bluuebunny/crossref_metadata_2025 huggingface dataset:
Globalization through global citizenship and right to migrate
Authors: Raina Sunil K. , Kumar Raman
Published: December 2023

All human beings of the world should be equal in status and stature. However, in reality human beings are divided by citizen status of nation states that are members of the United Nations. The human development index differs from one nation to another. Therefore quality of life, health, and life expectancy varies across countries and continents. Much depends on the governments representing human groups living in defined territorial boundaries. Governments defend sovereign territories and compete with other governments for business monopolies, territories and natural resources. From empires to colonisation, the world is passing through the phase of globalisation. There is an uneven divide of natural planetary resources and geographical territories. Also there is a continuous flow of financial resources from the poor nation states and in favour of the rich ones. Globalisation can no longer remain a refined chaotic balance of exploitation of one human territory by another. Travel and migration from one territory to another are highly regulated. The true idea of Globalization will only be realised when it is not linked to race, the level of skills, political affiliation or economic dividends and is able to add to the upward movement of the social structure of the poor. In a globalised world there should be equitable and fast paced distribution of benefits of modern development. Otherwise the global citizens of the world should look for alternatives.
Prospective assessment of mental and physical health of maternal near-miss women: A low-middle-income country's experience
Authors: Punj Pankhuri , Arora Aashima , Shah Ruchita , Patil Amol N. , Sikka Pooja , Jain Vanita , Suri Vanita , Saini Shiv Sajan
Published: December 2023

Background:

Traumatic birth experience is an unaddressed arena, especially in Asian women, with several societal stigmas lingering around.

Aim:

A study was undertaken to simultaneously assess the post-partum mental and physical health follow-up of maternal near-miss (MNM) women and compare it with women of uneventful deliveries.

Materials and Methods:

The prospective cohort study enrolled 88 MNM women (case cohort) and 80 women with an uneventful peri-partum period (control cohort) at the same time. The participants were followed up with Edinburgh Postnatal Depression Scale (EDPS), PTSD Checklist – Civilian Version (PLC-C), and a 36-item short-form-survey form over 6 months after the delivery.

Results:

The case group had higher mean EPDS and PLC-C scores, with poor quality of life (QOL) performance, compared to the control group at 6 weeks and 3 months, and 6 months follow-up (P< 0.05). At the sixth-week follow-up visit, the study observed that 28 (31.8%) women from the case group required a psychiatry consultation compared to the control group with only two (2.5%) participants (P< 0.001). At 3 months, an evident difference was noted on various QOL parameters, such as limitations due to physical health and emotional problems, energy fatigue, general health, and health change parameters between the two groups (P< 0.05). The difference persisted at 6-month follow-up as well for limitations due to physical health, energy fatigue, and general health parameters only (P< 0.05).

Conclusion:

There is an urgent need for a multi-departmental collaborative approach at the hospital level and policy-making decisions at higher levels for the mental health of Asian women facing MNM events.
Profile of type 2 diabetes mellitus patients attending family medicine clinic in a rural tribal locality in India
Authors: Kumar Sumit
Published: December 2023

Objective:

Diabetes prevalence has been predicted to reach 578 million worldwide in 2030 and is estimated to increase by 51% (700 million) in 2045. Type 2 diabetes mellitus (T2DM) is frequently associated with various cardiovascular (CV) risk factors secondary to associated dyslipidemias and good glycemic control is key for the prevention of long-term CV complications; this study was conducted to assess present glycemic status and lipid profile of the population residing in a rural tribal locality of Jharkhand (India).

Materials and Methods:

This cross-sectional study was conducted as a project for Fellowship in diabetes course by the Department of Endocrinology, DEDU, CMC Vellore. Whole blood and sera were analyzed for fasting blood sugar (FBS), glycated-hemoglobin (HbA1c), total cholesterol (CH), triglycerides (TGs), high-density-lipoprotein-cholesterol (HDL-C), low-density-lipoprotein-cholesterol (LDL-C), and very-low-density-lipoprotein-cholesterol (VLDL-C). A correlation test of HbA1c with lipid ratios and individual lipid indexes was done.

Results:

The mean Hb1Ac level was uncontrolled as 7.24 ± 1.80 and, interestingly, was marginally higher [7.31 ± 1.92 Vs 6.92 ± 1.16] in patients with T2DM <5 years as compared to those with T2DM >5 years. Mixed dyslipidemias were common with abnormal TG, LDL, VLDL, HDL, and total CH values. Hb1Ac levels showed a significant positive correlation with serum CH, TG, LDL, and VLDL levels, while a significant negative correlation with HDL levels in the study.

Conclusion:

Apart from being a reliable indicator of long-term glycemic control, HbA1c can also be used as a surrogate marker of dyslipidemia, and thus early diagnosis and treatment of dyslipidemia can prevent life-threatening cardiovascular complications that can be particularly useful in resource-poor rural tribal locality settings.
Comparison of psychological well-being, hope, and health concern in leukemia patients before and after receiving stem cells
Authors: Yavari Tahereh , Zahedi Amiryousef , Movahednia Nima , Hajhamidiasl Negin , Gheisvandi Fariba , Sheyni Fatemeh
Published: December 2023

Objectives:

The aim of this study was to compare psychological well-being, hope, and health concerns in leukemia patients before and after receiving stem cells.

Methods:

The statistical population of the present study consisted of leukemia patients in Tehran, and the research sample was among the patients referred to the Bone Marrow Transplant Center of Shariati Hospital in Tehran, and they were placed in two experimental and control groups (15 people in each group), which were selected by purposive sampling method.

