bluuebunny/crossref_metadata_2025 huggingface dataset:
Development and Validation of Iron Deficiency Anemia-Related Knowledge, Attitude, and Practices Questionnaire for Adolescents: A Psychometric Analysis
Authors: Chandrasekar Chethana , Pareek Priyanka , Thorat Aparna , Khanna Poonam , Kulkarni Rashmi
Published: February 2025

Iron deficiency anemia (IDA) is still the most prevalent public health issue worldwide especially the adolescent age group being more vulnerable. Understanding the knowledge attitude and practices (KAP) related to IDA is essential for planning and knowing the effectiveness of any nutrition intervention program. The purpose of this study was to develop and validate a comprehensive questionnaire that could specifically help in knowing about the KAP related to IDA among adolescent girls of age group 13–18 years. The questionnaire was formulated on the basis of Food and Agriculture Organization guidelines. Initial draft of the questionnaire contained 60 items. Content and face validity were measured by experts and participants, respectively, and content validity index (CVI) was calculated. CVI for all the items was satisfactory. As per the face validity responses, few of the questions were reframed for better understanding. Exploratory factor analysis was done for knowledge and attitude subscale to obtain construct validity. Single construct was obtained for knowledge and four constructs for attitude subscales, namely perceived benefits, attitude towards preference, perceived susceptibility, and perceived barriers. Cronbach α and interclass correlation coefficient analysis carried out for test-retest reliability and internal consistency showed acceptable results. The final questionnaire contained 62 items. The validation results provided evidence for the appropriateness of the questionnaire to assess the KAP related to IDA among adolescent girls.
Comparing the effectiveness of occupational stress training package with mindfulness-based cognitive therapy on job burnout of Tam Kar’s employees in order to health promotion
Authors: Gorji Somayeh
Published: February 2025

AIM:

The purpose of the present study was to compare the effectiveness of an occupational stress training package with mindfulness-based cognitive therapy (MBCT) on job burnout of Tam Kar employees.

MATERIAL AND METHODS:

The research method was a three-stage, three-group semiexperimental design. To this end, the statistical population including all the employees who worked in the technical departments of Tam Kar Company in Isfahan and in terms of the level of stress in middle and higher levels, using purposive sampling, 60 employees were selected and randomly divided into three groups (20 for each group). Geldard (1989) burnout inventory (GBI) was used for data collection. Experimental group 1 received eight 90-min sessions of mindfulness-based cognitive therapy training, and experimental group 2 received job stress coping training in ten 90-min sessions. Repeated measurement ANOVA was used to analyze the data with the help of a statistical software package in social sciences (SPSS) version 22.

RESULTS:

The results showed that coping with job stress training and mindfulness-based cognitive therapy were equally effective in reducing the employees’ burnout (P ≤ 0.05) and this effect continued at follow-up.

CONCLUSION:

Given the high prevalence of burnout and psychopathologic symptoms among industry staff, coping with job stress training and mindfulness-based cognitive therapy training can be suggested to reduce burnout syndrome in the industry.
Investigating the relationship between spiritual and emotional intelligence with academic procrastination in the students of the operating room of Hamadan University of Medical Sciences
Authors: Mohammadi Reza , Karbin Fatemeh , Sarayvand Sepehr , Najafi-Vasough Roya , Jamasbi Mehrdad Maleki , Beiranvand Firoozeh
Published: February 2025

BACKGROUND:

Academic procrastination is postponing the completion of educational assignments. Procrastination among students reduces the level of awareness, which can have irreparable consequences. Therefore, the present study was conducted with the aim of determining the relationship between spiritual and emotional intelligence with academic procrastination in the students of the operating room of Hamadan University of Medical Sciences.

MATERIALS AND METHODS:

This was a cross-sectional correlational study that was conducted on 69 undergraduate students of the operating room of Hamadan Medical Sciences University in 2023. A 4-part questionnaire collected demographic data, Spiritual Intelligence, Schering’s emotional intelligence, and Solomon’s procrastination. Statistical analysis of variables was done using descriptive (mean and standard deviation) and analytical (Mann–Whitney, Kruskal–Wallis, t-test, and Spearman) tests by means of SPSS 24.

RESULTS:

Participants were mostly female (60/9%), unemployed (79/7%), single (95/7%), and in their third semester (42%). No significant relationship was found between spiritual and emotional intelligence (r = -0.12, P = 0.20). Academic procrastination is directly and statistically significantly associated with spiritual intelligence (r = 0.27, P = 0.02) but not with emotional intelligence (r = 0.18, P = 0.12).

CONCLUSION:

Operating room students with low spiritual intelligence may procrastinate and perform poorly. Educational management should give courses on religious thinking, problem-solving, spiritual self-awareness, and morality to promote spiritual intelligence.
‘Beyond the blues’: A case report on depression as initial presentation of lung cancer with brain metastasis
Authors: D’Souza Priyanka Renita , Srivastav Aayush
Published: February 2025

