopolymer, chitosan is resulting from chitin deacetylation. Owing to its antimicrobial and antifungal effects, chitosan and/or its biological derivatives have gained extensive interest. The antibacterial activity of chitosan exhibits only in a low pH medium since its solubility above pH 6 is poor. Several factors affect chitosan antibacterial action such as chitosan type, polymerization degree, and certain other chemicophysical features.

Objectives:

The current study was intended to inspect the chitosan injury on hepatic and myocardial cells in rats in different concentrations.

Materials and Methods:

Chitosan was purchased and prepared at various concentrations. Laboratory Wistar albino rats were orally fed with different concentrations of chitosan. Histological examination of rat liver and cardiac tissues was performed accordingly.

Results:

A noticeable increase in animal weight is seen as the concentration of chitosan increases. Normal histological appearance with slight hemorrhaging and abnormal histological appearance with more abundant hemorrhaging and cellular vacuolation were present in liver tissues. Profound histological damage with more abundant hemorrhaging and lymphocytic infiltration along with sinusoid enlargement in the liver as well as districted nuclei was also present. Cardiac tissues were less affected by changes in chitosan concentration. Liver histological changes are attributed to the metabolic breakdown of chitosan in the liver. A noticeable decrease in vascular thickness is seen in both cardiac and liver vascular networks.

Conclusion:

The study found that chitosan has robust cytotoxic influences on certain organs. However histological damage is more prominent and is seen in rat liver tissues. Histological damage is confirmed by the abnormality of histological and cellular damage seen.
Study the association of Mycoplasma pneumoniae and (rs35445101) HLA-DRB1gene polymorphism with the immune susceptibility to rheumatoid arthritis
Authors: Alfatlawi Wael Rasheed Obaead , Al-Saadi Mohammed A K , Ali Akbar Adil Hasan
Published: May 2024

Background:

Rheumatoid arthritis (RA) is an inflammatory immune disease that primarily affects the joints and has its root cause in immune system malfunction. It is unclear what causes RA, but research points to a combination of genetic predisposition, environmental exposures, and microbial infections.

Objectives:

This study aimed to illustrate the relationship between RA and Mycoplasma pneumoniae.

Materials and Methods:

The work was performed on 50 RA subjects of various ages, ranging from 25 to 75 years of age, who were treated at the rheumatology clinic in the city of Medical Marjan between February 2022 and October 2022. Blood samples were used for DNA extraction. VEGF-A.HLA-DRB1 and mycoplasma were detected by enzyme-linked immunosorbent assay.

Results:

The results show a significant increase in the serum concentration level of VEGF-A in RA patients infected with M. pneumoniae as compared to healthy individuals, but the results of RA patients with M. pneumoniae infections and RA patients without M. pneumoniae infections were nonsignificant (P > 0.05). The results showed a significant increase in the serum concentration level of HLA-DRB1 in the RA patients infected with M. pneumoniae as compared to the RA patients noninfected with M. pneumoniae and healthy individuals.

Conclusions:

In HLA-DRB1, the SNP rs35445101 shows that A allele behavior as recessive pathogenic allele in which the individual that carries AA genotype has a susceptibility to the disease 9.75 fold compared to an individual that carries GG and AG genotype (odds ratio 9.75 confidence interval 95% 1.19–79.78).
Medication Adherence in Hypertensive Diabetic Patients
Authors: Baiee Hasan Alwan , Makai Mustafa Bahaa
Published: May 2024

Background:

Diabetes-related hypertension increases mortality risk by 7.2 times in the underdeveloped countries such as Iraq, with a greater risk of death. In developing countries, patients’ adherence to chronic illness treatments such as hypertension and diabetes is low. Nonadherence is linked to higher rates of hospitalization and poor health outcomes.

Objectives:

The aim of this study to determine the prevalence of medication adherence among the hypertensive diabetic patients and to identify factors that associated with poor or nonadherence to medications.

Materials and Methods:

This is a hospital-based descriptive cross-sectional study. The study included a sample of 385 hypertensive diabetic patients of both gender, their ages above 18 years. The study was carried out from February 2022 to the end of May 2022 at the consultation clinics at Imam Al-Sadiq and Marjan Teaching Hospitals, Babylon, Iraq. Following verbal consent, the participants were interviewed using a prepared structured validated and reliable questionnaire will be use that includes demographic characteristics using the Morisky 8 Item Medication Adherence Scale (MMAS-8) was used to assess medication adherence.

Results:

This study showed that more than half of the patients (51.2%) had low adherence, whereas 22.9% had medium adherence. Those with high adherence constituted 26.0%. There were statistically significant associations between good adherence and high level of education, younger age, and nonsmoking. Patients with good adherence to medications have better blood pressure and blood sugar control.

Conclusion:

The level of medication adherence among diabetic hypertensive patients in Babylon province is low.
Pattern of Substance Use in the Elderly
Authors: Karahda Aarti , Singh Priti , Gupta Rajiv , Prasad Shobhit Kumar
Published: May 2024

Background:

There are many unique features related to substance abuse in the elderly, which is an underestimated problem in society.

Objectives:

A cross-sectional exploratory study was conducted in a North Indian tertiary care setting to assess the pattern of substance use in the elderly.

Materials and Methods:

Fifty cases were included in the study via purposive sampling; a Drug Abuse Monitoring System pro forma and a semistructured pro forma designed to gather information on sociodemographic and substance use characteristics were used. Descriptive statistics were applied. Continuous variables were summarized as means and standard deviations and categorical variables as counts and percentages.

Results:

The mean age of the samples was 64.12 ± 4.54 years. Alcohol use was noted in 66% of the cases, tobacco use in 76%, opioid use in 16%, cannabinoid use in 4%, and sedative/hypnotic use in 4%. Majority of the cases were married, studied up to high school, self-employed, and living in joint family. Majority of the cases had initiation of substance use in young age due to peer pressure, and the reason for change in pattern were in majority mainly family issues and tolerance. Majority of the cases were brought by family members for treatment seeking.

Conclusions:

The issue of substance abuse in elderly population is underestimated, and studies are scarce in finding the exact prevalence in the society.