Results:

To collect the data for the research, three psychological well-being questionnaires were used by Riff (2002), Schneider's Hope Scale (SHS), and Schneider's (1991) Health Concern Questionnaire (HCQ). To analyze the data in this research, according to the “pre-test-post-test design with the control group,” covariance analysis was used.

Conclusion:

Based on the research findings, it was concluded that receiving stem cells increases hope and psychological well-being in leukemia patients and significantly reduces health concerns.
Liver function tests at admission as marker of severity and prognosis in COVID-19 patients – A retrospective analysis
Authors: Himral Pratibha , Bhawani Rajesh , Bhardwaj Manisha , Sharma Nikhil
Published: December 2023

Introduction:

With evolving pandemic, a substantial proportion of patients are presenting with liver dysfunction as an extra-pulmonary manifestation of COVID-19 illness. We planned this study to evaluate the incidence of liver dysfunction in COVID-19 pneumonia and find an association between abnormal liver function and the severity of the disease.

Method:

We retrospectively analysed the hospital records of 344 patients with moderate to severe COVID-19 illness admitted to a Dedicated COVID Hospital in North India.

Results:

Out of 344 patients included in the study, 59.9% were males. The abnormal liver functions were present in 78.49% of patients at admission. Mean age of the patient with liver dysfunction was 53.41 ± 15.71 years. The incidence of elevated aspartate aminotransferase (AST), alanine aminotransferase (ALT), and hypoalbuminemia was 82.96%, 74.91%, and 69.7%, respectively, in patients with COVID-19 at admission. A positive correlation was found between the levels of AST, ALT and hypoalbuminemia with severity of disease. Mortality was 33% in patients with liver dysfunction in comparison to 18.9% in patients with normal liver functions.

Conclusion:

More than 75% of the patient had abnormal liver functions at admission, and mortality was also high in this group. Mortality can be effectively reduced if laboratory parameters such as elevated AST and ALT and hypoalbuminemia are closely monitored at admission and during hospital stay in patients with risk factors like male, age <55 years and HTN.
Comparing the occurrence rate of gestational hypertension during pregnancy with frozen embryo transfer and natural pregnancy
Authors: Moramezi Farideh , Nikbakht Roshan , Saadati Najimeh , Farhadi Elham , Raad Negin
Published: December 2023

Introduction:

Recent researches have indicated that pregnancies with frozen embryo transfer are associated with the increment of risk of maternal and neonatal complications, especially hypertension during pregnancy. The present study aimed to compare the occurrence rate of gestational hypertension in pregnancy with frozen embryo transfer and normal pregnancy.

Materials and Methods:

This research, as a retrospective cross-sectional study, was performed on pregnant women with frozen embryo transfer (n= 97) and women with normal pregnancies (n= 164) referring to medical centers under the supervision of Ahvaz University of Medical Sciences in 2021. Women aged 18–35 were included in the study after week 20thof pregnancy. Maternal and neonatal outcomes including hypertensive disorders of pregnancy (including gestational hypertension and preeclampsia), preterm birth (before the week 37th), low birth weight (lower than 2500 g), neonatal asphyxia (Apgar score >7 in minute 5th), intrauterine growth restriction (IUGR) and bleeding in the first trimester of pregnancy were evaluated. The association between frozen embryo transfer and pregnancy outcomes was evaluated using multiple logistic regressions.

Results:

The findings of this study indicated that pregnancy hypertension was observed in 23 people (23.7%) from the frozen embryo transfer group vs. 18 people (11.0%) from the normal pregnancy group (P= 0.006). Frozen embryo transfer pregnancy has a higher risk of gestational hypertension (OR = 2.521, 95% CI: 1.281-4.962;P= 0.007), preterm birth (OR = 2.264, 95% CI: 1.335-3.840;P= 0.002), and low birth weight (OR = 2.017, 95% CI: 1.178-3.455;P= 0.011). However, the incidence of birth asphyxia (P= 0.850), intrauterine growth restriction (P= 0.068), first-trimester bleeding (P= 0.809), and placenta accreta (P= 0.143) did not show a significant difference between two types of normal pregnancy and frozen embryo transfer pregnancy.

Conclusion:

Frozen embryo transfer pregnancy was associated with a higher risk of maternal and neonatal complications, hypertension, preterm birth, and low birth weight compared to natural and spontaneous pregnancies.
Evaluation of changes in the cognitive, affective, and psychomotor domains of learning following an interprofessional intervention for malaria and its control among the Bedia tribe, a particularly vulnerable tribal group, in rural Eastern India
Authors: Paul Uttam Kumar , Paul Pritama
Published: December 2023

Background:

The “Bedia” tribal people are found all over India; they are poor, illiterate, and confined culturally. In many parts of India, malaria, a disease caused by mosquitoes, is becoming more common. Raising awareness and educating people about it is the best method to stop disease and maintain good health.

Objective:

This study aimed to determine the perception, attitudes, and practices of a particularly vulnerable tribal group—the “Bedia”—in the rural region of eastern India.

Methods:

A questionnaire with 19 structured questions has been created. The Bedia participants received the questionnaire from us. They had already responded. The intervention took the form of several health education workshops that were created in response to the deficiencies identified in the pre-test assessment's replies. The identical questionnaire used for the pre-test evaluation was given to each participant for the post-test who attended the training sessions.