Lung cancer usually presents with pulmonary symptoms such as cough, dyspnoea, and extrapulmonary symptoms with metastatic involvement of the brain may present as delirium or neurological deficits. However, in rare cases, psychiatric symptoms such as depression may be the only initial manifestation of lung cancer with brain metastasis, which may mislead the clinical picture. We describe a case of a middle-aged female with no past or family history of medical and psychiatric illness who was brought with low mood, decreased social interaction, fatigue, and decreased appetite in the past 2 weeks. She also had poor concentration and memory disturbances with difficulty in performing household chores. Interpersonal relationship issues in the family were attributed as precipitating factors. She was diagnosed with major depressive disorder and initiated on antidepressants but with no improvement. Later course of the illness, she developed a bilateral diffuse headache associated with vomiting. On mental status examination, she had decreased psychomotor activity. Her speech was minimal with decreased response rate and little variability in the tone. She was not able to describe her mood and her affect was restricted. No abnormal beliefs or psychotic symptoms were elicited. On general physical examination, mild deviation of the angle of mouth was noted. Because of the suspicion of organic etiology, a magnetic resonance imaging brain scan with contrast was suggested and an intracranial space-occupying lesion involving the left frontal lobe with significant perilesional edema causing mass effect was noted. Further, a positron emission tomography scan revealed hypermetabolic soft tissue mass over the supra-hilar region of the right lung likely indicating the primary site with brain metastasis. Here in this case, the initial presentation of psychiatric symptoms in lung cancer with brain metastasis obscured the underlying central nervous system pathology. This case illustrates the need for a holistic approach with prompt and detailed assessment including neuroimaging in patients with a high index of suspicion of organicity.
Effectiveness of an Information, Motivation and Behavior skills intervention on knowledge, practices, skills, and health-seeking behaviors on reproductive tract infections among married women – A quasi-experimental study
Authors: George Ann Merrin , Chacko Leena K
Published: February 2025

BACKGROUND:

Reproductive tract infections (RTIs) are a major health problem among women of the reproductive age group in India. Most of them are incompetent to handle their sexual and reproductive health needs. Enabling them with the knowledge and ability to recognize their own symptoms will prompt them to seek treatment and lessen the complications. This study determined the effectiveness of an Information, Motivation, and Behavior skills (IMB) program on the knowledge, practices, skills, and health-seeking behaviors of RTIs among women of reproductive age.

MATERIALS AND METHODS:

A quasi-experimental design was used. Ninety-nine married women who had experienced any two symptoms of RTIs in the last 3 months preceding data collection were selected using a disproportionate random sampling technique. Knowledge, practices, skills, and health-seeking behaviors were assessed before and at the end of the third and sixth months following the administration of the IMB program in the intervention group. SPSS version 16 was used for data analysis, and the effectiveness was determined using repeated measures ANOVA.

RESULTS:

Both the intervention and comparison groups were homogenous with regard to the socio-personal variables and baseline scores of the outcome variables. Significant improvement was observed in the knowledge (P < 0.001), practice (P = 0.002), and skill (P < 0.001) scores of the women in the intervention group and not in their health-seeking behavior scores (P = 0.830).

CONCLUSION:

The IMB program is an effective strategy for improving the knowledge, practice, and skills of the women on RTIs and can be utilized by nursing officers.
Overcoming challenges to ensure effective integration of entrustable professional activities in the medical curriculum
Authors: Shrivastava Saurabh RamBihariLal , Gade Shubhada , Vagha Sunita
Published: February 2025

Entrustable professional activities (EPAs) occupy a crucial place in the training of medical students and preparing them for the challenges related to their future medical practice. This is mainly because these activities target core competencies and responsibilities that students must acquire to deliver safe and effective patient-centered care. Acknowledging the utility of EPAs in improving the delivery of medical education and facilitating learning among medical students, there is an immense need to systematically plan and implement the introduction of EPAs in the medical curriculum. In conclusion, entrustable professional activities (EPAs) play a defining role in the attainment of subject-specific competencies. However, the process of implementation has to be systematically planned, with the help of different stakeholders, including faculty members.
Innovations in Cancer Immunotherapy Drug Delivery Technologies: A Systematic Review
Authors: Sharma Kavita , Shah Madhuri , Gour Samiksha , Mitra Rituparna , Bihani Nidhhi , Chandgothia Nehal
Published: February 2025

ABSTRACT

An innovative method in oncology, cancer immunotherapy uses the body’s immune system to fight cancer cells. Despite its potential, nonspecific inflammation and autoimmunity provide major obstacles to the clinical implementation of immunotherapy. The goal of recent developments in medication delivery technology was to improve these treatments’ effectiveness and safety. This systematic review explores innovative approaches such as nanoparticle-based delivery systems, biomaterial scaffolds, injectable hydrogels, transdermal delivery methods, and T-cell therapy delivery technologies. Nanoparticles are shown to improve drug localization and modulate pharmacokinetics, while biomaterials provide platforms for controlled and localized release of immunotherapies, reducing systemic toxicity. Injectable scaffolds create local immunogenic environments without requiring surgical implantation and transdermal delivery systems like microneedle patches enhance local immune activation. Advances in T-cell therapy delivery, such as DNA nanocarriers for in situ engineering and surface-conjugated nanoparticles, are intended to enhance the localization and effectiveness of adoptive T-cell therapies. Taken as a whole, these developments provide potential answers to the present problems with cancer immunotherapy, opening the door to safer and more efficient forms of treatment. Further research is essential to optimize these technologies for clinical application, ensuring long-term safety and efficacy.
Game-Based Learning Approach Using the “TAO Software” in Dental Academics: A Cross-Sectional Study
Authors: Kotnoor Santosh K. , Shiroya Smit , Pothanikat Neeta J. , Dupare Aditya S. , Pothanikat Joseph J. K. , Naveen Odiyil P. , Dayanithi B. S. , Tiwari Rahul
Published: February 2025

ABSTRACT

Introduction:

The evolution of game-based learning in the dental education has created a tremendous impact on achieving the goal set by educationalists and educational research committees all over the globe. The need to replace traditional passive teaching to active teaching has demanded inclusion of student-centric teaching methodologies for quality education. Involving game elements in teaching has proved to develop critical thinkers with attainment of 100% graduate attributes.

