bluuebunny/crossref_metadata_2025 huggingface dataset:
Variación de los indicadores epidemiológicos del COVID-19 a partir de las políticas de emergencia adoptadas en países sudamericanos
Authors: Moquillaza-Alcántara Victor , Romero-Cerdán Anthony , Munares-García Oscar , Merellano-Navarro Eugenio
Published: April 2020

Objetivo: Determinar la variación de los indicadores epidemiológicos del nuevo coronavirus (COVID-19) a partir de las políticas de emergencia en salud pública que adoptaron los países sudamericanos. Material y métodos: Estudio ecológico donde se recopiló información de 12 países sudamericanos respecto al número de casos totales por día, número de casos nuevos, coeficiente de crecimiento y tasa de letalidad respecto al COVID-19, hasta el 28 de marzo del 2020. Asimismo, se registraron las políticas de emergencia adoptadas por lo Estados, la cual fue verificada por residentes de los países considerados. Los datos fueron almacenados en una base Excel y analizados en el software STATA. Resultados: Los primeros países en adoptar políticas de emergencia en Sudamérica lo realizaron cuando no habían transcurrido muchos días desde el primer caso confirmado de COVID-19. Asimismo, aquellos países que adoptaron medidas en menos de 11 días presentaron un menor coeficiente de crecimiento de casos totales y una menor tasa de letalidad. Finalmente, el coeficiente de crecimiento promedio en Sudamérica presentó un descenso considerable durante la primera semana, para luego mantenerse ligeramente constante hasta la fecha evaluada. Conclusión: Los países que adoptaron políticas de emergencia a 11 días o más desde el primer caso de COVID-19 fueron aquellos que presentan un mayor coeficiente de crecimiento de casos totales y mayor tasa de letalidad. El crecimiento de casos en Sudamérica ha presentado un descenso desde que se registraron los primeros casos.
Traducción, adaptación y validación por expertos del Indice de Distrés Peri-traumatico relacionado a la enfermedad por coronavirus 2019 (CPDI) para su uso en el Perú.
Authors: Pedraz Petrozzi Bruno , Arevalo-Flores Martin , Krüger-Malpartida Hever , Anculle-Arauco Victor
Published: April 2020

Para disponer de un instrumento que mida impacto emocional relacionado a COVID-19, se procedió a la validación del indice de distrés peri-traumático relacionado a COVID-19 (CPDI) para su uso en el Perú. El CPDI fue traducido al castellano y luego adaptado en una primera ronda de expertos. En una segunda ronda de expertos (n = 13), se evaluó la validez del contenido y la fiabilidad del CPDI. De los 24 items originales, solo un ítem (S7) presentó valores no significativos para validez de contenido y se eliminó el ítem. Los valores de fiabilidad del CPDI original (24 items) y del modificado (23 items) permanecieron invariables. En conclusión, el CPDI en castellano presenta adecuadas validez de contenido y fiabilidad, por lo que se puede aplicar en el Perú. Finalmente, la modificación del CPDI no alteró sus caracteristicas por lo que se sugiere usar la versión modificada para una mejor evaluación.
Predicting Chemotherapy Toxicity in Older Patients with Cancer: A Multicenter Prospective Study
Authors: Feliu Jaime , Jiménez-Munárriz Beatriz , Basterretxea Laura , Paredero Irene , Llabrés Elisenda , Antonio-Rebollo Maite , Losada Beatriz , Espinosa Enrique , Gironés Regina , Custodio Ana Belén , del Mar Muñoz María , Díaz-Almirón Mariana , Gómez-Mediavilla Jeniffer , Pinto Alvaro , Torregrosa María-Dolores , Soler Gema , Cruz Patricia , Higuera Oliver , Molina-Garrido María José
Published: April 2020

Background

Standard oncology tools are inadequate to distinguish which older patients are at higher risk of developing chemotherapy-related complications.

Materials and Methods

Patients over 70 years of age starting new chemotherapy regimens were prospectively included in a multicenter study. A prechemotherapy assessment that included sociodemographics, tumor/treatment variables, and geriatric assessment variables was performed. Association between these factors and the development of grade 3–5 toxicity was examined by using logistic regression.

Results

A total of 551 patients were accrued. Chemotherapy doses (odds ratio [OR] 1.834; 95% confidence interval [CI] 1.237–2.719) and creatinine clearance (OR 0.989; 95% CI 0.981–0.997) were the only factors independently associated with toxicity. Only 19% of patients who received reduced doses of chemotherapy and had a creatinine clearance ≥40 mL/minute had grade 3–4 toxicity, compared with 38% of those who received standard doses or had a creatinine clearance <40 mL/minute (p < .0001). However, no satisfactory multivariate model was obtained using different selection approaches.

Conclusion

Chemotherapy doses and renal function were identified as the major risk factors for developing severe toxicity in the older patient. These factors should be considered when planning to initiate a new chemotherapy regimen and should also lead to a closer follow-up in these patients.
Recht als Wissenschaft
Authors: Schröder Jan
Published: April 2020

Die juristische Methodenlehre

in der Neuzeit (1500-1933) ist Gegenstand dieses bekannten Grundlagenwerkes. Damit beschreibt es einen besonders ereignisreichen Abschnitt der Rechtsgeschichte bis in unsere jüngere Gegenwart. Die Darstellung geht auf Grundfragen ein und zeigt, wie sich die Antworten darauf entwickelt haben.

Die 1. Auflage dieses Buches erregte 2001 beträchtliches Aufsehen und war eines (von vier) juristischen »Büchern des Jahres 2002«.

