bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of Surface Properties of Two Remineralizing Agents after Modification by Chitosan Nano Particles: An In vitro Study
Authors: Wahied Dina Mohamed , Ezzeldin Naglaa , Abdelnabi Ali , Othman Maha Sherif , El Rahman Mai Hesham Abd
Published: December 2023

Background:

Calcium phosphate-based systems have been introduced as promising bio-mimetic materials due to their close resemblance to the enamel. Chitosan and its derivatives have been an emerging biomaterial due to their additional antibacterial effect and promising re-mineralizing ability.

Aim:

The aim of this study is to evaluate the effect of chitosan nanoparticles on the remineralization of the demineralized enamel surface after being added to nano-hydroxyapatite and nano-calcium phosphate materials.

Setting and Design:

This was in vitro study.

Materials and Methods:

Twenty specimens of extracted permanent molars were collected, and then immersed in demineralizing solution, then distributed into four groups according to the remineralizing material. Group 1: Treated with Nano-beta-tricalcium phosphate (Nβ-TCP) gel, Group 2: Treated with Nβ-TCP with chitosan gel, Group 3: Treated with Nanohydroxyapatite (NHA) gel, and Group 4: Treated with NHA with chitosan gel. The surface hardness of the teeth was measured at baseline, after demineralization, and after remineralization. The structural changes in each group were analyzed using the scanning electron microscopy.

Statistical Analysis:

Shapiro–Wilk's test, one-way ANOVA followed by Tukey's post
hoc test was used.

Results:

In all groups, there was a significant difference in mean Vickers hardness number (VHN) at different intervals, with the highest value found after treatment (301.64–395.65) VHN, followed by the baseline (236.97–276.15) VHN, while the lowest value was detected after demineralization (121.23–124.39) VHN. It was also indicated that baseline treatment, the Hardness percentage change (%) of the nano NHA + Chitosan group showed the highest significant value (55.10%), while the Nβ-TCP group exhibited the lowest significant value (9.56%).

Conclusions:

It can be concluded that NHA and NΒ-TCP modified by chitosan NPs as remineralizing agents of enamel surface hold promising results.
Central retinal vessel trunk exit location: An important factor while evaluating the neuroretinal rim
Authors: Gandhi Monica , Rajsrinivas Divya , Jain Mugdha , Sabharwal Shailendra , Majumdar Atanu , Dubey Suneeta
Published: December 2023

Purpose:

Optic nerve head (ONH) evaluation plays a key role in differentiating normal from glaucomatous disk. Thinning of the inferior neuroretinal rim (NRR) has been noted in early glaucoma. However, NRR thickness in different quadrants appears to depend on various factors including central retinal vessel trunk exit (CRVT) position. We evaluated ocular parameters that determined the NRR thickness in the different quadrants of normal eyes.

Methods:

Retrospective review of demographic and ocular data from 773 eyes of 388 subjects with normal ONH over one year was undertaken.

Results:

Nearly 54% were males, and the mean age was 43.2 years. The CRVT exit was central in 50% (773). The common site for noncentral CRVT was superotemporal (ST) [37%, 141/384] followed by inferotemporal (IT) [35%, 135/384]. With noncentral CRVT, the probability that the inferior, superior, nasal and temporal (ISNT) rule was not followed was 1.42 times (P < 0.001). The thinnest rim quadrant (TRQ) was mostly ST (69%) irrespective of CRVT location. The TRQ was IT in 40% when CRVT was noncentral and 82% with IT CRVT exit. With noncentral CRVT, round disks favored noncompliance [132 (54.1%), odds ratio (OR) 2.56] with the ISNT rule. The OR of noncompliance with the ISNT rule increases 1.89 times with inferonasal CRVT and 1.22 times with a unit increase in the axial length.

Conclusion:

TRQ was IT in IT CRVT, and noncompliance with the ISNT rule was observed with large disks, longer axial length, and noncentral CRVT. This implies that despite the ISNT rule being violated these eyes do not have optic nerve pathology and should not be subjected to unnecessary diagnostic tests.
Short- to intermediate-term surgical outcome of Keiki Mehta valve implantation in refractory glaucoma
Authors: Mitra Ankita , Bhadra Tania Ray
Published: December 2023

Background:

Keiki Mehta body pressure (BP) valve is a glaucoma drainage device that works on the simple mechanism of body pressure.

Purpose:

To evaluate the short- to intermediate-term efficacy and safety of Keiki Mehta valve implantation in treating refractory glaucoma.

Methods:

This was a prospective, interventional, institution-based study. Adult patients (age >18 years) having refractory glaucoma who underwent Keiki Mehta valve implantation from May 2019 to December 2019 in a tertiary hospital in eastern India were followed up to 18 months.

Results:

Twenty patients (20 eyes) with refractory glaucoma who underwent Keiki Mehta valve implantation were followed up on postoperative day 1 and at 1, 3, 6, 12, and 18 months postoperatively. Visual acuity, intraocular pressure (IOP), antiglaucoma medications, and success rate were measured at every visit. There was significant reduction in mean IOP from the preoperative values at every postoperative follow-up (P < 0.05). Kaplan–Meier survival analysis demonstrated a probability of 50% complete success and 20% qualified success at 18 months. Hypotony was the most common postoperative complication.

