bluuebunny/crossref_metadata_2025 huggingface dataset:
Exploring Tourist Attitudes and Satisfaction in Religious Tourism Through Neuro Marketing in Mandi District's Himachal Pradesh
Authors: Thakur Mayur , Sharma Shikha
Published: October 2024

The study explores how and why tourist behavior and satisfaction in religious tourism can be better explained by reference to the culture, history, and spirituality of Mandi District in Himachal Pradesh, India, as explained through ‘Neuro Marketing.' This region is blessed with natural beauty and religious importance, which makes many visitors in the form of religious tourists and pilgrims every year. The study uses a neuro-marketing approach of marketing and neuroscience to reveal other factors affecting tourists' attitudes, behaviors, and satisfaction rates. Thus, using this novel approach, the study intends to make theoretical and practical contributions to the overall empirical body of knowledge as well as to benefit the stakeholders in the religious tourism of Mandi by coming up with the most suitable marketing strategies that would ultimately improve the religious tourism experience of the tourists while boosting the economic and cultural value of the sector in the region.
Driving Sustainable Futures
Authors: Shukla Rishi Prakash , Thakur Rajveer Singh
Published: October 2024

The multifaceted nature of sustainability challenges in the 21st century necessitates an intricate convergence of academic research, industrial innovation, and policy formulation. The confluence of these domains has significant ramifications on predicting consumer trends, particularly as they gravitate towards more ecologically attuned behaviors. This paper explores the synergistic collaborations among academia, industry, and policymakers, examining how research-driven insights can be operationalized in practical business environments. Additionally, it delves into how policy frameworks, informed by neuromarketing research, can catalyze sustainable finance behaviors. Finally, the paper discusses the role of educational initiatives and public awareness campaigns in augmenting societal transition towards a sustainable future.
Exploring the Machine Learning-Based Decision Tree Technique in Assessing Credit Risk Likelihood of P2P Fintech Lending for Effective Marketing
Authors: Kaur Arvinder , Bhatnagar Dyal , Singh Gurvinder
Published: October 2024

Peer-to-Peer lending as a significant alternative finance source in reducing the credit gap worldwide. It is an innovative Fintech business model that integrates lenders and borrowers through the internet without the interference of banks. These lending platforms as Non-banking financial institutions (NBFCs) perform the credit assessment and determine borrower's eligibility to safeguard investors and reduce default risk. The study aims to provide insight into their functionality introducing a novel concept of linking borrowers and lenders by exploring the decision tree technique algorithm based on machine learning for forecasting default risk. Additionally, it highlights the parameters for judging the reliability of borrowers raising funds through such platforms. Additionally, the credibility of these techniques has a psychological effect on investors in making effective investment decisions, and it has a significant impact on corporate professionals in the effective marketing of such platforms.
Artificial Intelligence for Social Good in Service Marketing
Authors: Shukla Dharna , Tripathi Ranjeeta
Published: October 2024

Artificial Intelligence (AI) has revolutionized service marketing by enabling personalized customer experiences, efficient operations innovative solutions to social challenges. This study investigates how AI can be leveraged to achieve positive social outcomes in service marketing, focusing on three key areas: the integration of AI with social good initiatives, the ethical implications of AI in marketing, and successful AI implementations across various sectors. The research highlights the potential of AI to improve accessibility, encourage ethical marketing practices and promote sustainability. The study emphasizes the need for responsible AI practices to ensure that technological advancements align with social values Through literature analysis, this research outlines AI-driven social good initiatives in sectors such as healthcare, finance, education, and environmental sustainability. The findings highlight the need for responsible AI implementation, emphasizing on aspects of transparency, inclusivity, and continuous learning to maximize its benefits for society.
Attraction of Digital Nomads as Significant Tourism Potential
Authors: Lazarević-Moravčević Marija , Domazet Ivana S.
Published: October 2024

Due to the many benefits this can bring, attracting digital nomads has become a challenge for many destinations in recent years. Accordingly, the aim of this paper is to identify the key factors that guide digital nomads when choosing a specific destination for their stay and to analyze the current position of the Serbia in the world of nomadic tourism. Serbia has exceptional potential for the development of nomadic tourism, but it has not been effectively utilized due to the lack of a strategic approach to attracting this market segment. In this context, the paper examines the potential, but also the limitations for a more intensive arrival of digital nomads in Serbia and offers certain solutions in the form of recommendations to overcome them. The results can serve as a basis for the development of strategies, programs and other mechanisms with which it is possible to attract the attention of digital nomads and improve the visibility of Serbia on the map of nomadic tourism.
Exploring user-led spatial practice and user design tools in urban low and middle-income residences: a study based in Kitulwatte, Colombo
Authors: Maheshika Inuri
Published: October 2024

