bluuebunny/crossref_metadata_2025 huggingface dataset:
Taming the HiPPO (Highest Paid Person's Opinion) With Agile Metrics and Value Management
Authors: Gupta Chabi
Published: July 2023

If the organisation's ecosystem has an excess of HiPPOs, data, measured analytics, and other real-time information that minimises uncertainty can help them mitigate the consequences. They disregard the wisdom of the crowd, overlook the front-line staff's abilities, and risk disengaging the workforce. This research advocates agile metrics and value management to tame the HiPPO. The authors posit to reign in opinions with metrics. The corporate enlightenment brought about a revolutionary idea over three centuries ago: to elevate science and knowledge above magical thought and mysticism. When the authors convert this into modern terms, they are referring to data-driven management, analytics, and hypothesis validation. In fact, the idea of applying science in the form of true evidence, confirmed data, etc. to production processes underlies much of the industrial revolution.
Apparecchiando la Tavola: l’ordine degli elementi
Authors: Parmeggiani Fabio
Published: July 2023

The periodic table of the chemical elements, published in 1869 by Dmitri Mendeleev, is actually the destination of an exciting journey that lasted over 3000 years, which will be broken down into key steps and briefly discussed herein. To this journey, driven mainly by the innate curiosity of scientists and philosophers to understand the structure and composition of the world around us, the greatest minds of chemistry and natural philosophy, from Empedocles, to Priestley, to Lavoisier, to Davy, have contributed with essential individual pieces that combined into the solution of such a majestic jigsaw puzzle by Mendeleev. Although the periodic table is a milestone of chemistry and one of the greatest triumphs of scientific knowledge, it is continuously evolving and it is still nowadays one of the most useful and versatile tools for the understanding and rationalizing a broad range of chemical and physical phenomena.
Testicular prostheses – impact on quality of life and sexual function
Authors: Araújo Ana Sofia , Anacleto Sara , Rodrigues Ricardo , Tinoco Catarina , Cardoso Andreia , Oliveira Carlos , Leão Ricardo
Published: July 2023

Orchiectomy is the recommended treatment for many testicular conditions. However, testicular prosthesis placement is not always performed for different reasons. In this study, we aimed to evaluate patients’ opinions and the impact on sexual function and quality of life. This retrospective observational single-center study included patients who underwent orchiectomy between January 2014 and December 2020 at the Department of Urology, Braga’s Hospital (Braga, Portugal), where testicular implants were always available and the decision to undergo the procedure was made fully independent of cost. Patients completed four questionnaires that assessed demographic data, satisfaction, self-esteem, and sexual function. Of the 96 patients who underwent orchidectomy, 59 replied to the questionnaires, and of these patients, 86.4% decided to undergo silicone-based testicular prostheses implantation. The remaining 13.6% refused the implant based on concerns about complications (37.5%), because they felt that it was unnecessary (37.5%), or because it was not offered by the doctor (25.0%). Overall, 96.1% of these patients were satisfied with the implant; however, 25.5% classified it as “too firm”. No statistically significant differences were found in sexual function (all P > 0.05). However, it can be observed that there are more patients with prostheses presenting normal sexual activity compared to patients without prostheses (74.0% vs 50.0%), and none of them reported severe erectile dysfunction (0 vs 16.7%). Regarding self-esteem, both patients with and without prostheses present very similar average scores with no statistically significant differences. The present study highlights the highest level of satisfaction among patients who received testicular prostheses. Testicular prostheses implantation is a safe procedure that does not hamper sexual function after orchiectomy.
Cognitive and Behavioral Profile of Egyptian Children with Duchenne Muscular Dystrophy
Authors: Khalil Mona , Morsy Nourhan Mohamed , Elmaksoud Marwa Abd
Published: July 2023

Background

Duchenne Muscular Dystrophy (DMD) is a progressive neuromuscular disorder that could be associated with cognitive and behavioral disorders.

Aim

To evaluate the cognitive abilities and behavioral disorders in children with DMD and possible relation to various clinical characteristics.

Subjects and methods

50 boys with DMD aged 6–14 years and an age-matched 50 boys as a control were included in the study. Assessment of cognitive function was the done using Arabic version of Stanford Binet intelligence test fourth edition, and behavioral assessment was done using the Arabic version of child behavior checklist.

Results

There was statistically significant difference between both groups regarding the total as well as all subscales of IQ test, cases showed lower scores on total and subscales IQ in comparison to controls. There was statistically significant difference between the mean scores in cases and control in all scales; internalizing problems, externalizing problems, other problems, as well as the total score. More children in the clinical and borderline categories in all domains were observed in the cases as compared to the control group. Positive relation was detected between internalizing behavioral problems and ambulatory state, duration of disease, associated conditions and cognitive abilities. Also, positive relation was observed between IQ and ambulatory state.