Conclusion:

Keiki Mehta valve implantation is an effective and safe treatment for refractory glaucoma.
Utilizing peripheral blood inflammatory biomarker (PBIB) to predict response to systemic therapy in patients with breast cancer
Authors: Abusanad Atlal
Published: December 2023

Background:

Inflammation is a recognized factor in cancer progression and resistance to treatments. Several studies correlated inflammation-related peripheral blood inflammatory biomarkers (PBIB) to disease progression and poor survival in various cancer types and different populations. Nonetheless, inflammation is affected by the distinctive characteristics and environmental exposure of each population. There is no prior study addressing the association of pre-treatment inflammatory markers with outcomes in patients with breast cancer (BC) from Saudi Arabia. In this study, we evaluated the prognosis of locally advanced breast cancer (LABC) in relation to several PBIB.

Materials and Methods:

We retrospectively analyzed the data of female patients with LABC undergoing neoadjuvant chemotherapy (NACT). Demographics, body mass index (BMI), clinicopathologic characteristics and stage of the tumor, follow-up status, and response to treatment were collected. Outcomes were evaluated in relation to pre-treatment peripheral blood indices that were grouped based on the local laboratory cutoff values. Objective response rate (ORR) was predefined and assessed according to the post-NACT magnetic resonance imaging (MRI) breast and subcategorized into complete response (CR), partial response (PR), stable disease (SD), and progressive disease (PD).

Results:

A total of 172 female patients with BC met the eligibility criteria from January 2014 to December 2019. The mean age at diagnosis was 53.4 ± 11, and BMI was 31.2 ± 6. Left BC accounted for 54.7%, and the majority was invasive ductal carcinoma (85.5%), moderately differentiated (51%), stage III (AJCC 8th edition) (73%), and estrogen receptor (ER)-positive tumor (79.1%). Human epidermal growth factor receptor 2 (HER2)-positive BC was reported in 32% and triple-negative breast cancer (TNBC) in 10%. Radiologic CR accounted for the majority of ORR (71.5%). Higher percentage of patients with normal red cell distribution width (RDW) of red blood cell (RBC) and low neutrophil–lymphocyte ratio (NLR) had CR with a significant P value of 0.003 and 0.014, respectively.

Conclusion:

Among several peripheral blood indices, RDW and NLR significantly influenced ORR. They can be explored further to potentially predict response after systemic therapy in patients with LABC. The great advantage of these biomarkers stems from their availability and affordability in routine clinical practice.
Clinical study to determine the predictability of significant rebound hyperbilirubinemia in neonates after phototherapy and conditions likely to be associated with it: Prospective observational study in a teaching hospital in Eastern India
Authors: Belide Shivakumar , Uddin Md Waseem , Kumar Sushil , Sethi Rajesh Kumar , Diwakar Kumar , Jhajra Sandeep
Published: December 2023

Aim:

Neonatal hyperbilirubinemia is defined as yellowish discoloration of the skin, conjunctive, and sclera from the elevated serum or plasma bilirubin in the newborn. The standard of care for the management of neonatal hyperbilirubinemia is phototherapy to prevent long-term neurological sequelae. The aim of this study was to ascertain the predictability of significant rebound hyperbilirubinemia (SRH) in neonates after phototherapy and the factors associated with it.

Materials and Methods:

Neonates ≥ 35 weeks of gestation, who received treatment for hyperbilirubinemia and admitted in our hospital from 15th of March 2019 to 15th of September 2020 were enrolled after taking parental consent. SRH was defined as bilirubin levels crossing the treatment threshold within 72 hours of phototherapy termination. Logistic regression analysis was used to identify the predictability of SRH.

Results:

Out of 400 neonates treated with phototherapy, 10% developed SRH. Prematurity (Gestational age < 37 weeks), low birth weight (Birth weight < 2000 gram), ABO and Rh incompatibility, Glucose-6-phophate dehydrogenase deficiency (G6PD) deficiency, sepsis, and longer duration of primary phototherapy were found to be significantly associated with rebound hyperbilirubinemia. The probability of SRH increases for all American Academy of Paediatrics (AAP) risk categories as the gestational age decreases and total serum bilirubin at the stoppage of phototherapy increases.

Conclusions:

The presence of risk factors should be taken into account while planning discharge and follow-up of neonates admitted for neonatal hyperbilirubinemia to prevent long-term complication of bilirubin neurotoxicity.
A Study on Community needs, perceptions and demand regarding the use of the health services during COVID-19 pandemic in district Kathua, J and K
Authors: Sangra Sonika , Razdan Nazuk , Gupta Sujata , Dwivedi Nidhi
Published: December 2023

Introduction:

The impact of the COVID-19 pandemic on essential health services is a source of great concern. Health gains made during the last 2-3 decades have been halted due to shifting of resources to fight the COVID-19 pandemic.

Aim and Objective:

This study was conducted to identify community needs, demands, and perceptions regarding the effectiveness of using health services during the pandemic.

Methodology:

This was a qualitative study which was conducted through focus group discussions. The participants comprised of three groups: community leaders, healthcare providers, and field workers. Discussion among the participants was conducted using the standardized World Health Organization community assessment tool.

Result:

In our study, it was reported that most of the essential health services were disrupted due to COVID-19 pandemic. The barriers to accessing essential health services have been exacerbated and the provision of community-based services is effected due to this. In regard to COVID-19 vaccination also, there remain individuals who are reluctant to be vaccinated.

