bluuebunny/crossref_metadata_2025 huggingface dataset:
Sofrimento moral dos profissionais das técnicas radiológica em serviço de radiologia convencional de Santa Catarina
Authors: Anderson Tiago Jorge
Published: December 2021

Introdução: o uso da radiação ionizante na prática médica pode ocasionar eventos nocivos à saúde do indivíduo exposto. Diante disso, o emprego ético da radiação ionizante deve contemplar o que preconiza a legislação nacional e internacional, assim como os princípios de proteção radiológica e da bioética. O sofrimento moral relaciona-se à dimensão ética na prática da saúde, podendo afetar os profissionais das técnicas radiológicas. Objetivo: identificar as situações desencadeadoras de sofrimento moral nos profissionais das técnicas radiológicas em um serviço de radiologia convencional. Metodologia: trata-se de uma pesquisa qualitativa, descritiva e exploratória. Usou-se como técnicas de coleta de dados a observação participante, a entrevista semiestruturada e a validação consensual. Os dados foram analisados por meio da análise temática. Resultados e discussão: observou-se situações de sofrimento moral quando o profissional da técnica radiológica se deparava com pacientes em condições clínicas de se dirigir a unidade de diagnóstico e imagem, diante da não indicação clínica do exame radiológico, ante ao desrespeito dos princípios de proteção radiológica e perante a falta de autonomia para fazer cumprir os preceitos éticos do emprego da radiação ionizante. Conclusão: o desrespeito dos princípios legais, assim como dos princípios de proteção radiológica e bioéticos levam o profissional das técnicas radiológicas ao sofrimento moral.
Representações sociais de doadoras sobre a doação de leite humano em um hospital universitário
Authors: Benevenuto de Oliveira Marcia Maria , Silva Isília Aparecida
Published: December 2021

Objetivo: conhecer as representações sociais de doadoras sobre a doação de leite humano em um hospital universitário. Método: Trata-se de uma pesquisa qualitativa utilizando como marco conceitual a Teoria das Representações Sociais. Para a análise qualitativa foi utilizado o método de análise de conteúdo. Resultados: Participaram do estudo 30 doadoras de um banco de leite humano de um hospital universitário público do Sul do Brasil. Os temas relacionados à doação que emergiram das falas dessas doadoras foram: banco de leite humano: lugar de acolhimento e aprendizagem; doar o leite materno: dá trabalho e exige compromisso e ser doadora é compartilhar o que tem e ajudar a quem precisa. Conclusão: A doação de leite humano esteve relacionada ao sentimento de orgulho e compartilhamento, tendo a família importante papel nesse processo. Além disso, observou-se a pertinência do acolhimento e apoio recebido no banco de leite como forma de fortalecer o vínculo entre doadora e instituição e estimular tal prática.
Aspectos epidemiológicos, clínicos e angiográficos de pacientes submetidos à Intervenção Coronária Percutânea primária
Authors: Constancia de Melo Alves Silva Louise , Medeiros da Silva Tamara Taynah , Santos Costas Ilanne Caroline , Moreira de Lima Maria Solange , Vieira Dantas Daniele , Assis Neves Dantas Rodrigo
Published: December 2021

Introdução: Dispor do perfil de pacientes submetidos à angioplastia colabora para a melhoria da qualidade de vida dos mesmos e trabalho assistencial da equipe de saúde. Objetivo: analisar os aspectos epidemiológicos, clínicos e angiográficos e suas relações com o sexo dos pacientes submetidos à intervenção coronária percutânea primária. Método: estudo descritivo e transversal realizado em Hospital Universitário do Rio Grande do Norte. A coleta de dados ocorreu entre abril e outubro de 2017 a partir de dados encontrados no prontuário informatizado e impresso de 93 pacientes submetidos à Intervenção Coronária Percutânea Primária.Utilizaram-se testes como o Kolmogorov-Sminorv, Mann-Whitney (U) e Qui-quadrado de Pearson (X2) para a avaliação das informações evidenciadas pela pesquisa. Resultados: dos 93 pacientes inclusos no estudo, 64,5% eram homens, com média de idade de 62,3 anos. Sobre o tempo porta-balão,18,2% das mulheres e 8,3% dos homens conseguiram o tempo menor que 90 minutos. Quanto às comorbidades, destacam-se Hipertensão Arterial Sistêmica, diabetes mellitus, além do hábito de vida etilismo. Conclusão: os resultados sobre os aspectos epidemiológicos, clínicos e angiográficos evidenciados neste estudo favorecem um maior conhecimento, contribuindo para a geração de estratégias para a prevenção de agravos de pacientes submetidos à Intervenção Coronária Percutânea primária.
Pesquisa como princípio científico e educativo na formação do enfermeiro
Authors: Begui Janaína Recanello , Guariente Maria Helena Dantas de Menezes , Garanhani Mara Lúcia , Carvalho Brígida Gimenez de , Ferrari Rosângela Aparecida Pimenta , Galdino Maria José Quina
Published: December 2021