Conclusion

Cognitive and behavioral problems are common in DMD. Cognitive impairment have an association with the progression of muscular deterioration and loss of ambulation. Internalizing problems are more common with prolonged duration of illness, loss of ambulation, presence of associated conditions and cognitive abilities.
Chylolymphatic cyst of abdomen in a toddler: a rare case report
Authors: Balakrishnan Padmapriya , Babu Thirunavukkarasu Arun
Published: July 2023

Cystic lesion of abdomen in a toddler is a rare condition. It can be developmental, infectious, benign or malignant in nature. The site of origin may be from intrabdominal organs, omentum, mesentery, retroperitoneum, vasculature and lymphatics. They often present as acute abdominal pain, abdominal distension or constipation. Radiology and histopathology helps to arrive at diagnosis. We report a rare case of chylolymphatic mesenteric cyst in a 2 year old male child diagnosed by histopathology.
Clinico-epidemiological aspects of fever of unknown origin in children: tertiary hospital study
Authors: Attia Wafaa E. M. , Elhussiny Myada S. , AbuElhassan Samir M.
Published: July 2023

Background

Fever of unknown origin (FUO) is one of the most complex diagnostic quandaries in infectious diseases and tropical medicine. When treating patients having prolonged opaque fever, clinicians should base their diagnostic decisions on the frequency distribution of the illnesses that cause FUO. Patients reported with FUO are extremely given unnecessary excessive investigations and antimicrobial treatments, making FUO a difficult problem in clinical practice. There is no gold standard protocol for establishing the cause of FUO.

Aim

The aim of the current study was to determine the common causes of fever of unknown origin in children and its prevalence according to demographic data which may guide the pediatricians to narrow the diagnostic approach and the priority of work-up.

Patients and methods

This was an observational retrospective study conducted on a total of 134 children aged 1 to 17 years old, of both sexes admitted at Mansoura University Children’s Hospital (MUCH) from January 2015 to December 2020 and fulfilling the FUO definition (Classic FUO is as fever with a body temperature greater than and equal to 38.3°C for at least 3 weeks duration with a failure to reach a diagnosis after 1 week of inpatient investigations.

Results

Total 134 patients were identified. Confirmed diagnosis was attained in 108 patients (80.6%). Among them, infectious diseases (n=50, 37.3%) were the most common, followed by collagen vascular diseases (n=15, 11.2%), malignancies (n=10, 7.5%), and miscellaneous (n=33, 24.6%). Whereas 19.4% of cases (n=26, 19.4%) remained undiagnosed. Respiratory infections were the most common among the infectious diseases, juvenile idiopathic arthritis and acute leukemia were common causes of collagen vascular diseases and malignancies, respectively.

Conclusion

The current study concluded that; infectious diseases were the main cause for fever of unknown origin in children and respiratory infections were the most infectious cause.
Evaluation of Left Ventricular Dysfunction after Single-Chamber Pacemaker Implantation in Patients with Normal Left Ventricular Function in a Tertiary Care Institution in South India
Authors: Narasaiyan Hariharan , Swaminathan N.
Published: July 2023

Background:

In pacemaker recipients with preserved left ventricular ejection fraction, there is scant evidence regarding the effect of single-chamber pacing on left ventricular systolic function. The objective of the study was to assess the echocardiographic progression of pacemaker patients with preserved left ventricular ejection fraction at the baseline in relation to the level of right ventricular pacing and indication for pacing.

Methodology:

The clinical and diagnostic data from 200 patients who had undergone pacemaker implantation during 2018–2019 were analyzed. Of 200 patients, 32 patients were not included in the study in view of their baseline ejection fraction being <55% in 22 patients, loss to follow-up in six patients, and owing to four patients dying during the study. At admission and after a year of follow-up, the patient’s biodata, indications for pacemaker insertion, pacing percentage and echocardiographic parameters, and treatment profile were recorded.

Results:

A total of 168 patients (48.2% of males and 51.8% of females) were implanted with single-chamber permanent pacemaker. By 1 year, the mean ejection fraction, which was 61.47%, had significantly dropped to 50%. Mitral annular tissue velocity diastolic (E/e′) increased significantly (>4%) after 1 year compared to the baseline. By 1 year, there has been a significant (>10%) change from the baseline in the transannular plane systolic excursion parameter. The left ventricular systolic dysfunction happened in a greater degree in patients with advanced conduction disease compared to those who had sinus node dysfunction.

Conclusion:

Clinically significant left ventricle dysfunction and right ventricle dysfunction developed in a large number of pacemaker recipients with normal left ventricular function at the baseline.
Reinventing Nature in Kaziranga National Park
Authors: Sarmah Biswajit
Published: July 2023

A restrictive approach in managing Protected Areas (PA) is often attributed to ‘Western’ ideas of nature. This view claims that national elites embraced Western ideas of nature—which supposedly has no place for humans—to produce pristine wilderness in PAs by banning grazing, fishing, and foraging inside them. This article foregrounds cultural politics as an alternate driver of creating wilderness in the global south. The article explores the history of conservation of the Greater One-horned Rhino (Rhinoceros unicornis) in Kaziranga Wild Life Sanctuary (KWLS), the previous avatar of Kaziranga National Park in Assam, India. It shows that Assamese cultural politics pertaining to the rhino not only augmented the Assam Forest Department’s (FD) enduring efforts to sanitise KWLS from human activities but also paved the way for the militarised protection of the rhino, which in turn, reinforced wilderness. By the late 1960s, when a larger debate about wildlife conservation surfaced in India, developments in KWLS subtly informed exclusionary conservation in other national parks and tiger reserves.
Diagnostic performance of transthoracic ultrasound in patients with pulmonary embolism
Authors: Al-Salahy Mahmoud M , El-Mahdy Mohammad A -E , Sabry El-Shaimaa M , Ahmed Samar N , Elnaggar Marwa E
Published: July 2023

Background

Pulmonary embolism (PE) is an acute, significant, and life-threatening condition. Transthoracic ultrasound (TUS) is one of the noninvasive diagnostic modalities that has been presented for detection of numerous chest disorders as well as PE.