Conclusion:

Our study shows that the community faced barriers in accessing and using health services during the pandemic. To ensure the public's access to health services and strengthen healthcare preparedness strategies like health budget allocation, manpower, infrastructure, trainings, integration with primary healthcare, etc., need to be carried out during and after the pandemic. Thus, participation and inter-sectoral coordination across levels are required to overcome these barriers.
Sleep hygiene a neglected paediatric identity – A cross-sectional study
Authors: Maniraj Pradeep , Jegadeesan Podhini , Ananthakrishnan Shanthi
Published: December 2023

Background:

Sleep is the physiological need of any human being; its role in paediatric mental and physical development is irreplaceable. However, in recent days, the rising trend of childhood obesity makes it essential to assess the sleep hygiene of the children to know if there is any adjacent association.

Objectives:

1. To estimate the prevalence of poor sleep quality using Sleep Hygiene Index Scoring. 2. To determine the association of sleep quality with academic performance and body mass index among the school children.

Materials and Methods:

The present cross-sectional study was conducted among 322 children aged between 7 and 12 years attending paediatric OPD of a private tertiary care hospital, Puducherry. Using Sleep Hygeine Index scoring with the cut off 16, prevalence of poor sleep quality was assessed and its association with BMI and academic performance was determined. Frequency, proportion, and Chi-square test were used for analysis; P value < 0.05 was considered statistically significant.

Results:

The mean age of the participants was 8.8 ± 2 years, and most of them were boys. Around 53% of the children had poor quality of sleep, and there was a positive association between poor sleep quality with obesity (P value: 0.0003) and unfavourable academic performance (P value: 0.00001).

Conclusion:

Sleep hygiene importance should be taught to the parents and periodical assessment helps in predicting the neglected reason for obesity and poor academic performance, which could be managed easily with small lifestyle changes.
View Score: An early warning score to detect possible complications among COVID-19 patients
Authors: Bhakare Meenakshi , Nikalje Rajkumar , Patil Reshma , Shukla Urvi , Bokade Rupesh , Sakhare Gajanan , Joshi Shardul , Pais Aditi
Published: December 2023

Introduction:

Understanding pulmonary function at various phases after coronavirus disease 2019 (COVID-19) infection is critical for determining the exact pathophysiological mechanism of COVID-19.

Research Question:

What is the correlation between spirometry indices and clinical indicators in COVID-19 patients over a 6-week follow-up?

Objectives:

1) To assess deterioration or improvement in spirometry parameters including forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and ratio FEV1/FVC in COVID-19 patients. 2) To study the correlation between FVC, FEV1, and FEV1/FVC with oxygen saturation and clinical findings.

Materials and Methods:

A prospective observational study was conducted for a 6-week period among 25, COVID-19 patients who were either asymptomatic or mildly symptomatic. Each patient received a home-use-connected spirometer—SpiroPRO®, a pulse oximeter, and a thermometer from Briota Technologies Pvt Ltd. (BRIOTA). Patients and healthcare professionals were given training for performing spirometry twice a day as well as access to mobile apps was provided. Spirometry indices, patient symptoms, and vital statistics were used to calculate the VIEW™ score using machine learning algorithms.

Result:

The Bland–Altman plots showed that FEV1 reduced slightly up to 21–28 days and comes back to normal around 42 days. VIEW™ score increased up to day 21 and then decreased toward day 42. An increase in VIEW™ score increases the risk of COVID-19 complications. VIEW™ score and FEV1 showed a significant correlation.

Conclusion:

Home-based spirometry acts as an effective tool for COVID-19 patients to predict lung complications and also promote self-monitoring thereby reducing the burden on the health system.
Comprehensive, continuous, and compulsory monitoring of frailty in elderly
Authors: Deore Hiranya S. , Taranikanti Madhuri , Gaur Archana , Varatharajan Sakthivadivel , John Nitin A. , Katta Roja , Taranikanti Sai Shriya , Umesh Madhusudhan , Ganji Vidya , Medala Kalpana
Published: December 2023

Background:

The increasing elderly population makes frailty an increasing concern in society with vulnerability to stress and functional decline. Unrecognised comorbidities are common among the elderly due to lack of mention by the patients. Physicians should be equipped with effective interviewing skills along with the use of screening tools to assess any impairments in activities of daily living, cognition and signs of depression.

Objectives:

To measure the degree of independence or dependence using scales and stratify patients based on Clinical Frailty Scale (CFS) so as to recommend it as a routinely usable tool.

Materials and Methods:

In total, 191 elderly subjects above the age of 65 years were recruited for geriatric assessment. Tools that assess performance in daily living activities and cognition were used. The prevalidated CFS was used to score frailty to stratify patients into frail and non-frail groups, and the parameters were compared.

Results:

Mean age of the study population was 69.54 years with 53.4% males and 46.6% females. Mean Katz index and mean Lawton score were >5. The mean Global Deterioration Scale (GDS) score was 1.5, and the mean clinical frailty score was 3.55. Significantly high number of male individuals were found in the frailty group. Hypertension was significantly higher in the frail group. The mean Katz scores were significantly lower, and mean GDS scores were significantly higher in the frailty group. Multivariable logistic regression has shown gender to be an important determinant of frailty with an odds ratio of 0.05 (CI-0.01-0.20). The higher Lawton score and GDS scores were significantly associated with frailty with an odds ratio of 0.33 (CI: 0.21–0.52) and 2.62 (CI: 1.14–6.02), respectively.