Objetivo: Identificar como a abordagem do tema investigação científica pode contribuir para o desenvolvimento da competência científica na percepção de estudantes do curso de Enfermagem. Método: Trata-se de uma pesquisa qualitativa, descritivo-exploratória do tipo estudo de caso desenvolvida em um curso de graduação em Enfermagem de uma universidade pública do Sul do Brasil. A coleta de dados deu-se por meio de três grupos focais com 23 estudantes e de análise documental. Os dados foram submetidos à análise de conteúdo e discutidos na perspectiva teórica de Pedro Demo. Resultados: Dos dizeres, evidenciaram-se duas categorias: “Construindo a competência investigativa: definição, importância e momentos de aprendizagem” e “A competência científica em formação: a pesquisa como subsídio para a prática profissional”. Considerações finais: A competência investigativa para a formação do enfermeiro atribuiu-se aos arranjos curriculares, ao método da problematização, à estratégia pedagógica tutorial, ao papel do professor como ativador no processo ensino-aprendizagem em pesquisa e às atividades extracurriculares, para aperfeiçoamento da prática.
Prevalência de dermatite associada à incontinência em pacientes adultos de um hospital universitário
Authors: Cabral Belini Rafaela , Aparecida dos Santos Sokem Jaqueline , Guimarães Felix Lima Fernanda , Perez Rodrigues Bergamaschi Fabiana , Aparecida Mye Takamatu Watanabe Elaine , Rahmeier Fietz Vivian
Published: December 2021

Introdução: a dermatite associada à incontinência (DAI) é uma inflamação da pele, relacionada ao contato com a umidade, frequente em pacientes com incontinência urinária e/ ou anal que constitui importante desafio no cuidado de enfermagem. Objetivo: identificar a prevalência pontual e as características da dermatite associada à incontinência (DAI) em pacientes adultos internados na clínica médica de um hospital geral. Método: estudo descritivo, de corte transversal,realizado com amostra não probabilística de pacientes incontinentes. Os dados foram coletados em 2 dias do mês de março de 2019, mediante entrevista, exame físico e consulta a prontuário,e analisados por meio de estatística descritiva simples. Resultados: constatou-se prevalência de dermatite associada à incontinência de 56,2% nos pacientes incontinentes.Entre os tipos de incontinência, identificou-se que 12,5%dos pacientes apresentavam incontinência urinária, 18,8% incontinência anal e 68,7% dupla incontinência. A DAI foi mais frequente em mulheres, acima de 70 anos de idade, com dupla incontinência. Conclusão: a prevalência de DAI na clínica médica do hospital em estudo é considerada elevada, sendo mais frequente a categoria 2, ou seja, com ruptura da pele associada a edema e eritema. Os achados suscitam a necessidade de maiores estudos, discussões e implementação de ações de educação permanente em saúde, sobretudo para o cuidado de enfermagem relacionado ao tema.
Avaliação positiva da assistência às pessoas com Diabetes Mellitus na atenção básica
Authors: De Lima Santos Aliny , Silva Marcon Sonia , Bastos Silva Nataly Cristina , Hibary Nati Vitória , Grasso Pacheco Gabriela , Lopes Maciel Bolsoni Ludmila , De Freitas Góes Herbert Leopoldo
Published: December 2021

Objetivo: Verificar os fatores associados à avaliação positiva da assistência prestada às pessoas com diabetes tipo 2 na Atenção Primária. Método: Estudo descritivo transversal, no qual foram entrevistadas 408 pessoas com diabetes tipo 2, da zona urbana de um município da região Sul do Brasil, de 65 equipes da Estratégia Saúde da Família. Foi utilizado questionário contendo variáveis sociodemográficas, clínicas, comportamentais e indicadores da assistência e do acesso ao serviço de saúde na atenção básica; realizado o teste qui-quadrado de Pearson, regressão logística múltipla e cálculo do Odds Ratio para análise dos fatores relacionados à avaliação positiva da assistência. Resultados: A prevalência da avaliação positiva da assistência prestada foi de 81,9%. Os fatores que apresentaram associação significativa com a avaliação positiva foram: sexo masculino (OR=2,96), atividade física (OR=2,54), ser atendido no mesmo dia em que vai à Unidade Básica (OR=2,60), receber os antidiabéticos orais e/ou insulina (OR=0,12) e orientações sobre alimentação adequada (OR=2,72); e conseguir mostrar os resultados de exames com maior facilidade (OR=3,09). Conclusão: O diabetes tipo 2 pode ser um indicador da qualidade do serviço prestado pelas equipes da ESF e a satisfação dos usuários está relacionada ao serviço de qualidade, ao acolhimento às demandas e ao cuidado contínuo.
Ano internacional da enfermagem e a pandemia da covid-19: a expressão na mídia
Authors: Almeida Ventura-Silva João Miguel , Pimenta Lopes Ribeiro Olga Maria , Lima Trindade Letícia , Assunção Almeida Nogueira Maria , José Monteiro Maria Amélia
Published: December 2021

Objetivo: analisar o que foi retratado na mídia portuguesa referente aos enfermeiros durante os três primeiros meses da pandemia da COVID-19. Metodologia: estudo documental, qualitativo, baseado em notícias publicadas em jornais de grande circulação de Portugal Continental e Regiões Autônomas, referentes aos três primeiros meses de pandemia, com enfoque nos enfermeiros e no atual cenário pandêmico. A coleta de dados foi realizada entre os dias sete e dez de junho de 2020 e para o tratamento dos dados, recorreu-se à análise temática. Resultados: foram analisadas 39 notícias, tendo emergido aspectos sobre os apelos da Ordem dos Enfermeiros (OE) e das Associações Sindicais a respeito da carência e necessidade de contratar profissionais de enfermagem e a falta de equipamentos de proteção de individual para o cuidado ao cliente. Evidenciaram-se também preocupações dos enfermeiros sobre a situação pandêmica vivenciada e estratégias de apoio aos profissionais de enfermagem. Conclusão: a mídia publicou essencialmente notícias sobre as preocupações sentidas nos contextos da prática quanto à falta de recursos humanos e materiais para fazer face ao cenário de pandemia.No ano internacional da Enfermagem, ficaram omissas as fragilidades decorrentes do não investimento na força de trabalho da enfermagem, assim como o valor dos enfermeiros para a sociedade.
O SER HUMANO É ASSIM, SOFRE, MAS ALGUNS DIAS SÃO PIORES: A PERCEPÇÃO DOS PACIENTES PARA O INÍCIO DO USO DOS MEDICAMENTOS PSICOTRÓPICOS
Authors: Fonseca Ribeiro Filardi Agnes , De Araújo Medina Mendonça Simone , Ramalho de Oliveira Djenane
Published: December 2021