In many developing Asian countries, informal user-led architectural production is prevalent, with dwellings designed and built largely without professional input. Unlike traditional architectural practices, where design, construction, and inhabitation are distinct phases, users perceive these aspects as interconnected, influencing each other continuously and simultaneously, resulting in unexpected and rich spatial experiences. This study focuses on informal user-led architectural production in Sri Lanka, examining the design methods users employ through Jonathan Hill’s framework of user creativity types. By analysing the architectural features of user-designed homes, identifying manifestations of user creativity, and assessing the influence of user-led production on urban adaptability and vibrancy, this research aims to underscore the creative and significant architectural contributions of users. Through an analysis of four residences in Kitulwatte, Colombo, the research reveals the conscious and subconscious processes inherent in user-led design, highlighting their substantial contribution to the urban fabric. This holistic approach transforms architecture from a static product into a dynamic process that continually evolves to meet individual needs. By elucidating the unique design tools and approaches employed by users, this paper enriches the discourse on architectural agency and challenges conventional notions of authorship, showcasing the profound impact of user influence on shaping the built environment.
Space to inculcate imagination in children through picture books
Authors: Perera Jerusha , Samarawickrama Sumanthri
Published: October 2024

Imagination is a complex cognitive process that has been interpreted by different disciplines to define it and its functions. It is a process that draws from past experiences and socio-cultural influences to create new and innovative future outcomes. The pursuit of comprehending imagination has led to the understanding that it is a process that can be cultivated. This study focuses on ‘imagination’ as a concept that can be inculcated in children between the ages of two and six who are in their ‘high season of imagination’, a stage where they are most receptive to the growth of their imagination. Out of alternative media options, it was noted that there is a space to cultivate imagination in children of this age group via picture books. The importance of this medium is evident, as proven by numerous experts, specifically concerning how picture books can be designed to provoke imaginative inculcation. Therefore, this research aims to explain how imagination can be inculcated in children through picture books. This aim is accomplished through a literature review of three cases representing picture book practitioners, writers, and academics. The methodology was conducted in three parts. The first was a content analysis through index cards and annotations. Subsequently, a thematic analysis of literature content through tabulation was performed, followed by a final overall analysis. The results of this study identify five key picture book elements that should be taken into consideration during the creation of picture books to inculcate imagination in children. These five are: (1) Role of picture books, (2) The writing component, (3) Characterisation, (4) Location, situation, and setting, and (5) Layout. Future studies can take this outcome by utilising the five elements to analyse picture books within any context.
Simulation modelling of cost overruns in building projects: a panel data analysis
Authors: Sachchithananthan M. , Niranjan K. , Thayaparan M.
Published: October 2024

Cost overrun is often a challenge in the construction industry due to its complex nature and inefficient project management. Despite extensive research, cost overruns persist in construction. Hence, to minimise these challenges, factors attributing to the cost overrun need to be identified. A country-based assessment is needed since these factors vary from nation to nation. Research conducted almost two decades ago has identified the key cost-related factors influencing cost overrun of Sri Lankan building projects as variation, extra work, fluctuation of price and currency, day works and others. However, given the significant developments and technological advancement in the Sri Lankan construction industry since then, it is crucial to reassess the factors influencing cost overrun in the current context. Therefore, this research intends to re-evaluate the cost-related factors contributing to cost overrun in Sri Lanka. Further, a panel data analysis was conducted to analyse how the influence of the cost-related factors that cause cost overrun has changed over time. This research adopted a survey strategy and used document review on the final BOQ, tender document, and final statement as the data collection technique. Mote-Carlo simulation was adopted to analyse the data collected from twenty random building projects in the western province of Sri Lanka. The findings concluded that work sections measured as ‘item’ in the BOQ and variations and extra work cause overruns in Sri Lankan construction. Hence, clients, contractors, and consultants should give more priority to these factors to minimise the cost overrun by reducing the errors in BOQ, making accurate estimations, and reducing changes over time. However, as the simulation model was derived based on cost-related factors, this study recommends considering other factors influencing the cost overrun of buildings in future research.
Virus-specific Th17 Cells Are Induced by Human Cytomegalovirus after Renal Transplantation
Authors: Dhital Ravi , Flint Kaitlyn , Kaptsan Irina , Hegde Shweta , Daloul Reem , Shimamura Masako
Published: October 2024

CMV infection and Th17 cells are independently associated with increased risk for late allograft loss after renal transplantation. Although CMV-specific Th17 cells are detectable in animal models and nontransplant clinical populations, evidence linking CMV and Th17 cells after renal transplantation remains unclear. This prospective observational study evaluated a cohort of renal transplant recipients during 12 mo posttransplant to assess the presence of CMV-specific Th17 cells in peripheral blood and their relationship to pretransplant CMV serostatus and CMV DNAemia. CMV-specific Th17 cells were identified among CMV serostatus donor (D)+ and/or recipient (R)+ recipients and expanded during both primary (D+/R−) and reactivated (D+/R+, D−/R+) CMV DNAemia. A subset of CMV-specific Th17 cells coexpressed IFN-γ, indicating a Th1/17 phenotype. These Th17 and Th1/17 cells expressed CCR6, CCR5, activation and terminal differentiation markers (CD95, OX40, HLA-DR, CD57), and a central/effector memory phenotype. CMV-specific Th1/17 cells expressed activating/inhibitory receptors (CD57, 4-1BB, CD160, CTLA-4, PD-1) at higher frequencies than Th17 cells. In contrast, staphylococcal enterotoxin B–induced Th17 cells did not expand during CMV DNAemia, did not differ between CMV serostatus groups over time, expressed CCR6, predominantly coexpressed TNF-α, and had lower expression of activating and inhibitory receptors than pp65-specific Th17 and Th1/17 cells. These data show that CMV-specific Th17 cells expand during episodes of CMV DNAemia among renal transplant recipients, and that these virus-specific Th17 and Th1/17 cells have distinct phenotypes from global circulating Th(1)/17 cells. These results suggest a potential proinflammatory pathway by which CMV-induced Th17 cells may contribute to allograft injury, increasing risk for late allograft loss.
Morbidity related to major lung thoracoscopic resections in children
Authors: Ugolini Sara , Tofani Lorenzo , Zolpi Elisa , Montalva Louise , Lotti Cosimo , Morabito Antonino , Chiarenza Fabio , Bonnard Arnaud
Published: October 2024

