bluuebunny/crossref_metadata_2025 huggingface dataset:
Risk of work addiction in academic physicians prevalence, determinants and impact on quality of life
Authors: Merchaoui Irtyah , Gana Abir , Machghoul Samia , Rassas Ines , Hayouni Marouen , Bouhoula Marwa , Chaari Neila , Hanchi Adnene , Amri Charfeddine , Akrout Mohamed
Published: November 2021

The prevalence of work addiction is constantly increasing worldwide, ranging from 8.3% to 30%, especially among physicians. The aim of this study was to assess the prevalence and characteristics of Work Addiction among academic physicians and its influence on their mental and physical health. This is a cross-sectional survey conducted among the 293 academic physicians practicing in the teaching hospitals of the faculty of Medicine of Monastir in Tunisia. We used a self-administered questionnaire, with the «Work Addiction Risk Test » and the «SF-8 health survey». The participation rate was 24.3%, 24% were addicted to work and 56% were at high risk of addiction. WART score was significantly higher in single, females with medical history of depression or associated depression, poor physical and mental health and psychosomatic symptoms. It was significantly decreased with age, and seniority. Certain psychosocial factors increased WART score. Mental health score was significantly lower in single, females, assistant professor and increased with age, seniority and number of children. Academic physicians are at a high risk of developing work addiction. Preventive guided measures to reconcile family life and work as well as organizational strategies are recommended.
Análise de redes sociais no esporte pela ótica da abordagem ecológica: um ensaio teórico
Authors: Melli Neto Bruno , Fuini Puggina Enrico , Pombo Menezes Rafael , Cláudio Machado João , Vanella Ricardo , Aquino Rodrigo
Published: November 2021

A análise de desempenho é uma disciplina intimamente relacionada à pedagogia do esporte. As bases teóricas que sustentam as escolhas metodológicas devem ser bem estabelecidas para existir uma convergência entre os instrumentos de avaliação e o processo de ensino e treinamento. Este ensaio teórico teve por objetivo apresentar e discutir a importância e representatividade da análise de redes sociais para avaliar o desempenho em esportes coletivos. O principal objetivo da análise de redes sociais é estudar a relação entre os jogadores para identificar possíveis causas e consequências dos eventos ocorridos durante a partida. Sendo assim, a análise de redes sociais trabalha de forma diferente das análises tradicionais, nas quais o principal foco está no sujeito, ou em análises notacionais que são as mais comumente utilizadas e que buscam a acumulação da frequência dos eventos ocorridos (e.g. gols marcados, posse de bola, zonas de finalização). Tal instrumento de avaliação, teoricamente posicionado numa abordagem ecológica, mostra-se eficaz para a identificação dos padrões de interação em um grupo e o entendimento dos artifícios sociais que ajudam a compreender o desempenho em uma equipe. Assim, as equipes passam a ser analisadas como grupos sociais e não como sujeitos isolados. Neste ensaio, também expomos as principais aplicações práticas desse instrumento de avaliação em diferentes esportes coletivos, como o futebol, futsal, handebol, basquetebol e voleibol.
Speaking from Experience: Medicaid Consumers as Policy Storytellers
Authors:   North Carolina State University, North Carolina Institute of Medicine, Colville Kathleen , Merry Melissa K. ,   University of Louisville
Published: November 2021

Kentucky’s proposed Medicaid reforms, initiated in 2016 and blocked in federal court in 2018 and again in 2019, elicited an extraordinary volume of public input on the value of Medicaid (publicly-funded health insurance for low-income individuals). Personal statements from current and former Medicaid consumers, through written comments submitted to the Centers for Medicare and Medicaid Services, offer insights into the strategies employed by a segment of the public that contributes infrequently to policy debates. Through a combination of manual and automated content analysis of a random sample of 1100 public comments, we analyze the policy narratives of participants, examining how narrative and non-narrative elements varied depending on commenters’ relationship to Medicaid consumers. Nearly all comments met (and most exceeded) the threshold for a policy narrative, while relatively few comments drew on research-based content typically considered privileged in the rule-making process. Further, these narrative elements cohered in distinct storylines from current and past Medicaid consumers and from those who identified as service providers. This research underscores the importance of narratives as sources of evidence in regulatory processes and suggests that public comments are fertile ground for research using the Narrative Policy Framework. This work also illuminates bottom-up narrative construction, a process thus far overlooked in micro-level research presuming that citizens are passive recipients of narratives, rather than producers themselves. For future work examining micro-level narrative production, we identify important considerations, including the role of narrator trust, audience, forms of evidence, setting, and the interaction between the meso and micro levels.
Liquidez acionária e agressividade fiscal no mercado de capitais brasileiro
Authors: Prímola Bernardo Fernandes Lott , Nascimento Eduardo Mendes , Campos Octávio Valente
Published: November 2021