Conclusion:

Men are more frail than women and co-morbidities like hypertension and coronary artery disease contribute to frailty with cognitive decline and decreased autonomy. A comprehensive assessment to identify frailty will provide a holistic view of well being among the elderly.
“Paediatricians brace thyself” – Healthcare provider perspectives on childhood and adolescent hypertension: A qualitative study
Authors: Pusdekar Yamini Autkar , Dixit Jagannath V. , Dani Akanksha P.
Published: December 2023

Context:

Paediatric and adolescent hypertension is becoming a public health concern as it contributes to the development of cardiovascular diseases. However, the problem largely remains undiagnosed. This makes early detection and institution of appropriate preventive measures difficult. The existing diagnostic guidelines and management policies for paediatric hypertension are complex. They have individual specific cut-offs (based on age, gender and height), making their interpretation difficult.

Aims:

The present study aims to gain insights into paediatrician's perspectives on childhood hypertension.

Settings and Design:

Qualitative Studies using Key Informant Interviews (KIIs) were conducted with paediatricians to know about their perspectives on blood pressure assessment in children and adolescents, its barriers, their experience, practices and expectations for main streaming hypertensive screening in national health programmes. The interviews were audio recorded after taking their consent.

Statistical Analysis Used:

Grounded theory was used to analyse transcripts.

Results:

A total of 40 providers within the public and private health sector were invited to participate; 36 consented and completed the interviews. There was a perception of increased prevalence of paediatric hypertension. Several system, provider and patient-level barriers, like unavailability of paediatric-sized cuffs, and complicated guidelines for interpreting blood pressure, prevented screening and accurate diagnosis.

Conclusions:

Despite the lack of guidelines for screening, paediatricians still recommended lifestyle interventions. They expressed concerns about implementing standard guidelines for screening. They also expressed the need for a clinical assessment tool to assist in accurate diagnosis. They were willing to contribute to the development and implementation of training programme for health providers to overcome barriers to blood pressure measurement in children.
Vocational skill training programs for persons with intellectual disability (PID) and trainers' perspective during and post vocational skill training
Authors: Venkatesh Kundurthi , Reddy Shanivaram K , Angothu Hareesh
Published: December 2023

Background:

Employment is one of the primary goals of persons with intellectual disabilities (PID). Employment can lead to positive psychosocial and economic benefits for people with ID, but people with disabilities are not afforded this opportunity to contribute to society through work due to multiple challenges, as well as the transition from vocational skill training to getting employed for PID is more challenging.

Materials and Methods:

Seven vocational skill trainers were chosen from the seven vocational skill training centres offering skill training for PID and located in urban Bengaluru were selected using a purposive sampling design for this study. The trainers were interviewed to understand their perspectives on challenges during and post vocational training for PID.

Results:

Training offered to PID in several vocational centres ranged from unskilled to semi-skilled. A range of barriers including gaps in awareness and knowledge of the various training programs for PID challenges associated with their transition after training, unique challenges in placing the trained PID into external organizations, stigma, and attitudinal barriers associated with disability are described to be influencing the skill training of PID and their subsequent employment.

Conclusion:

Skill training offered for PID across the centres with significant challenges while providing the training and supporting their transition into the community for employment. The challenges of the PID need to be studied at a broader level through including all the stakeholders.
Frailty assessment: An emerging concept in aged People Living with HIV (PLHIV)
Authors: Mehta Adhya , Halder Sohini , Pandit Sanjay , Anuradha Subramanian
Published: December 2023

Introduction:

As the life expectancy of People Living with HIV (PLHIV) has improved with effective antiretroviral treatment (ART), they now face the challenges of accelerated ageing. Frailty is an emerging concept in the management of PLHIV and up to 28% of PLHIV are identified as frail. Frailty is a determinant of adverse clinical outcomes and is a complex clinical endpoint that has not been studied in India. This exploratory study was done to evaluate frailty and its determinants among PLHIV in India.

Materials and Methods:

This was a cross-sectional study in 76 PLHIV aged 50 years or more. All the study subjects underwent a comprehensive clinical assessment. The Fried's criteria and Veterans Aging Cohort Study (VACS) Index were used to evaluate for frailty. Socio-demographic, clinical, immunological, and virological variables were assessed for their association with frailty. The study was registered under Clinical Trials Registry-India (ICMR-NIMS): REF/2019/05/025616.

Results:

The mean age of the subjects was 56.05 ± 5.8 years (range 50-76), and males constituted 81.57% (62/76) of the subjects and majority (60.53%) were underweight. On frailty assessment, 57.89% of the PLHIV were identified as prefrail/frail. Frailty had a significant association with low CD4 count (P = 0.0001) and number of comorbidities (P = 0.017) especially when comorbidities ≥2 (P = 0.04) and polypharmacy (P = 0.033). VACS index, polypharmacy, and low CD4 count ≤200 cells/mm3 were strong predictors of frailty. On multivariate regression analysis, CD4 count ≤200 emerged as the strongest independent predictor of frailty.