Objectives

The goal of this work was to estimate the accuracy, sensitivity, and specificity of bedside TUS in PE detection.

Patients and methods

Fifty patients with moderate-to-high clinical suspicion of PE were examined by TUS. Diagnosis of PE depended on clinical suspicion and was confirmed by computed tomography pulmonary angiography.

Results

Most of the lesions related to PE and detected by US examination were on the right side (60%) and posterior lower lobe (70%) with predominance of A profile. Sensitivity, specificity, accuracy, negative, and positive predictive values of TUS in diagnosis of PE were 93.3, 65, 82, 86.7, and 80%, respectively.

Conclusion

TUS is an important diagnostic tool as a noninvasive bedside test in detecting PE principally for critically ill or unmoving patients with high sensitivity and moderate specificity.
Prevalence of hypothyroidism in newly diagnosed patients with obstructive sleep apnea syndrome: a prospective cross-sectional study
Authors: El-Maboud Suliman Lucy A , El Metwally Ali Raed , Ahmed Magda A , Aboelazm Maged E A
Published: July 2023

Introduction:

One of the most common presentations of OSAS is daytime sleepiness, which is also seen in patients with hypothyroidism. We hypothesized that hypothyroidism is one of contributing factors in the development of OSAS; thus, adequate management of hypothyroidism can simply help to alleviate OSAS symptoms.

Aim of the Study:

The aim of this study was to evaluate the prevalence of hypothyroidism in OSAS patients in our locality and to compare respiratory polysomnographic parameters of OSAS patients with hypothyroidism versus those without hypothyroidism.

Patients and Methods:

In a descriptive prospective cross-sectional study, our patients attending Sleep Disordered Breathing Clinic at Sleep Disordered Breathing Unit, Chest Medicine Department, Mansoura University Hospital. All patients were subjected to full history taking with stress on sleep questionnaires, pulmonary complaints, physical examination, anthropometric measures, diagnostic PSG, laboratory evaluation (serum TSH and free T4 levels), and chest radiology and echocardiography.

Results:

There were two groups of OSAS participants (hypothyroid and euthyroid). Hypothyroidism was evident in 12% of patients;they were classified according to AHI, 13, 15, and 60 of Euthyroid patients had mild, moderate, and severe OSAS, respectively. hypothyroid patients, 2 mild OSAS, 1 moderate OSAS and 9 severe OSAS. Epworth sleepiness scale scores were significantly higher in the hypothyroid group with a mean score of 18 ± 4.8 vs 12.47 ± 6 in the euthyroid group (P = 0.003). Different PSG parameters showed no difference between the two groups. AHI, serum TSH level, and T4 levels were positively correlated but with insignificant P values.

Conclusion:

Hypothyroidism is thought to be one of the key players in the development of sleep-breathing disorders. It was evident in 12% of OSAS patients; however, the a proven insignificant difference in PSG parameters in OSAS with hypothyroidism versus euthyroid group, except for affection of daytime sleepiness.
High-velocity nasal insufflation success assessment using ROX index in patients with acute respiratory failure
Authors: Shalaby Heba M , Mohamed Hoda A
Published: July 2023

Background

High-velocity nasal insufflation (Hi-VNI) in patients with acute respiratory failure (ARF) gives humidified, heated oxygen, with a higher velocity, and gas flow up to 40 l/min, and FiO2 up to 1.0 through more comfortable, relatively small nasal prongs. respiratory rate-oxygenation (ROX) index is an easy bedside test, variable with time, and helps in decision making in the daily follow-up of patients on Hi-VNI.

Aim

The aim was to validate the accuracy of ROX index in the early detection of patients with ARF who will fail using Hi-VNI and need early intubation without worsening their clinical prognosis.

Patients and methods

A prospective observational cohort study was performed on 40 patients with ARF who received Hi-VNI treatment. Application of Hi-VNI was done once indicated, and after 2, 6, and 12 h, intensivists calculated ROX indices. Then, follow-up patients was performed for the need for intubation, ICU length of stay, and 28-day mortality.

Results

Patients treated with Hi-VNI were divided into two groups: the successful group and the unsuccessful group. A total of 20 patients (50%) required intubation after Hi-VNI. Their median ROX indices were 4.25, 4.6, and 4.8 after 2, 6, and 12 h, respectively. The ROX index can predict the risk of intubation in patients with ARF. However, in the successful group, ROX indices were 6.35, 6.29, and 7.05 after 2, 6, and 12 h, respectively. The ROX index was an accurate predictor of success (area under the curve=1.00).

Conclusion

In patients with ARF treated by Hi-VNI, the ROX index is a bedside test, daily used in ICU, and can early predict patients who will fail using Hi-VNI and need intubation, thus avoiding delayed intubation and worse clinical outcome.
The role of chest ultrasound in the diagnosis of thoracic tuberculosis
Authors: Marwa Al Makkawy , Emad Korraa , Ashraf Madkour , Noha Ahmed
Published: July 2023

Introduction

Data regarding the role of chest ultrasound (CUS) in thoracic tuberculosis (TTB) are deficient. If the diagnostic accuracy of CUS for pulmonary tuberculosis (PTB) is similar to that for CUS in the diagnosis of pneumonia, CUS could play an important role in its diagnosis.

Aim

This study aimed to describe the diagnostic features and use of CUS in TTB and compare CUS findings in PTB versus community-acquired pneumonia (CAP).