Este estudo investigou a potencial relação entre a liquidez acionária e a agressividade fiscal no mercado de capitais brasileiro. Utilizando uma base de dados de companhias brasileiras de capital aberto do período de 2010 a 2019 - não incluindo o ano de 2020 pelos efeitos atípicos da pandemia da Covid-19 - foram desenvolvidos modelos de dados em painel cuja metassíntese consistiu em avaliar os efeitos longitudinais da liquidez acionária, variál independente, sobre o book tax difference, variável dependente e proxy da agressividade fiscal. Os resultados apontaram uma relação estatisticamente significante e economicamente positiva entre a proxy de agressividade fiscal e a liquidez acionária. O resultado sugere que empresas com ações menos voláteis, com maiores participações relativas em negócios da B3 e menor custo de negociação tendem a adotar um planejamento tributário mais agressivo. Este artigo contribui para demonstrar que em um mercado de capitais emergente, como o brasileiro, os investidores tendem a menosprezar com parcimônia a aumentos pontuais dos lucros por práticas tributárias mais agressivas, contudo, que possam resultar em prejuízos futuros. Outrossim, o presente estudo contribui para demonstrar a importância das divulgações sobre planejamentos tributários, a fim de que os agentes de mercado possam adequadamente apreçar os ativos financeiros.
Immobilization of Providencia stuartii Cells in Pumice Stone and Its Application for N-Acetylglucosamine Production
Authors: Halim Yuniwaty , Devianita Devianita , Hardoko Hardoko , Handayani Ratna , Soedirga Lucia C.
Published: November 2021

Research background. Shrimp shells contain chitin that can be further processed into N-acetylglucosamine, which has been extensively used to treat joint damage. Providencia stuartii has a strong chitinolytic activity and may be utilized in the form of immobilized cells in repeated fermentation. Pumice is a porous and rigid stone that offers superior mechanical strength, making it suitable for immobilization.
Experimental approach. In the research submerged fermentation with different pumice stone sizes and pumice stone/growth medium ratios (m/V) was carried out for 4 days at 37 °C and pH=7.0. The optimum pumice stone size and pumice stone/growth medium ratio (m/V) were used to determine the optimum fermentation cycle for the production of N-acetylglucosamine using immobilized P. stuartii.
Results and conclusions. Pumice stones of 1.0 cm×1.0 cm×1.0 cm and pumice stone/growth medium ratio of 1:5 were found to be the optimum conditions for successful immobilization of (90.0±1.6) % cells and production of (331.4±7.3) g/L N-acetylglucosamine. The highest N-acetylglucosamine concentration of (323.0±2.5) g/L was obtained in the first fermentation cycle, which then decreased and remained stable throughout the last three cycles.
Novelty and scientific contribution. P. stuartii, a strong chitinolytic bacterium previously isolated from rotten shrimp shells, was used for the first time in immobilized form to produce N-acetylglucosamine. The findings in this research showed the potential use of P. stuartii cells immobilized in pumice stone for continuous production of N-acetylglucosamine in repeated fermentation.
Effects of Growth Medium Variation on the Nutri-Functional Properties of Microalgae Used for the Enrichment of Ricotta
Authors: Khemiri Sheyma , Bouchech Ines , Berrejeb Nadia , Mejri Mondher , Smaali Issam , Khelifi Nadia
Published: November 2021

Research background. Microalgae represent an emergent sustainable source of bioactive compounds such as antioxidants, vitamins, minerals and polyunsaturated fatty acids that can ameliorate the nutritional characteristics of foods. The biochemical composition of microalgae could be modulated by varying the culture conditions to enhance the accumulation of biomolecules of interest. The aim of this work is to optimise the nutri-functional properties of two microalgae that can be used in food production.
Experimental approach. Nannochloropsis gaditana L2 and Chlorella sp. SM1 were screened for growth, biochemical composition and radical scavenging activity employing four different growth media (algal, BG-11, f/2 and Conway) with different nutrient composition. The feasibility of using Chlorella sp. SM1 cultivated in BG-11 medium, in an under-investigated Mediterranean dairy product ricotta cheese and its effect on the sensory attributes was investigated. Additionally, Arthrospira platensis was used as reference in sensory analysis.
Results and conclusions. Nitrate- and phosphate-rich media (BG-11 and algal) enhanced the biomass productivity. However, the highest lipid production (23.10 and 11.86 mg/(L·day) by strains SM1 and L2 respectively) and carbohydrate content (34.79 and 44.84 % by SM1 and L2 respectively) were obtained with the nitrate-deficient f/2 medium. Regardless of the used medium, the lipid profile of Chlorella sp. SM1 and N. gaditana L2 remained adequate for different applications with >50 % C16-18 as the main fatty acids. Significant increase in oleic acid (C18:1) content was recorded in response to nitrogen deficiency, being the highest in SM1 in f/2 medium (34 %). Nitrogen deficiency was also found to enhance phenolic compound (expressed as gallic acid equivalents, 48.8 and 35.1 mg/g in SM1 and L2 respectively) and carotenoid contents (2.2 and 2.0 mg/g in SM1 and L2 respectively). Due to its interesting antioxidant potential, Chlorella sp. SM1 was used at different mass fractions (0.2, 1 and 1.5 %) to enrich the ricotta cheese. The sample with 0.2 % Chlorella sp. SM1 was found to give the most appreciated product.
Novelty and scientific contribution. This study presents the production of an innovative ricotta cheese using Chlorella sp. as a functional ingredient, without altering the manufacturing procedure, while maintaining acceptable sensorial characteristics. The biochemical composition of the used strains varied depending on the culture medium composition, which enabled the accumulation of phytonutrients of interest.
Effect of Chitosan Nanoparticles Incorporating Antioxidants from Salvia hispanica L. on the Amaranth Flour Films
Authors: Morales-Olán Gema , Ríos-Corripio María Antonieta , Hernández-Cázares Aleida Selene , Zaca-Morán Placido , Luna-Suárez Silvia , Rojas-López Marlon
Published: November 2021