O processo de medicalização da nossa sociedade, na atualidade, acontece em várias direções, indicando que todo e qualquer tipo de mal-estar pode ser tratado com medicamentos. O objetivo da pesquisa foi compreender o início do uso dos psicotrópicos para superar os problemas enfrentados no cotidiano. Entrevistas em profundidade foram realizadas com 19 pessoas sobre os problemas que levaram ao início do uso de medicamentos psicotrópicos. Este estudo utilizou os pressupostos filosóficos de Heidegger e o tratamento de dados conforme proposto por Max van Manen. A análise desvelou o tema ‘O ser humano é assim, a gente sofre, mas alguns dias são piores’, que diz respeito às dificuldades vividas que desencadearam os sentimentos de raiva, ansiedade, estresse, tristeza e angústia, levando ao uso dos medicamentos psicotrópicos. A vivência das dificuldades enfrentadas na vida foi apontada como principal motivo para o início do uso do medicamento, como forma de preservar a saúde mental.
Um olhar ético para o sofrimento da família da criança com autismo
Authors: Pandjarjian Mekhitarian Anna Victória , Martins Bialer Marina , Lerner Rogério
Published: December 2021

No presente artigo, temos como objetivo discutir, do ponto de vista da ética, alguns impactos que o autismo pode ter nas relações familiares e, de maneira específica, no irmão mais novo da criança autista. Para tanto, recorremos a uma revisão bibliográfica acerca de possíveis efeitos do autismo nas relações familiares e também à apresentação de recortes autobiográficos de famílias de crianças autistas. Por décadas, a questão da etiologia do autismo foi tema de persistentes estereótipos e perspectivas reducionistas, que frequentemente culpabilizaram a mãe ou cuidadores pelo autismo da criança. Operamos uma torção no sentido de pensarmos sobre como a criança autista, com suas singularidades, pode vir a impactar as relações familiares, refletindo sobre como a subjetividade da criança afeta a família ao mesmo tempo em que é afetada por ela. Dessa forma, esperamos alargar as pesquisas psicanalíticas que enfocam este tema e escapar de uma perspectiva exteriorizada, especialista e culpabilizante.
Universidades populares
Authors: Almeida Paula Josiane , Teixeira Corrêa Rosa Lydia
Published: December 2021

Discorrer sobre a origem das universidades populares na França do século XIX e em Portugal no XX é a proposta deste artigo. A ideia de uma formação para os operários ganhou proporção após a Revolução Francesa (1789), especificamente, após o projeto de Instrução Pública de Condorcet e os desdobramentos da Comuna de Paris (1871). Porém, enquanto espaço próprio, as universidades surgem a partir de 1896 com George Deherme e com as Bolsas de Trabalho, por Fernand Peloutier. Com base nesses apontamentos o trabalho se debruça para a compreensão da origem dessas instituições, sua expansão na França e influência em terras portuguesas. Esta pesquisa é de natureza histórica, fundamentada na História Cultural e busca demonstrar o surgimento das universidades populares, identificando a forma como elas foram idealizadas, constituídas e representadas.
Aire Controls Heterogeneity of Medullary Thymic Epithelial Cells for the Expression of Self-Antigens
Authors: Nishijima Hitoshi , Matsumoto Minoru , Morimoto Junko , Hosomichi Kazuyoshi , Akiyama Nobuko , Akiyama Taishin , Oya Takeshi , Tsuneyama Koichi , Yoshida Hideyuki , Matsumoto Mitsuru
Published: December 2021

The deficiency of Aire, a transcriptional regulator whose defect results in the development of autoimmunity, is associated with reduced expression of tissue-restricted self-Ags (TRAs) in medullary thymic epithelial cells (mTECs). Although the mechanisms underlying Aire-dependent expression of TRAs need to be explored, the physical identification of the target(s) of Aire has been hampered by the low and promiscuous expression of TRAs. We have tackled this issue by engineering mice with augmented Aire expression. Integration of the transcriptomic data from Aire-augmented and Aire-deficient mTECs revealed that a large proportion of so-called Aire-dependent genes, including those of TRAs, may not be direct transcriptional targets downstream of Aire. Rather, Aire induces TRA expression indirectly through controlling the heterogeneity of mTECs, as revealed by single-cell analyses. In contrast, Ccl25 emerged as a canonical target of Aire, and we verified this both in vitro and in vivo. Our approach has illuminated the Aire’s primary targets while distinguishing them from the secondary targets.
Novel hormonal agents for metastatic Castration-Resistant Prostate Cancer: comparing outcomes. A single-center retrospective study
Authors: Jarimba Roberto Saldanha , Eliseu Miguel Nobre , Pedroso Lima João , Quaresma Vasco , Moreira Pedro , Coelho Nunes Pedro , Tavares da Silva Edgar , Figueiredo Arnaldo José
Published: December 2021