Patients and methods

Consecutive patients presenting with TTB and CAP were enrolled in this study. Computed tomography (CT) chest, CUS, mediastinal US, and abdominal US were performed. CUS lesion pattern in TTB, PTB, and CAP cases were recorded.

Results

CUS in patients with PTB uniquely and significantly detected pleural gap (28 patients, 27%), fragmented pleura (35 patients, 34%), subpleural fluid collection (three patients, 2.9%), and subpleural nodules (SPN) (97 patients, 95%), which were not detected by CT (P<0.05 for all). Moreover, CUS in patients with PTB uniquely and significantly detected absent sliding sign in a cavitary lesion, pleural gap, and SPNs, which were absent in CUS in CAP (P<0.05 for all) and highly significant more subpleural consolidations when compared with CUS findings in CAP. However, more significant air bronchogram CUS patterns were encountered in patients with CAP than in those with PTB.

Conclusion

CUS is a complementary tool in assessing TTB. It can report new PTB patterns (pleural gap, fragmented pleura, subpleural fluid collection, SPN, and subpleural consolidation) not detected by CT. CUS detects different sonographic patterns in PTB than CAP.
Occult pneumothorax in patients with blunted polytrauma: an experience of Tanta University Hospitals
Authors: Abdelwahab Amr , Salem Heba
Published: July 2023

Aims

The objective of this study was to retrospectively evaluate the incidence, management, and outcome of occult pneumothorax (OPTX) in patients with blunt chest trauma (BCT).

Settings and design

A retrospective observational study was performed.

Patients and methods

Over 9 years, cases with BCT were identified retrospectively from the database between 2012 and 2021. Data were evaluated and compared based on the first management (conservative vs. intercostal tube).

Results

Of the 2113 cases, 51 (2.4%) admitted with BCT during the study period were found to have OPTX. The mean age of patients was 37 ± 6.58 years, and there was a male predominance (78.43%). Intercostal tube intervention was done in 29 (53.8%) cases, and conservative management was done in 22 (43.13%) cases. Cases that needed tube thoracostomy had significantly higher rates of lung and chest contusions and high Abbreviated Injury Scale compared with those who were treated conservatively. However, pneumonia, rib fracture, hospital length of stay, and ventilatory days were insignificantly different between both groups. Overall mortality was 9.8%.

Conclusions

In cases with BCT that did not require major interventions or needed to be mechanically ventilated, their OPTX can be safely managed conservatively.
Role of GeneXpert in extrapulmonary tuberculosis
Authors: Azzouz Ahmed M , El-Sokkary Raafat T I , Wafi Lamiaa S , Khalaf Mohammad G A
Published: July 2023

Background

Tuberculosis (TB) commonly affects the lung (pulmonary TB). Extrapulmonary TB (EPTB) can involve many systems. Diagnosis is often difficult. EPTB may be misdiagnosed with many other inflammatory, granulomatous, and neoplastic disorders. GeneXpert mycobacterium tuberculosis /rifampicin is a valuable test in diagnosis of pulmonary TB. There is limited research about its diagnostic role in EPTB.

Patients and methods

The aim of this study was to assess the diagnostic value of GeneXpert in EPTB. Samples from EPTB cases were sent for standard mycobacterial culture and GeneXpert assay. The sensitivity and specificity of GeneXpert were calculated.

Results

A total of 100 patients were included. Overall, 61 cases were definitely diagnosed as EPTB, whereas 39 cases were negative according to culture. GeneXpert was positive in 40 cases, which represent 65.6% of EPTB cases, and negative in 21 (34.4%) cases. Sensitivity and specificity of GeneXpert was 65.6 and 97.4%, respectively. The positive predictive value and negative predictive value were 97.4 and 64.4%, respectively.

Conclusion

GeneXpert is a rapid, valuable tool in diagnosis of patients with EPTB. It is a highly specific test with fair sensitivity. A multicenter study with larger sample size is needed to evaluate the diagnostic role of GeneXpert in different sites of EPTB.
Polysomnography in women: is there any difference between childbearing period and menopause?
Authors: El Helbawy Rana H , Abo Shady Heba M , El-Koa Amal A
Published: July 2023

Background

Women may have a wide range of symptoms in the menopausal period, which includes vasomotor, mood changes, and disturbances of sleep. Disturbance of sleep leads to adverse health problems with poor quality of life. This study researched the comparison of polysomnographic parameters between menopausal and childbearing women.

Patients and methods

This study was carried out on 47 women (divided into two groups of premenopausal and postmenopausal), who attended for polysomnography in the Unit of Sleep in the Department of Chest Diseases in Menoufia University Hospital from the period of September 2021 to September 2022. After taking informed written consent, all participants were subjected to history taking, full examination, Epworth sleepiness scale, STOP-Bang questionnaire, and polysomnography.

Results

This study was carried out on 47 women who were divided into two groups: group I (29 participants) in menopause with an age of 58.9 ± 6.3 (mean±SD) and group II (18 participants) in the childbearing period with an age of 37.28 ± 8.064 (mean±SD). Polysomnographic parameters showed statistically significant differences between both groups regarding sleep latency (min) (P=0.026), sleep efficiency% (P=0.019), apnea–hypopnea index (P<0.001), O2 desaturation index, and lowest O2 saturation during sleep (P<0.001 and 0.01, respectively).