Für die 2. Auflage wurde das Werk überarbeitet und um einen neuen umfangreichen 4. Teil erweitert, der den Zeitraum von 1850 bis 1933 behandelt.

Der Autor Jan Schröder

ist seit 1989 o. Professor für deutsche Rechtsgeschichte und Bürgerliches Recht in Tübingen, seit 2001 ordentliches Mitglied der Akademie der Wissenschaften und der Literatur Mainz, 2003 Ehrendoktor der Universität Stockholm. Hauptarbeitsgebiet: Geschichte der Rechtswissenschaft.
TIM, a Targeted Insertional Mutagenesis method utilizing CRISPR/Cas9 in Chlamydomonas reinhardtii v1
Authors: Picariello Tyler , Hou Yuqing , Kubo Tomohiro , A. McNeill Nathan , Yanagisawa Haru-aki , Oda Toshiyuki , B. Witman George
Published: April 2020

Generation and subsequent analysis of mutants is critical to understanding the functions of genes and proteins. Here we describe TIM, an efficient, cost-effective, CRISPR-based targeted insertional mutagenesis method for the model organism Chlamydomonas reinhardtii. TIM utilizes delivery into the cell of a Cas9 ribonucleoprotein (RNP) together with exogenous double-stranded (donor) DNA. The donor DNA contains gene-specific homology arms and an integral antibiotic-resistance gene that inserts at the double-stranded break generated by Cas9. After optimizing multiple parameters of this method, we were able to generate mutants in six out of six different genes in two different cell-walled strains with mutation efficiencies ranging from 40% to 95%. Furthermore, these high efficiencies allowed simultaneous targeting of two separate genes in a single experiment. TIM is flexible with regard to many parameters and can be carried out using either electroporation or the glass-bead method for delivery of the RNP and donor DNA. TIM achieves a far higher mutation rate than any previously reported for CRISPR-based methods in C. reinhardtii and promises to be effective for many, if not all, non-essential nuclear genes.
Evaluation of F5 Individuals Obtained from B28×Kunduru-1149 Reciprocal Cross Population by Functional Markers
Authors: AYDEMİR Gülan , DUMLUPINAR Ziya , YÜCE İlker , NARLI Tuğba , SUNULU Selçuk , GÜNGÖR Hüseyin
Published: April 2020

In the study, B28 and Kunduru-1149 durum wheat genotypes were crossed as reciprocal in 2012-2013 cropping season. 13 (B28/Kunduru-1149 and Kunduru-1149/B28) reciprocal crosses were obtained and were used as materials at F5 stage. The cross combinations and the parents were screened with 10 DNA markers to determine alleles of gluten strength (Bx7OE), Yellow rust (Sun104, Xgwm18, Xwgp115 and Xgwm47), stem rust (Sun209 and Sun479), high protein ratio (UHW89), powdery mildew (Xgwm66) and leaf rust (Xgwm130). In the study, the average polymorphism information content (PIC) was calculated as 0.98 and the lowest PIC value was obtained from Xwgp115 marker with 0.96, while the rest of the markers had 0.99 PIC values. Stem rust resistance allele Sr49 was detected in B28/Kunduru-1149_F5_4 (Sun479) and B28/Kunduru-1149_F5_1 (Sun209) genotypes. One of the yellow rust resistance alleles Yr15 (Xgwm18) was detected in B28/Kunduru-1149_F5_2 and B28/Kunduru-1149_F5_3 genotypes, while Yr51 (Sun104) was identified in B28/Kunduru-1149_F5_3, B28/Kunduru-1149_F5_6, B28/Kunduru-1149_F5_7, Kunduru-1149/B28_F5_2 and Kunduru-1149/B28_F5_6 genotypes. A dendrogram was created to determine kinship of the individuals with the parents. The highest genetic similarity was observed between B28 / Kunduru-1149_F5_6 and Kunduru-1149 / B28_F5_2 genotypes with 0.714, while the most diverse ones were Kunduru-1149 and B28/Kunduru_F5_7 with 0.10.
Comparison of the effect of two drugs paracetamol with intravenous ibuprofen in patent ductus arteriosus treatment
Authors: Mirzarahimi Mehrdad , Emamzadeghan Ramin , Enteshari Moghaddam Afsaneh , Falsafi Narges
Published: April 2020

Background: Patent ductus arteriosus (PDA) is a common cause of morbidity and mortality among premature infants that affects more than 40% of them. PDA treatment includes medical and surgical treatment. Most drugs used to block PDA are cyclooxygenase inhibitors (ibuprofen and indomethacin). The role of paracetamol as an alternative therapy in PDA ligation has been considered in recent years due to the potential side effects of cyclooxygenase inhibitors.Methods: Patients in the first group were treated with intravenous paracetamol at a dose of 15 mg/kg every 6 hours for three days and the second group was treated with intravenous ibuprofen at a daily dose of 10 mg/kg daily and 5 mg/kg for the second and third days. At the end of the treatment period (day 3), they underwent echocardiography again. If the echocardiographic findings indicated no closure of the arterial duct, patients were treated with the aforementioned drug for another period and rechecked at the end of the third day, and at each stage required information was collected.Results: Arterial duct closure in paracetamol group was 96.7% and in ibuprofen group was 100%. The effects of both paracetamol and ibuprofen were similar in terms of renal parameters but in terms of effects on liver parameters. The effect of paracetamol on all liver parameters except aspartate transaminase (AST) was significant, but ibuprofen was able to affect only bilirubin among liver parameters and had no significant effect on both AST and alanine aminotransferase, parameters.Conclusions: Results showed that both paracetamol and ibuprofen are effective in treating of PDA and had similar impact.
A prospective cross-sectional study to evaluate the economic burden of patients diagnosed with depression in a tertiary care hospital
Authors: Dhodi D. K. , Sinha S. R. , Dawer F. , Chavan M. S.
Published: April 2020