Aim:

To apply the TAO software in teaching dental academics as a new innovative game-based learning approach.

Methodology:

A cross-sectional study design was conducted among 100 dental students enrolled for the BDS program during the period of November 2022 to November 2023. The inclusion criteria were students enrolled in the first-year BDS course. The exclusion criteria were students enrolled in other courses of different disciplines of health sciences (medicine, nursing, physiotherapy, allied sciences, and pharmacy). The “toss a coin” method of randomization was applied for categorizing the samples equally into control group and study group. The mode of teaching for control groups was decided to be traditional PowerPoint presentation method, and the mode of teaching for study group was selected to be TAO game-based learning software. The “chit method” was applied for the selection of topic to avoid selection bias. The assessment method deployed was “Questionnaire method” that consisted of 10 close-ended questions on the topic, as formulated, validated, and approved by the experts. The scores obtained by both methods were subjected to statistical analysis.

Results:

The mean of knowledge gained by study group students 86% was significantly higher than the mean of knowledge gained by control group students 38% (P = 0.003).

Conclusion:

Game-based learning using the TAO software proved to have positive impact on academic performance of students with better learning outcomes, thereby opening a new avenue for enhancing quality teaching in the dental education.
Retrospective Review of Surgical Techniques in the Management of Abdominal Aortic Aneurysms
Authors: Nooreen Rimsha , Babu K. Suresh , Khalid Mohammed K. , Shibu Pampa , Issac Anu S. , Tiwari Rahul , Dixit Heena
Published: February 2025

ABSTRACT

Introduction:

The purpose of this retrospective research is to examine the patterns of reintervention and long-term survival rates linked to various surgical approaches used to treat abdominal aortic aneurysms (AAA).

Methods:

Retrospective data collection was conducted from a tertiary care centre for the time frame of 2017-2022. Patients [n = 77] with endovascular aneurysm repair (EVAR), open repair, and hybrid techniques having surgery for diagnosed AAAs were included. Analysis was done on the following: survival rates, follow-up data, perioperative complications, demographics, and causes for reinterventions.

Results:

There were notable changes in age, comorbidities, and aneurysm diameter (P < 0.05) across the surgery groups› demographic parameters. At particular time periods, the long-term survival rates differed among the approaches (P < 0.05). There were differences in the reintervention rates across the groups, with EVAR showing the lowest rates (P < 0.05).

Conclusion:

Current research emphasises how crucial it is to take patient demographics and comorbidities into account when deciding on the best surgical strategy for managing AAA. The research places a strong emphasis on the complex relationships between open repair, EVAR, and hybrid treatments and long-term survival and reintervention rates. Comprehending these discrepancies is essential to enhancing patient care and guiding professional judgement in AAA therapies.
Assessment of Implant Take Up in Patients Suffering from Diabetic Mellitus: An Original Research
Authors: Khetan Jitendra , Sharma Piyush , Salim Sanjith P. , Agrawal Pratik , Bright E. C. , Sasikala Jummala , Rai Shivprasad
Published: February 2025

ABSTRACT

Objectives:

To evaluate, throughout a 12-month follow-up, the success rate of dental implants in patients with diabetes versus non-diabetic patients.

Methods:

A prospective study was carried out on 100 patients, 50 of whom had diabetes and the other 50 did not. Patients with diabetes had verified type 2 diabetes, as indicated by HbA1c values ≤8%. Every patient received normal dental implants, and they were all checked on every 3, 6, and 12 months. The implant success rate, frequency of peri-implantitis, marginal bone loss, and patient satisfaction were the main outcomes.

Results:

Individuals with diabetes had an implant success rate of 85%, which was considerably lower than that of non-diabetic individuals (95%; P = 0.04). Patients with diabetes had higher rates of peri-implantitis (10% vs. 4%, P = .03) and more marginal bone loss (1.5 mm vs. 0.8 mm, P < .01) in their cases. On a 5-point scale, diabetic patients’ satisfaction was somewhat lower (4.2 vs. 4.6, P = .05).

Conclusion:

Compared to non-diabetic patients, diabetic individuals had a worse implant success rate, a higher incidence of peri-implantitis, and greater marginal bone loss. There are still many obstacles; however, patient satisfaction remains high. Improving the results of dental implant treatments for diabetic individuals requires optimal glycemic control and customised management approaches.
Management Strategies for Xerostomia in Patients with Sjögren’s Syndrome: A Comprehensive Review
Authors: Swathi Dadi , Sailo Jenny Lalmalsawmi , Ausare Surabhi S. , Bhattacharjee Debangana , Buvariya Shreya , Dolker Tundup , Maini Anuj Paul
Published: February 2025