Research background. Amaranth (Amaranthus hypochondriacus) flour produces films with excellent barrier properties against water vapor, allowing food preservation, but the mechanical properties are poor compared to synthetic films. One strategy to improve these properties is the incorporation of nanoparticles. The particles can also serve as a vehicle for the addition of antioxidant agents into the films. The objective of this work is to optimize the formulation for the preparation of amaranth flour films treated with antioxidant chia (Salvia hispanica L.) extract-loaded chitosan particles using response surface methodology (RSM).
Experimental approach. Chitosan nanoparticles with the extract were synthesized by ionic gelation, and the films were made by the casting method. Three independent variables were assigned: amaranth flour (4–6 %), glycerol (25–35 %) and chitosan nanoparticles loaded with the chia extract (0–0.75 %). We then evaluated the physical (thickness), mechanical (tensile strength, Young´s modulus and elongation), barrier (water vapor permeability, moisture and water solubility) and antioxidant properties of the films. The experimental results of the properties were analyzed using a Box-Behnken experimental design generating 15 runs with three replicates at the central point.
Results and conclusions. Second and third order polynomial models were obtained from the ANOVA analysis of the evaluated responses, and high coefficients of determination were found (0.91–1.0). The water vapor permeability of the films was 0.82−2.39·10–7 (g·mm)/(Pa·s·m2), tensile strength was 0.33−1.63 MPa and antioxidant activity 2.24−5.65 %. The variables had different effects on the films: glycerol negatively affected their properties, and the permeability values increased with increased amaranth flour content. The nanoparticles improved the mechanical, barrier and antioxidant properties of the films compared to the films without nanosystems. The optimal formulation was 4 % amaranth
flour, 25 % glycerol and 0.36 % chitosan nanoparticles. The optimized films had better
mechanical (1.62 MPa) properties, a low water vapor permeability value (0.91·10–7 (g·mm)/(Pa·s·m2)) and moderate antioxidant activity (6.43 %).
Novelty and scientific contribution. The results show the effect of chitosan nanoparticles on the properties of amaranth flour films for the first time. The resulting equations are useful in the design of food packaging.
Rice (Oryza sativa) Bran and Soybean (Glycine max) Meal: Unconventional Supplements in the Mead Production
Authors: Araújo Geiza Suzart , Ribeiro Gislane Oliveira , de Souza Sílvia Maria Almeida , da Silva Gervásio Paulo , de Carvalho Giovani Brandão Mafra , Bispo José Ailton Conceição , Martínez Ernesto Acosta
Published: November 2021

Research background. Due to the lack of nitrogen in honey, fermentation of honey must is limited or delayed, in addition to stimulating the production of unpleasant sensory compounds, such as sulfur derivatives. The use of natural supplements has been investigated as low-cost alternatives mainly to correct the nutritional deficiency of nitrogen in honey must in mead production.
Experimental approach. Initially, the physicochemical characterization of the rice bran and soybean meal extracts was carried out. The fermentation of three yeasts (Saccharomyces bayanus Premier Blanc, Saccharomyces cerevisiae Montrachet and Saccharomyces cerevisiae Safbrew T-58) in honey must supplemented with 30 g/L rice bran or soybean meal extracts was evaluated. The trials were compared with the fermentations of the must with commercial supplement (30 g/L) and the control trials. Fermentations were carried out in Erlenmeyer flasks containing honey must with supplements, inoculated with 106 cell/mL yeast and incubated at 30 °C for 264 h.
Results and conclusions. There was significant difference in the evaluated properties of the extracts, with the exception of reducing sugars. The fermentations with soybean meal extract reached the highest cell concentrations, as well as the largest consumption of glucose, fructose and ethanol. The glycerol concentrations slightly increased when soybean meal extract and commercial supplement were used. The highest concentrations of succinic and acetic acids were registered in the control trials produced by Saccharomyces strains Premier Blanc, Montrachet and Safbrew T-58. Formic and lactic acids were not produced. Results showed that the extracts can be used as low-cost alternatives for correcting the nutritional deficiency of nitrogen in honey must since their effect was similar to that of synthetic supplement.
Novelty and scientific contribution. The use of low-cost, unconventional supplements such as those used in this work, in addition to reducing the cost of the process by reducing fermentation time and providing nutrients needed to improve yeast metabolism, prevents the formation of undesirable compounds in the beverage due to prolonged fermentation time. It also makes it possible to add value to industrial by-products. Unconventional supplements have still been little tested in mead production.
[RETRACTED] Eagle Hemp CBD Gummies Shark Tank - It Worth the Money? Scam or Legit? v1
Authors: not provided samcurren
Published: November 2021

[RETRACTED]

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A prospective study of clinical and diagnostic methods of ovarian tumors admitted in a tertiary care hospital and its correlation with histopathology
Authors: Madria Silika , Ghanghoriya Vineeta , Singh Kavita N. , Lokwani Manisha , Tiwari Ranu
Published: November 2021