Conclusion

Women in menopausal women experience more sleep disturbance, insomnia, and sleep breathing disorders than they did during the childbearing years. Women in this age group, therefore, require a more thorough assessment of sleep difficulties and other relevant variables.
Role of interleukin-6 in coronavirus disease 2019 pneumonia: sensitive marker of inflammation, a predictor of ventilatory support and early marker of post-coronavirus disease lung fibrosis. A single center experience
Authors: Patil Shital , Gondhali Gajanan , Acharya Abhijit
Published: July 2023

Background

Robust data on interleukin-6 (IL-6) is available in bacterial infection, and now it can be utilized in the currently ongoing coronavirus disease 2019 (COVID-19) pneumonia pandemic to guide treatment strategy as a marker of inflammation.

Patients and methods

Prospective, observational, and 12 weeks follow-up study, included 1000 COVID-19 cases confirmed with reverse transcription PCR. All cases were assessed with lung involvement documented and categorized on high-resolution computed tomography thorax, oxygen saturation, IL-6 at the entry point, and follow-up. Age, sex, comorbidity, and bilevel positive airway pressure/noninvasive ventilation (BIPAP/NIV) use and outcome as with or without lung fibrosis as per computed tomography severity. Statistical analysis is done by χ
2 test.

Results

In the study of 1000 COVID-19 pneumonia cases, age (<50 and >50 years) and sex has a significant associations with IL-6. High-resolution computed tomography severity score at entry point has significant correlation with IL-6 level (P<0.00001). IL-6 level has a significant association with duration of illness (P<0.00001) comorbidities has a significant association with IL-6 level (P<0.00001). IL-6 level has a significant association with oxygen saturation (P<0.00001). BIPAP/NIV requirement has a significant association with IL-6 level (P<0.00001). Timing of BIPAP/NIV requirement during the course of hospitalization has significant association with IL-6 level (P<0.00001). Follow-up IL-6 titer during hospitalization as compared with entry point abnormal IL-6 has a significant association in post-COVID lung fibrosis (P<0.00001). Follow-up IL-6 titer during hospitalization as compared with entry point normal IL-6 has a significant association in post-COVID lung fibrosis (P<0.00001). Follow-up IL-6 titer during hospitalization as compared with entry point abnormal IL-6 has a significant association in predicting cytokine storm irrespective normal or abnormal of IL-6 at entry point (P<0.0001).

Conclusion

IL-6 has documented a very crucial role in COVID-19 pneumonia in predicting the severity of illness, progression of illness, and ‘cytokine storm.’ Sequential IL-6 titers will help assess response to treatment during hospitalization and analyze post-COVID lung fibrosis.
Bronchoalveolar lavage in lung cancer: does it increase the positive yield of bronchoscopy?
Authors: Salama Khadiga S M , Hafez Manal R , Farag Abeer S , Salim Doaa L A
Published: July 2023

Background

Cells obtained from bronchoalveolar space can give a definite diagnosis in malignancies. The present study aimed to assess the diagnostic yield of bronchoalveolar lavage (BAL) in lung cancer and to assess the relationship of its yield with radiology, endoscopy, and pathological subtypes.

Patients and methods

A retrospective study with re-revision of saved bronchoscopic video, computed tomography (CT) films, and pathology slides was conducted on 101 patients with definite bronchogenic carcinoma diagnosed over 4 years.

Results

BAL positive yield was found in 42.4% of cases, and its yield coincided with other bronchoscopic sampling methods in 43.6% of cases. Regarding CT findings, the BAL positive yield was significantly higher in peripheral lesions (79.1%), mass size more than or equal to 3 cm (62.8%), CT bronchus sign (46.5%), hilar and/or mediastinal adenopathy (86.0%), and consolidation (51.2%). The most common bronchoscopic abnormality in patients with BAL positive yield was submucosal lesions (83.3%). The adenocarcinoma (48.8%) and bronchoalveolar carcinoma (11.6%) were the histopathological types having significant BAL positive yield. The most significant predictive factors for BAL positive yield were mediastinal adenopathy, endobronchial lesions, nonvisible lesions, adenocarcinoma type, submucosal lesions, CT bronchus sign, mass size more than or equal to 3 cm, peripheral lesions, and concomitant use of bronchial brushing. BAL had 40.3% sensitivity, 51.7% specificity, 67.4% positive predictive value, 25.9% negative predictive value, and 43.6% diagnostic accuracy in bronchogenic carcinoma.

Conclusion

BAL increases the positive yield of bronchoscopy by 13.9% with fair diagnostic performance, especially in peripherally locating nonvisible lesions. Although tissue biopsy remains the gold standard sampling, clinicians might rely on BAL cytology for diagnosis of lung cancer in some patients.
Proportion and prognosis of ICU-admitted coronavirus disease 2019-infected patients in relation to all hospitalized cases in Abbasia Chest Hospital, Cairo
Authors: Mahmoud Hend Hashem , Tageldin Mohamed A , Yousef Yehia R
Published: July 2023

Background

Because of the outbreak of coronavirus disease 2019 (COVID-19), there has been an increase in the demand for intensive care services all over the world. Severe cases fulfill one of the following criteria: respiratory rate more than 30/min, oxygen saturation less than or equal to 93%, and PaO2/FiO2 less than or equal to 300 mmHg. ICU admission is required for seriously ill patients who require high-flow nasal cannula, intubation, or more oxygen to treat hypoxemia or multiple organ dysfunctions. However, it is unclear whether patients with COVID-19 who are admitted to the ICU will survive.