ABSTRACT

Xerostomia, commonly known as dry mouth, is a significant complication in patients with Sjögren’s syndrome (SS), an autoimmune disorder primarily affecting the salivary glands. This comprehensive review discusses the various management strategies available to alleviate xerostomia symptoms, including pharmacological and non-pharmacological approaches. Pharmacological treatments, such as cholinergic agents (pilocarpine and cevimeline), have shown effectiveness in stimulating salivary secretion, while topical therapies, like saliva substitutes, provide temporary relief. Non-pharmacological methods, including salivary gland stimulation through chewing gum and dietary modifications, offer additional symptom control. Emerging therapies, such as gene and stem cell therapy, hold promise for future treatment. A multimodal approach tailored to the individual needs of the patient is essential for the optimal management of xerostomia in SS, ultimately improving patients’ quality of life. The review highlights the importance of ongoing research into novel therapeutic approaches to enhance treatment outcomes.
Oral Manifestations and Dental Management of Patients with Systemic Lupus Erythematosus: A Clinical Study
Authors: Chaudhary Romeshkumar Narayanbhai , Jerry Aldrin , Ahmed Zubair , Srivastava Amartya Prakash , Shah Shahi Jahan , Patel Mimansha , Maini Anuj Paul
Published: February 2025

ABSTRACT

Introduction:

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease affecting multiple organs, including the oral cavity. This study aims to investigate the prevalence of oral manifestations in SLE patients and their implications for dental management.

Methods:

A cross-sectional study was conducted on patients diagnosed with SLE. Three parameters were evaluated: Oral manifestations, impact on oral health-related quality of life, and the challenges in dental management. Data were collected through clinical examinations and questionnaires.

Results:

A total of 75% of SLE patients exhibited oral manifestations, with ulcers being the most common. Significant difficulties were observed in maintaining oral hygiene, necessitating specific management strategies.

Conclusion:

The study highlights the need for specialized dental care in SLE patients due to prevalent oral manifestations. Dental practitioners must be aware of the disease’s systemic implications to provide optimal care.
Postoperative Pain and Healing in Patients Undergoing Apicoectomy: A Comparative Study of Techniques
Authors: Patil Sneha A. , Shivanand Sunita , Rizwan Rukhsar , Sirigiri Mohan K. R. , Uppalapati Pragnya , Chohan Hitesh , Gaur Abhishek
Published: February 2025

ABSTRACT

Introduction:

Apicoectomy, a surgical procedure to remove the apex of a tooth, is used when conventional root canal treatment fails. Various techniques, such as root-end resection with or without retrograde fillings, influence postoperative outcomes like pain and healing. This study compares postoperative pain and healing rates following apicoectomy using two different techniques. The research aims to determine which method offers better patient outcomes in terms of pain relief and healing.

Methods:

A total of 100 patients undergoing apicoectomy were divided into two groups. Group A received root-end resection with retrograde filling using Mineral Trioxide Aggregate (MTA), while Group B underwent root-end resection without filling. Postoperative pain was assessed using the Visual Analog Scale (VAS) at intervals of 24 hours, 3 days, 7 days, and 14 days. Healing was evaluated through radiographic analysis over six months.

Results:

Group A exhibited significantly less postoperative pain at 24 hours and 7 days (P < 0.05). Healing rates, assessed radiographically, showed faster bone regeneration in Group A compared to Group B, with statistical significance observed at the six-month follow-up (P < 0.01).

Conclusion:

Apicoectomy with retrograde filling using MTA significantly reduces postoperative pain and enhances bone healing compared to apicoectomy without filling.
Comparative Study of Local Anesthesia Techniques for Pain Management in Mandibular Third Molar Extractions
Authors: Jahagirdar Abhishek , Yarichev Ubayda , Chigurupati Lakshmi , Ummar M , Humne Abhijeet , Acharya Trayeemay , Rana Ravinder P. S.
Published: February 2025

ABSTRACT

Background:

Ensuring that after mandibular third molar extractions, patients can live life in comfort with no ill effects is a priority. Thus, the onset time, duration of action, and efficacy of relieving pain differ from one drug to another.

Materials and Methods:

Patients undergoing mandibular third molar extractions were compared with regard to the efficacy of local anesthesia in each group receiving 2% lignocaine with adrenaline, 0.75% ropivacaine, and 0.5% bupivacaine. Various parameters were evaluated.

Results:

Ropivacaine exhibited a longer duration of anesthesia and superior postoperative pain control compared to lignocaine and bupivacaine (P < 0.05). While lignocaine had the fastest onset, its analgesic duration was the shortest. Bupivacaine showed intermediate results. Statistical analysis confirmed significant differences among the groups.

Conclusion:

Ropivacaine is more effective in managing postoperative pain and offers a longer duration of anesthesia than lignocaine making it the preferable agent for mandibular third molar extractions.
Efficacy of Different Triage Protocols in Reducing Waiting Times in Emergency Settings: A Randomized Controlled Trial
Authors: Balu P R S , Syed Afroz Kalmee , Kotian Tejashwini , Padala Hemanth Satya Subhash , Gupta Surendra , Tiwari Rahul , Kamboj Saloni
Published: February 2025

ABSTRACT

Introduction:

Prolonged waiting times in emergency departments (EDs) can result in adverse outcomes for patients. Implementing efficient triage protocols is critical in reducing these delays. This study evaluates the efficacy of different triage protocols in decreasing waiting times in emergency settings.

Methods:

A randomized controlled trial (RCT) was conducted to compare three triage protocols (Manchester Triage System, Nurse-Initiated Triage, and Digital Triage Systems). The primary outcome was the reduction in waiting times. Secondary outcomes included patient throughput and satisfaction.

Results:

A statistically significant reduction in waiting times was observed in the Nurse-Initiated Triage group compared to the Manchester Triage system (P < 0.05). The Digital Triage System showed the highest patient throughput but lower satisfaction scores.