In pediatric thoracic surgery, reported predictors for increased risk are symptoms and active/previous infections (RAP). We investigated the adverse events related to Video-Assisted Thoracic Surgery (VATS) in pediatric patients when considering RAP predictors. A retrospective analysis of pediatric VATS major lung resections in 2008-2021 was conducted at three institutions. We employed the pediatric surgical risk calculator to define patients’ preoperative predicted risk (PredR). Postoperative complications were classified according to the Thoracic Morbidity & Mortality (TM&M) system. The observed TM&M rate (ObsR) and the PredR were compared. A subgroup analysis by RAP predictors was conducted. 37 patients (54% female) were included. Mean age and weight were 5.8 years and 22.8 kg. 56.7% had respiratory symptoms, 38.9% active infection and 59.5% history of infections (RAP subpopulations). VATS procedures were lobectomy (n=32), segmentectomy (n=3), bilobectomy (n=1) and pneumonectomy (n=1). The conversion rate was 5.4%. The mean PredR was of 4.43% (±1.8) and the overall ObsR was 45.94% with a median severity of II (I-III). This difference was significant and a higher PredR was not associated with complications development. PredR does not show association among the RAP vs non-RAP group. ObsR showed positive association with RAP, even if it reached statistical significance only for “respiratory symptoms” risk factor. ObsR reflected the number of bronchiectasis patients in our series (n=9), aligning with the hypothesis of “earlier and safer surgery”. The risk calculator underestimates VATS morbidity. Multicentre studies will clarify the correlation between inflammation and surgical adverse events.
Engaging healthcare students in innovative approaches for antimicrobial resistance containment
Authors: Kasujja Hassan , Kajumbula Henry , Tusiimire Jonans , Waswa J. P. , Nanyonga Stella M. , Kiggundu Reuben , Mwandah Daniel C. , Murungi Marion , Mugenyi Nathan , Mukenya Irene M. , Joshi Mohan P. , Schwarz Dan , Bongomin Felix , Konduri Niranjan
Published: October 2024

No abstract available.
Study on the influence of the sY1192 gene locus in the AZFb/c region on sperm quality and pregnancy outcome
Authors: Chen Gang-Xin , Sun Yan , Yang Rui , Huang Zhi-Qing , Li Hai-Yan , Zheng Bei-Hong
Published: October 2024

Y chromosome microdeletions are an important cause of male infertility. At present, research on the Y chromosome is mainly focused on analyzing the loss of large segments of the azoospermia factor a/b/c (AZFa/b/c) gene, and few studies have reported the impact of unit point deletion in the AZF band on fertility. This study analyzed the effect of sperm quality after sY1192 loss in 116 patients. The sY1192-independent deletion accounted for 41.4% (48/116). Eight patterns were found in the deletions associated with sY1192. The rate of sperm detection was similar in the semen of patients with the independent sY1192 deletion and the combined sY1192 deletions (52.1% vs 50.0%). The patients with only sY1192 gene loss had a higher probability of sperm detection than the patients whose sY1192 gene locus existed, but other gene loci were lost (52.1% vs 32.0%). The hormone levels were similar in patients with sY1192 deletion alone and in those with sY1192 deletion and other types of microdeletions in the presence of the sY1192 locus. After multiple intracytoplasmic sperm injection (ICSI) attempts, the pregnancy rate of spouses of men with sY1192-independent deletions was similar to that of other types of microdeletions, but the fertilization and cleavage rates were higher. We observed that eight deletion patterns were observed for sY1192 microdeletions of AZFb/c, dominated by the independent deletion of sY1192. After ICSI, the fertilization rate and cleavage rate of the sY1192-independent microdeletion were higher than those of other Y chromosome microdeletion types, but there was no significant difference in pregnancy outcomes.
Trigonelline nanocrystal-based topical creams for the treatment of hair loss
Authors: Shetty K. Shreya , Koland Marina , Ashwini M.
Published: October 2024