Aim

To estimate the proportion and prognosis of ICU-admitted COVID cases in relation to whole COVID cases admitted at Abbassia Chest Hospital and estimation of risk factors responsible for mortality.

Patients and methods

This retrospective observational study was conducted on all cases of COVID-19-infected patients admitted at respiratory ICU of Abbassia Chest Hospital in relation to all hospitalized cases during the period between January 2021 and June 2021. All of the cases were subjected to full history taking, laboratory investigations, and radiological assessment with chest radiograph and computed tomography.

The reported outcomes included weaning from mechanical ventilation, discharge, mortality, and cause of death.

Results

The study included 76 patients with COVID-19. Overall, 43 (56.6%) were males and 33 (43.4%) were females, with a mean age of 57.17 ± 12.54 years. The incidence of mortality was 32.9%. The acute respiratory distress syndrome (ARDS) was the most common cause for ICU admission and encountered in 57.4% of the cases. All of the dead cases had severe ARDS. The use of invasive mechanical ventilation was reported in 76.5% of the included died cases, and this was statistically significantly higher as compared with the survived group. On the contrary, the length of ICU stay was statistically significantly higher in the survived group.

Conclusion

COVID-19 infection is associated with a high percentage of ICU admission with a high mortality rate. Many factors are associated with the high risk of mortality among the ICU admitted COVID-19-infected patients including severe ARDS, deterioration of the systemic organ functions, and the utilization of invasive mechanical ventilation.
Changes in eotaxin-2 and periostin levels in patients with bronchial asthma according to their smoking status: a cross-sectional study
Authors: Abdelghany Mohammed F , El-Karn Atef F , Sherif Mahmoud F , Seddik Mohamed I , Eid Safaa A , Youssif Sahar F
Published: July 2023

Background

Smoking influences the nature of airway inflammation in patients with bronchial asthma though synthesis of certain cytokines. Patterns of bronchial asthma are differentiated clinically, functionally, and regarding inflammatory biomarkers.

Aim

The research aimed to study the clinical, functional, sputum cytological differences, and serum eotaxin-2 and periostin levels in asthmatic patients regarding smoking status.

Patients and methods

The research was a cross-sectional study. The collection of cases began in August 2018 and ended in January 2020 at the Chest Department, Assiut University Hospital. We studied 117 asthmatic patients who were classified regarding their smoking status (45 nonsmokers, 42 smokers, and 30 former smokers) for serum eotaxin-2 and periostin by enzyme-linked immunosorbent assay. The effects of smoking were analyzed on inflammatory cells including eosinophilic and neutrophilic percentages in sputum and serum eotaxin-2 and periostin levels.

Results

Smokers with asthma had worse clinical and functional outcomes. Asthmatic smokers had mainly neutrophilic phenotype. Serum eotaxin-2 level was higher in smokers compared with nonsmokers and former smokers. However, serum periostin level was higher in nonsmokers compared with smokers and former smokers. Serum eotaxin-2 had a positive correlation with smoking index and eosinophilic and neutrophilic count in sputum, whereas serum periostin was correlated negatively with smoking index and positively with eosinophilic count.

Conclusion

Asthmatic smokers had worse clinical and functional outcomes with increased neutrophils in the sputum. The inflammatory biomarkers seen in smokers with asthma showed low serum periostin and increased serum eotaxin-2 levels.
Assessment on Quality of Healthcare Services during Childbirth: A Community-based Mixed-method Study in the Women of Puducherry
Authors: Chellamuthu Lalithambigai , Kanagat Sadhvika , Dakshinamurthy Senkadhirdasan , Boratne Abhijit Vinodrao
Published: July 2023

Background:

A women’s right to a positive childbirth experience should be the heart of any care provided. To assess the quality of childbirth services and mistreatment by healthcare providers among reproductive age group women and to explore factors influencing the same between women and stakeholders.

Material and Methods:

A community-based, mixed-method study was conducted from April to September 2021 in field practice areas of a medical college in Puducherry district. The sample size for the quantitative study was 348 and the women were chosen using a multi-stage sampling technique. Women were interviewed with a semi-structured questionnaire. In-depth and key informant interviews between women and stakeholders were done for the qualitative data collection.

Results:

Three-fourths (77.0%) of women preferred government tertiary healthcare facilities for obstetric care. Although 69.0% and 75.6% of the participants did not experience any verbal and physical abuse, respectively, the qualitative study results were quite the opposite. While 92.8% of the women complained that no birth companion was allowed during their delivery. Moreover, 79.9% of the women did not have the freedom to choose their comfortable birthing position. The levels of mistreatment in the rural areas were slightly higher than that of the urban areas.

Conclusion:

Quality care is a fundamental approach to maternity care. A fair bit of women experiences mistreatment during childbirth in healthcare setups. However, the chief concern here is the perception of such abuse by the mothers as normal due to their lack of knowledge regarding women’s rights.
To Try or Not to Try: A Questionnaire Study among Women with Previous Lower Segment Cesarean Section
Authors: Kansara Megha , Yadav Garima , Singh Pratibha , Gothwal Meenakshi , Kathuria Priyanka
Published: July 2023

Background:

The recent increase in the cesarean section (CS) rate worldwide has led to global concerns and vaginal birth after CS (VBAC) as an effective way to reduce the CS rate. In this study, our main aim was to know about various factors that help women make their preferred mode of delivery following a previous CS.