Background: Aim of the study was to study demographic profile and diagnostic modalities of ovarian tumors and their correlation with histopathological report (HPR).Methods: Prospective observational study conducted in NSCB medical college, Jabalpur from February 2019 to July 2020 on subjects with ultrasonographically diagnosed ovarian tumors. Relevant history obtained, gynecologic examination, investigations recorded. Subjects followed up to collection of HPR and correlation with histopathology done.Results: Out of 120 cases of ovarian tumors, 39.16% were malignant and 60.83% were benign ovarian tumors. Out of 80 premenopausal females, majority (78.75%) had benign ovarian masses. Amongst 40 postmenopausal females, 75% of ovarian masses were malignant. CA125 had sensitivity 76.59%, specificity 76.71% and accuracy 76.66% in diagnosing ovarian malignancy. Amongst 4 RMI scores, RMI 1 has the highest sensitivity and specificity 85.10%, 86.30% respectively. Sensitivity, specificity, and accuracy of ultrasound score was 65.21%, 86.30% and 77.5% respectively. Sensitivity and specificity of clinical diagnosis was 83% and 95.89% respectively and ROC analysis showed clinical diagnosis can accurately predict benign and malignant ovarian tumors in 89% cases.Conclusions: RMI 1 score has the highest sensitivity and specificity in our study. When all 4 methods of diagnosis i.e., RMI Score, ultrasound score, CA125 and clinical diagnosis were compared, clinical diagnosis has highest prediction of malignancy.
Prevalence of pre-diabetes in adolescents aged 11-17 years with high risk factors
Authors: Balamurugan Kuppan , Ponprabha Rajangam , Sivashankari Veeramani
Published: November 2021

Background: Obesity is a rising global epidemic in children which leads to pre-diabetes and overt diabetes. Identification at early stage helps in early intervention. This study was undertaken to study the prevalence of pre-diabetes in urban school going adolescents aged 11-17 years with high risk factors.Methods: This was a prospective cross-sectional study conducted in Chennai, India between December 2011 and November 2012. Overweight or obese adolescents in the age group 11-17 years, either with family history of diabetes or acanthosis nigricans or both were included. After obtaining informed consent from parents, history was obtained in pre-tested questionnaire.Results: 148 adolescents were enrolled in the study (n=148), 71.62% were females, mean weight was 59.54±10.44 kg, mean height was 150.92±8.62 cm, mean BMI was 26.19±3.23 and mean blood glucose was 82.1 mg/dl. 60.81% of subjects were overweight and others obese. Girls had statistically significant higher mean weight and mean BMI than boys. 78.37% had acanthosis nigricans, 47.29% had family history of diabetes, 12.16% had pre-diabetes and the mean blood glucose in pre-diabetics was 104.9 mg/dl. Pre-diabetes was higher in adolescents with family history of diabetes (p=0.038).Conclusions: Recognition of risk of type 2 diabetes in the asymptomatic pre-diabetes phase needs to be emphasized and targeted screening of high risk children for pre-diabetes seems to be justified. The morbidity and mortality of youth onset type 2 diabetes can be reduced only by early detection and treatment.
Near total laryngectomy: a single institutional experience
Authors: Das Manas P. , Sarma Mridul K. , Choudhury Mrinmoy M. , Missong Ajit K.
Published: November 2021

Background: Near total laryngectomy (NTL) aims to remove cancer of larynx and hypopharynx while maintaining a lung powered, prosthesis free voice. The oncological and functional outcomes of NTL have been encouraging but the surgical procedure is complex. In this study, we present our experience with NTL in order to encourage more ENT and head and neck surgeons to take up the procedure.Methods: Twenty-eight patients, who had undergone NTL at State cancer institute, Guwahati are analysed retrospectively for survival, disease free status, functional outcomes and complications.Results: There were two recurrences: one local recurrence which was salvaged by a completion total laryngectomy. The other patient had distant metastasis and died eventually. Overall survival (OS) was 96.43% and event free survival (EFS) was 92.86%. The patient who died had extra-nodal extension (ENE) on post op histology (p=0.274). Two patients failed to develop any speech had stenosis of the shunt. One of these was the only Salvage NTL case (p=0.057). Tracheostome stenosis, poor swallow and shunt stenosis were the common complications in our series. Most of them resolved with some intervention. Multiple complications were seen in the salvage NTL cases.Conclusions: Careful case selection and well executed surgery leads to acceptable results following NTL. Special attention should be paid to the salvage cases as they are prone to develop complications and failure to attain speech. Patients with adverse post-op histopathological examination (HPE), like ENE should be kept under close follow up.
A prospective study of myoconjunctival enucleation for enhanced implant motility
Authors: Asari Wilhemina A. , Rawat Supriya , Siddhpura Nirali P.
Published: November 2021

Background: After enucleation rehabilitation and cosmesis remain the nemesis of an enophthalmic socket, the cosmetic goal is to replace the lost volume of the socket and to restore natural appearance and movement with an artificial eye. The aim of this is to determine implant motility after myoconjunctival enucleation technique.Methods: The study was conducted in 35 patients who underwent myoconjuctival enucleation at M and J Western Regional Institute of Ophthalmology, Civil Hospital, Ahmedabad from the period November 2019 to December 2021. Simple random sampling method was used and subjects were selected based on the inclusion and exclusion criteria. All patients were evaluated on 1st post-operative day, 1st week, 4th week and 12th week of surgery. Post-operative results were compared on the follow-ups in terms of motility index.Results: Average motility index (sum of medial movement, lateral movement, upward movement and downward movement divided by 4) of the 35 patients measured after first week of surgery was 3.2 mm, which was 3.21 mm in 4th week and at 12th week it was 3.23 mm.Conclusions: In contrast to conventional enucleation technique, in myoconjunctival enucleation technique each rectus is sutured to the respective fornix thus preventing stretching, increasing implant stability and motility. Thus it is considered procedure of choice in primary enucleation.
Deranged hematological profile in patients presenting with malarial parasitaemia
Authors: Haroon Amber , Zameer Huda , Naz Aneeqa , Afzal Sohaib , Ammar Tooba , Zafar Ifrah
Published: November 2021