Introduction: Prostate cancer is the most common cancer in men, accounting for 15% of all diagnosed cancers and is the sixth leading cause of cancerrelated deaths amongst men worldwide. Abiraterone and enzalutamide were the first two novel hormonal agents approved for the treatment of metastatic prostate cancer but there is a lack of quality evidence regarding which is associated with better outcomes and who would benefit the most with one or another of these drugs. Objective: To evaluate the clinical outcomes of real-world patients submitted to treatment with novel hormonal agents, enzalutamide and abiraterone, for castration resistant metastatic prostate cancer in an academic center.Patients and methods: We retrospectively reviewed patients treated for castration-resistant prostate cancer with either abiraterone or enzulatamide between January 1, 2016 and December 31, 2019. The primary endpoints were biochemical response, biochemical progression, radiological progression, clinical deterioration (attributed to disease progression) and death. Results: Enzalutamide had a higher biochemical response rate than abiraterone in patients with mCRPC (77.1% vs 58.1%, p = 0.016). Achieving a biochemical response was associated with a lower risk of biochemical progression (OR: 0.248, p = 0.017) and death (OR: 0.302, p = 0.038). Conclusions: Enzalutamide conferred higher biochemical response rate than abiraterone in patients with mCRPC. Despite the trend to better performance of other endpoints in the enzalutamide group, it did not achieve statistical significance. Well-designed prospective studies are needed to elucidate the comparative efficacies of these agents.
Is robotic radical nephroureterectomy a safe alternative to open approach: The first prospective analysis
Authors: Mourmouris Panagiotis , Argun Omer Burak , Tzelves Lazaros , Tuna Mustafa Bilal , Gourtzelidou Maria , Tziotis Andreas , Kural Ali Riza , Skolarikos Andreas
Published: December 2021

Purpose: To test the efficacy and safety profile of robotic radical nephroureterectomy compared to the open approach. Methods: We enrolled 45 consecutive patients who suffered from non-metastatic, upper urinary tract urothelial carcinoma from September 2019 to March 2021 and underwent radical nephroureterectomy. Patients were divided in two groups: group A consisted of 29 patients (open approach) and group B consisted of 16 patients (robotic approach). The factors which were taken into consideration were age, sex, body mass index, tumour size, side and grade, cancer stage, ASA score, operation time, drain removal time, foley time, hospitalization time, estimated blood loss, surgical margins, preoperative and postoperative creatinine, Hct and bladder recurrences. Statistical analysis was performed with the use of SPSS version 26 and p < 0.05 was the cut-off for reaching statistical significance. Results: The mean age in group 1 was 67.12 years and in group 2 68.12 years, whereas the mean body mass index (BMI) in group 1 was 26.54 kg/m2 and in group 2 25.20 kg/m2. Operative time was better in group A (124 vs 186 mins p < 0.001) and estimated blood loss were better in group B compared to group A (137 vs 316 ml p < 0.001). Length of stay (LOS) was significantly less in the robotic group (5.75 vs 4.3 days p = 0.003) and the same applied for time required for drain removal (4.5 vs 3.3 days p = 0.006). Conclusions: Robotic radical nephroureterectomy is a safe and efficient alternative to open approach. It provides a favorable perioperative profile in patients suffering from upper urinary tract carcinoma without metastasis.
Outcomes of fluoroscopy-free retrograde intrarenal surgery and predictive factors of stone-free
Authors: Kocakgol Huseyin , Aydin Hasan Riza , Guctas Ahmet Ozgur , Sekerci Cagri Akin , Ozturk Kocakgol Deniz , Aksoy Hamit Zafer , Tanidir Yiloren , Kocakgol Huseyin
Published: December 2021

Objective: To evaluate the outcomes of flouroscopy-free retrograde intrarenal surgery (ffRIRS) and to investigate the factors that may affect stone-free rate. Materials and methods: The charts of patients who underwent ffRIRS between January 2017 and August 2019 were reviewed retrospectively. Patients with missing preoperative imaging and patients with kidney anomalies were excluded from the study. Age, gender, stone size, stone localization, stone density, laterality, operation time, stone-free rate, complications and auxiliary procedures were recorded and analyzed. Results: Study group involved 44 (43.1%) female and 58 (56.8%) male patients. Stone-free rate in a single-session ffRIRS were found to be correlated with stone localization (p = 0.003), stone volume (p = 0.004), and stone density (p = 0.009) but not with age (p = 0.950). Patients with multiple calyceal stones and a stone burden over 520 mm3 were found to be less stone-free. The complication rate in female gender (n = 7) was significantly higher compared to male (n = 1) (p = 0.011). No major complications such as ureteral injury or avulsion were observed. Overall, 13 patients (12.7%) needed auxiliary procedures. The operation time seemed to be affected by stone size and gender (p = 0.005; p = 0.044, respectively). Conclusions: Stone-free rate in ffRIRS were found to be affected by stone density, size, and localization. Patients with multiple caliceal stones and high stone burden (< 520 mm3) have been found to have low stone-free rate, so one can speculate that having fluoroscopy assistance in RIRS might help us to improve surgical success.
Is the arterial echo-Doppler a useful tool in the detection of subclinical arteriosclerosis?
Authors: Rios Jorge
Published: December 2021

INTRODUCTION:

Arteriosclerosis has its history since ancient times, rare at that time due to the high mortality from infectious diseases. It arises with changes in dietary habits and the aging of the population. The disease is characterized by being an inflammatory chronic process, generalized and progressive, with multiple risk factors that converge at the onset of itself. However, it is important to bear in mind that 20%–30% of patients lack risk factors and debut with cardiovascular and cerebrovascular accidents.

OBJECTIVES:

To determine in asymptomatic patients without previous atherothrombotic events, with risk factors and without them, the presence of atheroma in the carotid and iliofemoral sectors, with the use of Echo Doppler Color.

MATERIALS AND METHODS:

Patients were included between January and December 2019, without previous atherothrombotic events, with and without risk factors. All were studied with Echo Doppler color with transverse and longitudinal sections in the carotid and iliofemoral sectors.