Background: The objective of the study was to evaluate the cost of care of depression in terms of direct and indirect costs.Methods: 150 patients diagnosed with depression attending psychiatry OPD at Sir J.J. Group of Hospitals, Mumbai, fulfilling the inclusion criteria were explained about the study. Written informed consent were taken. Direct and Indirect costs were recorded in structured case record forms by interviewing the patients. Cost driving factors were identified.Results: Total annual direct cost were INR 6,378.16 which included drug costs, travel expenses, physician’s consultation, cost of investigations, hospitalisation cost while total Indirect costs were INR 16,860 which included days of work both of the patient and the caretaker.Conclusions: The indirect cost was almost thrice the direct costs. Hospitalisation cost and loss of working days due to depression was contributed the most to the direct costs and indirect costs respectively. Economic burden of depression is found out to be 16.30% of per capita gross domestic product in year 2018-19.
Study of adverse drug reactions among tuberculosis patients in a tertiary care hospital: a retrospective observational study
Authors: Mogali Sahana M. , Ratnakar Jagadishchandra S. , Kotinatot Basavaraj C.
Published: April 2020

Background: The aims of the study was to study adverse drug reactions (ADRs) among tuberculosis (TB) patients in a tertiary care hospital and to determine causality, severity and outcome of ADRs.Methods: A retrospective observational study was conducted in a tertiary care hospital over a period of 6 months. Data was collected from records of TB patients in RNTCP centre of a tertiary care hospital regarding information of patients, drugs used, ADRs. It was evaluated using appropriate scales. Simple descriptive statistics was used for analysis.Results: Out of 37 patients who experienced ADRs, 22 (59.45%) were male and 15 (40.54%) were female. Majority of patients were in the age group of 36 to 45 years (37.83%). 36 (97.3%) patients were diagnosed with pulmonary TB and 1 (2.7%) patient had extra pulmonary TB. Among 37 ADRs gastrointestinal (GI) reactions were most common 11 (29.72%) followed by musculoskeletal 9 (24.32%). Causality assessment showed 19 (51.35%) as probable and 18 (48.65%) ADRs as possible, Severity assessment was 24 (64.8%) reactions were in mild, 10 (27.02%) in moderate and 3 (8.1%) in severe grades. Outcome assessment was 26 (70.3%) patients were recovering from reactions, 9 (24.32%) had recovered and 2 (5.4%) did not recover at the time of reporting.Conclusions: Proper monitoring of ADRs helps in reducing patient’s burden of repeated hospital visits and expense occurring due to admissions. This can be prevented by educating patients about early reporting of ADRs.
Pattern of adverse drug reactions occurring at department of neurology of a tertiary care hospital in India
Authors: Kushwaha Virendra , Agrawal Pooja , Srivastava Ruchi , Verma Alok
Published: April 2020

Background: The objective of the study was to study the pattern and trends of adverse effects of drugs used in department of neurology in a tertiary care hospital.Methods: A prospective, observational study was carried out for a duration of 12 months from November 2018 to October 2019 at Department of Neurology and Department of Pharmacology and Therapeutics, G.S.V.M. Medical College, Kanpur after getting an approval from institutional ethical committee. Data was collected by analyzing OPD prescription slip, treatment charts and investigation reports. All relevant information regarding adverse drug reactions (ADRs) were collected as per norms of Indian Pharmacopoeia commission (IPC).Results: During the study period, a total of 130 ADRs reported. Most of the ADRs were reported due to antiepileptic drugs followed by antiparkinsonian drugs. Dizziness was the most frequent ADR reported. Most of the ADRs were reported due to phenytoin. Other ADRs observed were drowsiness, nausea/vomiting, weakness, joint pain, dyskinesia.Conclusions: Most of the ADRs were due to anti-epileptic drugs. Most of the reactions were of mild severity.
Prescribing pattern of antibiotics in pediatric department of a tertiary care teaching hospital
Authors: G. K. Nalini , . Neelamma , Kumar D. G. Prasanna , P. Deepak , G. N. Sahana , G. N. Jayashree , Anna Valder Bhavishya Keerthi
Published: April 2020

Background: Prescription is an order from doctor for medicine. Rational use of medicines requires that "patients receive medications appropriate to their clinical needs, in doses that meet their own individual requirements, for an adequate period of time, and at the lowest cost to them and their community". Irrational use of medicines is a major problem worldwide. This leads to serious morbidity and mortality also leads to reduction in the quality of treatment due to antibiotic resistance. Evaluation of prescribing pattern will help in minimizing adverse drug reactions, resistance among children. Also help to know the attitude of the physicians towards prescribing. Aim of the present study was to evaluate the prescription pattern of antibiotics in paediatric inpatients of Hassan institute of Medical Sciences.Methods: A prospective study, conducted among 110 patients below the age of 18 years and being treated with antibiotics were included in our study. The results were analyzed using descriptive statistics.Results: Out of 110 patients, female (58) and male (52) are enrolled in the study from inpatient paediatrics department, majority of patients belonged to age group of 0-5 years (74%), respiratory tract infections 29 (35%) , gastrointestinal infections 26 (22%) and central nervous system in 9 (11%). Out of 227 antimicrobial agent, about 83.48% were cephalosporins, followed by ciprofloxicin (33.94%), amoxicillin (32.11%), and amikacin (6.42%).Conclusions: Cephalosporins (ceftriaxone) were most commonly used antibiotic, which covers gram positive, gram negative and anaerobic organism.
A review of pharmacological effects of xylopic acid
Authors: Oge Elizabeth N. , Obese Ernest , Biney Robert P. , Adakudugu Emmanuel , Agbenyeku Mary , Osei Silas A. , Cassera Maria B. , Valenciano Ana Lisa , Merino Emilio F. , Boampong Johnson N. , Woode Eric , Adanusa Madison , Ameyaw Elvis O.
Published: April 2020