Results:

The current study found that while the first cognitive domain question on malaria transmission was not statistically significant, changes in malaria breeding grounds, regions with higher mosquito numbers, and the source of information about malaria are. Their knowledge of the treatment for malaria and the agent used to treat it is statistically significant in the current study, but the fifth question on the most common symptom of malaria was not statistically significant. The answers to the questions about “What you will do if you see someone suffering from malaria,” “How much time was spent in the malaria control program,” “Malaria detection,” and “Regular usage of bed-nets” in the affective and psychomotor domains all had statistical significance.

Conclusions:

Our research on interventions to raise awareness of malaria in this tribal region of northern West Bengal, eastern India, bordering Bangladesh, was published for the first time to our knowledge. In the majority of the items from the cognitive, psychomotor, and affective learning domains, we have seen significant changes.
Impact of Remdesivir on inflammatory and prognostic markers of COVID-19: Findings of an event-monitoring study
Authors: Singh Shruti , Sinha Nishi , Lohani Pallavi , Agarwal Neha , Singh Pratibha , Singh CM
Published: December 2023

Introduction:

Remdesivir is currently approved for treating hospitalised patients with COVID-19. However, it is a priority to monitor its safety and effectiveness in various clinical settings. This study was undertaken to assess the impact of remdesivir on inflammatory and prognostic markers of COVID-19.

Materials and Methods:

A hospital-based prospective longitudinal study was conducted over two months comprising event monitoring of COVID-19 patients administered remdesivir as per standard guidelines. The demographic details, risk factors and all baseline parameters were collected. The patients were followed up for the appearance of any adverse drug reactions (ADRs) after the start of remdesivir therapy from Day 1 to discharge or death every day. Repeat Lab tests were done on days 2, 4, 6 and 10 days to assess the impact of remdesivir on inflammatory and prognostic markers of COVID-19 over time. Significant predictors of survival in the cohort were also assessed.

Results:

A total of 60 COVID-19 patients were administered remdesivir. The mean age of the patients was 59.2 (+13.7) years. There was a significant improvement in the serum creatinine (decreased from 0.9 to 0.7 mg/dL), lymphocyte count {decreased from 9.2 to 7.3 (109 cells/L)} and serum sodium (increased from 134.6 to 137.4) of the patients over six days after the administration of remdesivir. The significant survival predictors were multiple organ failure (P 0.046) and WBC count on Day 10 (P 0.001).

Conclusion:

Remdesivir administration improved the prognostic biomarker profile in COVID-19 patients.
Prevalence of psychiatric morbidity and cognitive impairment among non-communicable disease patients in Southern Chennai, Tamil Nadu
Authors: Kavya P , Ilanchoorian Divya , Hari Krishnan R
Published: December 2023

Introduction:

According to the WHO, non-communicable diseases cause 71% of all deaths globally. Despite many studies showing a significant association between non-communicable diseases (NCDs) and cognitive decline, it is not researched in Tamil Nadu. Hence, this study was conducted to screen for psychiatric morbidity and cognitive impairment (CI) among NCD patients in Southern Chennai.

Aims:

The aim of this study was to estimate the prevalence of psychiatric morbidity and CI and their associated factors among NCD patients attending NCD clinics of tertiary care hospitals.

Methods and Material:

A cross-sectional study was carried out in NCD patients (n = 343) attending an NCD clinic in a tertiary care hospital. Basic sociodemographic and clinical details were obtained by a semi-structured questionnaire. Cognition function and psychiatric morbidity were assessed using mini-mental state examination, patient health questionnaire 9 and generalised anxiety disorder 7 tools, respectively.

Results:

The mean age of the study participants was 58 years. Of 343 participants, 19.2% had severe CI, 26.8% had severe depression, and 29.7% had severe anxiety. Among 180 participants aged 59–86 years, 25.5% participants had osteoarthritis; of these, 41.3% had severe CI (P < 0.0001), 82.6% had severe depression (P < 0.0001) and 63% had severe anxiety (P < 0.027), and their association was statistically significant.

Conclusions:

This study concludes that about one-fourth of the NCD patients suffered from CI and psychiatric morbidity, which are of rising concern. Musculoskeletal diseases are neglected to be assessed under NCDs, and in this study, osteoarthritis was found to be significantly associated with depression, anxiety and CI.
Role of biomarkers in prognostication of moderate and severe COVID-19 cases
Authors: Pal Santasmita , Sengupta Suvendu , Lahiri Subhayan , Ghosh Amrita , Bhowmick Kaushik
Published: December 2023

Background:

COVID-19 pandemic demanded upgrading of laboratory medicine to limit morbidity, disability and mortality from moderate and severe SARS-COV-2 infections.

Objective:

To assess among moderate and severe COVID-19 patients, C-reactive protein (CRP), procalcitonin (PCT), ferritin, D-dimer, interleukin 6 (IL-6), lactate dehydrogenase (LDH), total and differential leucocyte count (TLC and DLC), neutrophil-to-lymphocyte ratio (NLR), absolute platelet count (APC), prothrombin time (PT), activated partial thromboplastin time (APTT) and international normalized ratio (INR) to find their interdependence and role in prognosis.

Methods:

This open label analytical cross-sectional noninterventional study evaluated array of independent biochemical, haematological and coagulopathy markers, viz. CRP, PCT, ferritin, D-dimer, IL-6, LDH, TLC, DLC, NLR, absolute platelet count, PT, APTT and INR on consecutive 100 patients with diagnosis of moderate and severe COVID-19 from July to August 2021.