Background: Alterations in the hematological parameters are thought to have the capacity to act as an adjuvant tool in strengthening the suspicion of malaria, thereby prompting a more meticulous search for malaria parasites.Methods: 186 cases with malaria positive for immunochromatographic test (ICT) malaria presenting with fever ≥101 °F, confirmed on peripheral blood film, of 20-60 years were included. Patients with coagulopathy and bleeding disorders such as hemophilia, brain tumors, tuberculosis meningitis, viral or bacterial encephalitis and multiple sclerosis were excluded. Sample was taken to the laboratory, for routine investigations like ICT malaria and complete blood count (CBC) to diagnose anemia and low platelet count.Results: Patients of 20 to 60 years of age with mean 41.80±8.51. Out of 186 patients, 101 (54.30%) were male and 85 (45.70%) were female with 1:2:1 ratio. Mean duration of disease was 4.91±1.32 days. Frequency of derangement in hematological parameters was anemia in 27 (14.52%) patients and 142 (76.34%) with thrombocytopenia. 127 cases were of Plasmodium vivax and 59 cases were of Plasmodium falciparum. Patients were more anemic as disease period prolonged. Patients infected by Plasmodium vivax showed more tendencies towards anemia and reduction in platelet count as compare to Plasmodium falciparum.Conclusions: The frequency of derangement in hematological parameters i.e. anemia and low platelet count, among malarial patients is quite high and more cases were of Plasmodium vivax and it showed anemia and thrombocytopenia was more pronounced in Plasmodium vivax.
Definitions, importance, and application of selective mutism questionnaire in the primary care setting
Authors: Esmail Mustafa E. , Alharbi Manar B. , Alayed Ibrahim S. , Alqahtani Mohammed S. , Aldeeb Hassan F. , Alanazi Yazeed H. , Almasoud Hassan A. , Almohaimeed Omar A. , Alharthi Suhail M. , Alsuhaiman Yousef H. , Doshi Tahani A.
Published: November 2021

Children with selective mutism might suffer from less frequent involvement in school activities, reduced social and cognitive abilities, in addition to being at increased risk of subjective suffering and developing other associated morbidities. There is a lack of evidence regarding the assessment modalities that should be used to evaluate selective mutism. However, recent data show that the selective mutism questionnaire (SMQ) is validated among different investigations with well-established psychometric properties. In the present literature review, we have discussed the definition, uses, and importance of the SMQ for children with selective mutism in primary care settings. Our results show that the different included studies indicate the sensitivity and reliability of the tool to assess the severity of behavioral speaking among these children. Besides, evidence has shown that the tool can be used to assess the impact of treatment on the behavioral outcomes of these children. Based on these data, it has been demonstrated that the treatment of selective mutism can significantly enhance the scores and the behavioral speaking patterns. However, these scores were still relatively lower than the ones estimated for the typically developing children. The impact of more intensive treatment modalities has been suggested but was not adequately validated, and therefore, further research is a must for adequate interpretation and validation of the current findings to achieve better outcomes.
Challenges in smoking prevention among healthcare workers
Authors: Alharbi Shada Murshed , AlTurki Mona Moneer , Almutib Alwaleed Khalid , Subahi Esraa Jamel , Tayeb Raghda Khaled , Alruwaili Maha Nahi , Alatiyyah Abrar Talal , Alali Mohammed Talib , Alsuhaymi Ibrahim Mohsen , Alzahrani Mohammed Ali , Bantan Saja Jamal
Published: November 2021

Many diseases have been reported in association with smoking, including chronic obstructive pulmonary disease, lung cancer, and coronary artery disease. Healthcare workers (HCWs) play an essential role in such campaigns being in the first-line of management of the corresponding patients. Therefore, it is essential to investigate the smoking status among HCWs to make sure adequate interventions are appropriately delivered to their patients. Unfortunately, different studies in the literature indicate that the prevalence of smoking is high among HCWs. Furthermore, adopting restricting policies against smoking has been reported to be of limited efficacy in reducing the frequency of smoking. Therefore, other pharmacological therapies have been proposed. However, the duration of the effectiveness of these modalities does not allow for favorable long-term outcomes. Accordingly, psychological interventions, web-based campaigns, and person-to-person interviews can be the most appropriate modalities to achieve better outcomes. Further investigations are still needed for further validation of the most optimal and suitable intervention.
Epidemiology of hereditary anemias in Saudi Arabia
Authors: Alharbi Shada Murshed , Alshaiti Jawad Hussain , Ghazwani Jamila Mofareh , Ghazwani Afia Mofareh , Abushelwah Nawaf Mohammed , Banjar Mohammad Yosof , Alqahtani Hager Saleh , Alkathiri Saleh Hamdan , Alhamyani Razan Abdullah , Althumairy Abdulsalam Ibrahim , Amer Mohammed Mustafa Al
Published: November 2021