Conclusion:

The study highlighted the high prevalence of frailty and under nutrition among aged PLHIV. The study emphasizes the need for a shift away from traditional clinical endpoints to other outcome measures for a holistic approach to PLHIV.
Factors influencing the quality of life of GERD patients in the Aseer Region, Saudi Arabia
Authors: Alzahrani Mohammed A. , Alamri Faisal S. , Alshahrani Hatem M. , Alshahrani Ali M. , Mohammed Ali M. , Saif Rayan A. , Alqarni Saeed A. , Godhaif Naif A. , Al Mudawi Abdulrahman Abdullah M
Published: December 2023

Gastroesophageal reflux disease (GERD) is a common upper gastrointestinal disorder characterized by troublesome symptoms, including heartburn and acid regurgitation. GERD is associated with complications such as peptic stricture, Barrett's esophagus, and esophageal adenocarcinoma, and it negatively affects quality of life (QoL).

Aims:

To assess the factors influencing the QoL of GERD patients in the Aseer region of Saudi Arabia.

Settings and Design:

This descriptive cross-sectional study used self-administered questionnaires in a study population of patients aged ≥18 years from Aseer, Saudi Arabia, between January 15, 2023–February 15, 2023.

Materials and Methods:

A previously validated GERD health-related QoL (GERD-HRQoL) questionnaire was used to assess the patients' sociodemographic data, GERD, and GERD-HRQoL.

Statistical Analysis Used:

Descriptive analysis included describing the frequency distribution and percentage for study variables, including demographic data, GERD-related QoL symptoms, and QoL, which were graphed. Cross-tabulation presented the distribution of GERD-HRQoL scores by their personal data and other factors using the Pearson Chi-square and exact probability tests.

Results:

Overall, 502 participants previously diagnosed with GERD completed the questionnaire. Participants' were aged 18–65 years (mean age of 31.5 ± 14.6 years), and 384 (76.5%) were male. The most frequent symptom affecting QoL was heartburn (85.9%), followed by postprandial heartburn (84.3%), heartburn while lying down (82.7%), bloating or gassy feelings (79.9%), and heartburn while standing up (77.3%).

Conclusions:

Our study showed that patients with GERD had a poor QoL due to GERD-related symptoms, mainly heartburn. Younger age, male sex, and lower educational status were associated with lower GERD-HRQoL scores.
Surveillance of bacterial carriage in the nose and hands of healthcare workers and patients attending maternity and children's hospital
Authors: Mitra Sohini S. , Pachpute Samir R.
Published: December 2023

Introduction:

Nosocomial infections have been acknowledged as a significant pathogen responsible for human illness due to the rise in the incidence of these infections that are mainly caused by resistant strains. As a result, it is important to prevent nosocomial infections. Therefore, in the epidemiology and pathogenesis of infection bacterial carriage appears to be of great importance and in healthy persons, three patterns of carriage are observed over time. The common ecological niches of microorganisms are the anterior nares and hands; hence, the present study aims to evaluate the surveillance of bacterial carriage from the hands and noses of healthcare workers that involve doctors, nurses, and housekeeping staffs and patients involving pregnant women or mothers.

Materials and Methods:

An observational prospective study was conducted for 1.5 years in which collection of swabs from both the hands and nose were taken and inoculated on mannitol salt agar, blood agar, and MacConkey agar and incubated at 37°C for 24 h following which biochemical reactions were performed from isolates and 160 nasal swabs and hand swabs were studied for bacterial growth.

Results:

The percentages of bacterial growth in the hands of mothers, doctors, housekeeping staff, and nurses were 17.5, 12.5, 52.5, and 25%, respectively, and in the nose were 7.5, 5, 32.5, and 12.5%, respectively. Total bacterial carriage in hand and nose swabs were 26.87 and 14.37%, respectively.

Conclusion:

Methicillin-resistant Staphylococcus aureus was the most common microorganism isolated and as a result to prevent its spread along with other nosocomial microorganisms, appropriate precautions should be taken as the spreading of these organisms can lead to drug resistance strains.
Study of aggression and its factors among school going adolescents of Delhi, India
Authors: Kumar Mukesh , Kapoor Richa , Hiremath Ravishekar N. , Nimonkar Ravi , Goswami Arpita
Published: December 2023

Background:

Adolescence is an important developmental phase of life associated with various ideas and emotions filled with energy, many times spent in the form of aggressive behavior. Mental Health, as an important part of healthy well-being, cannot be ignored, and hence it becomes imperative to study aggression and associated factors among adolescents.

Objective:

To determine the prevalence of aggression among school-going adolescents and to study factors associated with aggression amongst study participants.

Materials and Methods:

A cross-sectional study was conducted using a self-administered semi-structured questionnaire having questions regarding socio-demographic data, details of friends, history of substance use etc. and the Buss and Perry Aggression Questionnaire (BPAQ). Data were analyzed using appropriate statistical tests. Ethical clearance was obtained from the Institutional Ethics Committee of Safdarjung Hospital, and informed written consent was taken from participants.

Results:

The study involved a total of 463 school-going adolescents with a mean age of 13.78 ± 2.06 years. More than half (50.5%) of the participants were found to be aggressive. Male gender, history of family member ever jailed, parent's argument in front of them, ever tried cigarette/smoking, being involved in some fight and provocation by friends for aggression were the factors found to be significantly associated with aggression.