RESULTS:

In this period, 426 patients were studied, 303 women with an age range of 37–84 with an average of 59.86 years old, 123 men with an age range of 40–92 with an average of 62.42 years old. The number of women with risk factors was 129 (42.62%), of which 41 (32.13%) had subclinical arteriosclerosis affectations and of the 174 women without risk factors, no subclinical arteriosclerosis was found. In men, the factors of present risk were in 55 (45.23%) patients, all of whom had arteriosclerosis subclinical and 25 (20.40%) patients had arteriosclerosis without risk factors. The presence of subclinical arteriosclerosis was 65.63% in men. The prevalence of cardiovascular risk factors according to sex were: Arterial hypertension (M 48%, H 41%), diabetes (M 9%, H 11%), dyslipidemia (M 43%, H 48.5%), and smoking (M 21%, H 25%). The region more affected was the carotid in both men and women, with a slight predominance of single-site impact versus multiple sites.

CONCLUSION:

According to the results obtained, we can say that risk factors can predict events, but the use of Doppler ultrasound to detect atheromas increases the possibility of finding subclinical arteriosclerosis, which allows patients to be reclassified and thus intensify preventive measures.
Identification of Microorganisms associated with intraamniotic infection among women with preterm birth at Ruhengeri Referral Hospital, Rwanda: A case control study
Authors: Yadufashije Callixte , Umugwaneza Jasmine , Muhimpundu Liliane , Izere Cedrick , Munyeshyaka Emmanuel , Mala Albert , Francois Niyonzima , Mucumbitsi Joseph , Sangano Georges , Ndayambaje Martin , Mwanzia Lydia , Habyarimana Thierry
Published: December 2021

Background: Preterm birth is a global public health threat for maternal and child health. Each year, 15 million neonates are born preterm worldwide, with 40% resulting from intrauterine infections. Materials and Methods: This cross-sectional and case–control study was conducted from October to February 2019 at Ruhengeri Referral Hospital. A total of 120 swab samples were collected from 40 women, of which 20 were full-term delivery, while the other 20 were preterm delivery. The three samples, including the placental membranes, amniotic fluids, and fetal membranes, were collected immediately after birth. A sterile cotton swab was used to collect the samples and put into swab Stuart sterile plastic container to avoid sample contamination. Samples were transported in a tightly covered carrier to the clinical microbiology laboratory at INES Ruhengeri for microbiological investigation. Gram staining, culture, and biochemical tests were performed. The independent t-test was used to test for significant differences between the means of the two groups, while the Chi-square test (χ2) was used to test for significant association with microorganisms and intra-amniotic infections. Results: A half of the participants were in the age range of 24–29 years. Non-albicans candida (32.7%) and mold (27.9%) were the predominant microorganisms isolated. Non-albicans candida and mold were common to preterm and full-term samples. Staphylococcus species were observed in placental and fetal membrane samples. Escherichia coli, Klebsiella species, Streptococcus species, and Candida albicans were observed among women with preterm birth samples. There was a statistically significant difference between the two means in the amniotic fluid isolates (t = 4.023, P < 0.007), placental membrane isolates (t = 7.17, P < 0.0004), and fetal membrane isolates (t = 6.7, P < 0.0006). Association with microorganisms and intra-amniotic infection was statistically significant with E. coli (χ2 = 3.98, P < 0.05), Streptococcus species (χ2 = 5.53, P < 0.019), non-albicans candida (χ2 = 8.37, P < 0.004), and C. albicans (χ2 = 3.98, P < 0.05). Conclusions: Invasion of the amniotic fluid, placenta, and fetal membranes by pathogenic microorganisms may be associated with the incidence of preterm labor and birth. Early diagnosis is recommended to avoid both maternal and fetal complications.
Small bite closure in midline laparotomy; A practice to reduce the surgical site infection, wound dehiscence, and incisional hernia
Authors: Hassan Yaqoob , Arajmand Shah , Wani Anayatullah , Gilkar Ishfaq , Shah Syed
Published: December 2021

Background: Postoperative wound site complications are a significant source of morbidity after midline laparotomy. The study's objectives were to compare the two suture patterns for fascial closure in midline abdominal wounds and their effect on postoperative wound site complications. Materials and Methods: Over 4 years, the prospective comparative study was conducted at the Government Medical College Hospital, Srinagar. All the patients ≥18 years and ≤70 years of age underwent midline laparotomy for various indications were included. Patients were randomized to two groups using computer-generated numbers based on closure techniques. Group A; Large Tissue Bite closure (10 mm from the wound edge and 10 mm apart and Group B; Small Tissue Bite closure (5–7 mm from the wound edge and 5–7 mm apart). Effect of age, sex, body mass index (BMI), albumin, and suture bite on postoperative complications were analyzed. Results: Among 324 patients who met the inclusion criteria, the mean age was 39.17 years, 84.56% were male with a Male: Female ratio of 5.48. Two hundred and two (62.35%) patients had large tissue bite closure, and 122 (37.75%) had small bite closure. There was no statistically significant difference between the two groups concerning age, sex, albumin levels, BMI, and type of surgery. About 35.64% of patients in the large tissue bite closure group and 19.67% patients in small bite closure developed surgical site infection (SSI) (P = 0.002). The difference in wound dehiscence between the two groups (15.84% vs. 7.38%) was statistically insignificant (P = 0.29). In midline laparotomy closure, the small bites technique results in significantly less incisional hernias than the large bites technique (P = 0.00001). None of our patients expired during the study period. Conclusion: The small bite technique substantially reduces SSIs, wound dehiscence, and incisional hernia. The accident-emergency and general surgery residents, in particular, should be made familiar with this technique to avoid postoperative wound site complications and improve the quality of postoperative life.
Diagnosis, staging, and associated conditions of cardiovascular autonomic neuropathy in Libyan patients with diabetes
Authors: Elmiladi Samia , Elgdhafi Elham , Shukri Ahmed
Published: December 2021