The prevalence rates of hereditary anemias in Saudi Arabia are remarkably high when compared to other countries. For instance, estimates show that the prevalence of thalassemia constitutes one of the highest rates globally. Furthermore, it has been demonstrated that epidemiology significantly differs between the different regions across the Kingdom. Therefore, many epidemiological investigations were conducted. In this context, it has been demonstrated that the prevalence of thalassemia ranges from 0.4% to 5.9% in the Northern and Eastern regions, respectively. In the present literature review, we have discussed the different findings of epidemiological studies that studied the epidemiology of hereditary anemias in Saudi Arabia. We mainly discussed the epidemiology of glucose-6-phosphate dehydrogenase deficiency (G6PD), sickle cell disease, and thalassemia. Recent evidence indicates that the trends of β-thalassemia are significantly decreasing over the past years. On the other hand, it has been demonstrated that the prevalence trends of sickle cell disease is constant over the past years. G6PD is also highly prevalent in Saudi Arabia. However, recent evidence is lacking in the literature and needs to be updated by future investigations. Consanguineous marriage has been reported to be an important risk factor for the high prevalence of β-thalassemia and sickle cell disease across the Kingdom.
Role of percutaneous thermal ablation in cancer treatment
Authors: Ahmad Doha Jamal , Alyami Amal Yahea , Alasker Abdullah Ahmed , Fallatah Kholoud Bakur , AlReshan Reshan Mane , Althuwaybi Meshari Tael , Alhabes Fawzyah Salem , Alnefaie Bader Bandar , Alzahrany Ahmed Mosa , Alshehri Hiaallah Ali , Hethwell Saeed Ahmad
Published: November 2021

The main aim of using thermal ablation strategies is to eliminate the targeted malignant cells within a specific volume. However, it should be noted that some researchers have reported the potential limitations of some of these techniques. On the other hand, more updated investigations indicated that these limitations could be overcome by the adjuvant use of other management modalities as chemotherapy. Many limitations have been reported with the modality, including the prolonged therapeutic time. Therefore, cryoablation and microwave ablation techniques were introduced in the literature as safe and efficacious modalities that overcame the limitations of the radiofrequency technique. Overall, percutaneous thermal ablation is associated with favorable outcomes and should be used in clinical settings due to the various advantages that have been reported for the modality, in addition to being less invasive.
Knowledge and attitude of people above 18 years regarding COVID-19 vaccination in a rural area of Kerala
Authors: Thadathil Suchithra Erath , N. Rithu , S. Sindhu P.
Published: November 2021

Background: The COVID vaccination programme in conjunction with other control measures, are needed to control the COVID-19 pandemic. The mass vaccination with COVID vaccines, will help to increase the herd immunity. This study is an attempt to assess the knowledge and attitude of the adult population of a panchayat area of Thrissur district of Kerala towards COVID-19 vaccination and socio-demographic determinants associated with it.Methods: We have done a cross-sectional study among 350 study participants selected by cluster sampling technique from a panchayat area of Thrissur district of Kerala and the data was collected, using a pretested semi structured questionnaire. The knowledge and attitude were assessed by proportion and association of socio-demographic determinants was found out using ‘t’ test and ‘ANOVA’ test.Results: The result obtained, showed 94.3% of persons responded that there is a vaccine for preventing COVID and 85.2% were aware that Covishield and Covaxin were the vaccine freely available. The 78.3% respondents knew that there should be 84 days between the doses of Covishield and 77.1% knew that 28 days for Covaxin. The 100% respondents had attitude to take the vaccine and 99.1% were ready to continue COVID prevention measures even after vaccination. As per this study, younger age (p=0.04) and religion (0.000) had an association with knowledge.Conclusions: The high level of knowledge and a100% attitude towards COVID vaccination may be due to high political will and accountability of the governments towards it. The places with low acceptance rate can be able to model on it.
Treatment response of Epley’s manoeuvre in the management of posterior semicircular canal benign paroxysmal positional vertigo
Authors: Sharma Rimjhim
Published: November 2021

Background: Benign paroxysmal positional vertigo (BPPV) is the most common reason for vertigo. Most common site of BPPV is posterior semicircular canal. The commonest symptom is episodic vertigo. This study aimed at the treatment response of Epley’s manoeuvre for posterior semicircular canal BPPV.

Methods: 87 patients out of 114 were enrolled for the study from 2020 to 2021. After proper history and examination, Dix-Hallpike test (DHT) was done for diagnosis. Epley’s manoeuvre was done at first visit and was repeated at subsequent visits.

Results: The mean age of the patients was 54 years. In this study, out of total 87 patients, there were 59 females (67.82%) and 28 males (32.18%). The male to female ratio was 1:2.11. Out of 87 patients, 53 patients (60.92%) recovered in the first visit, 18 patients (20.69%) recovered in second visit, 11 patients (12.64%) recovered in the third visit and remaining 5 patients (5.75%) recovered in fourth visit. In 3 out of 87 cases, that is, in 3.45%, recurrence was seen with return of the BPPV symptoms.