Conclusion:

The prevalence of aggression among school-going adolescents of Delhi was quite high. There is a need to make the students aware about aggression and how to deal with it. A holistic approach may be adopted in which all authorities and stakeholders must work together to provide safer and nurturing environment to all students.
Drivers for COVID 19 vaccine hesitancy among breastfeeding women in Eastern tribal state, India
Authors: Trivedi Kiran , Anand Shikha , Atta Prami , Kujur Manisha , Kujur Anit , Singh Shashibala , Prasad Anupa , Kiran Kumari Asha
Published: December 2023

Background:

In the COVID-19 pandemic age, vaccination hesitancy also known as vaccine refusal is a cause for worry since it hinges on the five Cs of confidence, complacency, convenience, calculation, and shared responsibility. The current study was to pinpoint the elements that contribute to breastfeeding women's hesitation to receive the coronavirus disease-19 (COVID-19) vaccine.

Materials and Methods:

A cross-sectional observational study was carried out at the Department of Obstetrics and Gynaecology, Tertiary Care Hospital, Ranchi, Jharkhand.

Result:

Out of 365 nursing mothers, 242 (66.3%) were hesitant to get the COVID-19 vaccination. Those who chose not to receive the COVID-19 vaccination mostly belong to those aged 18 to 25 (38.1%), living in rural regions (44.9%), and belonging to non-tribal ethnic groups (41.1%). On application of logistic regression, it was found that rural areas had 3 times higher rate of vaccine hesitancy than urban residents, and that husbands' education levels up to the 12th grade had a 3.55 times higher rate and 5 times agriculture by husband's occupation, which was statistically significant (P value less than 0.05) The most prevalent grounds for rejection were fear of side effects (85.8%) and worry of adverse effects on newborns (83.48%).

Conclusion:

Both husband and wife, who had completed high school and were aware of the vaccination, were fearful of the COVID-19 vaccine. Concerns about the side effects and undesirable effects of vaccination on their newborns were the main reasons for refusal.
Social entrepreneurship in medical education: Model to establish SinnoLABs (social innovation labs) for health sciences universities
Authors: Raut Juhi M. , Joshi Abhishek U.
Published: December 2023

Social entrepreneurship is a cross-cutting competency. It draws on knowledge from various disciplines and personal experiences. Health, social sciences and humanities are usually technically sound but lack specific business knowledge and skills. Entrepreneurial education makes it possible to establish training environments where students join as ‘novices’, develop skills and undergo experiences that help them build capable profiles and prepare for their professional careers in today's economy. It is important to note that the development of skills for social entrepreneurship is increasingly demanded in all disciplinary fields. Interest from the academic, business and civil society in social innovation and social entrepreneurship is growing rapidly since social value creation and social innovation are considered vital to the social entrepreneurship phenomenon. The innovation process aims to fill the gap between working life and educational framework so that students can develop innovation capabilities they will need during their careers. Taking cognizance of the importance of social innovation and entrepreneurship, the Government of India formulated a policy for Biomedical Innovation and Entrepreneurship in 2022. Our University established a first of its kind Social Innovation Lab (SinnoLAB) under a Collaborative European Union Project. Our University is one of the collaborating partners and the only health sciences university to set up a SinnoLAB in India. We discuss in this article how a SinnoLaB can be set up, its functions, need for such labs in medical institutes, its role in medical education and its beneficiaries and propose that other health sciences institutes can also take up social innovation and entrepreneurship considering the benefits to all stakeholders.
Role of Pro-BNP in predicting outcome in acute heart failure patient presenting to a medical emergency: An observational study from North India
Authors: Singhal Arjun K. , Singh Gaurav , Singh SK , Karunanand Busi , Agrawal Sonu
Published: December 2023

Background:

Acute heart failure (AHF) is a clinical syndrome defined as the new onset or acutely decompensated heart failure (ADHF) leading to signs and symptoms of heart failure (HF). The critical cut-off values for these biomarkers that suggest high mortality are not clearly defined in previous studies. More studies are required to better understand the correlation of Pro- BNP and its association with HF. The primary objective is to study the role of Pro-BNP and critical factors in predicting outcomes in AHF patients presenting to a medical emergency.

Materials and Methods:

The data from the patients presented with symptoms of HF in the Department of Medical Emergency at our hospital were recorded and analysed. AHF is a clinical syndrome defined as the new onset or ADHF leading to signs and symptoms of HF, as based on the European Society of Cardiology.

Results:

The present study highlights the various risk factors of AHF in patients and their association with mortality. In the present study, mortality in patients with very high Pro-BNP levels ≥2000 pg/ml was significantly higher than in patients with moderately elevated Pro-BNP. The patients who survived after 5 days of hospitalization had Pro-BNP levels ≤2000 pg/ml, suggesting that very high Pro-BNP levels ≥2000 pg/ml are associated with fatal outcomes.

Conclusion:

To conclude, diabetes and sepsis are critical factors for the hospitalization and mortality of patients with AHF in northern India. Very high Pro-BNP levels ≥2000 pg/ml in patients with AHF requiring hospitalization and associated with fatal outcomes.
Effect of the home care model in orthopedic wounds management
Authors: Lei Xinhuan , Xiang Jie , Chen Xiaoxiao , Pan Wenjun
Published: December 2023

Objective:

To explore the effect of home care on orthopedic wound management.

Materials and Methods:

Patients with orthopedic wounds admitted from January 2020 to December 2022 were divided into a control group and a nursing group, with 23 cases in each group. After discharge, the control group was given routine health guidance and the nursing group was given home care. The mood score of the two groups of patients was evaluated, the time and cost were compared, and the patients' degree of trust and satisfaction with the medical staff were investigated.