This study aimed to develop a topical nanoparticulate form of trigonelline to enhance delivery to hair follicles and promote hair growth, addressing the limitations of conventional topicals. Trigonelline nanocrystals were synthesized using sonoprecipitation and optimized through the Box–Behnken design. The optimized nanocrystals were analyzed using scanning and transmission electron microscopy. In vitro permeation and in-vivo skin irritation tests were conducted. The effect on hair length and density was evaluated in cyclophosphamide-induced alopecia in Wistar rats. The optimized nanocrystals had a particle size of 142.7 nm, a polydispersity index of 0.137, and a zeta potential of −25.9 mV. The topical cream contained 79.0% drug. In vitro studies showed higher flux with high Trigonelline loading. In vivo tests indicated the product was innocuous. Hair length and density were significantly greater (P < 0.01) in the nanocrystal-treated group compared to controls and commercial hair oil, but not greater than the Minoxidil group after 30 days. Nanocrystal-based trigonelline formulations show promise for treating alopecia, potentially offering an alternative to minoxidil and finasteride.
The effectivity of emulgel from ethanolic extract of cocoa pod husk in mice model of painful diabetic neuropathy
Authors: Fajrin Fifteen Aprila , Restanto Didik Pudji , Azkiyah Lailatul , Witono Yuli , Sulistyowaty Melanny Ika
Published: October 2024

Painful diabetic neuropathy (PDN) is nerve damage caused by the accumulation of oxidative stress. Resveratrol, an antioxidant compound found in various plants, including cocoa pod husk, combats this condition. To prove the efficacy of an emulgel from an ethanolic extract of cocoa pod husk in PDN mice. The cocoa husk ethanol extract was formulated into emulgel and evaluated. Dermal sensitization reactions and a dermal acute toxicity test were conducted. In the PDN model, mice were induced using alloxan 225 mg/kg BW i. p. After 14 days, mice were randomized into eight groups: Normal, diabetic, 0.1% capsaicin cream, and cocoa pod husk extract emulgel (CPHEE) (0.25%, 0.5%, 1%, 2%, and 3%). Treatment was given three times a day for 14 days. Latency time and blood glucose levels were observed every week. Plantar skin sections were stained with h and e for histological observation and the transient receptor protein vanilloid (TRPV)-1 for immunohistochemistry. In vivo tests showed that a 2% dose of CPHEE improved hyperalgesia by 92.33% ±1.52%, improved histology, and minimized the expression of TRPV-1 in the skin, same as capsaicin 0.1%. Notably, up to a dose of 2000 mg/kg, CPHEE did not show toxic symptoms in mice or erythema and edema, further confirming its safety for use in PDN. The study confirms that a 2% CPHEE is effective and safe for topical use in PDN, providing a potential solution for patients suffering from this condition.
Fourier Transform Infrared Spectroscopy combined with chemometrics for quality control of Curcuma aeruginosa rhizomes: An essential oil analysis
Authors: Nugraheni Bekti , Rohman Abdul , Susidarti Ratna Asmah , Purwanto Purwanto
Published: October 2024

Rhizome of Curcuma aeruginosa is a traditional herb utilized in many nations. The compound content in C. aeruginosa rhizomes can vary depending on their geographical origin. This study aims to determine the chemical fingerprints for quality control and identify the active ingredients in C. aeruginosa essential oil (CAEO) based on multiple geographic origins. Chemical fingerprints of CAEO from five different geographic origins have been determined using Fourier Transform Infrared Spectroscopy (FTIR). Principal component analysis and partial least squares discriminant analysis were utilized to examine the chemical data of CAEO utilizing pattern recognition techniques. A total of 52 fluctuating compounds were identified in gas chromatography-mass spectra instrumentation, and the highest essential oil result was the 1,8-cineole compound content. According to the results from the FTIR analysis, CAEO samples were successfully grouped based on their geographical origins. The experimental results showed that the wave numbers 1489.0715, 1475.3892, 1520.7538, and 1653.0743 per cm were used as markers to identify compounds in the CAEO based on the differences in the place of growth and quality control. This study showed that chemometric methods combined with FTIR-based fingerprinting could offer a dependable platform for verifying quality control and authentication.
Trichoderma reesei JCM 2267, fungi-associated sponge Stylissa flabelliformis: Effects of applied different fermentation methods on their antibacterial activity
Authors: Wigati Dyan , Setyowati Erna Prawita , Pratiwi Sylvia Utami Tunjung , Nugraha Ari Satia
Published: October 2024

Trichoderma is one of the fungi producing a wide range of metabolites with potent biological activities, including antibacterial. Selecting appropriate fermentation methods can improve the production of metabolite compounds and provide the best biological activity. This study investigates Trichoderma reesei JCM 2267’s antibacterial activity, which is fermented using submerged fermentation (SmF) and solid-state fermentation (SSF). The effect of fermentation time on antibacterial activities and yield weight was also determined. Antibacterial activity was tested against Staphylococcus aureus (S.a) ATCC 25923, Escherichia coli (E.c) ATCC 25922, and Pseudomonas aeruginosa (P.a) ATCC 27853 using the Agar well diffusion method. This research successfully demonstrated that the SmF and SSF methods provided extracts with antibacterial activity ranging from weak to strong, against bacteria tested. The extract fermented by SSF showed the best activity on day 25 of fermentation with a diameter clear zone 12.2 ± 0.20; 5.0 ± 0.17, and 3.3 ± 0.1 (mm) against S.a ATCC 25923, E.c ATCC 25922, and P.a ATCC 27853. The extract fermented by SmF, especially the supernatant extract, reached the higher inhibition on day 8 with diameter inhibition 6.90 ± 0.05 and 8.20 ± 0.04 (mm) against E.c ATCC 25922 and P.a ATCC 27853, whereas 15.3 ± 0.10 (mm) against S.a ATCC 25923 on day 14 of fermentation. The various times of fermentation affect the antibacterial activities. The maximum growth of TR JCM 2267 was reached on day 14 of fermentation. The SSF methods showed a higher yield of extract than SmF, increasing over time of fermentation. This research provides a possible alternative fermentation method suitable for fungal growth related to its antibacterial activity and extract yield.
Assessment of awareness level of sexually transmitted disease/reproductive tract infection (STI/RTI) among people visiting district STI/RTI clinic Chamba, H.P.
Authors: Singh Harinder , Raghuvanshi Vandna , Arora Lalit , Bansal Kuldeep , Arora Ishan
Published: October 2024