Results:

In our study, on consecutive designated 100 cases (55 cases moderate and 45 cases severe), more severity were reported as the age progressed; gender difference was not noted. Among independent markers, CRP, PCT, ferritin, D-dimer, IL-6 and LDH had statistically significant relation in comparison with severity of the disease as Chi-square calculated value (P < 0.05). TLC, DLC and APC showed no significant relation in comparison with severity of the disease; NLR had highly significant relation. PT showed significant relation in comparison with severity, though APTT and INR did not show significant relation.

Conclusion:

Our research group felt that CRP, PCT, ferritin, D-dimer, IL-6, LDH and NLR should be in included in clinical practice guidelines to prognosticate COVID-19 cases. Furthermore, translational researches are needed at all levels of healthcare to improve validity for practices of primary care physicians.
A cross-sectional study on adherence to treatment and life-style modifications in hypertensive patients attending the urban health centre of a teaching hospital in Hyderabad
Authors: Varma Pavani , Mohandas Anu , Ravulapalli Pratyusha , Pattnaik Snigdha , Varaprasad K Satya
Published: December 2023

Introduction:

The burden of hypertension is expected to double by 2025 and adherence to treatment has a key role in disease outcome. The World Health Organization defines adherence as the extent to which a person's behaviour of taking medication, following a diet and/or exceeding life-style changes, corresponds with the agreed recommendations of health care providers. The study tries to assess the level of adherence to medication and life-style modifications in hypertensive patients.

Materials and Methods:

It is a cross-sectional study among patients attending urban health centres of a teaching hospital. The study population included all hypertensive patients above 30 years. Based on the prevalence of non-adherence to hypertensive medication, 70% of the sample size is calculated as 182. A Morisky medication adherence scale is used to find adherence to treatment. Life-style modification was also assessed. Scoring was done based on their adherence to treatment and life-style modifications and quantified.

Results:

The mean age of the study population was 55 years (38–80 years). In total, 58.33% were illiterate and 21% were retired from work. Around 87.5% had to spend money on medication. Mean weight, height, hip and waist circumference was 66 kg, 157 cm, 108 cm and 100 cm, respectively. Mean BMI was 26.6. Prevalence of good adherence to medication was 129 (70.83%) and that of good life-style modifications was 127 (70.17%).

Conclusion:

The adherence to medication and life-style modification was satisfactory. Family physicians have a key role in Non communicable diseases (NCD) management and should focus on ongoing education programmes for treatment adherence and life-style modifications at a community level, and grass-root level workers should conduct regular follow-up activities.
Bombay Begums—A treasure for social guidance films on determinants of women's mental health
Authors: Abhilasha Pallavi , Philip Sharad , Bora Nirmitasha , Jamir Limalemla , Ghosh Nilanjana
Published: December 2023

A woman's health should reach beyond the narrow perspective of maternal and reproductive health and should encompass physical as well as mental health across the life cycle. The focus should be shifted to a broader, social, legal, and economic factors rather than just immersing on lifestyle and individual factors. Recognition of mental health issues among women, education, training, and interventions at various levels would contribute to the improvement of mental health issues among women.
Novel genetic syndrome manifesting with cerebral atrophy, cataract, hypoacusis, diabetes, and brachy-/syndactyly
Authors: Finsterer Josef
Published: December 2023

Genetic disorders manifest clinically in a variety of phenotypes. A patient with cataract, hypoacusis, hand and foot deformities, and diabetes was not reported. The patient is a 74-year-old male with a history of congenital foot and hand deformities manifesting as brachydactyly of fingers 4 and 5 on the right side and brachydactyly and syndactyly of the fingers 1-5 on the left side. Foot deformities required orthopedic surgery from an early age. He later developed cataract that required surgery, hypoacusis with tinnitus on the left side, and diabetes. Cerebral MRI revealed generalized atrophy. Since the family history was positive for deaf muteness in his father, a genetic defect was considered. In summary, a novel syndrome has been described that manifests itself in cerebral atrophy, cataract, hypoacusis, hand and foot deformities, and diabetes. Considering the father's deaf muteness, a genetic cause of the syndrome is likely.
Breastfeeding pattern and its relationship with weight gain in children older than 6 months
Authors: Esfarjani Shahla V. , Alaei Saeid , Saki Azadeh
Published: December 2023

Introduction:

According to the World Health Organization (WHO), breastfeeding is the best way to feed infants. Adoption of some inappropriate nutritional patterns along with breast milk, especially in infants older than 6 months, may lead to a delay in the child's growth. Therefore, the present study was conducted to investigate the relationship between breastfeeding and weight gain in children aged 6–24 months.

Materials and Methods:

This case-control study was conducted on 120 infants aged 6–24 months and their mothers recruited from health centers of Ahvaz, southwest of Iran. The data collection tool in the present study included a questionnaire to record demographic information and information in the child's medical records in health centers. Statistical analysis of the data was done by SPSS 23 using the Chi-square test and t-test.

Results:

No significant difference was observed between the control and case groups in terms of the infant's age (P = 0.741) and gender (P = 0.564) and the mothers' age (P = 0.614), her educational attainment (P = 0.389), and socioeconomic status of the infant's family (P = 0.563). The type of delivery (P = 0.650), mothers' opinion (P = 0.133), and the interval between breastfeeding and complementary feeding (P = 0.144) had no significant relationship with the infant's growth disorder. On the other hand, duration of breastfeeding per meal (P = 0.007) and frequent breastfeeding (dependency on the mother's breast) (P = 0.049) had a significant relationship with children's developmental disorders.