Material and Method:

This was a questionnaire-based study conducted in the Department of Obstetrics and Gynecology, All India Institute of Medical Sciences (AIIMS), Jodhpur, among 200 women with previous one lower segment CS (LSCS).

Results:

Elective repeat cesarean delivery (ERCD) was found to be more among uneducated women and those who had complications in their previous babies. The most common reason for opting for ERCD was fear of labor pains. Women who were counseled by senior doctors were more likely to opt for a trial of labor after cesarean section (TOLAC).

Conclusion:

Improving the education levels of mothers, counseling about advantages associated with vaginal birth, counseling by senior obstetrician, and information regarding labor analgesia can decrease CS rates.
Prevalence of Stress and Insomnia among Health Care Workers in India during COVID-19 Pandemic: A Systematic Review and Meta-analysis
Authors: Khobragade Ashish W. , Agrawal Nitin
Published: July 2023

Background:

Health care workers (HCWs) are prone to stress and insomnia because of pandemic situations. Assessment of the actual burden of this stress and insomnia is essential to form preventive strategies. The study’s objective was to find out the pooled prevalence of stress and insomnia among HCWs in India during the coronavirus disease (COVID-19) pandemic.

Material and Methods:

We conducted a systematic review and meta-analysis to determine the prevalence of stress and insomnia among HCWs during the COVID-19 pandemic in India. Cross-sectional studies conducted in India regarding stress and insomnia among HCWs were searched from PubMed, Scopus, Embase, and Google Scholar. These studies were published after the declaration of the COVID-19 pandemic till August 31, 2021. Articles were searched independently by both authors. Data were extracted in an Excel sheet and analyzed using the ‘Meta’ package of the ‘R’ software version 4.1.0.

Result:

A total of 23 and 16 studies were included in the final pooled analysis of stress and insomnia, respectively, following preferred reporting items for systematic review and meta-analysis guidelines. A random-effects model was used to determine the pooled prevalence of stress and insomnia. This study is registered in Prospero. The registration number is CRD42021253917. The total numbers of HCWs from India included were 8125 and 4974, respectively, for finding out the pooled prevalence of stress and insomnia. The pooled prevalence of stress and insomnia among HCWs is 43% [95% confidence interval (CI) 30–56%] and 35% (95% CI 28–44%), respectively. Two out of five and one in three Indian HCWs have stress and insomnia, respectively, during the COVID-19 pandemic.

Conclusion:

Human resource development should be prioritized to decrease the workload among HCWs. The findings from this study will be useful in preparing policy guidelines on mental health screening of HCWs during the pandemic.
A Global Comprehensive Study of the Distribution of Type I-E and Type I-E* CRISPR-Cas Systems in Klebsiella pneumoniae
Authors: Kannadasan Anand Babu , Sumantran Venil Naranan , Vaidyanathan Rama
Published: July 2023

Background:

The CRISPR-Cas (clustered regularly interspaced short palindromic repeats–CRISPR-associated proteins) systems are the short DNA sequences and RNA-dependent nuclease involved in the adaptive immunity in bacteria and archaea. The type of CRISPR-Cas system influences antibiotic susceptibility in Klebsiella pneumoniae. Here, our objective was to study the diversity of CRISPR-Cas system in the genome of K. pneumoniae from the available whole genome sequencing (WGS) data.

Material and Methods:

We identified the CRISPR-Cas systems of K. pneumoniae using the CRISPR-CasFinder database. The complete genome sequence and its submission details were obtained from the National Center for Biotechnology Information (NCBI) database.

Results:

A total of 1607 K. pneumoniae whole genome sequences were analyzed. The major contributors of WGS data of K. pneumoniae were China (26.6%), United States (21.5%), Australia (10%), South Korea (8%), India (5.5%), and United Kingdom (4.9%). Out of 1607 genomes analyzed, almost one-fourth were CRISPR-Cas positive (403/1607) and three-fourth were CRISPR-Cas negative (1204/1607). Among CRISPR-Cas positive strains, 220 belonged to type I-E* and 183 were type I-E. Furthermore, type I-E* CRISPR-Cas systems were significantly higher in Asia (P < 0.001), whereas type I-E were significantly higher in Europe (P < 0.01). Among countries, typically, type I-E* strains were found to be higher in China (P < 0.01) and India (P < 0.01), whereas type I-E strains were higher in Germany (P < 0.01).

Conclusion:

Hence, it is important to know the type of CRISPR-Cas systems in K. pneumoniae strains across the countries and it can help to understand the diversity of CRISPR-Cas systems worldwide.
Sleep Quality of Undergraduate Medical Students during and Post-Lockdown: A Cross-Sectional Research
Authors: Sebastian Loana M. , Tojo Joyal , Fathima Farah N.
Published: July 2023

Background:

The COVID-19 and associated lockdowns have significantly impacted the lives of undergraduate medical students, including their sleep quality. This study attempts to investigate how sleep patterns, sleep quality, and associated factors altered during and post-lockdown.

Material and Methods:

In this cross-sectional study, 171 medical students from colleges registered under the National Medical Council participated. The study used a validated PSQI questionnaire. The data collected through Google forms were analyzed using SPSS v2021.