Xylopic acid (15β-acetyloxy-kaur-16-en-19-oic acid) is a kaurene diterpene that can be obtained from various Xylopia spp. Xylopic acid has demonstrated several pharmacological activities in vitro and in vivo. The compound has shown promising effect as a potent analgesic, anti-inflammatory and anti-allergic agent. Xylopic acid is a CNS depressant and was able to ameliorate anxiety-like symptoms in mice in addition to its neuroprotective effects. Deleterious effects of xylopic acid on the reproductive system of mice have been well documented but extensive toxicity study detailing effect of the acid upon chronic exposure needs to be determined. Due to the heavy consumption of X. aethiopica fruits, it is recommended that the pharmacokinetics of xylopic acid be determined to ascertain the possible food-drug interaction that may occur when conventional drugs are taken together with foods containing xylopic acid.
Rimegepant: first novel oral calcitonin gene-related peptide inhibitor for migraine
Authors: Ramasubbu Saravana Kumar , Dakshinamurthy Senkadhirdasan , Palepu Sarika , Bandyopadhyay Arkapal , Rajendran Sathish Kumar
Published: April 2020

Migraine is a neurological condition characterized by intense, debilitating headaches. Symptoms may include nausea, vomiting, numbness or tingling, sensitivity to light and sound. There are multitude of drugs available to treat migraine like triptans, non-steroidal anti-inflammatory drugs, ergots and opioids. But these drugs are associated with adverse effects especially triptans causing cardiovascular effects limiting its use. During last decade, calcitonin gene-related peptide (CGRP) has emerged as a possible mechanism for management of migraine. CGRP has been shown to release during episode of migraine attack and it may play a causative role in induction of migraine. Rimegepant is a novel CGRP antagonist has been approved by FDA for treatment of acute migraine. Rimegepant is a first oral CGRP antagonist compared to other gepants. The oral bioavailability of Rimegepant is 64% and high fat meal can decrease the Cmax, Tmax and area under the curve. This drug is mainly metabolized by CYP3A4 and to lesser extent by CYP2C9. Most common adverse reactions associated with this drug were nausea and urinary tract infection. Clinical trials for Rimegepant have been positive, and results suggest that the drug may be a new safe and effective option for treatment of acute migraine.
Effect of metformin on fibrinolysis in type 2 diabetes mellitus: an explorative study
Authors: Reddy Siddharth K. , Nadig Pratibha , Andra Ravikiran , Sarathi Vijaya
Published: April 2020

Type 2 diabetes mellitus (T2DM) is associated with a high incidence of vascular disease which can cause significant morbidity and mortality. The risk of cardiovascular mortality in T2DM patients is observed to be more compared to the age-matched subjects. This is attributed to depression of the fibrinolytic system which maintains patency of blood vessels. Endogenous inhibitors such as plasminogen activator inhibitor-1 (PAI-1) inhibit the activation of plasminogen and thus prevent the degradation of fibrinogen. In T2DM there is increased levels of PAI-1. Such a state of altered fibrinolysis is attributed to insulin resistance. A previous study done at our institute demonstrated higher euglobulin lysis time (ELT) in T2DM patients than controls, suggesting altered fibrinolytic activity in the former group. D-dimer is a degradation product of fibrin. Its presence indicates a state of hypercoagulability.  In a study by Nwose et al rise in D-dimer levels were observed in diabetics, especially with cardiovascular complications as compared to controls indicating D-dimer could be a useful marker for predicting the complications in T2DM.
Combined liver-visceral resection for neoplastic lesions correlates with increased postoperative complications
Authors: El-Badry Ashraf Mohammad , Ali Mohamed Mahmoud
Published: April 2020

Background: Combined liver-visceral resections (CLVRs) may impose increased risk of postoperative complications. The clinical outcome of CLVRs versus sole liver resection (SLR) has not been adequately reported from upper Egypt cancer surgery programs.Methods: Medical records of adult non-cirrhotic patients who electively underwent liver resection from February 2015 to April 2018 at Sohag University Hospital, Egypt, were retrospectively reviewed. Indications for liver resection comprised definitively malignant tumors and those with equivocal radiologic features. The severity of surgical complications, including mortality, was compared among patients who underwent CLVRs versus SLR control group with matching age, gender, number of resected liver segments, method of hepatic inflow occlusion and parenchyma transection techniques.Results: Twenty-six patients were enrolled, including 13 with CLVRs group and their 13 SLR control group. Histopathologic examination of resected specimens confirmed malignancy in 17 patients (10 in CLVR group and 7 in SLR group). Major liver resection (≥3 segments) was carried out in 14 (54%) patients, 7 per each group. The complication score was significantly higher in CLVRs (p<0.05). Similarly, the length of hospital and intensive care unit stays was significantly prolonged in CLVRs group (p<0.05). Overall, 2 patients died (8%), exclusively in the CLVRs. Elderly patients (>65 years) who underwent CLVRs exhibited increased complications compared with their matching controls.Conclusions: CLVR predisposes to increased morbidity rates and mortality. It should be carried out in carefully selected patients to avoid worse clinical outcome.
A study of retrospective analysis of the outcome of parasagittal meningioma
Authors: Pazhaniyandi A. , Ramkumar R. R.
Published: April 2020