Conclusion:

Nurse-Initiated Triage protocols can effectively reduce waiting times in ED settings. Digital Triage Systems while improving efficiency may need to address patient satisfaction concerns.
Volar Plate Versus Kirschner-Wire Fixation in Intra-Articular Fracture of Distal Radius
Authors: Samal Barada Prasanna , Pradhan Sasmita , Mohanty Rashmi Ranjan , Chatterjee Gaurav , Acharya Tonima , Sahoo Braja Sundar
Published: February 2025

ABSTRACT

Background:

Fractures of the distal radius are common and increasing in incidence due to osteoporosis and high-risk sporting activities. This study aims to compare the clinical, functional, and radiological outcomes of intra-articular distal radius fractures treated with volar plating versus Kirschner-wire (K-wire) fixation.

Methods:

A prospective randomized study was conducted on 50 patients with intra-articular distal radius fractures. Patients were divided into two groups: 25 treated with volar plating and 25 with K-wire fixation. Outcomes were assessed using the MAYO wrist score, DASH score, range of motion, grip strength, and radiological evaluation.

Results:

The mean time to union was significantly shorter in the plating group (6.72 weeks) compared to the K-wire group (8.64 weeks; P = 0.04). The plating group had better functional outcomes with higher MAYO scores (87.8 vs. 73.6; P = 0.001) and lower DASH scores (7.86 vs. 13.94; P = 0.03). Radiological parameters and grip strength were also significantly improved in the plating group.

Conclusion:

Volar plating provides superior functional and radiological outcomes compared to K-wire fixation in treating intra-articular distal radius fractures, especially in patients with complex fractures.
The Effectiveness of Different Sequences of Irrigation on Root Canal Disinfection: A Microbiological Study
Authors: Alshudukhi Saleh H. , Alattas Mustafa H. , Dutta Smita D. , Javed Muhammad Q. , Almosua Abdulkarim M. , Almutairi Nawaf M. , Mohmed Ahmed N.
Published: February 2025

ABSTRACT

Purpose:

This study evaluates the effectiveness of different sequences of irrigation using sodium hypochlorite (NaOCl) and ethylenediaminetetraacetic acid (EDTA) on root canal disinfection, measured through bacterial reduction.

Methods:

A total of 48 mandibular molars were divided into two groups. Group A received irrigation with NaOCl followed by EDTA, while Group B received EDTA followed by NaOCl. Passive ultrasonic irrigation (PUI) was applied in both groups. Bacterial samples were collected at three stages: before chemomechanical preparation (S1), after preparation (S2), and after ultrasonic activation (S3). Quantitative PCR (qPCR) was used to assess bacterial load reduction. ANOVA was performed to determine statistical significance.

Results:

Group A demonstrated a significant reduction in bacterial load at all stages, with an ANOVA F-statistic of 9.40 (P = 0.00023). Group B showed a less pronounced reduction, with an F-statistic of 14.99 (P = 0.0000031). Bacterial reduction was more effective when NaOCl was used first followed by EDTA.

Conclusion:

The sequence of irrigation influences the effectiveness of root canal disinfection. NaOCl followed by EDTA achieved greater bacterial reduction compared to the reverse sequence.
Enhancing the Conversion of Patients from Outpatient to Inpatient Department: A Comprehensive Analysis
Authors: Sharma Sandesh K. , Chowhan Sudhinder S. , Bhargava Rahul , Chopra Arshia , Antony Deepu , Tiwari Rahul , Belza Maria S. L.
Published: February 2025

ABSTRACT

Purpose:

This study aims to enhance and analyze the patient conversion rate from the outpatient department (OPD) to the inpatient department (IPD) in tertiary care hospitals. The study focuses on understanding the factors influencing patients’ decisions to decline inpatient admissions despite medical recommendations.

Methods:

A prospective descriptive research design was used to study a sample of 251 patients who visited the OPD. Both qualitative (patient questionnaires) and quantitative data (admission rate tracking) were collected. Pareto and Root Cause analyses were used to identify the main reasons for patient refusal, and a Chi-squared test was used to evaluate the statistical significance of these factors.

Results:

The primary reasons for declining inpatient admission included a preference for medical treatment over surgical interventions (21.7%), seeking second opinions (20%), financial concerns (13.9%), and long waiting times for consultations and test results (12.1%). The Chi-squared test indicated that these factors were statistically significant, with a P value less than 0.05, highlighting their impact on the decision-making process.

Conclusion:

Addressing the key reasons for refusal—medical treatment preference, second opinions, financial constraints, and operational inefficiencies—can significantly improve patient conversion rates from OPD to IPD. Hospitals should focus on improving patient education, communication, financial counseling, and operational efficiency to enhance the transition process and patient satisfaction.
Psychiatric Nurse-Led Interventions: A Pathway to Improved Coherence and Social Support in Alcohol Dependency
Authors: Paramasivam Kala , Ethiraj Theranirajan , Rajendran Shankar Shanmugam , Mathankumar Venkatesh , Marudan Anbalagan , Vidhya Balasubramanian Sri , Sathiyanathan Schwartzlin V.
Published: February 2025

ABSTRACT

Background:

Alcohol dependency is a significant global health issue, marked by continuous use despite harmful effects. Psychiatric nurse-led interventions are crucial for addressing the complex needs of alcohol-dependent individuals by enhancing coherence and social support.

Methods:

A quasiexperimental study at the De Addiction Department in Chennai involved 120 male clients aged 20–45 years, divided into experimental and control groups.

Results:

The experimental group showed significant improvements in coherence and social support postintervention.