Conclusion:

According to the results of the present study, growth disorders in infants in the case group could be attributed to their mothers' inappropriate breastfeeding patterns.
Serum gamma-glutamyl transferase level as a risk factor in acute stroke
Authors: Ismail Quazi M. , Prasad Manoj K. , Marandi Sujeet , Guria Rishi T. , Dungdung Ajit
Published: December 2023

Background:

Worldwide stroke is the second major cause of mortality and the fourth prominent cause of disease load after coronary heart disease and all types of malignancy. Greater than 3/4thof these cases are in low-priced and middle-priced nations. Several epidemiological studies have shown that alcohol consumption is a risk factor for stroke. The correlation between alcohol consumption and stroke involves various processes. For excessive alcohol consumption, GGT (gamma glutamyl transferase) is used as a marker. The study aims to see whether serum GGT level is an independent risk factor for stroke in young and elderly patients who do not have a history of alcohol intake.

Material and Method:

The study is an analytical cross-sectional comparative hospital-based study done in the Department of Medicine, RIMS, Ranchi from November 2019 to April 2021. A total number of 100 cases including both sexes who presented with the first episode of stroke have been compared with 100 age–sex-matched healthy control subjects without any cerebrovascular or cardiovascular disease meeting inclusion and exclusion criteria. Analysis of data is done by SPSS software and R studio software.

Result:

Serum GGT is lower in the age group of 40–60 years (24-hour GGT mean 50.70 U/L+SD 16.86) than the age group of 60–80 years (24-hour GGT 65.89 U/L+SD59.04) with aPvalue of 0.005. This is also true in 48-hour GGT (48.02 U/L+SD16.02) in 40–60 years compared to 57.94 U/L+SD42.81 in 60–80 years with aPvalue of 0.001 and 72-hour GGT (44.80 U/L+SD16.98) in 40–60 years compared to the mean (56.16 U/L+SD43.82) in 60–80 years with aPvalue of 0.001. This suggests that serum GGT level is significantly lower in the 40–60 years age group with aPvalue < 0.01. The serum GGT level in the case population is mean 58.30 (U/L) + SD43.87, and that in the control group is mean 17.48 (U/L) + SD4.32 withPvalue < 0.001. This implies an increased level of serum GGT level in stroke patients.

Conclusion:

Serum GGT level is independently correlated with stroke even in the presence of other risk factors for stroke such as diabetes mellitus, hypertension, and dyslipidemia. Serum GGT level is more in hypertensive, dyslipidemic, and ischemic stroke patients than in non-hypertensive, non-dyslipidemic, non-ischemic stroke patients, but serum GGT level cannot predict the outcome (survival or death) in stroke patients.
Determinants of awareness on pictorial health warnings on tobacco products in an Eastern state of India
Authors: Naik Bijaya N. , Nirala Santosh K. , Patil Shreyas , Rao Rajath , Yankannavar Basavaraj S.
Published: December 2023

Background:

Pictorial health warnings (PHW) are an effective strategy to deter or reduce tobacco use. This study was conducted to determine the level of awareness of PHWs on tobacco products and their correlates among adults attending the outpatient department (OPD) of a tertiary care facility in Eastern India.

Materials and Methods:

This cross-sectional study was conducted over a period of 3 months among 307 patients aged 18 years to 65 years. A pre-tested semi-structured questionnaire was used for the collection of data and inferential statistics were performed using JAMOVI version 2.3.21.

Results:

About 84% (95% CI, 78.9-87.2) of the participants were aware of PHW on tobacco products, 82.4% (95% CI, 77.8-86.3) for smoked forms and 51.8% (95% CI, 46.2-57.3) for smokeless forms. More than half of the participants felt that the current PHW were ineffective. Male [AOR, 3.13; 95% CI, 1.33-7.37], being educated [AOR, 3.37; 95% CI, 1.29-8.76], employment [AOR, 5.65; 95% CI, 1.21-26.30] and ever-tobacco use [AOR, 3.23; 95% CI, 1.43-7.2] were found to be independent correlates of PHW awareness for smoked tobacco products, whereas as being male [AOR, 2.01; 95% CI, 1.02-3.95] and being young (18-30 years) [AOR, 2.51; 95% CI, 1.08-5.84] were found to be the independent predictors of PHW awareness for smokeless tobacco products (SLT).

Conclusion:

Four out of every five individuals were aware of pictorial health warnings (PHW) on tobacco products; however, it was much less for SLT compared to smoked tobacco products. Male, being educated, employment and ever-tobacco use were independent correlates of awareness for the smoked form of tobacco products, whereas being young (18-30 years) was an independent predictor of awareness for SLT.
A case of rectus sheath hematoma in the setting of paroxysmal coughing and platelet dysfunction
Authors: Harris Erika , Fleshman Taylor , Franks Adam
Published: December 2023

Rectus sheath hematoma (RSH) is an uncommon cause of acute abdominal pain that may mimic other intra-abdominal pathologies. It is caused by the rupture of the superior or inferior epigastric artery or vein in the rectus abdominis muscle. Clinical features include sudden-onset abdominal pain and a palpable mass, and common risk factors include anti-coagulants, platelet dysfunction, and cough. Workup includes a physical exam, complete blood count, coagulation profile, ultrasound, and computed tomography. While most cases are treated conservatively, uncontrolled hemorrhage may be lethal and requires prompt recognition. We discuss a case of RSH which developed in the setting of paroxysmal coughing and platelet dysfunction. The purpose is to highlight the diagnosis and treatment of RSH and emphasize the importance of its inclusion in the differential for acute abdominal pain.
Congenital tuberculosis causing hydrops fetalis: A case report and review of literature
Authors: Bansal Eshita , Mehra Shuchi , Bhalla Kapil
Published: December 2023

Tuberculosis (TB) is an infectious disease of which congenital TB is a rare form even in TB-endemic countries such as India. There are very few case reports of the same in the literature. Though the incidence rate of congenital TB is low, mortality rates are very high.