Conclusions: Treatment response of Epley’s manoeuvre in posterior semicircular canal BPPV is good. Maximum number of patients’ recovered in the first visit.
Role of stroboscopy in evaluation of patients with vocal abnormalities
Authors: Kedilaya Yashveer Jayantha , Alexander Ashly , Malviya Abhishek , Tamrakar Akshay V.
Published: November 2021

Background: Stroboscopy is an examination in which strobe light is combined with laryngoscopy, to visualize the vocal fold vibration. It makes use of the Talbot’s law for visualizing the vibrating vocal fold having frequency of around 250 times per sec. This technique was used for studying voice abnormalities and evaluate related pathologies. The aim and objective was to evaluate patients with vocal abnormalities with the help of stroboscope and to study the mucosal wave pattern pre and post treatment of vocal cord pathologies.

Methods: A prospective observational study was conducted at a tertiary care facility in central India. 50 patients with vocal abnormalities for more than 2 weeks were subjected to stroboscopy. Written informed consent from eligible patients was obtained and they were evaluated by stroboscopy using Karl Storz stroboscope with 70 degree 8 mm telescope, model no.: 20140020032. A second follow up stroboscopy was done two months post treatment and the parameters were recorded.

Results: VC nodule was observed as the most common pathology followed by vocal polyp, carcinoma and chronic laryngitis. It was also observed that there was statistically significant difference (p<0.001) in pre and post treatment findings of different parameters of voice evaluated using stroboscopy.

Conclusions: Video stroboscopic evaluation proved to be a useful and reliable tool for evaluation and treatment of the patients with voice abnormalities as the changes in pre and post treatment voice parameters were found to be statistically significant.
Utility of Ottawa ankle rules in excluding ankle fractures in Indian scenario
Authors: Mandal Malay K. , Paul Anirban , Sen Abhijit , Rahman S. Sariful , Hazra Bimalendu Bikash
Published: November 2021

Background: Patients with acute ankle injuries form a major bulk in outdoor and emergency room, and many of them get radiographs done to rule out fractures. Ottawa ankle rules (OAR) may reduce the need for unnecessary radiographs by detecting fractures only with help of simple clinical findings.  We conducted this study to see the extent of usefulness of these rules in our day-to-day practice.

Methods: Our study is observational in nature. A total of 107 patients who visited the clinic of the chief investigator between the time period from 1st January 2019 to 31st December 2020, fulfilling inclusion criteria and willing to participate, were enrolled. The patients were examined clinically, and the assessor recorded the findings on a previously prepared assessment form. Data analysis was done from the master chart.

Results: Among the 107 patients, 46 patients were ‘suspicion positive’ by OAR. After the radiographic assessment, we found 11 fractures, all of which belonged to the ‘suspicion positive’ group. Statistical analysis showed that OAR had a sensitivity of 100% for ankle fractures, whereas specificity for the same was 63.54%. We found the positive predictive value to be 23.91% and negative predictive value to be 100%, positive likelihood ratio of 2.74, and negative likelihood ratio of 0.

Conclusions: OAR is an easy and reliable tool to screen ankle fractures. In a country with as massive a health care burden as ours, it can reduce the number of unnecessary radiographs and thus reduce exposure, cost, and time of medical professionals.
Modification in practice of anaesthesia in COVID-19 pandemic: A review article
Authors: Anand Neelesh , Singh Braj Nandan , Gupta Reetika , Madia Mandeep M H , Chandramani
Published: November 2021

During current COVID-19 pandemic, anaesthesiologists should modify their practices and take high precautions. Anaesthetist should reduce their exposure to respiratory secretions and risk of perioperative transmission. In this article we explore the practical considerations, concerns for anaesthesiologist and measures recommended for conducting safe anaesthesia. We also emphasise on ensuring safety of healthcare workers, protection of equipment, and prevention of infection. We tried to illustrate the importance of infection control practices in anaesthesia. A proper plan of anaesthesia for management of COVID-19 patients will result in the best possible outcome for both healthcare workers and patients.
Role of oxygen concentrators in covid pandemic
Authors: Lakshmi S Kalyani Surya Dhana , Chandrasekhar C N , Prasad Ch Ramakrishna , Garre Sandeep , Ayya Syama Sunder , Bhatia Vikas
Published: November 2021

The need for oxygen, as well as the scarcity caused by the second wave of the Corona epidemic, has caused everyone to reconsider the sustainability and self-sufficiency of oxygen. Medical oxygen therapy is a standard treatment for patients with severe Covid manifestations. Ensuring a consistent supply of oxygen to meet the rising demand for oxygen must be planned at the national, state, and institutional levels.

In this article we would like to emphasise the importance of oxygen adequacy.

This narrative review covers the methods of estimating oxygen requirements of a hospital, and the alternate oxygen sources available, highlighting the role of oxygen concentrators in a low resource settings.

Oxygen concentrators specially as pressure swing adsorption plants can be used by hospitals as a main source of oxygen being both economical, as well as reducing the dependency on refilling and transport.