Conclusion:

This study underscores the effectiveness of psychiatric nurse-led interventions in promoting resilience and social support in alcohol-dependent clients, essential for effective addiction treatment.
Effectiveness of 10% Carbamide Peroxide in the Home Bleaching Technique on Vital Teeth: An Original Research
Authors: Jain Saloni , Rai Aparna , Puri Surekha , Kahate Mayur M. , Jain Anushree , Mishra Rachana
Published: February 2025

ABSTRACT

Introduction:

A prevalent esthetic concern, tooth discoloration has led to the development of numerous dental bleaching methods. One common bleaching agent that is used at home is carbamide peroxide, which is both economical and convenient. There has not been much research on its effectiveness for at-home bleaching, especially on important teeth.

Methods:

Fifty people with mild to moderate tooth discoloration were enrolled in this randomized controlled study. The subjects were randomized to receive a placebo gel (control group) or a 10% carbamide peroxide gel (experimental group) in a home bleaching kit. A spectrophotometer was used to analyze the shade both at baseline and following a 2-week bleaching period. Adverse effects and patient satisfaction were also evaluated.

Findings:

When compared to the control group, the experimental group’s tooth shade improved statistically significantly (P < 0.05). The experimental group reported fewer side effects than the control group, and patient satisfaction levels were higher in the former.

Conclusion:

In summary, the study proves that 10% carbamide peroxide is both safe and effective for at-home tooth whitening. Its usefulness as an efficient and well-tolerated bleaching method in cosmetic dentistry is supported by the noticeable change in tooth shade and the high level of patient satisfaction.
Histopathological characteristics of keratoconus
Authors: Mazza Massimo , Bergeron Sabrina , Cheema Devinder , Coblentz Jacqueline , Nguyen Anne Xuan-Lan , Dias Ana Biatriz Toledo , Palomino Angela Fajardo , Burnier Miguel Noel
Published: February 2025

Purpose:

Keratoconus (KC) is a bilateral and asymmetrical corneal ectasia that affects vision. In this study, we performed a histopathological analysis of 150 cases of KC, to document and catalogue the primary morphological features of cornea with KC.

Subjects and Methods:

The corneas were obtained from penetrating keratoplasties at the MUHC – McGill University Ocular Pathology & Translational Research Laboratory in Montreal, Quebec, Canada. Information was obtained for age and sex at time of surgery.

Results:

The histopathological characteristics were breaks in Bowman’s layer in 91% (n = 136), epithelial thinning in 87% (n = 130), compaction of the stromal fibers in 65% (n = 97), folds in Descemet’s membrane in 63% (n = 94), endothelial cell loss in 31% (n = 47), deep stromal scarring in 30% (n = 45), epithelial scarring in 29% (n = 44), superficial iron deposition in 27% (n = 40), and breaks in Descemet’s membrane in 18% (n = 27).

Conclusion:

These results further suggest that changes in the superficial layers, such as the epithelium and Bowman’s layer, precede stromal involvement. These results also confirmed previous data from a published study conducted in 2008.
Friction Stir Spot Welding Characteristics of Dissimilar Materials of Aluminum-Based Damping Composites and Steel Plates
Authors: Park Si-Seon , Jeong Young-Keun
Published: February 2025

Friction Stir Spot Welding (FSSW) is a solid-state welding technology that is rapidly growing in the automotive industry. Achieving superior welding characteristics requires the proper selection of tool geometry and process conditions. In this study, FSSW was performed on dissimilar materials comprising AA5052-HO/hot-melt aluminum alloy sheets and Steel Plate Cold Rolled for Deep Drawing Use(SPCUD) steel sheets. The effects of tool geometry, plate arrangement, and tool plunge depth on the welding process were investigated. At the joint interface between the aluminum alloy and the steel sheet, new intermetallic compounds (IMCs) were observed. As the plunge depth increased, thicker and more continuous IMC layers were formed. However, excessive plunge depth led to discontinuous layers and cracking defects. An analysis of the IMCs revealed a correlation between the IMC thickness and the shear tensile load. Furthermore, compared to the conventional Al-Top arrangement, the St-Top arrangement exhibited reduced deformation and superior shear tensile load values. These findings indicate that plate arrangement significantly influences the mechanical properties of the joint.
Exploration of metformin-based drug combination for mitigating diabetes-associated atherosclerotic diseases
Authors: Qu Biao , Li Zheng , Hu Wei
Published: February 2025

Diabetes mellitus is a substantial global health threat due to its high prevalence and its serious complications. The hyperglycemic state causes damage to vascular endothelial cells and disturbance of lipid metabolism, thus contributing to the development of vascular disorders, especially atherosclerotic diseases. Aggressive glycemic control combined with vascular intervention is critical to the prevention and treatment of diabetes-associated atherosclerosis. It is suggested that metformin should be combined with hypoglycemic agents with proven vascular benefits for treating type 2 diabetes (T2DM) complicated with atherosclerotic diseases. Clinical studies indicates that the preferred combination is metformin with either glucagon-like peptide-1 receptor agonist or sodium/glucose cotransporter-2 inhibitor, which could offer additional vascular benefits and reduce the risk of atherosclerotic complications. Likewise, combination therapy with metformin and hypolipidemic agents has also shown additive effects on glucose control and lipid-lowering in patients with both diabetes and dyslipidemia, whereas extensive clinical trials using atherosclerotic-associated outcomes are required to support the vascular benefits. Moreover, co-administration of metformin with systemic antioxidant or anti-inflammatory therapy may also provide additional vascular benefits as indicated by several animal studies. For instance, a recent study found that additional supplementation of cholecalciferol and taurine enhanced metformin efficacy in controlling diabetes while reducing the risk of associated atherosclerotic complications. However, these potential benefits remain need validation by the evidence from clinical studies. Despite the limitations, such as heterogeneity across different patient populations, and deficiency in long-term outcomes, such efforts can contribute to finding optimal drug combinations to improve the management of T2DM and reduce its atherosclerotic complications.
Hemoglobin glycation index among adults with type 1 diabetes: Association with double diabetes features
Authors: Ji Xiao-Lin , Yin Min , Deng Chao , Fan Li , Xie Yu-Ting , Huang Fan-Su , Chen Yan , Li Xia
Published: February 2025