Results:

The patients received home care had higher scores in mood, degree of trust and satisfaction with medical staff, and spent less time (P < .05). However, the cost was significantly higher than that of the control group (P < .05).

Conclusions:

Home care for patients with orthopedic wounds can significantly reduce the time spent on medical treatment. Moreover, improve patients' moods and trust and satisfaction with medical staff in a certain extent. However, better service often means more economic cost.
Assessment of the relationship of systemic vascular dysfunction and cardiac autonomic neuropathy (CAN) with diabetic retinopathy
Authors: Hari Prakash KJ , Parija Sucheta , Kar Manisha
Published: December 2023

Context:

Diabetic retinopathy, a form of microvasculopathy, is the leading cause of the visual abnormality. However, there is no conclusive evidence of the relationship of systemic vascular dysfunction with retinal microvasculopathy. In addition, diabetes-associated cardiac autonomic neuropathy may also compromise vascular function.

Aims:

The present study intends to correlate arterial stiffness, endothelial function, and heart rate variability (HRV) as a standardized measure of cardiac autonomic neuropathy with diabetic retinopathy.

Settings and Design:

The present cross-sectional, observational study was conducted in the Department of Physiology.

Materials and Methods:

Twenty subjects were recruited in group 1 (T2DM, type 2 diabetes mellitus patients, without retinopathy) and group 2 (T2DM with retinopathy). The vascular parameters such as heart rate, peripheral and central blood pressure, augmentation index [AIx (%)], brachial -ankle pulse wave velocity (baPWV), and reactive hyperaemia index (RHI) were recorded.

Statistical Analysis Used:

Independent sample t-test (for parametric data) and Mann–Whitney U test (for non-parametric data) were employed to compare the variables of two groups. Spearman correlation was used to examine the relationship among the parameters. Linear regression analysis was performed to examine the important vascular predictor for diabetic retinopathy.

Results:

baPWV was significantly higher in group 2 than in group 1 and positively associated with group 2. RHI was significantly less in group 2 than group 1 and negatively associated with group 2. Among HRV metrics, standard deviation of successive differences (SDSD), root mean square of successive differences between normal heartbeats (RMSSD), and high frequency (HF) power were significantly decreased in group 2 than in group 1. SDSD, RMSSD, and HF power were negatively associated with group 2. RHI emerged as a significant predictor of diabetic retinopathy following linear regression.

Conclusions:

Overall, the result of the present study indicates that metabolic dysregulation of glucose may affect the normal functioning of the autonomic nervous system and vascular function. Therefore, screening of vascular function and cardiac autonomic tone may be advocated in diabetic patients in routine clinics to examine the existence of any comorbid condition, such as diabetic retinopathy, as systemic vascular changes may also affect ophthalmic vasculature.
Sexual dysfunction in bipolar depression: Gender differences
Authors: Malik Gunjan , Mishra Preeti , Chaurasia Neha , Garg Shobit
Published: December 2023

Objective:

To find sexual dysfunction in acute-phase bipolar depression patients and subsequently characterize the gender-wise differences in sexual functioning.

Materials and Methods:

A cross-sectional, descriptive, observational, purposeful, and hospital-based study was done with 45 patients (age range: 18–59 years) with moderate to severe acute phase bipolar depression (HAM-D scores >18). The domain-wise (Pleasure, Desire/Frequency Desire/Interest, Arousal/Excitement, and Orgasm/Completion) sexual functioning was assessed by the Change in Sexual Functioning Questionnaire (CSFQ-14) (≤41 for females, ≤47 for males as a cut-off for dysfunction). This study is registered in the CTRI (Clinical Trials Registry India, Number: CTRI-2021-07-035182).

Results:

The prevalence of sexual dysfunction was 91% of bipolar disorder patients with more male participants (53.3%) compared to females (46.7%). The mean HAM-D score for the study sample was 27.93 ± 8.035. The female gender had more dysfunctional scores in desire/frequency (t = 2.229,P= 0.031), desire/interest (t = 2.448,P= 0.019), orgasm/completion (t = 2.974,P= 0.005), and overall total CSFQ (t = 2.946,P= 0.005). The odds of sexual dysfunction were significant given a one-unit increase in suicidal ideation in the index episode (adjusted OR = 1.222, 95% CI: 1.004-1.488,P= .049).

Conclusion:

Acute-phase bipolar patients have very high sexual dysfunction rates. Females have both global and specific sexual response cycle deficits in comparison to acute phase bipolar depressed males. Future trials shall amuse neurobiology grounded, more individualistic sexual rehabilitation-based interventional paradigms, and longitudinal research models in acute phase bipolar depression.
Prevalence of oral lesions and evaluation of the periodontal status among diabetic females attending Princess Nourah Bint Abdulrahman University (PNU)
Authors: Alkaabinah Wejdan , Alghenaim Farah , Basha Soha , Shawky Heba
Published: December 2023

Objective:

To evaluate the prevalence of different oral lesions and periodontal status among diabetic Saudi female patients in the College of Dentistry, PNU University.

Materials and Method:

A retrospective study was performed by reviewing the files of all patients who visited the College of Dentistry, PNU University, during the last 5 years. We selected diabetic 20–40-year-old Saudi female patients. Ethical approval was obtained from the Institutional Review Board of PNU University. Data collection sheets were used to gather information on demographics, education, medical and dental history, and extra and intra-oral findings. Data on the duration of diabetes, any major complications, and type of diabetes therapy were retrieved from medical records. The data were entered into an Excel sheet, and descriptive statistics were performed. The analytical phase proceeded to correlate oral lesions with patient age, type of diabetes, and periodontal status.