Background: Cardiovascular autonomic neuropathy (CAN) can affect daily activities and patients' quality of life and evoke potentially life-threatening outcomes in diabetes mellitus (DM). Objectives: We aimed to identify and characterize CAN and associated disorders in Libyan patients with DM at National Diabetes Hospital. Patients and Methods: Ninety-nine patients with DM seen in the outpatient clinics from October 2017 to April 2018 at National Diabetes Hospital were prospectively evaluated. Assessments for CAN were made by clinical symptoms and signs, cardiovascular autonomic reflex tests, and echocardiogram. Patients with potentially confounding concomitant medical conditions were excluded. CAN is defined as possible (one abnormal cardiovagal test), confirmed (two abnormal such tests), and severe (with concomitant orthostatic hypotension and heart rate abnormality). Results: Sixty-two percent of the studied patients (mean age: 52 ± 1.5 years, 53% – female) with DM had CAN. CAN diagnosis was possible in 18% of these patients, confirmed in 6%, and severe in 38%. The presence of severe CAN was associated with hypoglycemic unawareness (P = 0.01), dyslipidemia (P = 0.012), and microvascular diabetic complications (P = 0.04). Conclusions: In this cohort of relatively old and high-risk cardiovascular disease, patients with diabetes, uncontrolled blood pressure, associated dyslipidemia, presence of microvascular complication of diabetes, and history of hypoglycemic unawareness were strongly associated with a severe form of cardiac autonomic neuropathy with potentially serious clinical consequences. Larger and more detailed studies are needed to elucidate further the complex association between hypoglycemia and cardiac autonomic dysfunction.
Correlation between cotinine urinary levels & cardiovascular autonomic function tests among smokeless tobacco chewers
Authors: Nikam Kiran S. , Wingkar Kanchan C. , Joshi Rajesh K. , Kallur Rajashekar K.
Published: December 2021

Background & objectives:

Cardiovascular disease (CVD), the leading cause of death worldwide is responsible for over 17 million deaths globally, of which 10 per cent deaths have been expected due to consumption of tobacco. The association between CVD and chewing of tobacco is limited and remains arguable. The aim of this study was to find out the correlation between urinary cotinine level and cardiovascular autonomic function tests of tobacco chewers.

Methods:

In the present study, 600 participants, 300 smokeless tobacco chewers (STC) and 300 non-tobacco chewers (NTC), between 18 and 65 yr were selected. Various parameters such as anthropometric, systolic blood pressure (SBP), diastolic blood pressure (DBP), autonomic function tests and urinary cotinine levels were measured.

Results:

Significant difference (P<0.001) was noted in STC and NTC for anthropometric parameters, SBP, DBP and urinary cotinine levels. Sympathetic and parasympathetic autonomic function test showed significant difference on comparison in STC and NTC groups, except in Valsalva ratio. Correlations with urinary cotinine levels were significant for sympathetic autonomic functions, SBP fall (r=0.138, P=0.016), DBP rise (r=−0.141, P≤0.014); parasympathetic autonomic function, heart rate (HR) response to standing (r=−0.208, P≤0.003), deep breathing (r=−0.473, P≤0.001) and Valsalva ratio (r=−0.396, P≤0.0001).

Interpretation & conclusions:

Correlation between urinary cotinine levels and autonomic function tests elucidates the linkage involving autonomic nervous system damage which can be considered as an important associated relationship for early diagnosis of CVD health risk factors among smokeless tobacco (ST) users.
Predictors of chemotherapy resistance & relapse in gestational trophoblastic neoplasia
Authors: Singhal Seema , Kumar Lalit , Kumar Sunesh , Khurana Sachin , Bhatla Neerja
Published: December 2021

Background & objectives:

Gestational trophoblastic neoplasia (GTN) is a chemosensitive malignancy with an excellent cure rate. The primary objective of the present study was to determine the predictors of chemoresistance and disease relapse, and the secondary objective was to appraise the WHO/FIGO risk scoring and course of disease in women with GTN.

Methods:

In this retrospective study, case records of women treated for GTN from January 2011 to June 2019 were reviewed. For the purpose of comparison, sub-stratification of FIGO/WHO low risk group (≤6) into low (0-4) and intermediate (5-6) risk was done. Similarly, WHO high risk (≥7) group was sub-stratified into high (7-12) and ultra-high risk (≥13) groups.

Results:

Case records of 116 patients were included: 51.7 per cent (60/116) were of low risk disease and 48.2 per cent (56/116) were of high risk disease. Chemoresistance developed in 28.4 per cent (33/116) and relapse in 10.3 per cent (12/116) cases. Risk of chemoresistance was higher in low risk (0-6) while risk of relapse was more in high risk (≥7) group. On sub-stratification, chemoresistance was more with intermediate [0-4: 28.5% (10/35), 5-6: 44% (11/25), 7-12: 22.5% (9/40), ≥13: 18.7% (3/16)] and relapse with ultra-high risk score [0-4: 5.7% (2/35), 5-6: 4% (1/25), 7-12:10% (4/40), ≥13: 31.2% (5/16)]. Age, myometrial invasion, serum beta-human chorionic gonadotropin and tumour size were not related to chemoresistance or relapse.