Here, we report a case of a 2-day-old neonate who presented to Pediatrics Accident and Emergency with complaints of fast breathing and swelling all over the body. The baby had swelling all over the body and subcutaneous edema suggestive of hydrops fetalis. She was investigated and subsequently diagnosed to have congenital TB for which appropriate treatment was started. The baby is still on regular follow-up with no active complaints.
Evaluation of Potential Drug–Drug Interactions and Risk Factors in Elderly Patients with Peripheral Neuropathy
Authors: Singh Alok , Kannauje Pankaj Kumar , Dhaneria Suryaprakash , Balasundaram Mahesh Kumar
Published: December 2023

Background and Objectives:

The geriatric population is at excessive risk of potential drug–drug interactions (pDDIs). Nevertheless, polypharmacy is quoted as a significant associated factor; several other factors were only explored a little. The study aimed to evaluate the profile of pDDIs and the associated risk factors among geriatric peripheral neuropathy patients in a tertiary care teaching hospital.

Materials and Methods:

The study was an extended evaluation of data gathered during a randomized clinical trial for the first-line drugs used to treat peripheral neuropathy, which enrolled participants aged ≥60 years. Data were collected from the outpatient department cards of the patients and were scrutinized using Lexicomp-UpToDate software.

Results:

The study included 80 patients. Most (56.3%) were male, and half of the included patients had diabetes. In the analysis of 80 prescriptions, 55 different drugs were prescribed. The incidence of pDDIs was 40%. About 57.5% of prescriptions had at least one fixed-dose combination (FDC). Polypharmacy (≥5 drugs) was observed in 41.2% of the prescriptions. Among the several risk factors analyzed, patients with >2 comorbidities (RR: 1.99; confidence interval [CI]: 1.09–3.65; P = 0.02*), the triad of diabetes, hypertension, and dyslipidemia (RR; 2.27; CI: 1.42–3.62; P = 0.003*), receiving polypharmacy (RR: 5.1; CI: 2.5–10.35; P = 0.00001*), and FDC (RR: 7.14; CI: 2.3–21.53; P = 0.00001*) were found to be statistically significant predictors of pDDIs.

Conclusion:

Our study found that multimorbidities lead to polypharmacy and FDC, resulting in clinically significant pDDIs.
Verbal Recall in Aging: Effects of Stimulus Modality
Authors: Niharika M. K. , Rashmi D. G. , Aishwarya G.
Published: December 2023

Purpose:

Free recall tasks target cognitive and linguistic processes such as episodic memory, lexical access, and retrieval. Consequently, the free recall paradigm is suitable for assessing memory deterioration caused by aging, which can be influenced by stimulus presentation modality. Hence, the present study aimed to determine if aging has an effect on visual and auditory recall abilities.

Materials and Methods:

Twenty young adults (mean age: 25.4 ± 0.99) and older adults (mean age: 63.3 ± 3.51) participated in the study. Participants performed a free recall task under two conditions – related and unrelated and two modalities – visual and auditory where they were instructed to recall as many items as possible with no specific order and time limit.

Results:

Free recall performance was calculated as the mean number of correctly recalled items. Although younger participants recalled a higher number of items, the performance across conditions and modality was variable.

Conclusions:

The findings of the present study revealed an age-related decline in the efficiency of episodic memory, which is crucial to remember recent events.
Risk Factors for Mortality in Elderly COVID-19 Patients
Authors: Fernandes Jonita Evett , Ashok J. M. R. Michael , Idiculla Jyothi
Published: December 2023

Background:

Advancing age and multimorbidity are well-established risk factors for the incidence and severity of coronavirus disease 2019 (COVID-19) infection.

Aims:

To describe the clinical profile of hospitalized elderly patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and to assess the risk factors for mortality.

Methodology:

Data on 465 consecutive patients aged 60 years and above admitted with COVID-19 at St John’s Medical College Hospital, Bangalore, were analyzed using the Statistical Package for the Social Sciences (SPSS) version 20.0 software (SPSS Inc., Chicago, IL, USA).

Results:

A total of 465 patients were included for the analysis. The overall mean age of the study group was 67 ± 4 years with 315 (67.9%) male patients. Eighty-one patients had mild, 117 had moderate, and 267 had severe COVID-19. After adjusting for age, gender, glycemic status, and COVID severity in the multivariate logistic regression analysis, elevated neutrophil-to-lymphocyte ratio (adjusted odds ratio [aOR] 1.93 95% confidence interval [CI] 1.14–3.29), end stage renal disease (aOR 3.49, 95% CI 1.34–9.06), acute kidney injury (aOR 3.25, 95% CI 1.94–5.41), shock (aOR 13.53 95% CI 6.35–28.82), mechanical ventilation (aOR 8.53, 95% CI 4.85–15.00), and intensive care unit care (aOR 14.5 95% CI 7.42–28.38) were the independent predictors of mortality.