Result:

Among 171 study participants, 9.4% had bad sleep quality during lockdown which reduced to 4.7% post-lockdown significantly. Sleep latency and sleep duration were also significantly affected by the lockdown. There was a weak correlation between PSQI score during and post-lockdown, suggesting that individuals with poor sleep quality during lockdown also had poor sleep post-lockdown. According to the study, poor sleep quality decreased after lockdown as opposed to lockdown, with improvements in sleep latency and decreased use of sleep duration.

Conclusion:

However, there was a weak correlation between PSQI score during and post-lockdown. Increased screen time during lockdown negatively affected sleep quality, emphasizing the importance of practicing sleep hygiene and promoting outdoor activities to reduce stress levels and improve mental health.
Knowledge and Prevention of Vertical Transmission of Hepatitis B Infection: A Cross-Sectional Study among Pregnant Females in Varanasi, India
Authors: Maheshwari Kalika , Kansal Sangeeta
Published: July 2023

Background:

300 million individuals worldwide suffer from chronic HBV infection. India, an intermediate endemicity zone, has a 3-4% HBsAg prevalence in the general population and 0.9-11.2% among pregnant women. As 95% of infantile infections progress to chronicity, vertical transmission is a vital intervention area. To assess the knowledge of pregnant women and post-natal mothers concerning Hepatitis-B infection transmission and prevention.

Material and Methods:

A cross-sectional study was conducted with 143 participants (124 pregnant females and 19 postnatal mothers) attending the antenatal clinic at the rural block primary health center. A semi-structured questionnaire was used. Blood samples were evaluated for HBsAg using RAPIKIT. SPSS-22 was utilized for descriptive statistical analysis.

Results:

91.6% of respondents had heard of Hepatitis. 1.4% stated that it can be caused by a virus, whereas 40% identified consumption of oily, spicy, and unhygienic food as causative. 67.1% of respondents underwent blood tests but could not specify what they were screened for. 5.2% were HBsAg positive. ~40% were aware of vertical transmission. 59.4% of respondents were unaware of any preventive modality, and 7.7% said vaccination is preventive. 97.9% had never been counseled during their antenatal period by health workers. 41.1% said that their newborns were vaccinated within 24 hours of birth.

Conclusion:

Findings emphasize the paucity of knowledge possessed by pregnant women and post-natal mothers concerning Hepatitis B causation, transmission, and prevention regardless of age, education, or socioeconomic status. Misconceptions were prevalent, and counseling was inadequate.
Prevalence, Pattern, and Predictors of Ever Use of Complementary and Alternative Medicine in Diabetes and Hypertension: A Cross-Sectional Study
Authors: Walia Parteek , Kumari Ranjeeta , Singh Mahendra
Published: July 2023

Introduction:

Noncommunicable diseases (NCDs) have emerged as a pandemic globally and the situation is worse for developing nations. The four major NCDs that are responsible for a major proportion of mortality across the globe are cardiovascular diseases, cancer, respiratory diseases, and diabetes. For a country with limited resources, an integrated approach toward the management of NCDs is of particular importance. Complementary and alternative medicines (CAMs) are those health-care and medical practices that are not currently an integral part of conventional medicine system. This study was undertaken to estimate the prevalence, pattern, and predictors of CAM use among patients with NCDs (diabetes, hypertension, or both).

Materials and Methods:

A health-facility-based cross-sectional study was conducted at different levels of government health-care facilities in Rishikesh, Uttarakhand. CAM categories included alternative medical systems, mind–body intervention, biologically based therapies, manipulative and body-based methods, and energy therapies. Additionally, jhaad phook/local healers were also included in our study.

Results:

The study showed that 41% of all the study participants were ever users of CAM. While most of the users were practicing more than one type of CAM, the most common type of CAM practiced was alternative medicine system (83.3%) followed by mind–body medicine (40.2%). Except religion and place of residence of the study participant, no other factor showed a significant association with ever usage of CAM.

Conclusion:

CAM use was popular among study participants as almost half of them were using/consuming it and alternative medicine system was the most common type of CAM practiced.
The Out-of-pocket Expenditures Incurred during Neonatal Hospitalization in a Public Hospital in Tamil Nadu - A Cross-Sectional Study
Authors: Kumaravel K. S , Anurekha V , Palanivelraja T , Gobinathan S , Gowri M , Ramya S
Published: July 2023

Background:

For effective policy making, it is important to understand out of pocket costs incurred in neonatal admissions in public hospitals. This cross sectional study was conducted with an objective to estimate out of pocket expenses expended on neonates and attenders during neonatal hospitalizations in a tertiary care referral hospital.

Material and Methods:

The data were collected using a pretested and semi structured questionnaire in 298 neonates during July’2022. Expenditures were reported as median values with interquartile range (IQR) and compared using the Kruskal Wallis test.

Result:

On analyzing the results, there were no direct medical costs. The median cost spent on food per day, transport during the stay, non medical expenses per day, and total expenses per day were Rs. 300 (IQR 200, 500), Rs. 1000 (500, 1500), Rs. 500 (333, 896), and Rs. 1080 (800, 1533), respectively. Higher expenses were associated with preterm, low birth weight, neonatal seizures, and longer stay (P values <0.001, 0.028, <0.001, and <0.001, respectively). About 9.39% and 1% of the families were found to be catastrophic health expenditures at 10% and 25% threshold levels, respectively.

Conclusion:

To conclude, all the direct medical costs were borne by the caregiver. However, some non medical and indirect costs are associated with neonatal hospitalizations in public hospitals and cash benefit schemes can offset them.