Interpretation & conclusions:

WHO risk score and presence of metastatic disease predict the probability of developing chemotherapy resistance and disease relapse. Risk of chemotherapy resistance was higher in women with intermediate-risk score (5-6), and risk of relapse was more in those with ultra-high risk score (≥13).
White paper on venomous snakebite in India
Authors: Chakma Joy Kumar , Menon Jaideep C. , Dhaliwal R.S.
Published: December 2021

Venomous snakebite is one of the leading preventable causes of mortality and morbidity with tremendous socio-economic impact on the family and nation. Venomous snakebite has been relisted as a neglected tropical disease after having been removed off the list in 2013. This paper discusses the various reasons which could be attributed to the high mortality and morbidity due to venomous snakes and also provides recommendations on policy decisions, improvement on the quality of venom and anti-snake venom and in promoting awareness on how to avoid snakebite.
Effect of slow breathing on autonomic tone & baroreflex sensitivity in yoga practitioners
Authors: Anasuya Boligarla , Deepak Kishore Kumar , Jaryal Ashok Kumar , Narang Rajiv
Published: December 2021

Background & objectives:

Slow breathing increases parasympathetic activity and baroreflex sensitivity (BRS) in healthy individuals, also similarly observed in yoga practitioners. Pranayama which is an important component of yoga when practiced at a slow pace was at a respiratory frequency of around 0.1 Hz (6 breaths/min). Therefore, it was hypothesized that yoga practitioners might have adapted to slow breathing. This study was aimed to decipher the role of yoga on cardiovascular variability during slow breathing (0.1 Hz) in yoga practitioners.

Methods:

A cross-sectional study was undertaken in naïve-to-yoga individuals (n=40) and yoga practitioners (n=40) with an average age of 31.08 ± 7.31 and 29.93 ± 7.57 yr, respectively. The analysis of heart rate variability, blood pressure variability (BPV) and BRS during spontaneous and slow breathing was compared between the two groups.

Results:

During slow breathing, the heart rate (P<0.01) was lower, respiratory rate interval (P<0.05) and pNN50 per cent (P=0.01) were higher, mean systolic BP (SBP) (P<0.05) and SDSD (Standard deviation of successive beat to beat systolic blood pressure differences) (P<0.01) of SBP variability were lower with sequence BRS (P<0.001) and α low frequency (P<0.01) and α high frequency (P<0.001) of spectral BRS were higher in yoga practitioners.

Interpretation & conclusions:

The present study indicated higher parasympathetic activity and BRS with lower SBP variability at rest and during slow breathing in yoga practitioners compared to naive group. Findings indicate that the short-term practice of slow breathing complements the augmented parasympathetic activity and BRS in the yoga group.
Cystic fibrosis transmembrane conductance regulator-related male infertility
Authors: Gaikwad Avinash , Khan Shagufta , Kadam Seema , Shah Rupin , Kulkarni Vijay , Kumaraswamy Rangaswamy , Kadam Kaushiki , Dighe Vikas , Gajbhiye Rahul
Published: December 2021

Background & objectives:

Due to limited information available on the frequency and spectrum of cystic fibrosis (CF) transmembrane conductance regulator (CFTR) gene mutations in congenital bilateral absence of vas deferens (CBAVD) in Indian population, it is difficult to provide accurate genetic counselling to couples. The present study was undertaken to investigate the spectrum and frequency of CFTR gene mutations in Indian men with CBAVD and to determine the female CF carrier status.

Methods:

Direct DNA sequencing of the CFTR gene was carried out in eighty CBAVD men, their female partners and fifty controls from the general population. Pathological significance of the identified novel CFTR gene variants was carried out using in silico tools. Appropriate genetic counselling was provided to the couples prior to intracytoplasmic sperm injection (ICSI).

Results:

A significant association was observed for CFTR gene variants in Indian CBAVD men versus controls (odds ratio: 12.1; 95% confidence interval: 4.8-30.4; P<0.0001). A total of 20 CFTR gene variants were identified in 53 CBAVD men. Eight novel missense CFTR gene variants (L214V, A238P, E379V, L578I, F587L, L926W, R1325K and R1453Q); two novel splice-site gene variants (c.1-30C>G and IVS1+2T>G) and ten previously reported mutations (R75Q, c.1210-12[5], F508del, A309G, R334W, I444T, R668C, R709X, A1285V and Q1352H) were detected in CBAVD men. The novel and reported CFTR gene mutations were L926W (2.5%, P=0.26), R1453Q (2.5%, P=0.26), F508del (8.75%, P=0.03) and c.1210-12[5] (42.5%, P=0.002). A total of 13 (16.2%) female partners were found to be a CF carrier. Nine couples had a risk of transmitting mutant CFTR allele to the offspring.

Interpretation & conclusions:

The heterogeneous spectrum of CFTR gene in Indian population suggests the necessity of screening CBAVD men and female partners for accurate genetic counselling prior to undergoing ICSI.
Antimicrobial susceptibility pattern of Burkholderia cepacia complex & Stenotrophomonas maltophilia from North India
Authors: Sethi Shveta , Sharma Megha , Kumar Sunil , Singhal Lipika , Gautam Vikas , Ray Pallab
Published: December 2021

Background & objectives:

With increased isolation of Burkholderia cepacia complex (Bcc) and Stenotrophomonas maltophilia from clinical specimens, knowledge of their antimicrobial susceptibility trend will aid in better patient management. This study provides a comprehensive picture of this trend over a decade.

Methods:

A retrospective analysis of laboratory records over 10 years for antimicrobial susceptibility pattern of Bcc and S. maltophilia was carried out. The susceptibility pattern to commonly used antimicrobials was determined using disk diffusion and compared at the beginning, mid and end of the study period.