Planning the oxygen resources for a hospital should include primary, secondary and reserve sources, among all these the oxygen concentrator plays a vital role both being economical in the long run as well as making the hospital largely independent of logistic issues.
The anesthesiologist and Covid-19 endocrinopathies
Authors: Desai Devyani , Chhanwal Heena
Published: November 2021

Covid-19 disease created a havoc since 2019, affected large number of number of people over worldwide. As the second wave is receding, we will be receiving patients with the long-term effects of Covid-19 for the surgeries either for their primary disease or for the complications arising from the Covid-19. Primarily, the Covid-19 is a disease affecting the pulmonary and cardiac system, many other systems including renal, hematology, central nervous, endocrine etc. also damaged with the same. Various endocrine glands are being involved in Covid-19 disease like pancreas, thyroid, pituitary, adrenals, reproductive system etc. as they are highly expressed with ACE. This may even lead to the permanent damage. Because of the unfamiliarity with the disease, plausible impact on the endocrine functions is still unclear. This article elaborates various endocrine manifestations of SARS Cov and SARS Cov-2 for better understanding and management of Covid-19 recovered patients.
COVID 19 and obstetrics: anaesthetic challenges, co-morbid conditions and critical care
Authors: Yadav Arvind Kumar , Choudhary Savita , Gupta Sunanda
Published: November 2021

The WHO has declared severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) as a pandemic; it affected approximately 44.5million people since its first breakout in December 2019. COVID-19 can present with wide spectrum of clinical manifestations which range from mild illness with myalgia only to acute respiratory distress syndrome with or without multi-organ dysfunction syndrome necessitating the advance critical care and life support. Pregnant women presenting to emergency department needs to be triaged based on imminent risk factors for maternal and fetal compromise, present haemodynamic status of mother with consideration of gestational age. Pregnant women with comorbid conditions require multidisciplinary team approach for better pregnancy outcomes, resource management and minimizing the risk infection to health care providers. This review emphasizes on management of labour, pregnancy outcomes, co-morbidities and complex critical situations associated with COVID-19 infected pregnant women. Development of safe medical practices and infection prevention protocols with involvement of multidisciplinary team including anaesthesiologist, obstetrician, neonatologist, critical care specialist, infectious disease experts and nursing staff for the perioperative management; is required to optimize the patient outcome and mitigate the infection risk to health personnel and their families.
Integrated oxygen therapy consisting of non invasive ventilation and nasal cannulae in respiratory failure secondary to COVID-19 pneumonia: Case series
Authors: Singh Anshul , Choudhary Suman , Saxena Ashok Kumar
Published: November 2021

Patients with moderate to severe COVID-19 disease develop hypoxemic respiratory failure demonstrating profound degrees of hypoxia with little or no distress. This has put the conventional management consisting of an early intubation in question. In this case series, we attempted an integrated oxygen strategy utilizing non invasive ventilation with standard oxygen therapy (SO) via nasal cannula. We managed both the patients with successful outcomes, without the need of intubation. Hence, integrated oxygen therapy was successfully utilized for the ventilatory management of moderate to severe COVID-19 patients by improving oxygenation, making patients more comfortable and reducing the work of breathing. By complete avoidance of intubation, this technique might help in preservation of much-needed critical care ventilators and help improve patient outcomes in the areas hit hard by the pandemic.
Covid-19 and a lost guidewire: A misty tale of misery!
Authors: Kumar Abhijit , Tripathi Parul , Tiwari Suman , Gupta Malvika , Kohli Amit , Kumar Deepak
Published: November 2021

Central venous catheterization (CVC) is a routine procedure in patients admitted in Intensive Care Units (ICU) worldwide. Most commonly, seldinger technique is being practiced irrespective of the site of insertion. Though considered very safe, guide wire related complications have been reported in the literature and incidence has increased in the COVID era where intensivists have to work in personal protective equipment (PPE).

  We are reporting about a patient of severe COVID-19, admitted in ICU. His right femoral venous catheterization was done to start vasopressors. The guide wire accidentally slipped inside the femoral vein during the procedure. It was immediately detected and managed with the assistance of interventional radiologist under fluoroscopic guidance.

 Complications like misplacement of guide wire can be catastrophic during CVC. We have discussed the measures that can prevent or reduce such complications while working in PPE in COVID ICUs.
Controlled comparison of ropivacaine with dexmedetomidine, clonidine and magnesium sulphate as adjuvant in caudal epidural block in paediatric population for infra-umbilical surgeries
Authors: Singh Guriqbal , Singh Vijaylaxmi , Trivedi Vandana
Published: November 2021

Caudal analgesia and anaesthesia is one of the safest and widely used methods for pain relief in paediatric population. Aim of this study is to compare the efficacy of dexmedetomidine, clonidine, magnesium sulphate as adjuvants to 0.25% ropivacaine in caudal anaesthesia for enhancement of duration of analgesia as well as to determine safety of the blockade in paediatric population.

It is prospective, randomised, double-blinded study in which eighty children (2–8 years), belonging to American society of Anesthesiologists physical status I and II scheduled for infra-umbilical surgeries were randomised into four groups namely: group R; Inj. Ropivacaine 0.25%, Group D; inj.ropivacaine 0.25% with adjuvant dexmedetomidine 0.5 μg/kg, Group C; inj.ropivacaine 0.25% with clonidine 1 μg /kgs, group M; inj.ropivacaine 0.25% with magnesium sulphate 50 mgs. The primary outcomes of study were time to onset of block and duration of analgesia. The secondary outcome was to study haemodynamic stability and adverse effects.

Duration of analgesia was significantly longer (f=855.4778 and p<0.0001) in adjuvant groups as compared to control group and was statistically significant (p = 0.0001 and 0.0411 respectively). No significant difference was observed in the incidence of haemodynamic changes or side effects.

Addition of above-mentioned drugs as adjuvants to 0.25% ropivacaine in caudal block significantly prolonged the duration of post‑operative analgesia with least effect on haemodynamic profile or any other significant adverse effects.