ABSTRACT

Background:

Sexually transmitted infections (STIs) and reproductive tract infections (RTIs) are significant public health concerns with widespread implications for individuals and communities. This research article aims to evaluate the awareness and practices regarding STIs and RTIs among individuals attending an RTI/STI clinic in a tertiary care hospital.

Methodology:

It is a hospital-based observational study using a universal sampling technique. The study utilizes one-on-one interviews with patients visiting the district STI/RTI Clinic.

Results:

Out of 147 study participants, 94% were female, with a mean age of 32 years. Maximum patients were in the age group of 25–35 years. Most (82%) of the participants were aware of the symptom of abnormal vaginal discharge for STIs and RTIs but less aware of the other symptoms. Approximately 78% of the subjects were aware that unprotected sexual intercourse with an infected person causes STIs and RTIs. Health-seeking behavior was also good among the participants.

Conclusion:

In this study, it was found that a lot of patients were unaware of the different modes of transmission and various symptoms of STI/RTI due to which additional actions are required by policy makers as well as family physicians.
Mothers making milestones: Awareness of rural mothers toward pediatric milestones
Authors: Nagaria Tapesh D. , Shukla Samarth , Acharya Sourya , Acharya Neema , Shinde Raju K.
Published: October 2024

ABSTRACT

Background:

Developmental milestones are easily identifiable events during a child’s development, and their thorough monitoring is of utmost importance till 6 years of age. Rural mothers are rarely explained these milestones, which may be a reason for the higher prevalence of developmental disorders in rural areas (≊18%). This study aimed to assess the knowledge of developmental milestones in rural mothers attending a rural, tertiary care hospital and further provides intelligence to the mothers on the same. These measures will aid toward the early detection of developmental milestone anomalies.

Method:

PNC mothers in the obstetric ward and mothers attending the pediatric outpatient department and inpatient department were selected for the study and assessed for their knowledge of childhood milestones with the help of a short questionnaire based on the Denver II Developmental Scale in three languages. Based on the feedback from mothers, the appropriate counseling was given.

Results:

The questionnaire was assessed based on four basic domains, fine motor skills (23.33% responded correctly), personal and social skills (51.66% responded correctly), language skills (41.66% responded correctly), and gross motor skills (41.25% responded correctly). Upon later feedback, 33.33% reported a suspected developmental delay in their child.

Conclusions:

This study indicates a very low maternal awareness of pediatric milestones in rural areas, and considering the high prevalence of developmental delays in these areas, across the world, education of mothers is a necessary and a very effective method for early diagnosis. Formulation of a framework to address this issue on the part of the authorities and healthcare professionals is an effective solution for this underreported and important issue.
A retrospective study to assess adolescent nutritional deficiencies and the association with post-COVID-19 status
Authors: Gupta Arti , Kumar Pentapati Siva Santosh , Desu Sai Subhakar , Aravindakshan Rajeev , Reddy B Venkatashiva , Naidu Navya Krishna
Published: October 2024

ABSTRACT

Introduction:

Adolescents represent 16% of the world’s population and around 21% of the Indian population. A study was done to assess the double burden of malnutrition, the proportion of inadequate intake of some important macronutrients and micronutrients, and the impact of COVID-19 pandemic on nutrient intakes among adolescents.

Methodology:

Retrospective data analysis of the adolescents presented at the Adolescent Health Clinic at a teaching hospital (tertiary care level) in Andhra Pradesh, India, between September 2022 and December 2022 was done in the current study.

Results:

A total of 800 adolescents were studied with the mean age of the participants as 15.8 (±2.38) years of age. Among the participants, the majority (59%) were immunized with Td vaccination at 10 years and/or 16 years, 21% were not immunized, and the rest 20% did not remember the status. Only 17 participants had a history of COVID-19 infection in the past. The majority (62.75%) of the participants belong to normal nutrition status as per BMI for age WHO growth charts. There is a significant difference in the nutrition status between males and females belonging to overweight and obese subgroups. There is no significant difference in the intake with respect to past COVID-19 status. Almost all the participants take inadequate amounts of carbohydrates (calories), pyridoxine, folate, iron, calcium, vitamin D3, and retinol. Protein intake is inadequate in 63% of participants, and the deficient intake rises with the age with respect to both EAR and RDA guidelines.