Background: Meningioma is a common benign tumours treated by neurosurgeons. They develop from arachnoid cap cells within the thin spider web-like membrane covering the brain and spinal cord. The arachnoid is one of the three protective layers of the central nervous system collectively known as the meninges surrounding the brain and spinal cord. The aim of our study is to analyze the outcome of parasagittal meningioma.Methods: The details of the patients diagnosed with parasagittal meningioma and operated upon during the study period of 2009-2013 were retrospectively collected from the medical records kept in the department of neurosurgery and different study parameters were documented for analysis.Results: Out of the total 40 patients with meningioma 15 (37.5%) patients had parasagittal meningioma in anterior 1/3rd of sagittal sinus, 21 (52.5%) patients had parasagittal meningioma in middle 1/3rd of sagittal sinus and 4 (10%) patients had parasagittal meningioma in posterior 1/3rd of the sagittal sinus and 28 (70%) patients  are treated by gross total resection (GTR), 7 (17.5%) patients were treated by subtotal resection (STR) and 5 (12.5%) patients were treated by dendritic cell (DC) and postoperatively 22 patients (55%) did not develop any complications. Weakness develops for 12 patients (30%), followed by recurrence in 3 patients (7.5%) and 3 patients (7.5%) died.Conclusions: Conservative resection of the tumour with residual lesion within the sagittal sinus followed by adjuvant treatment with modalities like radiotherapy, chemotherapy or targeted therapy for the residual lesion is an accepted mode of treatment.
Prospective study on outcome and advantage of primary skin grafting in cases of avulsion scalp injury following trauma
Authors: Tripati Neeraj , Singh Mayank , Singh Rahul , Devan Maha , Chauhan Anchal , Tripati Shashank , Chandra Dhruv , Singh Anil Kumar , Singh Pradeep Kumar , Sahi Hanuman Prasad , Singh Aryendra , Kumar Ashish , Yadav Ashish , Kumar Mukesh , Gupta Lalit , Singh Tej Pratap , Agrawal Ratika , Agrawal Shubham , Uttam Sarthak
Published: April 2020

Background: Traumatic avulsion injury poses severe risk as the overlying protective covering is lost and the raw tissue is exposed to the environment. Avulsion injuries involving the scalp are even more complicated to treat because of significant cosmetic concern involved. Aim of the study was to find a better solution than the existing method, we conducted a prospective study involving 13 patients with isolated traumatic scalp avulsion injury.Methods: This prospective study was conducted in Motilal Nehru Medical College and associated Swaroop Rani Nehru Hospital, Prayagraj,  after taking written and informed consents from the patients, between June 2017 and June 2019.These were divided into two groups (A and B) based on whether the underlying periosteum was intact or not.Results: Patients with intact periosteum (Group A) underwent primary thin thickness skin grafting within a few hours of their admission while the other group (Group B) was treated with a traditional conservative approach. We compared the results of both the groups and found that Group A patients not only had satisfactory graft uptake (≥85 TBSA) but also had significant decreased risk of infection, lesser hospital stay, overall decreased healthcare cost, better cosmoses and early return to routine activity.Conclusions: For the surgeon, this single step procedure is safe and technically easy. Thus this approach was found to be superior than the current traditional approach.
Perioperative complications of laparoscopic cholecystectomy: a cross-sectional observational study
Authors: Agarwal Sanjeev , Joshi Arpit D.
Published: April 2020

Background: Laparoscopic cholecystectomy (LC) has now become the gold standard in treatment of benign gall bladder disease. The intraoperative and immediate postoperative complication cannot be disregarded and remain of concern. The study aims to evaluate the perioperative complications of LC in patients undergoing the surgery.Methods: A total of 100 patients were included in this prospective analytical study from a June 2017 to September 2019. They were adequately evaluated and underwent LC in General surgery department of Geetanjali Medical College and Hospital, Udaipur. The relevant clinical details of all the patients were recorded and analysed.Results: Among the patients who underwent LC, majority were females. In case of 86 patients, LC was done due to chronic calculous cholecystitis. The conversion rate from laparoscopic to open was 6%. The most frequent intraoperative complication was trocar site bleeding and liver bed injury, 7%, followed by bile leakage from gallbladder 6%, bleeding from calots triangle in 4% and spilled gallstones in 2% cases. There was no case of injury to common bile duct, bowel injury or major vascular injury. Amongst the post-operative complications, wound infection was in 1% case. No perioperative mortality was present. The overall rate of complication was 18%.Conclusions: LC is a safe and effective procedure in almost all patients presenting with symptomatic gallbladder disease and remains one of the most frequently performed laparoscopic operations. It has a low rate of mortality and morbidity making this operation a safe procedure with favourable results.
Helicobacter pylori infection and its correlates among the patients of peptic perforation and gastric carcinoma
Authors: Saha Subhendu Bikas , Bakshi Sabyasachi , Mandal Tapas
Published: April 2020