Results:

Five hundred and thirty Bcc and 665 S. maltophilia isolated over the past 10 yr were included in the study. Over the years, susceptibility of Bcc for co-trimoxazole varied as 80, 70 and 89 per cent at the beginning, middle and end of the study, respectively. Susceptibility to tetracycline was 43 per cent at the beginning of the study and that to minocycline was 100 per cent mid-study and 74 per cent at the end. Susceptibility to ceftazidime varied as 83, 60 and 65 per cent, respectively, and to meropenem, increased during the first half of the study and decreased in the second half, as 60, 70 and 43 per cent, respectively. Bcc susceptibility to levofloxacin decreased from 84 (in 2014) to 76 per cent (in 2016). S. maltophilia susceptibility to co-trimoxazole varied as 90, 82 and 87 per cent, respectively, whereas that to levofloxacin was 80, 100 and 94 per cent, respectively, during the start, mid and end of the study. Susceptibility to minocycline decreased from 100 per cent mid-study to 96 per cent at the end. Susceptibility of S. maltophilia to ceftazidime increased from 24 (in 2012) to 37 per cent (in 2016). All variations among the three phases of the study were significant for all antimicrobials tested for both the organisms.

Interpretation & conclusions:

While Bcc showed increased resistance to ceftazidime, meropenem and minocycline, S. maltophilia maintained >80 per cent susceptibility to minocycline, levofloxacin and co-trimoxazole throughout the decade. By 2016, Bcc was most susceptible to co-trimoxazole, whereas S. maltophilia was most susceptible to minocycline and levofloxacin.
Prospective Study of Functional and Radiological Outcome of Proximal Fibular Osteotomy for Medial Compartment Osteoarthritis in Elderly
Authors: Kakumanu Ravi Kiran , Kunadharaju Ravi Teja , Ganesh Chinni
Published: December 2021

Background:

Osteoarthritis (OA) is the most common form of arthritis in Indian population. Proximal fibular osteotomy (PFO) is an alternative treatment to high tibial osteotomy and unicondylar arthroplasty or total knee arthroplasty. It is a surgical procedure for medial compartment knee osteoarthritis (KOA). The PFO helps in the correction of a varus deformity in KOA, which shift the loading force from the medial compartment more laterally. It, therefore, helps in decreasing the pain and satisfactory functional recovery.

Objective:

The objective of the study is to evaluate the clinical and radiological outcomes in medial compartment OA knee treated with minimally invasive PFO as a new and alternative modality of treatment.

Materials and Methods:

A total of 30 patients were selected (18 men and 12 women, age range between 50 and 72 years) from May 2019 to May 2020 who had undergone PFO for medial compartment OA knee were followed in a prospective manner. Preoperative and postoperative weight-bearing whole lower extremity scanogram was obtained to analyze the alignment of lower limb (femorotibial angle) and ratio of joint space (medial/lateral joint space). Functional outcome was assessed with American Knee Society Score (KSS), and knee pain was assessed with visual analog scale (VAS).

Results:

In our study, we had 30 patients who were managed by PFO and were followed up for a minimum period of 1 year. Following the surgery, all patients reported dramatic relief in pain with the VAS dropping significantly from 6.39 in the preoperative period to 2.1 postoperatively (P < 0.005). Weight-bearing lower extremities radiographs showed significant increase in medial knee joint space in 20% of patients. We also noted an increase in the medial joint space from 1.1 ± 0.29 mm preoperatively to 4.21 ± 0.7 min postoperatively. The femorotibial angle improved by around 7°, while the hip knee ankle angle improved by around 6°.

Conclusion:

PFO is a new alternative method in the management of medial compartment arthritis of the knee, which is minimally invasive, safe, and effective, relieves pain, and improves joint function. It helps in the correction of varus knee.
Efficacy of Lateral Extra-Articular Tenodesis on Anterior Cruciate Ligament Reconstruction with Quadrupled Hamstring Graft
Authors: Singh Lalit Pratap , Sinha Shivam , Kumar Ishan , Verma Ashish Kumar , Saraf Shyam Kumar , Singh Tej Bali , Pandey Shubhrendu Shekhar
Published: December 2021

Background:

Isolated anterior cruciate ligament (ACL) reconstruction is frequently associated with anterolateral ligament injury (ALL) and results in residual instability at follow-up. It was hypothesized that patients who underwent combined ACL and lateral extra-articular tenodesis (LET) reconstruction would exhibit less residual laxity, better clinical outcomes, and better graft incorporation on follow-up magnetic resonance imaging (MRI) as well.

Patient and Methods:

Sixty-four patients with concomitant ACL and ALL injuries who were operated over a period of 2 years were enrolled between 2016 and 2018. Two groups of patients were evaluated prospectively. Eighteen patients in control Group B underwent anatomical ACL reconstruction alone, and 20 in test Group A underwent ACL reconstruction combined with LET. Exclusions were multiligament injuries, chondral injury, meniscus tear, and ramp lesion. Follow-up by Lysholm and modified Cincinnati knee rating was done and MRI for status of graft at least 1-year postoperative.

Results:

After excluding dropout or inadequate follow-up, Group A (n = 20) with ACL + LET was compared with Group B (n = 18), with isolated ACL reconstruction, at final median follow-up of 18 months. There were no significant differences between groups regarding gender, age, and duration of injury. Regarding functional outcome scores, patients in the LET group presented better results on both the clinical scoring (P < 0.0001). In addition, patients in the LET group had better graft uptake on MRI and no pivoting at physical examination. Regarding graft failures, the isolated ACL reconstruction group had 5 and the LET group had 1 failure.

Conclusion:

The combined ACL and LET reconstruction in patients with ACL injury is an effective and safe solution and leads to good functional outcomes with no increase in complications and aids in early return to preinjury activities with a surviving healthy graft.