Conclusion:

A large proportion of adolescents suffer from the double burden of malnutrition in South India, and almost all the adolescents do not get the recommended intake of most of the macro- and micronutrients in their diet following the lockdown and online schooling due to the COVID-19 pandemic.
SEMAGLUTIDE: Weight loss, glycaemic control and safety profile in obese patients with and without type-II diabetes-An experience from Karachi, Pakistan
Authors: Memon Muhammad Y. , Ahsan Tasnim , Jabeen Rukhshanda , Latif Saba , Qasim Saeeda F. , Imran Paras
Published: October 2024

ABSTRACT

Objective:

To assess the efficacy and safety of Semaglutide (a GLP-1 receptor agonist) in obese patients with and without Type-II Diabetes Mellitus.

Methods:

This observational analytic cohort study was conducted in a private medical institute in Karachi Pakistan; from August 2022 to January 2023. A total of 65 obese individuals >18 years of age, with or without T2D were included. Semaglutide was started with an initial dose of 0.25 mg with an increase in dose to 0.5 mg, 1 mg and 2 mg with gap of 4 weeks between each dose escalation. Patients were kept on the maximally tolerated dose, not exceeding 2 mg/week. Patients were evaluated on the first and second follow-up at 3 and 6 months respectively, for the same parameters as noted at the initial visit, along with documentation of any adverse effect.

Results:

Out of 65 patients, 49.2% were female and 50.8% were male. Mean age was 49.16 ± 14.20 years. 47.7% of the patients had hypertension, 46.2% had diabetes mellitus, 35.4% had dyslipidemia and 13.8% had ischemic heart disease. All patients were using 0.5 mg of semaglutide after three months, however by six months 33.8% were using 1 mg, and 24.6% were on 2 mg, whereas 40% decided to adhere to 0.5 mg and only 1.5% decided to reduce the dose to 0.25 mg due to adverse effects. Patients reported start of the first adverse effect by 3.44 ± 2.27 weeks of starting the drug. By the end of three months, 55.4% of patients in our study reported adverse effect, which declined to 34.5% by the end of six months, and the majority being mild to moderate and the most frequent side effects were gastrointestinal in origin. There was no significant difference in side effect profile in between those with and without diabetes mellitus. The average weight loss was 5.81 ± 2.64 kg and 9.86 ± 3.54 kg after three and six months respectively and the amount of weight loss was almost equal in those with and without T2D. A significant decline was observed in the average HbA1c levels, body mass index (p = <0.001), systolic blood pressure (p = <0.001), diastolic blood pressure (p = <0.001), total cholesterol (p = <0.001), high-density lipoprotein (p = <0.001), low-density lipoprotein (p = <0.001), triglycerides (p = <0.001) and alanine transaminase levels (p = <0.001).

Conclusion:

Semaglutide showed substantial weight, HbA1c and cholesterol reductions in those with or without type-II diabetes.
Prevalence of sleep disorders and association with various occupations among Indian population aged ≥ 45 years: Insight from Longitudinal Ageing Study in India (LASI)
Authors: Sreepada Sai SreeValli Sarma , Halder Pritam , Amudhamozhi K S , Soni Vaishali , Sharma Hitendra , Rathor Shivani
Published: October 2024

ABSTRACT

Introduction:

By scrutinizing the impact of job schedules, workplace culture and stress levels, our study aims to determine the prevalence of sleep disorders among various occupations and its associated factors. The findings promise to enhance the overall well-being, sleep quality and productivity in various occupational settings.

Methods:

This is an analytical cross-sectional study involving secondary data from the nationally representative Longitudinal Ageing Study in India (LASI Wave I 2017-18) of 35 Indian states and union territories with exception of Sikkim. The study included 59441 Indian volunteers who older than 45 years. Multivariable logistic regression analysis was conducted to study the association of sleep disorders among various occupations while accounting for other associated factors.

Results:

Prevalence of sleep disorders was higher among the females (12.66%), unemployed (13.34%), ≥ 60-yr age group (13.45%), those who lived in rural areas (12.35%), those who were illiterate (12.80%) and reported themselves to be widowed, separated or divorced (14.54%), people with no health insurance (11.74%), smokers (12.11%), without physical activity (12.67%) and also rated themselves as poor in the self-rated health status (26.77%). Alcohol consumption was not statistically significant factor for sleep disorders.

Conclusions:

There is an emerging need for targeted screening, prompt detection and early management of insomnia and other sleep disorders among the high-risk groups. Provision of accessible and affordable screening tools, training skills for early diagnosis at primary care level and/or proper referral services to higher centres form the cornerstone for adequate management of sleep disorders.
Modern-day limeys: Clinical, laboratory, and radiological profile of 10 paediatric scurvy patients
Authors: Krishna Malvika , Madan Sumanth , Radhakrishnan Shilpa , Balan Suma
Published: October 2024