BACKGROUND

The hemoglobin glycation index (HGI) represents the discrepancy between the glucose management indicator (GMI) based on mean blood glucose levels and laboratory values of glycated hemoglobin (HbA1c). The HGI is a promising indicator for identifying individuals with excessive glycosylation, facilitating personalized evaluation and prediction of diabetic complications. However, the factors influencing the HGI in patients with type 1 diabetes (T1D) remain unclear. Autoimmune destruction of pancreatic β cells is central in T1D pathogenesis, yet insulin resistance can also be a feature of patients with T1D and their coexistence is called “double diabetes” (DD). However, knowledge regarding the relationship between DD features and the HGI in T1D is limited.

AIM

To assess the association between the HGI and DD features in adults with T1D.

METHODS

A total of 83 patients with T1D were recruited for this cross-sectional study. Laboratory HbA1c and GMI from continuous glucose monitoring data were collected to calculate the HGI. DD features included a family history of type 2 diabetes, overweight/obesity/central adiposity, hypertension, atherogenic dyslipidemia, an abnormal percentage of body fat (PBF) and/or visceral fat area (VFA) and decreased estimated insulin sensitivity. Skin autofluorescence of advanced glycation end products (SAF-AGEs), diabetic complications, and DD features were assessed, and their association with the HGI was analyzed.

RESULTS

A discrepancy was observed between HbA1c and GMI among patients with T1D and DD. A higher HGI was associated with an increased number of SAF-AGEs and a higher prevalence of diabetic microangiopathy (P = 0.030), particularly retinopathy (P = 0.031). Patients with three or more DD features exhibited an eight-fold increased risk of having a high HGI, compared with those without DD features (adjusted odds ratio = 8.12; 95% confidence interval: 1.52-43.47). Specifically, an elevated PBF and/or VFA and decreased estimated insulin sensitivity were associated with high HGI. Regression analysis identified estimated insulin sensitivity and VFA as factors independently associated with HGI.

CONCLUSION

In patients with T1D, DD features are associated with a higher HGI, which represents a trend toward excessive glycosylation and is associated with a higher prevalence of chronic diabetic complications.
Reasons for discontinuing tirzepatide in randomized controlled trials: A systematic review and meta-analysis
Authors: Kamrul-Hasan Abul Bashar Mohammad , Pappachan Joseph M , Dutta Deep , Nagendra Lakshmi , Kuchay Mohammad Shafi , Kapoor Nitin
Published: February 2025

BACKGROUND

Despite therapeutic benefits, discontinuation of tirzepatide is common in randomized controlled trials (RCTs) due to adverse events (AEs) and other causes. No previous systematic reviews have explored the reasons for discontinuing tirzepatide in the RCTs.

AIM

To explore the reasons for permanent discontinuation of tirzepatide vs controls [placebo, insulin, and glucagon-like peptide-1 receptor agonists (GLP-1Ras)] in RCTs.

METHODS

Relevant RCTs were systematically searched using related terms through multiple databases such as MEDLINE (via PubMed), Scopus, Cochrane Central Register, and ClinicalTrials.gov from their inception until June 20, 2024. RevMan web was used to conduct meta-analysis using random-effects models. Outcomes were presented as risk ratios (RR) with 95% confidence intervals (CI).

RESULTS

Seventeen RCTs (n = 14645), mostly having low risks of bias, were analyzed. Compared to placebo, the risk of permanent discontinuation of the study drug was substantially lower with tirzepatide 10 mg (RR: 0.69, 95%CI: 0.51-0.93, P = 0.02) and similar with tirzepatide 5 mg (RR: 0.74, 95%CI: 0.47-1.17, P = 0.20) and 15 mg (RR: 0.94, 95%CI: 0.68-1.31, P = 0.71). Tirzepatide had identical discontinuation risks when compared to insulin at 5 mg (RR: 0.96, 95%CI: 0.75-1.24, P = 0.77) and 10 mg (RR: 1.19, 95%CI: 0.77-1.82, P = 0.44) doses, whereas such risk was higher with tirzepatide 15 mg than insulin (RR: 1.31, 95%CI: 1.03-1.67, P = 0.03). Compared to GLP-1RA, the permanent discontinuation risk was similar with tirzepatide 5 mg (RR: 0.98, 95%CI: 0.70-1.37, P = 0.90) but was higher with tirzepatide 10 mg (RR: 1.40, 95%CI: 1.03-1.90, P = 0.03) and 15 mg (RR: 1.70, 95%CI: 1.27-2.27, P = 0.0004). Tirzepatide, at all doses, had higher risks of AE-related discontinuation than insulin; such risks were only greater with higher doses of tirzepatide than with placebo or GLP-1RA. Discontinuation risk due to withdrawal by the study subjects was lower with tirzepatide than with placebo or insulin. Compared to the placebo, tirzepatide (all doses) conferred a lower risk of study drug discontinuation due to other causes not specifically mentioned.