Background: Presence of H. pylori infection was found associated with peptic perforation and gastric carcinoma. Present study tried to estimate the prevalence of H. pylori infection in those patients and to find out the correlates of H. pylori infection.Methods: After matching the inclusion and exclusion criteria, all cases of diagnosed peptic perforation and gastric carcinoma were taken for this prospective, single center, observational study.Results: Among the study population, gastric carcinoma was found in higher age group; whereas peptic perforation was found in lower age group; male and female ratio was 2:1 in both groups of patient. Laborer and housewives were mostly affected in both cases. Gastric carcinoma was more prevalent in urban residents, opposite was seen in peptic perforation. Most patients in two groups had no previous co-morbid condition. Use of NSAIDs was found in high frequency in both groups. Most of the patients were chronic alcoholic and chronic smoker, and most of them had history of taking spicy foods more than twice in a week.Conclusions: H. pylori infection was found in high frequency in both group of patients, and it was higher in peptic perforation. The study establishes the association of H. pylori with the gastric carcinoma and peptic perforation.
A study to validate thoracic trauma severity score in chest trauma patients
Authors: Sharma Amit K. , Rathore Shaitan S. , Verma Vijay , Yadav Parul
Published: April 2020

Background: Aim of this study was to validate thoracic trauma severity score (TTSS) in assessing the requirement of mechanical ventilation, mortality, and predicting prognosis in chest injury patients.Methods: This study was conducted in department of general surgery, Dr. S. N. Medical College, Jodhpur, Rajasthan, from December 2018 to September 2019. This was a single centred, prospective, observational study, conducted in 110 patients, aged >18 years, of isolated chest injury, excluding polytrauma patients. Data was summarized in the form of proportions, histograms and tables to show relationships of parameters with results. Data was presented as mean±SD and proportions as appropriate. Chi square test, z test or t tests were used wherever necessary for association analysis between categorical variables. Diagnostic test characteristics for mortality and complications was calculated from the ROC curves. A two sided of p values of less than 0.05 was considered statistically significant.Results: Most common mode of chest injury was blunt trauma and most common age group affected was 42-54 years. Maximum mortality was seen in TTSS between 16-20, shows higher the TTSS more the mortality. Ventilator requirement was more in high TTSS. Patients with higher TTSS had longer hospital stay as compared to patients with lower TTSS.Conclusions: On application of TTSS on admission, TTSS had direct correlation with need for oxygenation, ventilator need, duration of hospital stay, mortality or outcome in chest trauma patients. Thus we recommend TTSS as a good useful score for evaluation of prognosis, outcome and mortality in chest trauma patients.
Low pressure versus standard pressure pneumoperitoneum in laparoscopic cholecystectomy: a comparative study
Authors: Mandal Arnab , Ghosh Arindam , Bakshi Sabyasachi
Published: April 2020

Background: With the establishment of laparoscopic cholecystectomy as gold standard management of cholelithiasis, the current stress is being given on increasing patient safety and reducing the post-operative morbidity associated with this procedure. An emerging trend is to use of low-pressure pneumoperitoneum in an attempt to lower the impact of pneumoperitoneum while providing adequate working space.Methods: In this prospective randomized study 66 participants were allocated into two arms i.e. low-pressure pneumoperitoneum (LPP) and standard pressure pneumoperitoneum (SPP). The necessary data were collected using laboratory investigations, clinical examination and perioperative findings. Data were analyzed using suitable statistical software.Results: Mean duration of surgery, surgical difficulty and field visualization difficulty were insignificantly greaterin LPP group than SPP group. CO2 consumption was significantly less in LPP. Incidence of bile spillage, usage of drain was insignificantly increased in LPP. Post-operative pain was significantly greater in SPP group. Time for per oral tolerance of food and incidence of nausea were significantly greater in SPP group. Standard pressure group needed significantly more tramadol injection than LPP. There were no significant haemodynamic changes in SPP group compared to LPP group. Length of hospital stay was significantly greater in SPP.Conclusions: Laparoscopic cholecystectomy in low pressure pneumoperitoneum is safe and feasible. Intra-operative complications like operative field visualization, operative difficulties, conversion rates, duration of surgery are not affected moreover, low-pressure pneumoperitoneum, decreases consumption of intra-operative CO2, post-operative pain, shoulder tip pain, need of analgesia, nausea and promotes early per oral feeding, thus reduces hospital stay.
Trichobezoars: a hairy cause of intestinal obstruction
Authors: Tiwary Anurag , Singhal Pragati , Khan Nida , Tiwary Pramod
Published: April 2020

Trichobezoars are an infrequent form of bezoar found in the stomach or intestine, created from ingested hair. Their most frequent location is in the stomach but they may extend through the pylorus into the small bowel. This condition is known as Rapunzel syndrome. Trichobezoar with Rapunzel syndrome is an uncommon diagnosis in children. Authors report 3 cases of Rapunzel syndrome with a large bezoar in paediatric age group that presented with features of acute intestinal obstruction. They were managed with surgical exploration.
Increased serum osteocalcin levels and vitamin K status by daily cheese intake
Authors: Lundberg Helge E. , Holand Trond , Holo Helge , Larsen Stig
Published: April 2020

Background: Cheese is a major source of long-chained vitamin K2 variants. How intake of vitamin K2 rich cheese affects vitamin K and osteocalcin has not been studied. The aim was to establish a maximum efficacy dose (MED) after daily intake of vitamin K2-rich cheese (Jarlsberg®) based on increase in ratio between carboxylated and undercarboxylated osteocalcin during a five-week diet.

Methods: 20 healthy healthy volunteers (HV) were recruited. The daily intake of Jarlsberg® cheese in the study varied from 20 to 152 g. Clinical investigation was performed initially and after three, four and five weeks with measurement of vital signs, hematological and biochemical variables, carboxylated and undercarboxylated osteocalcin and vitamin K. The ratio OR= carboxylated/undercarboxylated osteocalcin was the main variable.