ABSTRACT

Scurvy is often considered a disease of the past and well described in children with neurodevelopment and autistic spectrum disease. Clinicians overlook the diagnosis of scurvy, leading to unwarranted laboratory investigations and, unfortunately, significant delays in diagnosis. This study aims to describe 10 cases of scurvy in a tertiary hospital setup with their clinical profile, comorbidities, radiological, and subsequent disease course in children presenting to the pediatric rheumatology department at Amrita Hospital, Kochi, from 2017 to 2022. Demographic, imaging, and associated comorbid conditions including neuropsychiatric abnormalities were documented. They were all reviewed in 2 weeks for improvement of symptoms. A total of 10 children (3 females) were included in this study. The disease manifested predominantly in early childhood (median age: 5.5 years). All patients had unexplained bone pain and inability to bear weight. The referral diagnosis of 8/10 patients was juvenile idiopathic arthritis. Two patients had autism as a comorbidity. Selective eating habits and food faddism were present in 2/10 children. All patients have made a full functional recovery at review. All patients had imaging findings suggestive of scurvy. Pediatricians and rheumatologists alike must consider scurvy in a child with unexplained bone pain and symptoms masquerading as primary rheumatological diseases. Selective eating habits need to be treated with timely and appropriate psychological rehabilitation and dietary education. Resolution of symptoms and radiographic features with vitamin C supplementation is the strongest evidence for scurvy.
Tropical eosinophilia: Case series on varying presentations
Authors: Krishna Goutham , Manuel Shilpa M. , Ananthakrishnan V M
Published: October 2024

ABSTRACT

Eosinophilia can be due to both infectious and non-infectious causes, many of which may be clinically indistinguishable. Filariasis, a tropical and subtropical infection, is caused by Wuchereria bancrofti, Brugia timori (B. timori), and Brugia malayi. Filariasis is conventionally diagnosed by demonstration of microfilaria in the peripheral blood smear. The disease may be missed if one is not aware of the possibility. We report two cases in two individuals with eosinophilia due to filaria resulting in tropical pulmonary eosinophilia and deep vein thrombosis (DVT). They had complete symptomatic improvement after a 3-week course of diethylcarbamazine (DEC) +/- ivermectin.
Seropositivity and coinfection of hepatitis B and hepatitis C viruses in Central India: A hospital-based study
Authors: Jain Rajeev K. , Shrivastava Rakesh , Jain Shailendra K. , Chaurasia Deepti , Jain Anamika , Jain Swati , Ahirwar Kamlesh K. , Perumal Nagaraj
Published: October 2024

ABSTRACT

Background:

Hepatitis B virus (HBV) and Hepatitis C virus (HCV) show similarity in the transmission, distribution, hepatotropism, and leading to chronic asymptomatic infection. Coinfection of HBV and HCV can lead to more severe liver disease and an increased risk for progression to hepatocellular carcinoma (HCC). Most of the people with chronic infection are unaware of their HBV and HCV infections, hence facilitating these to go undiagnosed until these viruses have caused serious liver damage and they act as a potential source of infection for the community at large. Therefore, the present study aimed to find the prevalence of HBV and HCV along with incidences of coinfection of HBV and HCV in patients seeking hospital care in central India.

Methods:

A five-year hospital-based study was carried out at the tertiary care hospital in Central India from 2018 to 2022. A total of 72402 patients attending the outdoor patients and admitted indoor patients who were advised for HBV and HCV for screening before any invasive/surgical procedure and patients who presented with symptoms of acute or chronic liver disease were included in this study. Screening was done by immunochromatography-based card test followed by the confirmation of all samples by enzyme immunoassay.

Results:

Seroprevalence of HBV and HCV was found to be 3.71% and 1.91%, respectively. Coinfection with HBV/HCV was seen in 0.13% of the individuals. The overall prevalence of HBV, HCV, and HBV-HCV coinfection was significantly higher in the male population as compared to females.

Conclusion:

The study findings of seroprevalence of HBV and HCV among the hospital-based population will help to get a baseline understanding of the disease burden in central India. The HBV/HCV coinfection rate also raises serious concerns owing to its high prevalence rate among the younger age.
TRANSFORM-HF Trial: Choice of loop diuretic in acute heart failure does not matter!
Authors: Pradhan Akshyaya , Jaiswal Arvind , Bhandari Monika
Published: October 2024

ABSTRACT

The major clinical manifestations of heart failure (HF) are due to fluid retention and congestion, and thus, therapy targeting congestion plays a central role in HF management. Furosemide is by far the most commonly prescribed loop diuretic. However, data primarily derived from observational and small randomized trials point toward potential advantages with torsemide use including improvement in functional status, survival, and hospitalization for HF. The TRANSFORM-HF study aimed to answer a pragmatic query faced by physicians managing HF – Does the choice of loop diuretic matter in HF? There was no benefit of torsemide over furosemide in this large study of >2800 patients for mortality, hospitalization, and quality of life. Though, there were a few shortcomings of the study, the results are in sync with current HF guidelines which do not advocate the use of one loop diuretic or other. Hence, the focus in acute HF should be on optimizing the diuretic dose and other guideline-based therapies rather than the type of diuretics. Recent trials of acetazolamide and other diuretics have shown benefits when used in conjunction with loop diuretics. Since the primary care physician is often the first point of medical contact, the manuscript aims to provide insights into their practice. The message is clear that in acute heart failure, there is no benefit of choosing the type of loop diuretic and impetus should be on adding other class diuretics if needed as well as initiating other guideline-directed medical therapies.
A prospective blinded diagnostic accuracy study to assess the accuracy of fetal weight estimation at term by clinical method using Leopold’s maneuvers and ultrasonography in predicting the actual birth weight
Authors: Gifty D , Cherian Nidhi E. , Raj. S. L Arathy , Yenuberi Hilda G. , Rathore Swati , Mathews Jiji E.
Published: October 2024

ABSTRACT

Context:

Over-medicalization of normal pregnancy is associated with unnecessary inductions of labor leading to operative deliveries. In a busy outpatient department (OPD) or low-resource setup where ultrasound availability, experience, and cost will be a concern, routine ultrasound at term can be avoided if the clinical estimation of fetal weight is more or less equal to the actual birth weight.