CONCLUSION

The discontinuation risk is not higher in tirzepatide group than in the placebo arm. Many factors other than AEs led to drug discontinuation in the included RCTs.
Increased blood urea nitrogen levels and compromised peripheral nerve function in patients with type 2 diabetes
Authors: Wang Rui , Xu Yu-Xian , Xu Feng , Wang Chun-Hua , Zhao Li-Hua , Wang Li-Hua , Chen Wei-Guan , Wang Xue-Qin , Duan Cheng-Wei , Su Jian-Bin
Published: February 2025

BACKGROUND

Increased blood urea nitrogen (BUN) levels have been demonstrated to be associated with broader metabolic disturbances and the incidence of type 2 diabetes (T2D), potentially playing a role in the development of diabetic complications, including diabetic peripheral neuropathy.

AIM

To examine the relationship between BUN levels and peripheral nerve function in patients with T2D.

METHODS

This observational study involved the systematic recruitment of 585 patients with T2D for whom BUN levels and estimated glomerular filtration rate were measured. Electromyography was used to assess peripheral motor and sensory nerve function in all patients, and overall composite Z -scores were subsequently calculated for nerve latency, amplitude, and conduction velocity (NCV) across the median, ulnar, common peroneal, posterior tibial, superficial peroneal, and sural nerves.

RESULTS

Across the quartiles of BUN levels, the overall composite Z -score for latency (F = 38.996, P for trend < 0.001) showed a significant increasing trend, whereas the overall composite Z -scores for amplitude (F = 50.972, P for trend < 0.001) and NCV (F = 30.636, P for trend < 0.001) exhibited a significant decreasing trend. Moreover, the BUN levels were closely correlated with the latency, amplitude, and NCV of each peripheral nerve. Furthermore, multivariate linear regression analysis revealed that elevated BUN levels were linked to a higher overall composite Z -score for latency (β = 0.166, t = 3.864, P < 0.001) and lower overall composite Z-scores for amplitude (β = -0.184, t = -4.577, P < 0.001) and NCV (β = -0.117, t = -2.787, P = 0.006) independent of the estimated glomerular filtration rate and other clinical covariates. Additionally, when the analysis was restricted to sensory or motor nerves, elevated BUN levels remained associated with sensory or motor peripheral nerve dysfunction.

CONCLUSION

Increased BUN levels were independently associated with compromised peripheral nerve function in patients with T2D.
Clinical utility of glycated albumin and 1,5-anhydroglucitol in the screening and prediction of diabetes: A multi-center study
Authors: Ku Kam-Ching , Zhong Junda , Song Erfei , Fong Carol Ho-Yi , Lam Karen Siu-Ling , Xu Aimin , Lee Chi-Ho , Cheung Chloe Yu-Yan
Published: February 2025

BACKGROUND

Despite being the gold standard, the use of glycated hemoglobin (HbA1c) and fasting plasma glucose (FPG) for diagnosing dysglycemia is imperfect. In particular, a low level of agreement between HbA1c and FPG in detecting prediabetes and diabetes has led to difficulties in clinical interpretation. Glycated albumin (GA) and 1,5-anhydroglucitol (1,5-AG) may potentially serve as biomarkers for the detection and prediction of diabetes, as well as glycemic monitoring.

AIM

To explore the diagnostic performance of GA and 1,5-AG for screening dysglycemia; assess whether they can be used for glycemic monitoring in Chinese morbidly-obese patients; and examine their predictive ability for incident diabetes in a Chinese community-based cohort.

METHODS

GA and 1,5-AG concentrations were measured in 462 morbidly-obese patients from the Obese Chinese Cohort (OCC). A sub-group of diabetes subjects (n = 24) was prospectively followed-up after bariatric surgery. Differences between baseline and post-surgery biomarker values were converted to percentage change from baseline to assess the response to glycemic control. Predictive ability of the biomarkers was assessed in 132 incident diabetes cases and 132 matched non-diabetes controls in the community-based Cardiovascular Risk Factor Prevalence Study (CRISPS). A prediction model was developed and compared with clinical models based on conventional risk factors.

RESULTS

GA exhibited an excellent diagnostic value with an area under the receiver operating characteristic curve (AUC) of 0.919 (95%CI: 0.884-0.955) for identifying diabetes and a high agreement in the classification of diabetes with both FPG and HbA1c in the OCC. GA demonstrated the fastest response to glycemic control. In CRISPS, the ‘B3A’ prediction model, which consisted of body mass index (BMI) and 3 biomarkers (HbA1c, GA and 1,5-AG), achieved a comparable predictive value [AUC (95%CI): 0.793 (0.744-0.843)] to that of a clinical model comprising BMI, HbA1c, FPG and 2-hour glucose (2hG) [AUC (95%CI): 0.783 (0.733-0.834); DeLong P value = 0.736]. The ‘B3A’ was significantly superior to a clinical model including BMI, HbA1c, FPG and triglycerides [AUC (95%CI): 0.729 (0.673-0.784); DeLong P value = 0.027].

CONCLUSION

GA and 1,5-AG have the potential to act as robust biomarkers for the screening and risk prediction of diabetes. FPG and 2hG may be replaced by GA and 1,5-AG in future diabetes predictions.