Results: The MED decreased with treatment duration and was estimated to 57 g/day (95% CI: 47-67) after five weeks diet, resulting in a mean OR increase of 30% (95% CI: 23.8-36.8). Both OR and serum osteocalcin followed a quadratic dose response curve. For osteocalcin, a maximal increase of 46% was estimated at 59 g/day for five weeks. The serum content of long-chained vitamin K2 increased significantly with increasing cheese dose. The increase were mainly obtained the first three weeks and kept unchanged the following two weeks. The cheese doses close to the MED caused nearly significant reductions in total cholesterol, LDL-cholesterol, the LDL/HDL ratio and significant reduction in the blood pressures after five weeks diet (p≤0.05).

Conclusions: MED of Jarlsberg® cheese was estimated to 57 g/day. Daily intake of Jarlsberg® cheese increased the osteocalcin level, vitamin K2 and positively affected the lipid patterns and blood pressure.
Attenuation of haemodynamic responses to endotracheal extubation-diltiazem versus lidocaine
Authors: Farooq Shaik Umar , Rani B. Sandhya , Acharya Anand
Published: April 2020

Background: Endotracheal extubation is one of the frequently performed procedure in the practice of anaesthesia. This study was done to observe the haemodynamic responses during tracheal extubation and to compare the efficacy of IV diltiazem 0.2 mg/kg versus IV lidocaine 1 mg/kg in attenuating the hemodynamic response to tracheal extubation.

Methods: 90 patients aged 20 to 60 yrs, belonging to ASA I and II, normotensive were included in the study and they were randomly allocated into 3 groups of 30 each. Group I received normal saline and served as control. Group II received 0.2 mg/kg of IV diltiazem 2 min before extubation. Group III received 1 mg/kg of lidocaine IV 2 min before extubation. At the end of the surgery, heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were recorded served as base line values.

Results: After tracheal extubation, all the haemodynamic parameters increase from the basal level in the control group and decreased in the study group. The change in HR, SBP and DBP were significantly less in group II and group III compared to group I. The change in HR, SBP and DBP were significantly less in group II compared to group III.

Conclusions: Diltiazem hydrochloride, a calcium channel blocker belongs to the benzothiazepine group given in dose of 0.2 mg/kg IV 2 min before tracheal extubation in ASA grade I and grade II patients is a simple, effective and practical method of blunting cardiovascular responses to tracheal extubation. This suppressive effect of diltiazem was comparable to or even more potent than that of lignocaine 1 mg/kg IV 2 min before tracheal extubation.
Management of fast breathing pneumonia in young infants aged 7 to 59 days by community level health workers: protocol for a multi-centre cluster randomized controlled trial
Authors: Nisar Yasir Bin
Published: April 2020

Background: WHO does not recommend community-level health workers (CLHWs) using integrated community case management (iCCM) to treat 7-59 days old infants with fast breathing with oral amoxicillin, whereas World Health Organization (WHO) integrated management of childhood illness (IMCI) recommends it. We want to collect evidence to help harmonization of both protocols.

Methods: A cluster, randomized, open-label trial will be conducted in Africa and Asia (Ethiopia, Malawi, Bangladesh and India) using a common protocol with the same study design, inclusion criteria, intervention, comparison, and outcomes to contribute to the overall sample size. This trial will also identify hypoxaemia in young infants with fast breathing. CLHWs will assess infants for fast breathing, which will be confirmed by a study supervisor. Enrolled infants in the intervention clusters will be treated with oral amoxicillin, whereas in the control clusters they will be managed as per existing iCCM protocol. An independent outcome assessor will assess all enrolled infants on days 6 and 14 of enrolment for the study outcomes in both intervention and control clusters. Primary outcome will be clinical treatment failure by day 6. This trial will obtain approval from the WHO and site institutional ethics committees.

Conclusions: If the research shows that CLHWs can effectively and safely treat fast breathing pneumonia in 7-59 days old young infants, it will increase access to pneumonia treatment substantially for infants living in communities with poor access to health facilities. Additionally, this evidence will contribute towards the review of the current iCCM protocol and its harmonization with IMCI protocol.

Trial Registration: The trial is registered at AZNCTR International Trial Registry as ACTRN12617000857303.
Effectiveness of a 12-week physical exercise programme on blood pressure in adults with true resistant hypertension and high risk of obstructive sleep apnoea: a study protocol for a pre-post test non randomised clinical trial
Authors: Dassanayake Suranga , Wilkins Gerard , Sole Gisela , Skinner Margot
Published: April 2020

Background: Resistant hypertension, a special phenotype of hypertension, is associated with increased cardiovascular risk. Exercise and physical activity are recommended as non-pharmacological interventions to manage blood pressure in hypertension. Little is known about the effectiveness of exercise in resistant hypertension. A bidirectional relationship has been identified between resistant hypertension and obstructive sleep apnoea but the literature pertaining to the benefit of exercise for populations with both conditions, is minimal. This study aims to identify the effectiveness of exercise in reducing blood pressure in a cohort of adults with resistant hypertension and high risk of obstructive sleep apnoea.