Aims:

To assess the reliability and validity of fetal weight estimation at term by ultrasound and clinical estimation.

Settings and Design:

A prospective study of diagnostic accuracy was done over a period of 1.5 years in a tertiary hospital, which included 100 women with term singleton pregnancies admitted in obstetric wards or labor room.

Methods and Material:

To find out the agreement between actual birthweight and ultrasound fetal weight interclass correlation coefficient (ICC) was used. Mean difference plots (Bland–Altman plots) were done. The mean percentage error was compared with the consultant estimate and registrar estimate across groups. The sensitivity, specificity, and predictive values by clinical and ultrasound estimate were calculated for actual birth weight ≤ 2.5 kg.

Results:

Both methods of fetal weight estimation have moderate reliability in predicting the actual birth weight. The sensitivity of identifying birthweight < 2.5 kg babies by ultrasound was slightly higher. For birth weight less than 2.5 kg, there was an overestimation of fetal weight by clinical estimation done by postgraduate with mean percentage error being statistically significant as compared with ultrasound estimation.

Conclusions:

In a developing country like ours where ultrasound is not readily available in all healthcare setups, the clinical method is an easy, cost-effective, simple one that can be used by all medical professionals after adequate training.
Erythropoietin levels in geriatric anemia
Authors: Fathima OV , Shastri Malvika , Kotru Mrinalini , Jain Rajat , Goel Ashish , Sikka Meera
Published: October 2024

ABSTRACT

Background:

Defects in the production or action of erythropoietin (EPO) are important contributing factors in anemia. However, the exact impact of aging on levels of EPO and its role in the development of geriatric anemia is still underexplored. Moreover, the specific pattern of EPO in etiological subcategories such as nutritional anemia (NA), anemia of chronic disease (ACD), and unexplained anemia (UA) is not entirely known.

Objective:

The aim of the study was to determine the serum EPO levels in geriatric anemia and compare them across NA, ACD, UA, and NA with ACD.

Materials and Methods:

Ninety anemic geriatric patients (cases) along with 30 non-anemic geriatric controls were evaluated for serum EPO levels. A correlation between S.EPO and inflammatory markers was also done.

Results:

Serum EPO levels were higher in cases as compared to controls (P < 0.00). After adjusting for outliers, the reference range of EPO in controls was the same as in normal young adults (2.21–20.95 mU/mL). The majority (37/58, 63.7%) of NA patients had increased S.EPO levels (highest among all four subcategories and controls). S.EPO also correlated inversely with high-sensitivity CRP (hsCRP) and serum ferritin (SF), reinforcing that the inflammatory state suppresses S.EPO levels.

Conclusion:

Geriatric anemic patients have elevated S.EPO as compared to non-anemic controls (observed reference range similar to young adults). Raised EPO levels were detected more frequently in NA, while they were the lowest in UA.
Estimation of the adverse effects following immunization after SARS-CoV-2 Vaccine (Covishield and Covaxin) in lactating women: A single centre exploratory study from India
Authors: Panwar Parshika , Kumar Prakash , Tendulkar Prakash , Pathania Monika , Navriya Shiv C. , Saxena Vartika , Singh Mahendra
Published: October 2024

ABSTRACT

Context:

The global COVID-19 pandemic has universally impacted individuals, with lactating women being uniquely susceptible to severe infection. Vaccination plays a critical role in building population immunity, mitigating severe illness and curtailing the health crisis. However, data on adverse effects and vaccine safety in lactating women remains scarce.

Aims:

To assess the prevalence and types of adverse effects post-COVID vaccination in lactating women.

Methods:

This study was conducted at a tertiary care hospital’s COVID-19 vaccination centre in North India, and followed a prospective observational design over a specific timeframe. A total of 200 lactating women were surveyed, with specific inclusion and exclusion criteria applied. Telephonic follow-up was conducted for one month after the first dose for 152 participants and after the second dose for 123 participants. Adverse effects following immunization (AEFIs) were recorded and analyzed.

Results:

Of the study cohort, 45 (29.60%) reported minor adverse effects following the first vaccine dose, with just four (3.25%) experiencing adverse effects after the second dose. Common AEFIs included fever (18.42%) and body aches (9.21%), along with headache, malaise, injection site pain and diffuse abdominal pain.

Conclusions:

This study provides valuable insights into the adverse effects of COVID-19 vaccines in lactating women, which can help primary physicians and policy maker to improve vaccination policies and guidelines. The study revealed that lactating mothers experienced only mild AEFIs, aligning with current literature. Further broader, multicentre research is needed to reinforce these findings and to assess the long-term safety and efficacy of COVID-19 vaccines in this population.