Conclusion:

COVID-19 is characterized by poor outcomes and mortality, especially among older patients who have multiple comorbid illness.
Low Back Pain: An Unusual Presentation of Non-Hodgkin Lymphoma
Authors: Srivatsa Niveda , Vijayakumar Priya
Published: December 2023

Non-Hodgkin lymphoma (NHL) is a lymphoid tissue neoplasm originating from B- and T-cells and usually presents with fever, lymphadenopathy, and hepatosplenomegaly. Here is a case of NHL who presented to us with low backache. We describe a patient 63 year old female who had a known history of systemic hypertension, presented with spasmodic low back pain. On examination, she had a single right lymph node 1 cm × 2 cm palpable with spinal tenderness. Her blood reports were all within normal limits with slightly elevated inflammatory markers. Magnetic resonance imaging of the spine revealed multiple enlarged lymph nodes in the abdomen, which were compressing the celiac plexus. After a lymph node biopsy, it was revealed that she had follicular NHL. On the initiation of steroids and chemotherapy, her pain subsided. NHL has a variety of presentations. It is not necessary always fever should be a part of the presentation. Physicians should have a suspicion of lymphoma also in patients presenting with low backache.
Social Isolation and Depression and Its Predictors among Elderly of the Urban Field Practice Area of a Medical College: A Community-based Cross-sectional Study
Authors: Sayed Naila N. , Salunke Nandkumar Manikrao , Parande Malangori Abdulgani , Tambe Muralidhar P. , Bugade Vishvamohini Dinkar , Borle Pradip S.
Published: December 2023

Background:

The elderly population in India has been increasing rapidly. It has become crucial to the public health systems in India to meet the changing needs of this ever-growing population such as medical, psychological and social problems, mobility disorders, falls, incontinence, pressure ulcers, dementia, and delirium.

Aim:

This study aims to study the social isolation and depression and its predictors among the elderly population of the urban field practice area of a medical college.

Objectives:

(1) To estimate the prevalence of social isolation and depression among the elderly. (2) To study the predictors of social isolation and depression. (3) To find out the association between social isolation and depression.

Settings and Design:

The community-based cross-sectional study was conducted among 180 elderly population from the urban field practice area of medical college.

Subjects and Methods:

The Lubben Social Network Scale – having 6 items and Geriatric Depression Scale – having 15 items were used to assess social isolation and depression.

Statistical Analysis:

Data were entered into MS Excel and analyzed using SPSS version 20.

Results:

This study showed the prevalence of social isolation was 62.8%, depression was 43.9% among elderly and having mild depression (18.9%), moderate depression (13.9%), and severe depression (11.1%). The predictors for social isolation and depression were living status and education status.

Conclusions:

The study revealed that the majority of the elderly were socially isolated and depressed. Screening of elderly for social isolation should be done. Living status and education status were found to be the predictors of social isolation and depression. In addition, being socially isolated can lead to depression.
Effect of stress on contextual pain sensitivity in the preoperative period- A proof of concept study
Authors: Padhy Shibani , Fatima Ruhi , Jena Shubhranshu , Kar Akhya Kumar , Durga Padmaja , Neeradi Vishal Kumar
Published: December 2023

Background and Aims:

The importance of non-noxious contextual inputs in the interplay of pain with neurophysiologic and behavioral factors is gaining recognition. Stress of impending surgery can act as a negative context, leading to a decrease in pain threshold in patients. This study was conducted to assess the influence of stress conferred by the imminent and other contextual inputs such as anxiety, socioeconomic status, prior painful experience, and the effect of gender on modulation of pain perception in patients undergoing elective surgery.

Material and Methods:

In total, 120 patients aged between 18 and 60 years of either gender posted for elective gastrointestinal surgery under general anesthesia were recruited. Data were collected on preoperative anxiety level, socioeconomic status, education, and any prior painful experience. A pressure algometer was used to measure the pressure pain thresholds and pain tolerance on the day before surgery and on the morning of surgery in the preoperative suite.

Results:

There was a statistically significant decrease in both pain threshold (P< 0.0001) and pain tolerance in the immediate preoperative period in comparison to the baseline readings taken the day before surgery (P= 0.048). The magnitude of change in pain scalars was greater in females (P< 0.001), those with a high anxiety score, and a history of severe painful experience in the past.

Conclusion:

Preoperative surgical stress lowers the pain threshold and pain tolerance. Contextual modulation of pain by factors such as anxiety and memory of prior painful experience, especially in the female gender, could influence postoperative patient outcomes and warrants further research.
Target-controlled infusion: A comparative, prospective, observational study of the conventional TCI pump and the novel smartphone-based application iTIVA
Authors: Shah Shagun B. , Chawla Rajiv , Gupta Manish
Published: December 2023

Background and Aims:

Empirically adjusted, standard drug doses fail to address interindividual pharmacokinetic and pharmacodynamics variability. Target-controlled infusion (TCI) delivers drugs in calibrated boluses to achieve and maintain a selected target plateau drug level (plasma or effect site). Interactive total intravenous anesthesia (iTIVA™) smartphone software simulates TCI and employs 31 established pharmacokinetic models for 11 different intravenous agents and is coupled with standard volumetric infusion pumps for administering TCI.