Methods: Dunedin based adults with resistant hypertension and high risk of obstructive sleep apnoea will be recruited from the community and health centres to participate in the study. Consenting volunteers (no. of fourteen) will participate in a 12-week exercise programme including aerobic and strength training. The primary outcome measure will be 24h ambulatory blood pressure while the secondary outcomes will be anthropometrics, activity parameters, sleep parameters, cardiac structure and function, and quality of life. The measurements at the end of the 12-week exercise programme will be compared with baseline to determine the effectiveness of exercise in reducing blood pressure in the cohort with resistant hypertension and risk of obstructive sleep apnoea.

Conclusions: Exercise and physical activity are recommended to manage hypertension. Therefore, it is anticipated that the exercise programme will have a positive effect on the blood pressure of the participants. The findings have potential to change the direction of research in the area by filling the knowledge gaps.

Trial Registration: The Ministry of Health, New Zealand (Ethics Ref: 18/CEN/257), Trial registry: ACTRN12618001881224p).
A study of platelet to lymphocyte ratio in patients with metabolic syndrome
Authors: . Thyagaraj , Mohan Manjushree , . Sreedevi
Published: April 2020

Background: The prevalence of the metabolic syndrome varies around the world, in part reflecting the age and ethnicity of the populations studied and the diagnostic criteria applied. Numerous studies have shown an association of Metabolic Syndrome (MS) and insulin resistance (IR) with inflammation. Platelet-lymphocyte ratio (PLR) has recently emerged as a novel inflammatory index that may serve as an important predictor of inflammatory state and overall mortality. Aim of this study is to evaluate the PLR in patients with MS and to correlate the same with the severity of MS based on its categories.Methods: A cross sectional study was conducted on 210 subjects (105 subjects with Metabolic Syndrome and 105 age and gender matched control participants without Metabolic Syndrome) seen on outpatient basis at hospitals attached to Basaveshwara medical college and research institute, Chitradurga. Detailed history including history of risk factors if any, physical examinations and baseline investigations like complete blood counts, HbA1c levels, serum glucose levels, fasting lipid profile, electrocardiography and the data was analyzed using appropriate statistical methods.Results: PLR was 6% higher in males (PLR-144.77±34.6) when compared to females (PLR-136.57±30.4) in subjects with metabolic syndrome. There was 95.9% higher PLR in subjects with metabolic syndrome when compared to subjects without metabolic syndrome (p<0.05). Furthermore, PLR increased more as severity of metabolic syndrome increased (5/5 PLR-180.55±25.3,4/5 PLR-132.33±23.6, 3/5 PLR- 109.63±22.6 and non-metabolic syndrome (PLR- 77.45±19.5).Conclusions: In this study, PLR above 90 predicted significant inflammation. PLR is calculated from complete blood count with differential, is an inexpensive, easy to obtain, widely available marker of inflammation, which can aid in the risk stratification of patients with various cardiovascular diseases in addition to the traditionally used markers.
Correlation between HbA1c level and LDL cholesterol level in ischemic stroke patients
Authors: Gupta Gaurav , Aquiqe Mohammad , Giri Richa , Verma Shivendra
Published: April 2020

Background: Defects in insulin action and hyperglycemia could lead to Dyslipidemia in patients with diabetes.Methods: Cross sectional study carried out in patients presenting with ischemic stroke to medicine emergency unit of the LLRH Hospital from January 2018 to October 2019.Patient of age group 40-80 years The subjects in the present study were 450 patient comprised of 235 cases with ischemic stroke of age group of 40-80 years and 215 health y controls of age group of 40-80 years.Results: The correlation between these two variable as elicited from data obtained from study and, is significant (p<0.0001). The sensitivity of this correlation in the context of ischemic stroke is 75%, while the specificity is 60%. However, an impressive negative predictive value of 91% suggests a beneficial effect of normal or well controlled diabetes and Dyslipidemia. Conversely, a modest positive predictive value of 29% does not appear to help in utilizing this correlation as a measure of future likelihood of ischemic stroke. p value 0.00005 inference-highly significant.Conclusions: Study show statistically significant association (p < 0.001) of increased levels of HbA1c and LDL-C in patients of ischemic stroke.
Effect of ART 2 treatment on biochemical profile during treatment of second line ART
Authors: Singh Narendra , Varma R. K. , Giri Richa , Varma Punit , Dwivedi Seema , Kumar Lalit
Published: April 2020

Background: AIDS was the first recognized in U.S in summer of 1981 at centers for disease control and prevention reported the unexplained occurrence of pneumocystis jiroveci in previously healthy homosexual men in Los Angeles and Kaposi. First time in 1983 HIV syndrome was isolated from a patient of lymphadenopathy. Person with positive HIV serology who have ever had a CD4 lymphocyte count below 200celles/mcl and CD4 lymphocyte percentage below 14% are considered to have AIDS (CMDT 2017).Methods: This study was continuous longitudinal, prospective and retrospective, observational, at ART plus Centre, Kanpur K.P.S. institute of medicine (G.S.V.M. medical college) included the all patients on ART1 attending in Centre were screened for treatment failure based on clinical, immunological and virological criteria’s as decided by SACEP from 2016 to 2018.Results: Total numbers of patients are 118 among them 71 female and 47 males, age groups between 30-40 there are 54 patients. In study treatment with ART patients Hb levels more than 10%, Mean value before 10.85±1.31 and mean value after treatment was 10.5±1.31, TLC before 6970.94±6309.93 after treatment 6800.25±2522.99, Serum Bilirubin before and after treatment 0.69±0.49 and 0.95±1.13. Mean value of before and after treatment serum creatinin1.80±11.34 and 0.88±0.38.Conclusions: There is increased in serum creatinine and SGPT /SGOT and decrease in Hb levels in treatment of second line ART treatment so it should be monitored every monthly interval.