Result:

A total of 226 diabetic patients were found after reviewing the records. The most common oral mucosal lesions were traumatic ulcers (10.2%), cheek biting (8.8%), and fissured tongue (8.4%). Furthermore, 81.86% of them had periodontitis, and 18.14% had a healthy periodontal status.

Conclusion:

The prevalence of periodontitis among diabetic female patients is higher than that of oral lesions. Stage III periodontitis showed the strongest association to oral lesion.
Prescription Analysis and Evaluation of Potential Drug–Drug Interactions among Patients Attending the Geriatric Unit at a Tertiary Care Hospital
Authors: Joshi Harsh , Majumdar Falguni D. , Patel Shreya N. , Modi Krishna Bhavin , Rathod Jaydeep , Kanani Parth , Shah Karan B. , Malhotra Supriya Deepak
Published: December 2023

Background:

The elderly stand a greater risk of drug-drug interactions (DDIs). This study was an earnest attempt at in-depth prescriptions analysis and evaluating the potential DDIs (pDDIs) among patients in the geriatric outpatient department (OPD).

Aims and Objectives:

The aim is to conduct prescriptions analysis of patients and to evaluate the pDDIs among patients in the geriatric OPD.

Materials and Methods:

A retrospective observational study began after Institutional Review Board approval. Demographic details, clinical profile, and drugs prescribed were recorded. The prescription analysis was done by prespecified criteria and pDDIs were identified using various tools.

Results:

Prescriptions of 202 patients with a mean age of 68.76 years were collected. Mean drugs prescribed were 6.07. Total number of fixed-dose combinations (FDCs) and over-the-counter drugs were 669 (40.50%) and 430 (26.03%), respectively. 129 (63.9%) prescriptions were incomplete in terms of dose, duration, frequency, or dosage form. Maximum interactions - 367 (34.42%) were found with aspirin followed by cardiovascular drugs. Total prescriptions with pDDIs were 137 (67.82%) Out of 34 (3.82%) serious interactions, pharmacodynamic pDDIs were seen with aspirin and enalapril/ramipril and pharmacokinetic were between omeprazole/rabeprazole and clopidogrel. Consequences of common pDDIs were identified as deterioration in renal function and hyperkalemia. The number of interactions was positively correlated with number of FDCs and number of drugs prescribed (r = 0.427, P = 0.0001 and r = 0.189, P = 0.0001, respectively).

Conclusion:

Prespecified prescription analysis criteria were one of the most useful tools to improve prescribing patterns. Drug interactions can be reduced by prescribing minimum drugs in elderly, alteration in time of dosing and fractionation of dose along with amalgamating the use of online DDI checker in hospital information system. Training of prescribers especially in geriatric patients is the need of the hour.
A Curious Case of Hypervitaminosis D-related Hypercalcemia
Authors: Tom Rose , Idiculla Jyothi Mariam
Published: December 2023

Hypercalcemia can manifest with various symptoms and poses diagnostic challenges due to its multifactorial etiology. This case highlights a 74-year-old patient with hypercalcemia of complex origin. The patient had a history of chronic liver disease, chronic kidney disease, and a previous episode of hypercalcemia associated with excessive oral Vitamin D intake. On admission, the patient presented with disorientation and increased drowsiness. Further evaluation revealed persistently high serum calcium levels, low parathyroid hormone levels, and elevated levels of Vitamin D. Investigations identified a duodenal nodule with multiple lymph node enlargement, suggesting a malignancy as the underlying cause. Other potential factors contributing to hypercalcemia, such as a granulomatous disease, prolonged immobilization, and a deactivating mutation of the 24-hydroxylase gene (CYP24A1), were also considered. Despite interventions, including hemodialysis and denosumab administration, the patient’s condition deteriorated due to sepsis and hypotensive shock, ultimately resulting in death. This case emphasizes the importance of considering multiple etiologies in cases of hypercalcemia in the elderly and the challenges involved in managing severe symptomatic hypercalcemia. Medical professionals must employ sound clinical reasoning and comprehensive diagnostic approaches to accurately identify and address the underlying cause. Hemodialysis may be necessary in refractory cases to achieve serum calcium normalization.
Successful Thrombolysis of an Ischemic Stroke Immediately following Transurethral Resection of Prostate in an Elderly Male
Authors: Rathinasabapathi Muneeshwaran , Tiwari Ashutosh , Kumar Mritunjai , Kumar Niraj
Published: December 2023

The overall incidence of stroke in the perioperative period following noncardiac, nonneurologic, and noncarotid surgery has been reported to be between 0.1% and 0.8%. Thrombolysis in the postoperative stroke is controversial, with a possible high risk of surgical site hemorrhage (SSH) and intracerebral hemorrhage. We report a case of an old male who developed an ischemic stroke on postoperative day 0 of transurethral resection of prostate. He was thrombolysed with tenecteplase but developed minor SSH as well as cerebral hemorrhagic transformation (HI2). Both complications were managed with appropriate measures. The patient recovered completely (NIHSS 0) and was discharged 1 week later. To the best of our knowledge, this is the first report of a successful thrombolysis in a patient developing acute ischemic stroke following a major urologic surgery on the day of surgery.