Material and Methods:

This prospective, observational, study investigates the degree of agreement between iTIVA and a conventional TCI pump (CTP) for the volume of propofol infused using the Schnider pharmacokinetic model in adult patients of either sex undergoing oncosurgery lasting 1–3 h under total intravenous anesthesia. Bland–Altman analysis of 124 data pairs from 30 patients provided bias, precision, and limits of agreement between the volumes infused by CTP and iTIVA (V-CTP and V-iTIVA) during specific identical time periods. Spearman’s rho and Kendall’s tau rank correlation coefficients provided the degree of association between V-CTP and V-iTIVA.

Results:

Spearman’s rho and Kendall’s tau were 0.996 and 0.964, respectively. Bias or the mean of differences was −0.02, while the limits of agreement were 0.58 and −0.63, respectively (Bland–Altman plot). The maximum allowed difference of 2 ml was much larger than the 95% confidence intervals for the limits of agreement. The Mountain plot was short tailed (−1.28 to 1.55) and centred over zero (0.01).

Conclusion:

The volume of propofol infused using TCI pump was similar to that calculated by iTIVA in identical time periods, confirming the clinical applicability of iTIVA.
Evaluation of the antiplatelet effect of generic ticagrelor 90 mg (ticaspan®) alone and in combination with aspirin 75 mg as compared to ticagrelor (innovator)
Authors: Kamat S , Jalgaonkar S , Marathe P , Karekar S , Uchil D , Revankar S
Published: December 2023

Objective:

To evaluate an in vitro antiplatelet effect of generic ticagrelor 90 mg (ticaspan) alone and in combination with aspirin 75 mg as compared to the innovator formulation of ticagrelor alone and in combination with aspirin among healthy Indian volunteers.

Methods:

18 volunteers were enrolled and platelet viability was tested using lactate dehydrogenase (LDH) assay in six of 18 volunteers. In 12 volunteers, maximum platelet aggregation (MPA) and percentage inhibition of platelet aggregation (PI) were assessed using a platelet aggregometer in six study groups.

Results:

There was no significant increase in LDH levels when platelets were incubated with an innovator or generic drug alone and in combination with aspirin as compared to the dimethyl sulfoxide [DMSO] group. All five study groups showed a significant reduction in the MPA values compared to the DMSO group (P < 0.01). The extent of decrease in MPA observed with the generic drug was not significantly different from the innovator drug (P = 0.325). Similarly, the MPA observed with the two combination groups did not differ from each other (P = 1.000), but it was significantly different from the MPA observed with aspirin (P = 0.039, each). The PI of platelet aggregation was significantly more in four study groups [generic drug alone; innovator alone; generic drug + aspirin; and innovator drug + aspirin] (P < 0.01) as compared to the aspirin group.

Conclusion:

The generic ticagrelor and its combination with aspirin demonstrated an antiplatelet effect equivalent to the innovator drug and its combination with aspirin.
Complete agenesis of dorsal pancreas: A rare cause of insulin-dependent diabetes mellitus
Authors: Ray S , Behera KK , Tripathy TP
Published: December 2023

We report a 16-year-old boy who presented with abdominal pain and severe hyperglycemia. His random blood glucose on admission was above 300 mg/dL, without ketosis. Urine examination revealed mild ketonuria. Renal function tests were normal. Antibodies to glutamate acid decarboxylase (anti-GAD) and islet tyrosine phosphatase 2 (anti-IA2) were negative. Findings on enhanced abdominal computed tomography scan were compatible with complete dorsal pancreatic agenesis. The body and tail of the pancreas were not visualized. Additionally, ectopic and malrotated left kidney was detected. Magnetic resonance cholangiopancreatography confirmed the absence of the dorsal pancreatic duct. The patient was treated with multiple subcutaneous insulin injections and attained good glycemic control. He is currently doing well on follow-up. The present case is a rare combination of complete agenesis of the dorsal pancreas with an ectopic, malrotated kidney. Clinical awareness of this rare association will help improve patient management.
To study the role of hematological biomarkers in type 2 diabetes patients with diabetic retinopathy
Authors: Bajaj Ishita , Rohatgi Jolly , Kotru Mrinalini
Published: December 2023

Background:

Diabetic retinopathy (DR) is the most common and severe microvascular complication of diabetes mellitus (DM). It is the leading cause of irreversible blindness, and the prevalence is expected to double by 2030. Aim of this study was to compare the hematological biomarkers in diabetics with and without retinopathy. And also, as the grade of retinopathy increased.

Methods:

The study comprised three groups: DR (n = 66), NDR (n = 33), and controls (n = 33). Detailed workup included HbA1c levels, platelet indices (mean platelet volume (MPV), platelet distribution width (PDW), platelet count, and plateletcrit.

Results:

The mean age was 54 years. The mean duration of DM was 10 and 4 years in the DR and NDR groups, respectively. MPV values were significantly higher in the DR group (10.77 ± 1.2) than NDR (9.2 ± 1.1) and least in controls (8.3 ± 0.89) (P = 0.00). These values increased significantly with increasing severity of retinopathy (P = 0.04). There was a 6.13 times increased risk of developing diabetic retinopathy with increased mean platelet volume (MPV). Mean PDW was significantly higher in the DR group (19.22 ± 2.5) than NDR (13.89 ± 2.9) and least in controls (11.3 ± 2.5) (P = 0.00). These values increased significantly with increasing severity of retinopathy (P = 0.00). Other markers were not significant.

Conclusion:

MPV and PDW are important biomarkers which can predict the development and severity of retinopathy. Therefore, it is suggested that platelet indices be routinely done in diabetic workup. Furthermore, these are conveniently obtained from automated cell counters.